Published: 2017-02-09

Evaluation of chest pain by holter monitoring in patients of hypertrophic cardiomyopathy

Narayan Chandra Sarkar, Sidhant Jain, Piyabi Sarkar, Mahendra Tilkar, Nitin Modi


Background: Patients with hypertrophic cardiomyopathy frequently complain of pain chest during daily activities even despite normal resting ECG and normal coronary angiogram. It seems to be related to myocardial ischemia which may lead to progressive left ventricular remodeling and fibrosis. These morphological changes may produce intractable symptoms and life threatening arrhythmia. The aim of the study is to evaluate the chest pain and clinical significance of ST-segment depression during daily normal activities in the patients with hypertrophic Cardiomyopathy as a noninvasive marker of ischemia.

Methods: Continuous 48 hours Holter monitoring was perform in 106 patients aged (40 ±12 years) with hypertrophic Cardiomyopathy. 92 patients’ (86%) Holter recording were suitable for ST-segment analysis.

Results: A total of 97 episodes of ST-segment depression (>1 mm from baseline) were recorded in 26 patients (Male 21, Female 5). In patients < 30 years of age (but not > 30 years) were correlated between ST-segment desperation and history of exertional chest pain (9 of 15 vs 1 of 21, P- 0011) and dyspnea NYHA II/III ( 9 of 14 vs 1 of 22 P-004). There was no correlation between ST-segment depression and risk factors for sudden death, such as family history of sudden death, sustained and non sustained ventricular tachycardia and history of syncope.

Conclusions: In Holter monitoring ST-segment depression is common in younger patients with history of typical pain chest of cardiac origin and dyspnea.


Hypertrophic Cardiomyopathy, Chest pain, Dyspnea, ST-segment, Myocardial ischemia

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