Symptomatic and silent myocardial ischaemia in hypertensive patients with left ventricular hypertrophy.
OBJECTIVE
To assess the prevalence of symptomatic and silent myocardial ischaemia in patients with hypertensive left ventricular hypertrophy.


METHODS
Cross sectional study.


METHODS
University department of medical cardiology.


METHODS
90 patients (68 men and 22 women; mean age 57 (range 25 to 79)) with left ventricular hypertrophy due to essential hypertension.


METHODS
48 hour ambulatory ST segment monitoring (all patients), exercise electrocardiography (n = 79), stress thallium scintigraphy (n = 80), coronary arteriography (n = 35).


RESULTS
43 patients had at least one episode of ST segment depression on ambulatory electrocardiographic monitoring. The median number of episodes was 16 (range 1 to 84) with a median duration of 8.6 (range 2 to 17) min. Over 90% of these episodes were clinically silent. 26 patients had positive exercise electrocardiography and 48 patients had reversible thallium perfusion defects despite chest pain during exercise in only five patients. 18 of the 35 patients who had coronary arteriography had important coronary artery disease. Seven of these patients gave no history of chest pain.


CONCLUSIONS
Symptomatic and silent myocardial ischaemia are common in hypertensive patients with left ventricular hypertrophy, even in the absence of epicardial coronary artery disease.
Pringle
S D
SD
University Department of Medical Cardiology, Royal Infirmary, Glasgow.
Dunn
F G
FG
Tweddel
A C
AC
Martin
W
W
Macfarlane
P W
PW
McKillop
J H
JH
Lorimer
A R
AR
Cobbe
S M
SM
D000328:Adult; D000368:Aged; D006332:Cardiomegaly / Q000150:complications* / Q000209:etiology; D017023:Coronary Angiography; D003327:Coronary Disease / Q000000981:diagnostic imaging / Q000209:etiology*; D003430:Cross-Sectional Studies; D015716:Electrocardiography, Ambulatory; D005080:Exercise Test; D005260:Female; D006321:Heart / Q000000981:diagnostic imaging; D006801:Humans; D006973:Hypertension / Q000150:complications*; D008297:Male; D008875:Middle Aged; D011877:Radionuclide Imaging