Krishan Lal1, Navreet Singh2, Anil Kumar3, Naveen Agarwal4, Rajat Datta5, Rashmi Datta6, Prashant Bhardwaj7, D S Chadha8, A K Ghosh9, Ratheesh Kumar10. 1. SMO, HCMS, LNJP Civil Hospital, Kurukshetra, Haryana, India. 2. Senior Adviser (Cardiology), AFCME Subroto Park, New Delhi, India. 3. Senior Adviser (Medicine and Cardiologist), 7 Air Force Hospital, Kanpur, U.P., India. 4. Dy Commandant & Chief Instructor, Army Medical Centre, Centre & College, Lucknow, India. 5. IHQ, MoD (Navy), New Delhi, India. 6. MG (Med), Delhi Area, New Delhi, India. 7. Addl DGMS Army, Office of DGMS Army, IHQ MoD, New Delhi, India. 8. Professor and Senior Consultant (Cardiology), Manipal Hospitals, Kodihalli, Bangalore, India. 9. Senior Adviser (Medicine and Cardiology), Army Institute of Cardio Thoracic Sciences, Pune, 40, India. 10. Senior Adviser (Medicine and Cardiology), Command Hospital (Eastern Command), Kolkata, India.
Abstract
BACKGROUND: Soldiers native to lowlands, while sojourning at high altitude (HA), are referred to tertiary care centers with electrocardiographic (ECG) abnormalities. Exposure to HA may precipitate myocardial ischemia in subjects with underlying coronary artery disease (CAD). Conversely, it may produce physiological ECG changes mimicking those of CAD, causing a diagnostic dilemma. This study sought to correlate the presence of CAD on coronary angiography (CAG) with a putative diagnosis of CAD based on clinical findings and ECG. METHODS: A prospective study was conducted on patient's from HA areas, referred for evaluation for CAD to a single center at near-sea-level. Thirty-five minimally symptomatic/asymptomatic soldiers with ECG changes suggestive of CAD, underwent CAG. Correlation was sought between ECG and CAG evidence of CAD. RESULTS: The association of CAD on CAG with clinical and ECG diagnosis of CAD was not significant, 4 of the 35 soldiers (11.4%) showing CAG evidence of CAD (chi square 3.849, p = 0.697). The association between symptoms and coronary artery lesions was, also, not significant, only four of twenty-three (17.4%) minimally symptomatic subjects having CAD on CAG. CONCLUSION: Insignificant numbers of previously healthy persons, who present with minimal symptoms and ECG changes suggestive of CAD while sojourning at HA, have coronary artery involvement on CAG. Those with incidental ECG changes, without symptomatology, do not have CAD on CAG.
BACKGROUND: Soldiers native to lowlands, while sojourning at high altitude (HA), are referred to tertiary care centers with electrocardiographic (ECG) abnormalities. Exposure to HA may precipitate myocardial ischemia in subjects with underlying coronary artery disease (CAD). Conversely, it may produce physiological ECG changes mimicking those of CAD, causing a diagnostic dilemma. This study sought to correlate the presence of CAD on coronary angiography (CAG) with a putative diagnosis of CAD based on clinical findings and ECG. METHODS: A prospective study was conducted on patient's from HA areas, referred for evaluation for CAD to a single center at near-sea-level. Thirty-five minimally symptomatic/asymptomatic soldiers with ECG changes suggestive of CAD, underwent CAG. Correlation was sought between ECG and CAG evidence of CAD. RESULTS: The association of CAD on CAG with clinical and ECG diagnosis of CAD was not significant, 4 of the 35 soldiers (11.4%) showing CAG evidence of CAD (chi square 3.849, p = 0.697). The association between symptoms and coronary artery lesions was, also, not significant, only four of twenty-three (17.4%) minimally symptomatic subjects having CAD on CAG. CONCLUSION: Insignificant numbers of previously healthy persons, who present with minimal symptoms and ECG changes suggestive of CAD while sojourning at HA, have coronary artery involvement on CAG. Those with incidental ECG changes, without symptomatology, do not have CAD on CAG.
Authors: Colleen Glyde Julian; Andrew W Subudhi; Megan J Wilson; Andrew C Dimmen; Travis Pecha; Robert C Roach Journal: J Appl Physiol (1985) Date: 2011-06-02
Authors: Marc M Berger; Christiane Hesse; Christoph Dehnert; Heike Siedler; Petra Kleinbongard; Hubert J Bardenheuer; Malte Kelm; Peter Bärtsch; Walter E Haefeli Journal: Am J Respir Crit Care Med Date: 2005-06-09 Impact factor: 21.405