Abstract
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.
Keywords: pulmonary edema, circadian rhythm
Full Text
The Full Text of this article is available as a PDF (421.3 KB).
References
- 1. Quyyumi AA: Circadian rhythms in cardiovascular disease. Am Heart J 1990; 120: 726–733. [DOI] [PubMed] [Google Scholar]
- 2. Willich SN, Linderer T, Wegscheider K, Leizorovicz A, Alamercery I, Schroder R: Increased morning incidence of myocardial infarction in the ISAM study: Absence with prior adrenergic blockade. Circulation 1989; 80: 853–858. [DOI] [PubMed] [Google Scholar]
- 3. Mulcahy D, Keegan J, Cunningham D, Quyyumi A, Crean P, Park A, Wright C, Fox K: Circadian variation of total ischaemic burden and its alteration with anti‐anginal agents. Lancet 1988; 2: 755–759. [DOI] [PubMed] [Google Scholar]
- 4. Willich SN, Levy D, Rocco MB, Tofler GH, Stone PH, Muller JE: Circadian variation in the incidence of sudden cardiac death in the Framingham Heart Study population. Am J Cardiol 1987; 60: 801–806. [DOI] [PubMed] [Google Scholar]
- 5. Lichstein E, Morganroth J, Harrist R, Hubble E: Effect of propranolol on ventricular arrhythmia: the Beta‐Blocker Heart Attack Trial experience. Circulation 1983; 67: I5–I10. [PubMed] [Google Scholar]
- 6. Muller JE, Tofler GH, Stone PH: Circadian variation and triggers of onset of acute cardiovascular disease. Circulation 1989; 79: 733–743. [DOI] [PubMed] [Google Scholar]
- 7. Goldberger JJ, Peled HB, Stroh JA, Cohen MA, Frishman WH: Prognostic factors in acute pulmonary edema. Arch Intern Med 1986; 146: 489–493. [PubMed] [Google Scholar]
- 8. Colice GL: Detecting the presence and cause of pulmonary edema. Postgrad Med 1993; 93: 161–166. [DOI] [PubMed] [Google Scholar]
- 9. Yasue H, Omote S, Takizawa A, Nagao M, Miwa K, Tanaka S: Orcadian variation of exercise capacity in patients with Prinzmetal's variant angina: Role of exercise induced coronary artery spasm. Circulation 1979; 59: 938–948. [DOI] [PubMed] [Google Scholar]
- 10. Buff DD, Fleisher JM, Roca JA, Jaffri M, Wyrwinski PM: Orcadian distribution of in‐hospital cardiopulmonary arrests on the general medical ward. Arch Intern Med 1992; 152: 1282–1288. [PubMed] [Google Scholar]
- 11. Sothem RB, Vesely DL, Kanabroki EL, Bremner FW, Third JLAC, Boles MA, Nemchausky BM, Olwin JH, Scheving LE: Blood pressure and atrial naturetic peptides correlate throughout the day. Am Heart J 1995; 129: 907–916. [DOI] [PubMed] [Google Scholar]
- 12. Rocco MB: Timing and triggers of transient myocardial ischemia. Am J Cardiol 1990; 66: 18G–21G. [DOI] [PubMed] [Google Scholar]
- 13. Turton MB, Deegan T: Circadian variations of plasma catecholamine, Cortisol, and immunoreactive insulin concentrations in supine subjects. Clin Chim Acta 1974; 55: 389–397. [DOI] [PubMed] [Google Scholar]
- 14. Tofler GH, Brezinski D, Schafer AL, Czeisler CA, Rutherford JD, Willich SN, Gleason RE, Williams GH, Miller JE: Concurrent morning increase in platelet aggregability and the risk of myocardial infarction and sudden cardiac death. N Engl J Med 1987; 316: 1514–1518. [DOI] [PubMed] [Google Scholar]
- 15. Andreotti F, Davies GJ, Hackett DR, Khan MI, DeBart AC, Aber VR, Maseri A, Kluft C: Major circadian fluctuation in fibrinolytic factors and possible relevance to time of onset of myocardial infarction, sudden cardiac death and stroke. Am J Cardiol 1988; 62: 635–637. [DOI] [PubMed] [Google Scholar]
- 16. Gebara OCE, Tofler GH, Muller JE, Braunwald E: Circadian variation and possible triggers of acute myocardial infarction. Cardiovasc Rev Rep 1995; 16: 9–22. [Google Scholar]
- 17. Peters RW, Miller JE, Goldstein S, Byington R, Friedman LM: Propranolol and the morning increase in the frequency of sudden cardiac death (BHAT study). Am J Cardiol 1989; 63: 1518–1520. [DOI] [PubMed] [Google Scholar]
- 18. Ridker PM, Manson JE, Buring JE, Muller JE, Hennekens CH: Circadian variation of acute myocardial infarction and the effect of low‐dose aspirin in a randomized trial of physicians. Circulation 1990; 82: 897–902. [DOI] [PubMed] [Google Scholar]
- 19. Deanfield JE, Detry JRG, Lichtlen PR, Magnani B, Sellier P, Thaulow E: Amlodipine reduces transient myocardial ischemia in patients with coronary artery disease: Double‐blind Circadian Anti‐ischemia Program in Europe (CAPE Trial). J Am Coll Cardiol 1994; 24: 1460–1467. [DOI] [PubMed] [Google Scholar]
- 20. Clark L, Garefin O, Dwyer E: Acute pulmonary edema due to ischemic heart disease without accompanying myocardial infarction. Am J Med 1983; 75: 332–336. [DOI] [PubMed] [Google Scholar]