Diurnal variation in left ventricular function: a study of patients with myocardial ischaemia, syndrome X, and of normal controls.
Open Access
- 1 February 1987
- Vol. 57 (2) , 148-153
- https://doi.org/10.1136/hrt.57.2.148
Abstract
Angina can occur in the early morning. The mechanism of this is unclear and both haemodynamic changes and coronary artery spasm may be important. The purpose of this study was to investigate the diurnal variation in pulmonary artery diastolic pressure (an indirect measure of left ventricular filling pressure) in six normal subjects, 18 patients with coronary artery disease, five with variant angina, and six with syndrome X. A transducer tipped catheter and a simple recording system were used to record ambulatory pulmonary artery diastolic pressure for 24 hours. Variation in pulmonary artery diastolic pressure was related to the timing of episodes of ST segment depression and elevation by simultaneously recording a frequency modulated electrocardiogram. Episodes of ST segment change occurred predominantly in the early morning (midnight to 6 am) in variant angina (eight out of 14 episodes) whereas in syndrome X all episodes were recorded during the day. In coronary artery disease both painful and painless episodes were distributed throughout the day, with 10 out of 67 episodes occurring between midnight and 6 am. A similar diurnal variation in pulmonary artery diastolic pressure was seen in the groups--that is, values were low during the day and higher at night, with the maximum values between midnight and 6 am. The 24 hour median pulmonary artery diastolic pressure was higher in patients with coronary artery disease than in the control group and those with syndrome X. The finding that pulmonary artery diastolic pressure, and therefore left ventricular end diastolic pressure, is greatest in the early morning may represent the background haemodynamic state in which other factors lead to myocardial ischaemia during these hours.This publication has 24 references indexed in Scilit:
- The Classic: Commentaries on the History and Cure of Diseases. Digitorum NodiClinical Orthopaedics and Related Research, 2004
- Continuous ambulatory pulmonary artery pressure monitoring. A new method using a transducer tipped catheter and a simple recording system.Heart, 1986
- Circadian Variation in the Frequency of Onset of Acute Myocardial InfarctionNew England Journal of Medicine, 1985
- Continuous recording of pulmonary artery pressure.Heart, 1985
- Diurnal distribution of ST-segment elevation and related arrhythmias in patients with variant angina: a study by ambulatory ECG monitoring.Circulation, 1983
- Sequence of events in angina at rest: primary reduction in coronary flow.Circulation, 1980
- Acute changes in cardiopulmonary blood volume during upright exercise stress testing in patients with coronary heart disease.Circulation, 1979
- “Variant” angina: One aspect of a continuous spectrum of vasospastic myocardial ischemiaThe American Journal of Cardiology, 1978
- All-Night Polygraphic Studies of Nocturnal Angina PectorisJapanese Heart Journal, 1972
- The Arterial Medial Cell, Smooth Muscle, or Multifunctional Mesenchyme?Circulation, 1967