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. 1988 Jul;60(1):4–16. doi: 10.1136/hrt.60.1.4

The ST segment of the ambulatory electrocardiogram in a normal population.

R S Kohli 1, P M Cashman 1, A Lahiri 1, E B Raftery 1
PMCID: PMC1216508  PMID: 3408617

Abstract

The behaviour of the ST segment in everyday life was studied by ambulatory electrocardiography in 111 normal volunteers. Fifteen were excluded because of abnormal exercise responses (10 subjects) and significant postural ST segment shifts (five subjects). This left 62 men and 34 women, mean (SD) age 40.5 (12.6) years (range 20-67 years). Ambulatory monitoring of leads CM5 and CC5 for 24 hours was followed by a maximal treadmill exercise test. The tapes of the ambulatory monitoring were analysed by a computer aided system. The computer printed trend plots of the ST segment (measured both at the J point and at J + 60 ms) to detect episodes of ST segment elevation and depression, which were confirmed by visual analysis of real time printouts. Twelve subjects showed "ischaemic" ST segment depression and nine subjects showed ST segment elevation. Eight people with ambulatory ST segment changes were studied during exercise by radionuclide ventriculography and thallium-201 imaging scans. Although seven of the eight thallium studies were normal, radionuclide ventriculography showed functional impairment in five cases. Seven of the 10 subjects with abnormal exercise tests were similarly investigated and their results followed the same pattern, with normal thallium images in six and functional impairment in four. Ambulatory electrocardiography was repeated in 20 people after a median of 20 days. The ST segment changes were reproducible. ST segment changes of an apparently ischaemic nature occur even in a carefully defined normal population but they do not necessarily represent latent clinically significant coronary artery disease. This indicates that ST segment changes seen in patients with known obstructive coronary artery disease should be interpreted with caution.

