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Ambulatory Electrocardiographic Monitoring: The Test for Ischemia in 1988?

Robert L. Feldman, MD
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Requests for Reprints: Robert L Feldman, MD, Cardiac Catheterization Laboratory, The Heart Center, Munroe Regional Medical Center, Ocala, FL 32671.

Munroe Regional Medical Center, Ocala, Florida

Ann Intern Med. 1988;109(8):608-610. doi:10.7326/0003-4819-109-8-608
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This excerpt has been provided in the absence of an abstract.

Myocardial ischemia is the functional impairment that results from an imbalance of myocardial oxygen supply and demand. From a pathophysiologic perspective, during an ischemic episode first myocardial perfusion and metabolic imbalances occur, next myocardial relaxation and then contraction abnormalities, followed by electrocardiographic (ECG) changes and sometimes angina. Many ischemic episodes do not result in symptoms, and focusing on symptoms alone may reflect only a small percentage of all ischemic episodes. Several studies (1-3) have shown that approximately 80% of episodes of myocardial ischemia, occurring in a wide range of patient populations with ischemic heart disease, are not accompanied by any


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