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. 1975 Sep;37(9):897–903. doi: 10.1136/hrt.37.9.897

Maximal exercise testing in patients with spontaneous angina pectoris associated with transiet ST segment elevation. Risks and electrocardiographic findings.

J M Detry, P Mengeot, M F Rousseau, J Cosyns, R Ponlot, L A Brasseur
PMCID: PMC482895  PMID: 1103910

Abstract

Six patients with spontaneous angina associated with transient ST segment elevation had a multistate maximal exercise (bicycle) test. In 5 patients, typical electrocardiographic changes were recorded during exercise, namely ST segment elevation often accompanied by an increase in the voltage of the R wave and a widening of the QRS complex. Four of these patients developed severe rhythm disturbances: ventricular tachycardia (2 cases) and ventricular flutter (1 case) were the reason for early interruption of the test in 3 patients, while 1 patient had a short run of ventricular tachycardia after exercise. These rhythm disturbances which spontaneously regressed in all cases were consistently preceded by obvious ST elevation and in 2 patients were attended by slight chest discomfort. Maximal exercise testing of patients suspected of variant angina provides important diagnostic information in many patients, but the risks of potentially lethal arrhythmias should be considered and resuscitation facilities should always be immediately available.

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Selected References

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

  1. Bekaert S., Afschrift M., de Tollenaere G. Angor van Prinzmetal. Acta Clin Belg. 1971;26(4):228–233. doi: 10.1080/17843286.1971.11716790. [DOI] [PubMed] [Google Scholar]
  2. Betriu A., Solignac A., Bourassa M. G. The variant form of angina: diagnostic and therapeutic implications. Am Heart J. 1974 Mar;87(3):272–278. doi: 10.1016/0002-8703(74)90063-5. [DOI] [PubMed] [Google Scholar]
  3. Bobba P., Vecchio C., Di Guglielmo L., Salerno J., Casari A., Montemartini C. Exercise-induced RS-T elevation. Electrocardiographic and angiographic observations. Cardiology. 1972;57(3):162–171. doi: 10.1159/000169514. [DOI] [PubMed] [Google Scholar]
  4. Bodenheimer M., Lipski J., Donoso E., Dack S. Prinzmental's variant angina: a clinical and electrocardiographic study. Am Heart J. 1974 Mar;87(3):304–313. doi: 10.1016/0002-8703(74)90070-2. [DOI] [PubMed] [Google Scholar]
  5. Cheng T. O., Bashour T., Kelser G. A., Jr, Weiss L., Bacos J. Variant angina of Prinzmetal with normal coronary arteriograms. A variant of the variant. Circulation. 1973 Mar;47(3):476–485. doi: 10.1161/01.cir.47.3.476. [DOI] [PubMed] [Google Scholar]
  6. Cherrier F., Cuilliére M., Dodinot B., Hua G. Angor de Prinzmetal; aspects coronarographques; considèrations thèrapeutiques. A propos de 7 observations. Arch Mal Coeur Vaiss. 1973 May;66(5):579–592. [PubMed] [Google Scholar]
  7. Cosby R. S., Giddings J. A., See J. R., Mayo M. Variant angina: case reports and critique. Am J Med. 1972 Dec;53(6):739–742. doi: 10.1016/0002-9343(72)90191-x. [DOI] [PubMed] [Google Scholar]
  8. Dessertenne F. La tachycardie ventriculaire à deux foyers opposés variables. Arch Mal Coeur Vaiss. 1966 Feb;59(2):263–272. [PubMed] [Google Scholar]
  9. Detry J. M., Rousseau M., Vandenbroucke G., Kusumi F., Brasseur L. A., Bruce R. A. Increased arteriovenous oxygen difference after physical training in coronary heart disease. Circulation. 1971 Jul;44(1):109–118. doi: 10.1161/01.cir.44.1.109. [DOI] [PubMed] [Google Scholar]
  10. Dhurandhar R. W., Watt D. L., Silver M. D., Trimble A. S., Adelman A. G. Prinzmetal's variant form of angina with arteriographic evidence of coronary arterial spasm. Am J Cardiol. 1972 Dec;30(8):902–905. doi: 10.1016/0002-9149(72)90018-5. [DOI] [PubMed] [Google Scholar]
  11. EKMEKCI A., TOYOSHIMA H., KWOCZYNSKI J. K., NAGAYA T., PRINZMETAL M. Angina pectoris. IV. Clinical and experimental difference between ischemia with S-T elevation and ischemia with S-T depression. Am J Cardiol. 1961 Mar;7:412–426. doi: 10.1016/0002-9149(61)90485-4. [DOI] [PubMed] [Google Scholar]
