Certain clinical and electrocardiographic features of angina decubitus
Tung, C.; Huang, W.
Chinese Medical Journal 1(5): 375-380
1975
ISSN/ISBN: 0366-6999 PMID: 811451 Document Number: 83126
A report is made on 4 patients with severe angina decubitus. It is characterized: by rather prolonged, excruciating, anterior thoracic pain, occurring especially during sleep at midnight; in marked contrast to the immobile position assumed by the patient with classical angina, the patient becomes restless, gets out of bed and attempts to walk off the pain; the pain is associated with moderate tachycardia and a striking rise in systolic blood pressure; nitroglycerine exerts no appreciable effect on the pain; free aortic insufficiency appears to be the pathophysiologic basis in 3 of our patients; and the prognosis in this type of angina is grave. Of greater significance than the clinical features in this type of angina is the appearance of certain not well-known but very striking ECG alterations involving particularly the R waves in the inferior and left precordial leads during these spontaneous episodes. In 2 cases of aortic insufficiency there was an unusually marked increase in the voltage of the R wave by up to 400% during the anginal seizures. In the 3rd patient with aortic insuffiency there was marked increase in R voltage in some attacks and marked decrease in others. In the 4th patient who had coronary atherosclerotic heart disease there occurred a moderate reduction of R voltage in the inferior and left precordial leads at the height of pain. The electrophysiologic basis of these voltage alterations of the initial ventricular complex of ECG during episodes of angina is uncertain. It is thought that the striking increase in R wave voltage may be related to the sustained systolic precordial bulges commonly observed during episodes of severe myocardial ischemia, while the occasional reduction in R voltage might be due to a decrease of electromotive force in the ischemic portion of the myocardium and may be considered as a Q equivalent.