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Differentiation of digoxin-induced ST-segment changes from ischemia-induced ST-segment depression during Holter monitoring
sodesin patients with variant angina occur usually from midnight to early morning, we recommend the administration of slow-release nifedipine once a day at 10 P.M.or twice a day at 10 P.M. and 6 A.M., depending on the pattern and frequency of episodesin an individual patient.* Yaauhh M-1, MD HirDflmliYasue, MD
lant state that may be amenable to dietary intervention.5 Are we measuring triglycerides at the wrong time? Postprandial rather than fasting triglyceride measurements may be more useful in the risk prediction and management of coronary disease.These issues should be explored. Not long ago it occurred to me that there is Kumamoto City, Japan probably some important informa27 December 1991 tion at our disposal. In midafternoon I had a brief “insurance 1. Morikami Y, Yasue H. Efficacy of exam” as part of the processto inslow-release nifedipine on myocardial crease my life insurance. The testischemic episodes in variant angina. Am J ing included a nonfasting triglycerCurdiof 1991:68:580-584. ide level. I will bet that insurance companies have a wealth of information in their data banks regarding the relation of nonfasting triNonfasting Triglycerides and Insurance Companies glyceride levels to future coronary events and mortality in both men The National Cholesterol Educa- and women. I wish they would tion Program guidelines’ rightfully share it. Mwk R. Gold&in, MD emphasize the importance of lowUpland, Pennsylvania density lipoprotein cholesterol in 27 December 1991 the management of algorithm; however, triglycerides take a back 1. The Expert Panel. Report of the Naseat. Evidence is accumulating that tional Cholesterol Education Program triglyceride-rich lipoproteins have Expert Panel on detection, evaluation and atherogenic potential, and new treatment of high blood cholesterol in management strategies for hyper- adults. Arch Intern Med 1988;148:36-69. triglyceridemia have been pro- 2. Assmann G, Betteridge DJ. Management of hypertriglyceridemic patients. posed.2 Treatment classification and goals. Am .I Triglycerides are routinely mea- Cardiol 1991;68:30A-34A. sured in the fasting state. It is obvi- 3. Zilversmit DB. Atherosclerosis: a postous that most of the time we are not prandial phenomenon. Circulation 1979; fasting, and presumably our arteri- 60~473-485. al walls remain exposed to triglyc- 4. Groot PHE, van Stiphont WAHJ, eride-rich lipoproteins.3 There are Krauss XH, et al. Postprandial lipoprodata suggesting that normolipidem- tein metabolism in normolipidemic men ic subjects with coronary artery dis- with and without coronary artery disease have delayed clearance of tri- ease. Arteriosclerosis and Thrombosis 1991;11:653-662. glyceride-rich lipoproteins,4 which 5. Skartlien AH, Lyberg-Beckmann S, supports the theory that the slow Holme I, Hjermann I, Prydz H. Effect of removal of these lipoproteins pro- alteration in triglyceride levels on factor motes atherogenesis. Additionally, VII-phospholipid complexes in plasma. hypertriglyceridemia is a procoagu- Arteriosclerosis 1989;9:798-801.
844
THE AMERICAN JOURNAL OF CARDIOLOGY VOLUME 69
MARCH 15. 1992
Differentiation of DigoxinInduced ST-Segment Changes from Ischemia-Induced STSegment Depression During Hotter Monitoring
I read with interest the recent article by Mooss et al1 on false-positive ST-depression after digoxin administration detected by ambulatory electrocardiographic monitoring. Although it is true that digoxin may produce ST-segment depression on ambulatory electrocardiographic monitoring in healthy subjects, it should not be confused with ST depressiondue to coronary artery disease.Digoxin shortens the QT interval, whereas myocardial ischemia in coronary artery disease prolongs it. Therefore, digoxin-induced ST depressionis always associated with a shortened QT interval (as was evident in Figure 1 of the article), whereas ischemic ST depressionis usually associatedwith a prolonged QT interval. TSllllg0. chOll&MD Washington,DC. 10 December1991
1. Mooss AN, Prevedel JA, Mohiuddin SM, Hilleman DE, Sketch MH. Effect of digoxin on ST-segment changes detected by ambulatory electrocardiographic monitoring in healthy subjects. Am .I Cardiol 1991;68:1503-1506.