  12. Ellestad M. H., Allen W., Wan M. C., Kemp G. L. Maximal treadmill stress testing for cardiovascular evaluation. Circulation. 1969 Apr;39(4):517–522. doi: 10.1161/01.cir.39.4.517. [DOI] [PubMed] [Google Scholar]
  13. Fortuin N. J., Friesinger G. C. Exercise-induced S-T segment elevation. Clinical, electrocardiographic and arteriographic studies in twelve patients. Am J Med. 1970 Oct;49(4):459–464. doi: 10.1016/s0002-9343(70)80039-0. [DOI] [PubMed] [Google Scholar]
  14. Froment R., Normand J., Amiel L. Angine de poitrine du type Prinzmetal. Coronaires perméables, mais spasme de l'inter-ventriculaire antérieure en cours de crise. Arch Mal Coeur Vaiss. 1973 Jun;66(6):755–761. [PubMed] [Google Scholar]
  15. Gonin A., Berthou J. D., Delaye J., Roques J. C., Touboul P., Janin A. Angor de Prinzmetal: apports de la coronarographie et discussion de la chirurgie de revascularisation (à propos de 13 cas comportant 10 coronarographies sélectives et 9 pontages aorto-coronariens. Arch Mal Coeur Vaiss. 1973 May;66(5):571–578. [PubMed] [Google Scholar]
  16. Jouve A., Guiran J. B., Viallet H., Gras A., Blanc M., Arnoux M., Rouvier M., Brunel J. C. Les modifications électrocardiographiques au cours des crises d'angor spontané. Arch Mal Coeur Vaiss. 1969 Mar 3;62(3):331–351. [PubMed] [Google Scholar]
  17. Kerin N., Macleod C. A. Coronary artery spasm associated with variant angina pectoris. Br Heart J. 1974 Feb;36(2):224–227. doi: 10.1136/hrt.36.2.224. [DOI] [PMC free article] [PubMed] [Google Scholar]
  18. Krikler D. M. A fresh look at cardiac arrhythmias Pathogenesis and presentation. Lancet. 1974 May 11;1(7863):913–918. doi: 10.1016/s0140-6736(74)90360-2. [DOI] [PubMed] [Google Scholar]
  19. Mason R. E., Likar I., Biern R. O., Ross R. S. Multiple-lead exercise electrocardiography. Experience in 107 normal subjects and 67 patients with angina pectoris, and comparison with coronary cinearteriography in 84 patients. Circulation. 1967 Oct;36(4):517–525. doi: 10.1161/01.cir.36.4.517. [DOI] [PubMed] [Google Scholar]
  20. Motté G., Coumel P., Abitbol G., Dessertenne F., Slama R. Le syndrome QT long et syncopes par "torsades de pointe". Arch Mal Coeur Vaiss. 1970 Jun;63(6):831–853. [PubMed] [Google Scholar]
  21. Oliva P. B., Potts D. E., Pluss R. G. Coronary arterial spasm in Prinzmetal angina. Documentation by coronary arteriography. N Engl J Med. 1973 Apr 12;288(15):745–751. doi: 10.1056/NEJM197304122881501. [DOI] [PubMed] [Google Scholar]
  22. PRINZMETAL M., KENNAMER R., MERLISS R., WADA T., BOR N. Angina pectoris. I. A variant form of angina pectoris; preliminary report. Am J Med. 1959 Sep;27:375–388. doi: 10.1016/0002-9343(59)90003-8. [DOI] [PubMed] [Google Scholar]
  23. Poggi L., Bory M., Djiane P., Chabaud R., Sebaoun E., Serradimigni A. Les troubles du rythme au cours des crises d'angor spontaneé de Prinzmetal. Arch Mal Coeur Vaiss. 1971 Jun;64(6):874–886. [PubMed] [Google Scholar]
  24. Raynaud R., Brochier M., Morand P., Fauchier J. P., Raynaud P., Chatelain B. Une forme clinique de l'angine de poitrine: l'angor de Prinzmetal. Sem Hop. 1969 Oct 26;45(43):2662–2677. [PubMed] [Google Scholar]
  25. Robinson J. S. Prinzmetal's variant angina pectoris. Report of a case. Am Heart J. 1965 Dec;70(6):797–800. doi: 10.1016/0002-8703(65)90335-2. [DOI] [PubMed] [Google Scholar]
  26. Rousseau M. F., Brasseur L. A., Detry J. M. Hemodynamic determinants of maximal oxygen intake in patients with healed myocardial infarction: influence of physical training. Circulation. 1973 Nov;48(5):943–949. doi: 10.1161/01.cir.48.5.943. [DOI] [PubMed] [Google Scholar]
  27. Scherf D., Cohen J. [Editorial: "Variant" angina pectoris]. Circulation. 1974 May;49(5):787–789. doi: 10.1161/01.cir.49.5.787. [DOI] [PubMed] [Google Scholar]
  28. Sheffield L. T., Holt J. H., Reeves T. J. Exercise graded by heart rate in electrocardiographic testing for angina pectoris. Circulation. 1965 Oct;32(4):622–629. doi: 10.1161/01.cir.32.4.622. [DOI] [PubMed] [Google Scholar]
  29. Silverman M. E., Flamm M. D., Jr Variant angina pectoris. Anatomic findings and prognostic implications. Ann Intern Med. 1971 Sep;75(3):339–343. doi: 10.7326/0003-4819-75-3-339. [DOI] [PubMed] [Google Scholar]

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