Abstract
Exercise electrocardiograms must be interpreted with the understanding that not every positive test is indicative of coronary artery disease. Mitral valve prolapse mimics coronary heart disease clinically and often in the electrocardiographic response to exercise. Twelve patients with mitral valve prolapse in whom exercise testing was positive underwent a repeat study after beta blockade. All tracings returned to normal after adequate blockade, evidenced by 17 to 22% reduction of resting and exercise heart rates. To the best of our knowledge, this is the first such report in the English literature. The results of this study suggest that an exercise test after beta blockade should become part of the routine procedure in such patients. The elimination of false positive electrocardiographic responses by beta blockade should help improve the specificity of the exercise test. Moreover, similar responses should lead to the suspicion of mitral valve prolapse.
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- Abinader E. G. Adrenergic beta blockade and ECG changes in the systolic click murmur syndrome. Am Heart J. 1976 Mar;91(3):297–302. doi: 10.1016/s0002-8703(76)80212-8. [DOI] [PubMed] [Google Scholar]
- Boudoulas H., Reynolds J. C., Mazzaferri E., Wooley C. F. Metabolic studies in mitral valve prolapse syndrome. A neuroendocrine--cardiovascular process. Circulation. 1980 Jun;61(6):1200–1205. doi: 10.1161/01.cir.61.6.1200. [DOI] [PubMed] [Google Scholar]
- Devereux R. B., Perloff J. K., Reichek N., Josephson M. E. Mitral valve prolapse. Circulation. 1976 Jul;54(1):3–14. doi: 10.1161/01.cir.54.1.3. [DOI] [PubMed] [Google Scholar]
- Marcomichelakis J., Donaldson R., Green J., Joseph S., Kelly H. B., Taggart P., Somerville W. Exercise testing after beta-blockade: improved specificity and predictive value in detecting coronary heart disease. Br Heart J. 1980 Mar;43(3):252–261. doi: 10.1136/hrt.43.3.252. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 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]
- Taggart P., Carruthers M., Joseph S., Kelly H. B., Marcomichelakis J., Noble D., O'Neill G., Somerville W. Electrocardiographic changes resembling myocardial ischaemia in asymptomatic men with normal coronary arteriograms. Br Heart J. 1979 Feb;41(2):214–225. doi: 10.1136/hrt.41.2.214. [DOI] [PMC free article] [PubMed] [Google Scholar]