title: Intermittent claudication as a manifestation of silent myocardial ischemia: a pilot study.
abstract: One hundred consecutive patients with intermittent claudication were screened noninvasively with electrocardiography chest wall mapping stress test and transcutaneous aortovelography during bicycle ergometry. Electrocardiographic chest wall stress testing indicated three-vessel coronary disease in 25 patients and left anterior descending plus circumflex (left main stem equivalent) disease in seven. In these 32 patients transcutaneous aortovelography demonstrated a decrease in stroke distance (an index of cardiac stroke volume) (median, -28%; 90% range, +5% to -48%), and coronary angiography confirmed the presence and severity of the disease. The claudication distance ranged between 50 and 250 meters. After myocardial revascularization or medical therapy a significant increase occurred in the stroke distance after exercise (median, +20; 90% range, +40% to -25%); also a significant increase in the postexercise pressure index and a reduction in the recovery time (p less than 0.01). No change occurred in the ankle/pressure index at rest. Twelve patients were able to walk without being limited by claudication; 15 reported improvement with a two to tenfold increase in claudication distance. No change occurred in three. The results indicate that silent myocardial ischemia is a common finding in patients with intermittent claudication. It produces left ventricular dysfunction and a decrease in stroke volume leading to a large fall in ankle pressure and early onset of claudication during exercise. Niltrates and myocardial revascularization tend to reverse this.
authors.affiliation: Vascular Section, Irvine Laboratory for Cardiovascular Investigation and Research, St. Mary's Hospital Medical School, London, United Kingdom.
authors.forename: A M
authors.initials: AM
authors.lastname: Salmasi
authors.forename: A
authors.initials: A
authors.lastname: Nicolaides
authors.forename: A
authors.initials: A
authors.lastname: Al-Katoubi
authors.forename: T N
authors.initials: TN
authors.lastname: Sonecha
authors.forename: P R
authors.initials: PR
authors.lastname: Taylor
authors.forename: S
authors.initials: S
authors.lastname: Serenkuma
authors.forename: H H
authors.initials: HH
authors.lastname: Eastcott
mesh_terms: D000368:Aged; D001011:Aorta / Q000503:physiopathology; D002302:Cardiac Output; D017023:Coronary Angiography; D003327:Coronary Disease / Q000150:complications / Q000175:diagnosis* / Q000000981:diagnostic imaging; D004562:Electrocardiography; D005080:Exercise Test; D005260:Female; D006801:Humans; D007383:Intermittent Claudication / Q000150:complications* / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D010865:Pilot Projects