Circadian patterns in the onset of cardiogenic acute pulmonary edema.
BACKGROUND
Circadian patterns of onset favoring the morning hours have been demonstrated for many cardiovascular disorders. Although much is known about cardiogenic acute pulmonary edema (CAPE), the relationship between time of day and CAPE episode onset has not been previously studied.


METHODS
We examined 154 consecutive episodes of CAPE treated at an urban community hospital to determine whether circadian patterns existed in the time these episodes began.


RESULTS
For all episodes, a significant circadian pattern existed, with peak onset between 6:00 and 11:59 A.M. (p < 0.01). When CAPE episodes were analyzed by the most probable precipitant of pulmonary edema, only the pattern for patients with progressive symptoms, showing a peak in the 6:00 and 11:59 A.M. interval, was statistically significant (p < 0.01). Although a similar trend existed for CAPE occurring in association with acute myocardial infarction, the pattern fell short of statistical significance (p = 0.09).


CONCLUSIONS
These data suggest that circadian patterns favoring the morning hours exist for episodes of CAPE, and that patterns may vary depending on the precipitant of the episode.
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Department of Medicine, St. John's Episcopal Hospital, Far Rockaway, NY 11691, USA.
Calikyan
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Neches
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Bavli
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D000208:Acute Disease; D000368:Aged; D002940:Circadian Rhythm; D005260:Female; D006331:Heart Diseases / Q000150:complications*; D006801:Humans; D008297:Male; D011654:Pulmonary Edema / Q000209:etiology*