Exercise tests, atrial pacing, and myocardial lactate extraction in relation to coronary arteriography in young patients with angina pectoris

Abstract

An exercise ECG and atrial pacing with a simultaneous study of myocardial lactate metabolism were used in conjunction with coronary arteriographies for the examination of 33 women and 22 men aged 40 or below whose working capacity was impaired by angina pectoris. Most of the patients fell into the age group 36 to 40. The men with coronary changes had come for examination in a shorter time than other patients. Coronary artery narrowings were found in five women and six men. The findings in other tests were pathological with greater frequency in patients with coronary stenosis. When evaluated on the basis of coronary arteriograms, the exercise and lactate tests proved to be reasonably sensitive (66.6 per cent) and specific (56.3 per cent and 68.8 per cent) in men. In women the sensitivity was high (80 per cent), but the specifivicity low (exercise 35 per cent, pacing 14.3 per cent, and lactates 38.5 per cent, respectively). The pacing ECG was also highly unspecific in men (37.5 per cent). Seven patients gave totally normal findings. The examination did not identify any specific group of patients with changes as indicatives of a constitutional disease of the myocardium. The coronary changes indicated that even in this age it is proper to obtain arteriograms in patients with low working capacity even in the absence of any other changes that angina pectoris itself. There are more false-positive findings in women than in men in exercise tests, and in many situations arteriography assures the best basis for further measures.