Investigation in patients with previous myocardial infarction who present with chest pain
Thirty-five patients who presented with chest pain underwent mapping of the ECG with exercise and angiocardiography. Krypton-81m was used to assess regional myocardial perfusion before, during and after atrial pacing. Twelve of the 35 patients had negative exercise tests. Eight of these 12 had normal coronary arteries and four had less than or equal to 50% stenosis of at least one major coronary artery. All 12 patients had uniform increases in regional myocardial perfusion (98 plus/minus 14.0%) during atrial pacing. Thirteen of the 35 patients had a history of myocardial infarction and precordial areas of Q waves. During exercise, all 13 patients complained of chest pain and showed precordial areas of both ST-segment elevation and depression. These 13 patients had greater than or equal to 70% stenosis of at least one major coronary artery. Myocardial blood flow studies showed fixed defects of perfusion corresponding to the Q waves and ST-segment elevation. In addition, there were separate transient decreases of regional myocardial perfusion (70 plus/minus 9.0%) during atrial pacing corresponding to ST-segment depression and chest pain. Ten of the 35 patients had a history of myocardial infarction and precordial areas of Q waves. These areas showed no changes during atrial pacing. All the patients showed at least one remote region of myocardium that increased perfusion (74 plus/minus 170%) throughout pacing. Patients with a history of myocardial infarction may present with chest pain. In this study, ST-segment elevation during an exercise ECG was not associated with chest pain or detectable myocardial ischemia. Regional perfusion in infarcted segments of myocardium did not change with atrial pacing.
- Research Organization:
- Royal Postgraduate Medical School, London, United Kingdom
- OSTI ID:
- 5733844
- Journal Information:
- Circulation; (United States), Vol. 64:6
- Country of Publication:
- United States
- Language:
- English
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