Prevalence of silent myocardial ischemia in survivors of cardiac arrest.
The prevalence and type of ischemia (silent vs painful) in survivors of cardiac arrest not associated with acute myocardial infarction were studied to test the hypothesis that survivors may have an increased prevalence of silent ischemia. Of 48 survivors of cardiac arrest over a 4-year period who had undergone exercise testing, 24 met inclusion criteria. These 24 subjects had documented ventricular fibrillation and coronary artery disease proven by cardiac catheterization or a previous electrocardiographic pattern of myocardial infarction. Thirteen of 24 (54%) had a positive treadmill stress test (greater than or equal to 1.0 mm flat or downsloping ST depression). The mean resting left ventricular ejection fraction was 43%. Nine of 11 patients (82%) who had exercise radionuclide studies performed had ischemic abnormalities (less than 5% increase in left ventricular ejection fraction with new or worsened wall motion abnormalities). Thus, 16 of 24 (67%) had a positive treadmill stress test or radionuclide ventriculogram. Only 1 of 16 (6%) had painful ischemia (p less than 0.001 relative to an even distribution of painful vs painless ischemia). Thus, survivors of cardiac arrest have a high prevalence of exercise-induced ischemia, and in most the ischemia is silent.
Whitaker
M P
MP
Department of Medicine, University of North Carolina, Chapel Hill 27599.
Sheps
D S
DS
D003327:Coronary Disease / Q000175:diagnosis*; D003430:Cross-Sectional Studies; D004562:Electrocardiography; D005080:Exercise Test; D005260:Female; D006321:Heart / Q000000981:diagnostic imaging; D006323:Heart Arrest; D006801:Humans; D008297:Male; D008875:Middle Aged; D005082:Physical Exertion; D011877:Radionuclide Imaging; D012189:Retrospective Studies; D013318:Stroke Volume