A comparison of cardiac rate-pressure product and pressure-rate quotient with Holter monitoring in patients with hypertension and cardiovascular disease: a follow-up report.
OBJECTIVE
The purpose of this study was to evaluate patients with hypertension or cardiovascular disease, or both, for myocardial ischemia and cardiac arrhythmias while undergoing minor oral surgery.


METHODS
Sixteen patients were studied with noninvasive monitoring including heart rate, systolic, diastolic, and mean arterial blood pressure to calculate rate-pressure product (systolic blood pressure multiplied by heart rate) and pressure-rate quotient (mean arterial pressure divided by heart rate). These calculated measures were compared with the incidence of cardiac arrhythmias and ST segment depression recorded on a continuous Holter monitoring system.


RESULTS
Nine of 16 (56%) developed supraventricular or ventricular ectopy during dental extractions or minor preprosthetic surgery performed with local anesthesia 2% xylocaine with 1/100,000 epinephrine dilution. Three of the nine patients who experienced these arrhythmias had coincident abnormal rate pressure product and pressure-rate quotient values. None of these patients exhibited ST-T wave changes suggestive of myocardial ischemia. Atrial or ventricular ectopy suggests that myocardial irritability was more likely to occur than ischemia as measured by Holter monitoring and compared with abnormal rate pressure product and pressure-rate quotient values recorded.
Campbell
R L
RL
Department of Oral and Maxillofacial Surgery, Medical College of Virginia, USA.
Langston
W G
WG
Ross
G A
GA
D000328:Adult; D000368:Aged; D000766:Anesthesia, Dental; D001145:Arrhythmias, Cardiac / Q000209:etiology; D001794:Blood Pressure; D002318:Cardiovascular Diseases; D017742:Dental Care for Chronically Ill; D004562:Electrocardiography; D015716:Electrocardiography, Ambulatory; D005500:Follow-Up Studies; D006339:Heart Rate; D006801:Humans; D006973:Hypertension; D008875:Middle Aged; D016343:Monitoring, Intraoperative / Q000379:methods*; D017202:Myocardial Ischemia / Q000209:etiology; D013516:Oral Surgical Procedures, Preprosthetic / Q000009:adverse effects; D013312:Stress, Physiological; D014081:Tooth Extraction / Q000009:adverse effects