Plasma bradykinin and prostaglandin metabolism and exercise testing in patients with silent myocardial ischemia compared with patients with painful myocardial ischemia.

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Abstract
Bradykinin, alone or in combination with prostaglandin, is thought to produce pain in patients with coronary heart disease. To elucidate this further, we have investigated and compared serum bradykinin, TXB2 and 6KPGF1α levels in patients with silent myocardial ischemia (SMI, n=18), painful myocardial ischemia (PMI, n=8) and normal subjects (NL, n=18). In addition, SMI and PMI subjects were given exercise testing and the results then compared. After Holter monitoring for 48 hours, exercise testing was performed. Blood was sampled in the morning between the Holter and exercise regimen. Maximal heart rate, systolic blood pressure and the double products were not significantly different between the SMI and PMI groups. The duration of exercise for the SMI group was 7.08±2.1 min vs 5.9±1.9 in the PMI group (p2/6KPGF1α for the SMI group was 1.3±0.3, which was significantly higher than that for the NL group (0.8±0.3, p<0.01), though this did not greatly differ from the PMI group (1.2±0.3). These results suggest that SMI patients under Holter monitoring who manifest no symptoms but show significant ST segment depressions must receive the same careful attention given to PMI patients. In both group of patients bradykinin and prostaglandin metabolism is similarly change, as was demonstrated by exercise stress testing.

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