The prevalence of ST-segment depression on ambulatory electrocardiographic monitoring during daily life in high-risk asymptomatic police officers.

BACKGROUND: In individuals with no known ischaemic heart disease, the prevalence and significance of ST-segment depression on ambulatory electrocardiographic monitoring is unclear. We therefore determined the prevalence of ST-segment depression among middle-aged male police officers, an occupational group in whom an increased risk of ischaemic heart disease has been reported, who also had multiple individual coronary risk factors but no known ischaemic heart disease. METHODS: Full-time male police offices aged 45 years or more with at least two coronary risk factors but no known ischaemic heart disease performed a 24h ambulatory electrocardiographic monitor, timed to include a shift of work. The number and duration of episodes of ST-segment depression were determined. In those in whom ST-segment depression was detected, exercise thallium scintigraphy and repeat 24h ambulatory electrocardiographic monitoring were performed. RESULTS: The prevalence of ST-segment depression on 24h ambulatory electrocardiographic monitoring, including an 8h period of normal work, was 3.4% (95% confidence interval 1.3-8.3%). Exercise thallium scintigraphy was carried out in those in whom ST-segment depression had been detected. Despite two participants developing ST-segment depression during exercise, no evidence of myocardial ischaemia was observed on the perfusion scan. Therefore, the prevalence of ST-segment depression on ambulatory electrocardiographic monitoring in this asymptomatic but high-risk population was low and, when it did occur, no exercise-induced myocardial ischaemia was observed. CONCLUSION: These results suggest that ST-segment depression on ambulatory electrocardiographic monitoring in asymptomatic subjects may not represent myocardial ischaemia. The use of this parameter to screen asymptomatic populations for ischaemic heart disease is therefore highly questionable.

The effect of a selective beta adrenergic blocking agent on ventricular arrhythmias in the first year following myocardial infarction.

Fifty-five patients with recent acute myocardial infarction entered a single-blind cross-over trial to assess the effect of oral practolol 200 mg twice daily on the incidence and nature of ventricular arrhythmias in the first year following myocardial infarction. Patients had 24-hour Holter electrocardiogram tape monitoring at two weeks following infarction and at three-monthly intervals for one year. Twenty-six patients completed the full year of the trial with 12% of tape recordings technically unsatisfactory. A total of 46 periods of comparison of the action of practolol versus placebo therapy were available in thirty patients. Whilst receiving the selective beta adrenergic blocking agent, practolol, there was a significant reduction in the percentage of studied hours during which salvos of ventricular premature beats occurred (P < 0.025), however the percentage of patients in whom salvos were recorded was unchanged. The incidence of all other ventricular arrhythmias was not reduced in the practolol group. When the effect of practolol was related to the site of infarction, anterior or inferior, there was no significant reduction in the incidence of ventricular arrhythmias.

The diastolic murmur of renal failure.

A characteristic and transient early diastolic precordial murmur is commonly heard in patients with renal failure. On the basis of its clinical characteristics, this murmur has previously been attributed to functional aortic incompetence. We undertook a formal cardiac investigation, including aortography, in six of eight patients with renal failure in whom such a bruit developed. Aortic regurgitation was detected in only one of the six. Echocardiography revealed no abnormality of aortic-valve function but did indicate the presence of a small pericardial effusion in each of the five patients examined. We conclude that the early diastolic murmur associated with renal failure does not usually arise from functional aortic incompetence but may be a sound of pericardial origin.