Nocturnal Angina Pectoris

Abstract

To the Editor:— A major precipitating factor in nocturnal angina pectoris has not been stressed. I am impressed that angina occurring during sleep is the result of the tremendous physiologic response to dreams. Several authors have noted increases and irregularity of heart rate, respiration, and arterial pressure occurring in nearly all instances of D-sleep (sleep associated with dreaming). 1,2 Shifts in the blood pressure might be dangerous to a cardiac patient, and as early as 1921, it had been suggested that sudden death during sleep of patients with heart disease was probably caused by blood pressure changes associated with dreaming. 3 I have recently had occasion to see a 68-year-old woman with a two-month history of nocturnal angina. The patient had already been receiving long-acting nitrates, she eats lightly, and has no upper- gastrointestinal tract problems. The patient awakens with chest pain, walks around the room, and has dreamed of