Correction
In the December 15, 1991 issue, Table I on page 1725 of the Brief Report, “Lymphoproliferative Disorder Early After Cardiac Transplantation” by Rinde-Hoffman et al, incorrectly lists patient 2 as male. Patient 2 was a 34-year-old woman.
lant state that may be amenable to dietary intervention.5 Are we measuring triglycerides at the wrong time? Postprandial rather than fasting triglyceride measurements may be more useful in the risk prediction and management of coronary disease.These issues should be explored. Not long ago it occurred to me that there is Kumamoto City, Japan probably some important informa27 December 1991 tion at our disposal. In midafternoon I had a brief “insurance 1. Morikami Y, Yasue H. Efficacy of exam” as part of the processto inslow-release nifedipine on myocardial crease my life insurance. The testischemic episodes in variant angina. Am J ing included a nonfasting triglycerCurdiof 1991:68:580-584. ide level. I will bet that insurance companies have a wealth of information in their data banks regarding the relation of nonfasting triNonfasting Triglycerides and Insurance Companies glyceride levels to future coronary events and mortality in both men The National Cholesterol Educa- and women. I wish they would tion Program guidelines’ rightfully share it. Mwk R. Gold&in, MD emphasize the importance of lowUpland, Pennsylvania density lipoprotein cholesterol in 27 December 1991 the management of algorithm; however, triglycerides take a back 1. The Expert Panel. Report of the Naseat. Evidence is accumulating that tional Cholesterol Education Program triglyceride-rich lipoproteins have Expert Panel on detection, evaluation and atherogenic potential, and new treatment of high blood cholesterol in management strategies for hyper- adults. Arch Intern Med 1988;148:36-69. triglyceridemia have been pro- 2. Assmann G, Betteridge DJ. Management of hypertriglyceridemic patients. posed.2 Treatment classification and goals. Am .I Triglycerides are routinely mea- Cardiol 1991;68:30A-34A. sured in the fasting state. It is obvi- 3. Zilversmit DB. Atherosclerosis: a postous that most of the time we are not prandial phenomenon. Circulation 1979; fasting, and presumably our arteri- 60~473-485. al walls remain exposed to triglyc- 4. Groot PHE, van Stiphont WAHJ, eride-rich lipoproteins.3 There are Krauss XH, et al. Postprandial lipoprodata suggesting that normolipidem- tein metabolism in normolipidemic men ic subjects with coronary artery dis- with and without coronary artery disease have delayed clearance of tri- ease. Arteriosclerosis and Thrombosis 1991;11:653-662. glyceride-rich lipoproteins,4 which 5. Skartlien AH, Lyberg-Beckmann S, supports the theory that the slow Holme I, Hjermann I, Prydz H. Effect of removal of these lipoproteins pro- alteration in triglyceride levels on factor motes atherogenesis. Additionally, VII-phospholipid complexes in plasma. hypertriglyceridemia is a procoagu- Arteriosclerosis 1989;9:798-801.
844
THE AMERICAN JOURNAL OF CARDIOLOGY VOLUME 69
MARCH 15. 1992
Differentiation of DigoxinInduced ST-Segment Changes from Ischemia-Induced STSegment Depression During Hotter Monitoring
I read with interest the recent article by Mooss et al1 on false-positive ST-depression after digoxin administration detected by ambulatory electrocardiographic monitoring. Although it is true that digoxin may produce ST-segment depression on ambulatory electrocardiographic monitoring in healthy subjects, it should not be confused with ST depressiondue to coronary artery disease.Digoxin shortens the QT interval, whereas myocardial ischemia in coronary artery disease prolongs it. Therefore, digoxin-induced ST depressionis always associated with a shortened QT interval (as was evident in Figure 1 of the article), whereas ischemic ST depressionis usually associatedwith a prolonged QT interval. TSllllg0. chOll&MD Washington,DC. 10 December1991
1. Mooss AN, Prevedel JA, Mohiuddin SM, Hilleman DE, Sketch MH. Effect of digoxin on ST-segment changes detected by ambulatory electrocardiographic monitoring in healthy subjects. Am .I Cardiol 1991;68:1503-1506.
Correction
In the December 15, 1991 issue, Table I on page 1725 of the Brief Report, “Lymphoproliferative Disorder Early After Cardiac Transplantation” by Rinde-Hoffman et al, incorrectly lists patient 2 as male. Patient 2 was a 34-year-old woman.