ST-segment depression with  ST-segment  elevation in patient diagnosed  by Holter monitoring

İ. E.  Xəlilov

doi:10.28942/acj.v1i6y2014.71

Abstract

The diagnosis of stable coronary artery disease can be established by making a careful history of the patient, documentation of ECG changes (by Holter monitoring ) during episodes of coronary insufficiency, visualization of regions with temporarily impaired uptake of thallium-201 or other isotopes, measurement of impaired left ventricular function during ischemic episodes and, finally, coronary arteriography. Optimal results will be obtained when the proper methods are selected for each individual patient. The value of Holter Monitoring (HM) in patient with ST-segment change will be discussed here in our cases.

Cover Letter

In our cases a 62-year-old male patient reported episodes of palpitation and chest discomfort during last 10 days, (about 2 episode/day in ordinary daily life). His life style is active, driver. Weight – 70 kg, he was not ill during 62 y., had not hypertension, Diabetes and hereditary predisposition. He used alcohol non regular and was not heavy smoker.
During examination in Oxygen Clinic Hospital there were no echocardiographic, electrocardiographic changes or elevated troponin. The patient 5 time complaint of chest discomfort during 24 hours (Holter monitoring period) and 2 times severe ST-segment changes was detected during an chest discomfort episode. The patient was admitted in Medex hospital, where was performed CAG. Coronary angiogram showed 2 severe stenosis - 90 and 70% respectively at proximal part of LAD. The patient successfully was stented.

Discussion
In the 1970s, several groups of investigators began to use ambulatory monitoring of the ECG, and with this new technique, they described that ST depression, a cardinal sign of myocardial ischemia on the ECG, can occur in patients with IHD without accompanying pain.1-3Holter monitoring of ST - segment changes is a unique method of studying the character of transient myocardial ischemia that occurs during ordinary daily life. Detailed studies in patients with chronic stable angina have shown that transient ischemia is frequently silent and prolonged, and may occur without evidence of physical exertion. Silent myocardial ischemia is defined as objective documentation of myocardial ischemia in the absence of angina or anginal equivalents.4-5In our cases, patient with severe coronary artery diseases had not anysignificant complaints or (ECG) manifestation. İn this cases, for the first time we found not only the ST segment depression and also observed ST-segment elevation in this patient.

Conclusion:
Patient complaints, resting ECG, Color Doppler Echocardiography and also Blood exam was not informative for correct diagnosis in this cases. In other hand Stress - exercise treadmill test dangerous and contraindicated for such patients. We concluded, that HM as an indirect method suggesting of Coronary artery blood blok, may be considered as an 1st non invasive diagnostic procedure for all patients with Unstable Angina pectoris and pain free form of IHD. And all the such patients must be admitted on the CCU for emergency CAG.

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References

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Monitoring. Chicago, Ill: Year Book Medical Publishers, Inc; 1978:93–106.
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5. ACC/AHA 2007 guidelines for the management of patients with unstable angina/non-ST-
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