Ventricular tachycardia; prevalence and prognosis

Frequent or complex patterns of ventricular ectopic activity, whether occurring during routine activity or induced by exercise, are often a marker for serious heart disease and a harbinger of sudden death. The detection of such arrhythmias is thus an important responsibility of the physician. To find the prevalence, associated characteristics and prognostic significance of exercise induced non-sustained VT in a representative population. Nishtar Hospital, Multan. 1000 patients. Two years. Descriptive, analytical study. Convenient probability sampling done. Ten subjects, 7 men and 3 women, with exercise induced VT were identified, representing 1.1% of those tested; only 1 was young than 65 years. All episodes of VT were asymptomatic and non-sustained. In 9 of 10 subjects, VT developed at or near peak exercise. The longest run of VT was 6 beats; multiple runs of VT were present in 4 subjects. Two subjects had exercise induced ST segment depression, but subsequent exercise thallium scintigraphic results were negative in each. Compared with a group of age and sex matched control subjects. those with asymptomatic, non-sustained VT displayed no difference in exercise duration, maximal heart rate, or the prevalence of coronary risk factors or exercise induced ischemia as measured by electrocardiography and thallium scintigrahy. Over a mean follow period of 2 years, no subject has developed symptoms of heart disease or experienced syncope or sudden death. Thus, exercise induced VT in apparently healthy subjects occurs almost exclusively in the elderly, is limited to short, asymptomatic runs of 3 to 6 beats usually near peak exercise, and does not portend increased cardiovascular morbidity or mortality rates over a 2 year period of observation. Exercise induced VT in apparently healthy subjects occurs almost exclusively in the elderly, is limited to short, asymptomatic runs of 3 to 6 beats usually near peak exercise, and does not show increased cardiovascular morbidity or mortality rates over a 2 year period of observation

Variant angina; comparison of patients with and without fixed severe coronary artery disease

The syndrome of variant angina occurs in patients with a wide spectrum of coronary artery obstructions, ranging from normal coronary arteries to severe 3-vessel coronary artery disease [CAD]. Treatment of these patients is, in large part, determined by the extent and severity of the underlying fixed coronary obstructions. To determine the clinical features of variant angina with and without fixed severe coronary artery disease. Nishtar Hospital, Multan. Two years. Descriptive, comparative analytical study. Sample size 108 patients. Sampling technique: Convenient probability sampling done. 43 patients with variant angina who had less than 50% fixed coronary luminal diameter narrowing [group-I] were compared with 65 patients with variant angina who had 70% or greater diameter narrowing [group-II]. Statistically significant differences were found in 3 clinical features between group-I and group-II i.e. [1] a more than 3 months history of angina at rest before diagnosis [80% vs 23%, P <0.001]; [2] an abnormal electrocardiogram at rest [19 vs 48%, P <0.01]. [3] an abnormal stress test [26% [8 of 30] vs 84% [15 of 18], P <0.01. However, these features were not clinically reliable in separating patients with variant angina with and without fixed severe obstructions because of overlap between the two groups. No difference was found between the 2 groups in age, sex, predominant symptoms at the time of catheterization, history of exertional angina, syncope with angina, prolonged angina, previous artery disease. Coronary arteriography should be performed to define the underlying coronary anatomy and to determine optimal therapy in patients with variant angina