Unstable angina with tachycardia: Clinical and therapeutic implications

Samuel Sclarovsky*, Roni Bassevich, Boris Strasberg, Eliezer Klainman, Eldad Rechavia, Alex Sagie, Jacob Agmon

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

6 Scopus citations

Abstract

We prospectively evaluated 19 patients with prolonged chest pain not evolving to myocardial infarction and accompanied with reversible ST-T changes and tachycardia (heart rate > 100 beats/min) in order to correlate heart rate reduction with ischemic electrocardiographic (ECG) changes. Fourteen patients (74%) received previous long-term combined treatment with nifedipine and nitrates. Continuous ECG monitoring was carried out until heart rate reduction and at least one of the following occurred: (1) relief of pain or (2) resolution of ischemic ECG changes. The study protocol consisted of carotid massage in three patients (16%), intravenous propranolol in seven patients (37%), slow intravenous amiodarone infusion in two patients (10%), and intravenous verapamil in four patients (21%) with atrial fibrillation. In three patients (16%) we observed a spontaneous heart rate reduction on admission. Patients responded with heart rate reduction from a mean of 125 ± 10.4 beats/min to 84 ± 7.5 beats/min (p < 0.005) and an ST segment shift of 4.3 ± 2.13 mm to 0.89 ± 0.74 mm (p < 0.005) within a mean interval of 13.2 ± 12.7 minutes. Fifteen (79%) had complete response and the other four (21%) had partial relief of pain. A significant direct correlation was observed for heart rate reduction and ST segment deviation (depression or elevation) (r = 0.7527 and 0.8739, respectively). These patients represent a unique subgroup of unstable angina, in which the mechanism responsible for ischemia is excessive increase in heart rate. Conventional vasodilator therapy may be deleterious, and heart rate reduction is mandatory.

Original languageEnglish
Pages (from-to)1188-1193
Number of pages6
JournalAmerican Heart Journal
Volume116
Issue number5 PART 1
DOIs
StatePublished - Nov 1988

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