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Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Allen R. D., Gettes L. S., Phalan C., Avington M. D. Painless ST-segment depression in patients with angina pectoris. Correlation with daily activities and cigarette smoking. Chest. 1976 Apr;69(4):467–473. doi: 10.1378/chest.69.4.467. [DOI] [PubMed] [Google Scholar]
  2. Armstrong W. F., Jordan J. W., Morris S. N., McHenry P. L. Prevalence and magnitude of S-T segment and T wave abnormalities in normal men during continuous ambulatory electrocardiography. Am J Cardiol. 1982 May;49(7):1638–1642. doi: 10.1016/0002-9149(82)90240-5. [DOI] [PubMed] [Google Scholar]
  3. Balasubramanian V., Lahiri A., Green H. L., Stott F. D., Raftery E. B. Ambulatory ST segment monitoring. Problems, pitfalls, solutions, and clinical application. Br Heart J. 1980 Oct;44(4):419–425. doi: 10.1136/hrt.44.4.419. [DOI] [PMC free article] [PubMed] [Google Scholar]
  4. Bonow R. O., Bacharach S. L., Green M. V., Kent K. M., Rosing D. R., Lipson L. C., Leon M. B., Epstein S. E. Impaired left ventricular diastolic filling in patients with coronary artery disease: assessment with radionuclide angiography. Circulation. 1981 Aug;64(2):315–323. doi: 10.1161/01.cir.64.2.315. [DOI] [PubMed] [Google Scholar]
  5. Borer J. S., Brensike J. F., Redwood D. R., Itscoitz S. B., Passamani E. R., Stone N. J., Richardson J. M., Levy R. I., Epstein S. E. Limitations of the electrocardiographic response to exercise in predicting coronary-artery disease. N Engl J Med. 1975 Aug 21;293(8):367–371. doi: 10.1056/NEJM197508212930801. [DOI] [PubMed] [Google Scholar]
  6. Bragg-Remschel D. A., Anderson C. M., Winkle R. A. Frequency response characteristics of ambulatory ECG monitoring systems and their implications for ST segment analysis. Am Heart J. 1982 Jan;103(1):20–31. doi: 10.1016/0002-8703(82)90524-5. [DOI] [PubMed] [Google Scholar]
  7. Canhasi B., Dae M., Botvinick E., Lanzer P., Schechtmann N., Faulkner D., O'Connell W., Schiller N. Interaction of "supplementary" scintigraphic indicators of ischemia and stress electrocardiography in the diagnosis of multivessel coronary disease. J Am Coll Cardiol. 1985 Sep;6(3):581–588. doi: 10.1016/s0735-1097(85)80116-9. [DOI] [PubMed] [Google Scholar]
  8. Carboni G. P., Lahiri A., Cashman P. M., Raftery E. B. Ambulatory heart rate and ST-segment depression during painful and silent myocardial ischemia in chronic stable angina pectoris. Am J Cardiol. 1987 May 1;59(12):1029–1034. doi: 10.1016/0002-9149(87)90843-5. [DOI] [PubMed] [Google Scholar]
  9. Cecchi A. C., Dovellini E. V., Marchi F., Pucci P., Santoro G. M., Fazzini P. F. Silent myocardial ischemia during ambulatory electrocardiographic monitoring in patients with effort angina. J Am Coll Cardiol. 1983 Mar;1(3):934–939. doi: 10.1016/s0735-1097(83)80213-7. [DOI] [PubMed] [Google Scholar]
  10. Curry R. C., Jr, Pepine C. J., Sabom M. B., Feldman R. L., Christie L. G., Conti C. R. Effects of ergonovine in patients with and without coronary artery disease. Circulation. 1977 Nov;56(5):803–809. doi: 10.1161/01.cir.56.5.803. [DOI] [PubMed] [Google Scholar]
  11. Deanfield J. E., Maseri A., Selwyn A. P., Ribeiro P., Chierchia S., Krikler S., Morgan M. Myocardial ischaemia during daily life in patients with stable angina: its relation to symptoms and heart rate changes. Lancet. 1983 Oct 1;2(8353):753–758. doi: 10.1016/s0140-6736(83)92295-x. [DOI] [PubMed] [Google Scholar]
  12. Deanfield J. E., Ribiero P., Oakley K., Krikler S., Selwyn A. P. Analysis of ST-segment changes in normal subjects: implications for ambulatory monitoring in angina pectoris. Am J Cardiol. 1984 Dec 1;54(10):1321–1325. doi: 10.1016/s0002-9149(84)80090-9. [DOI] [PubMed] [Google Scholar]
  13. Froelicher V. F., Jr, Yanowitz F. G., Thompson A. J., Lancaster M. C. The correlation of coronary angiography and the electrocardiographic response to maximal treadmill testing in 76 asymptomatic men. Circulation. 1973 Sep;48(3):597–604. doi: 10.1161/01.cir.48.3.597. [DOI] [PubMed] [Google Scholar]
  14. Gibson R. S., Watson D. D., Craddock G. B., Crampton R. S., Kaiser D. L., Denny M. J., Beller G. A. Prediction of cardiac events after uncomplicated myocardial infarction: a prospective study comparing predischarge exercise thallium-201 scintigraphy and coronary angiography. Circulation. 1983 Aug;68(2):321–336. doi: 10.1161/01.cir.68.2.321. [DOI] [PubMed] [Google Scholar]
  15. HOLTER N. J. New method for heart studies. Science. 1961 Oct 20;134(3486):1214–1220. doi: 10.1126/science.134.3486.1214. [DOI] [PubMed] [Google Scholar]
  16. Hains A. D., Al-Khawaja I., Hinge D. A., Lahiri A., Raftery E. B. Radionuclide left ventricular ejection fraction: a comparison of three methods. Br Heart J. 1987 Mar;57(3):242–246. doi: 10.1136/hrt.57.3.242. [DOI] [PMC free article] [PubMed] [Google Scholar]
  17. Jones R. I., Lahiri A., Cashman P. M., Dore C., Raftery E. B. Left ventricular function during isometric hand grip and cold stress in normal subjects. Br Heart J. 1986 Mar;55(3):246–252. doi: 10.1136/hrt.55.3.246. [DOI] [PMC free article] [PubMed] [Google Scholar]
  18. Kaul S., Newell J. B., Chesler D. A., Pohost G. M., Okada R. D., Guiney T. E., Boucher C. A. Value of computer analysis of exercise thallium images in the noninvasive detection of coronary artery disease. JAMA. 1986 Jan 24;255(4):508–511. [PubMed] [Google Scholar]
  19. LACHMAN A. B., SEMLER H. J., GUSTAFSON R. H. POSTURAL ST-T WAVE CHANGES IN THE RADIOELECTROCARDIOGRAM SIMULATING MYOCARDIAL ISCHEMIA. Circulation. 1965 Apr;31:557–563. doi: 10.1161/01.cir.31.4.557. [DOI] [PubMed] [Google Scholar]
  20. Lahiri A., Rodrigues E. A., Al-Khawaja I., Raftery E. B. Effects of a new vasodilating beta-blocking drug, carvedilol, on left ventricular function in stable angina pectoris. Am J Cardiol. 1987 Apr 1;59(8):769–774. doi: 10.1016/0002-9149(87)91089-7. [DOI] [PubMed] [Google Scholar]
  21. Levy N., Abinader E. Continuous electrocardiographic monitoring with Holter electrocardiocorder throughout all stages of gastroscopy. Am J Dig Dis. 1977 Dec;22(12):1091–1096. doi: 10.1007/BF01072863. [DOI] [PubMed] [Google Scholar]
  22. Mancini G. B., Slutsky R. A., Norris S. L., Bhargava V., Ashburn W. L., Higgins C. B. Radionuclide analysis of peak filling rate, filling fraction, and time to peak filling rate. Response to supine bicycle exercise in normal subjects and patients with coronary disease. Am J Cardiol. 1983 Jan 1;51(1):43–51. doi: 10.1016/s0002-9149(83)80009-5. [DOI] [PubMed] [Google Scholar]
  23. O'Hara M. J., Lahiri A., Whittington J. R., Crawley J. C., Raftery E. B. Detection of high risk coronary artery disease by thallium imaging. Br Heart J. 1985 Jun;53(6):616–623. doi: 10.1136/hrt.53.6.616. [DOI] [PMC free article] [PubMed] [Google Scholar]
  24. Performance of ergonovine provocative testing for coronary artery spasm. Health and Public Policy Committee, American College of Physicians. Ann Intern Med. 1984 Jan;100(1):151–152. doi: 10.7326/0003-4819-100-1-151. [DOI] [PubMed] [Google Scholar]
  25. Quyyumi A. A., Wright C., Fox K. Ambulatory electrocardiographic ST segment changes in healthy volunteers. Br Heart J. 1983 Nov;50(5):460–464. doi: 10.1136/hrt.50.5.460. [DOI] [PMC free article] [PubMed] [Google Scholar]
  26. Redwood D. R., Borer J. S., Epstein S. E. Whither the ST segment during exercise. Circulation. 1976 Nov;54(5):703–706. doi: 10.1161/01.cir.54.5.703. [DOI] [PubMed] [Google Scholar]
  27. Schang S. J., Jr, Pepine C. J. Transient asymptomatic S-T segment depression during daily activity. Am J Cardiol. 1977 Mar;39(3):396–402. doi: 10.1016/s0002-9149(77)80095-7. [DOI] [PubMed] [Google Scholar]
  28. Selwyn A. P., Fox K., Eves M., Oakley D., Dargie H., Shillingford J. Myocardial ischaemia in patients with frequent angina pectoris. Br Med J. 1978 Dec 9;2(6152):1594–1596. doi: 10.1136/bmj.2.6152.1594. [DOI] [PMC free article] [PubMed] [Google Scholar]
  29. Stern S., Tzivoni D. Dynamic changes in the ST-T segment during sleep in ischemic heart disease. Am J Cardiol. 1973 Jul;32(1):17–20. doi: 10.1016/s0002-9149(73)80081-5. [DOI] [PubMed] [Google Scholar]
  30. Stern S., Tzivoni D., Stern Z. Diagnostic accuracy of ambulatory ECG monitoring in ischemic heart disease. Circulation. 1975 Dec;52(6):1045–1049. doi: 10.1161/01.cir.52.6.1045. [DOI] [PubMed] [Google Scholar]
  31. Taggart P., Carruthers M., Somerville W. Electrocardiogram, plasma catecholamines and lipids, and their modification by oxyprenolol when speaking before an audience. Lancet. 1973 Aug 18;2(7825):341–346. doi: 10.1016/s0140-6736(73)93190-5. [DOI] [PubMed] [Google Scholar]
  32. Taggart P., Gibbons D., Somerville W. Some effects of motor-car driving on the normal and abnormal heart. Br Med J. 1969 Oct 18;4(5676):130–134. doi: 10.1136/bmj.4.5676.130. [DOI] [PMC free article] [PubMed] [Google Scholar]
  33. Taggart P., Parkinson P., Carruthers M. Cardiac responses to thermal, physical, and emotional stress. Br Med J. 1972 Jul 8;3(5818):71–76. doi: 10.1136/bmj.3.5818.71. [DOI] [PMC free article] [PubMed] [Google Scholar]
  34. Tzivoni D., Stern Z., Keren A., Stern S. Electrocardiographic characteristics of neurocirculatory asthenia during everyday activities. Br Heart J. 1980 Oct;44(4):426–432. doi: 10.1136/hrt.44.4.426. [DOI] [PMC free article] [PubMed] [Google Scholar]
  35. Wackers F. J., Russo D. J., Russo D., Clements J. P. Prognostic significance of normal quantitative planar thallium-201 stress scintigraphy in patients with chest pain. J Am Coll Cardiol. 1985 Jul;6(1):27–30. doi: 10.1016/s0735-1097(85)80247-3. [DOI] [PubMed] [Google Scholar]
  36. von Arnim T., Höfling B., Schreiber M. Characteristics of episodes of ST elevation or ST depression during ambulatory monitoring in patients subsequently undergoing coronary angiography. Br Heart J. 1985 Nov;54(5):484–488. doi: 10.1136/hrt.54.5.484. [DOI] [PMC free article] [PubMed] [Google Scholar]

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