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Cardiology Research and Practice
Volume 2010, Article ID 541781, 7 pages
http://dx.doi.org/10.4061/2010/541781
Clinical Study

ST-Segment Depression in Hyperventilation Indicates a False Positive Exercise Test in Patients with Mitral Valve Prolapse

1Exercise Laboratory, 1st University Department of Cardiology, Athens Medical School, Hippokration Hospital, 15772 Athens, Greece
2Catheterization Laboratory, 1st University Department of Cardiology, Athens Medical School, Hippokration Hospital, 15772 Athens, Greece

Received 26 July 2010; Revised 15 October 2010; Accepted 16 October 2010

Academic Editor: Gavin W. Lambert

Copyright © 2010 Andreas P. Michaelides et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Linked References

  1. M. F. Fontana, “Mitral valve prolapse and floppy mitral valve: physical examination,” in Mitral Valve: Floppy Mitral Valve, Mitral Valve Prolapse, Mitral Valvular Regurgitation, H. Boudoulas and C. F. Wooley, Eds., pp. 283–304, Futura Publishing, Armonk, NY, USA, 2nd edition, 2004. View at Google Scholar
  2. M. J. Malkowski and A. C. Pearson, “The echocardiographic assessment of the floppy mitral valve: an integrated approach,” in Mitral Valve: Floppy Mitral Valve, Mitral Valve Prolapse, Mitral Valvular Regurgitation, H. Boudoulas and C. F. Wooley, Eds., pp. 231–252, Futura Publishing, Armonk, NY, USA, 2nd edition, 2000. View at Google Scholar
  3. E. Hayek, C. N. Gring, and B. P. Griffin, “Mitral valve prolapse,” The Lancet, vol. 365, no. 9458, pp. 507–518, 2005. View at Publisher · View at Google Scholar · View at Scopus
  4. B. Chaitman, “Exercise test indications: diagnostic use of exercise testing,” in Braunwald's Heart Disease: A Textbook of Cardiovascular Medicine, P. Libby, R. O. Bonow, and D. L. Mann, Eds., vol. 1, p. 206, Saunders Elsevier, Philadelphia, Pa, USA, 8th edition, 2008. View at Google Scholar
  5. C. M. Pratt, M. J. Francis, G. W. Divine, and J. B. Young, “Exercise testing in women with chest pain. Are there additional exercise characteristics that predict true positive test results?” Chest, vol. 95, no. 1, pp. 139–144, 1989. View at Google Scholar · View at Scopus
  6. J. K. Perloff, “Evolving concepts of mitral-valve prolapse,” The New England Journal of Medicine, vol. 307, no. 6, pp. 369–370, 1982. View at Google Scholar · View at Scopus
  7. S. Shrivastava, R. B. Guthrie, and J. E. Edwards, “Prolapse of the mitral valve,” Modern Concepts of Cardiovascular Disease, vol. 46, no. 12, pp. 57–61, 1977. View at Google Scholar · View at Scopus
  8. D. O. Nutter, C. Wickliffe, C. A. Gilbert, and S. B. King 3rd, “The pathophysiology of idiopathic mitral valve prolapse,” Circulation, vol. 52, no. 2, pp. 297–305, 1975. View at Google Scholar · View at Scopus
  9. E. G. Abinader and J. Shahar, “Exercise testing in mitral valve prolapse before and after beta blockade,” British Heart Journal, vol. 48, no. 2, pp. 130–133, 1982. View at Google Scholar · View at Scopus
  10. R. B. Devereux, J. K. Perloff, N. Reichek, and M. E. Josephson, “Mitral valve prolapse,” Circulation, vol. 54, no. 1, pp. 3–14, 1976. View at Google Scholar · View at Scopus
  11. P. J. Engel, B. L. Alpert, and J. R. Hickman Jr., “The nature and prevalence of the abnormal exercise electrocardiogram in mitral valve prolapse,” American Heart Journal, vol. 98, no. 6, pp. 716–724, 1979. View at Google Scholar · View at Scopus
  12. C. Tentolouris, P. Petropoulakis, M. Kyriakidis et al., “Normal coronary flow reserve in patients with mitral valve prolapse, a positive exercise test and normal coronary arteries,” European Heart Journal, vol. 16, no. 12, pp. 1960–1967, 1995. View at Google Scholar · View at Scopus
  13. H. J. Levine, “Difficult problems in the diagnosis of chest pain,” American Heart Journal, vol. 100, no. 1, pp. 108–118, 1980. View at Google Scholar · View at Scopus
  14. B. Massie, E. H. Botvinick, D. Shames, M. Taradash, J. Werner, and N. Schiller, “Myocardial perfusion scintigraphy in patients with mitral valve prolapse. Its advantage over stress electrocardiography in diagnosing associated coronary artery disease and its implications for the etiology of chest pain,” Circulation, vol. 57, no. 1, pp. 19–26, 1978. View at Google Scholar
  15. U. Tebbe, H. Schicha, and P. Neumann, “Mitral valve prolapse in the ventriculogram: scintigraphic, electrocardiographic, and hemodynamic abnormalities,” Clinical Cardiology, vol. 8, no. 6, pp. 341–347, 1985. View at Google Scholar · View at Scopus
  16. D. D. Tresch, J. S. Soin, and R. Siegel, “Mitral valve prolapse-evidence for a myocardial perfusion abnormality,” American Journal of Cardiology, vol. 41, p. 441, 1978. View at Google Scholar
  17. E. P. da Silva, M. M. Pedro, M. G. Varela et al., “Heart rate and blood pressure in mitral valve prolapse patients: divergent effects of long-term propranolol therapy and correlations with catecholamines,” Anatolian Journal of Cardiology, vol. 7, supplement 1, pp. 107–109, 2007. View at Google Scholar
  18. H. Boudoulas, J. C. Reynolds, E. Mazzaferri, and C. F. Wooley, “Metabolic studies in mitral valve prolapse syndrome. A neuroendocrine-cardiovascular process,” Circulation, vol. 61, no. 6, pp. 1200–1205, 1980. View at Google Scholar · View at Scopus
  19. A. Pasternac, J. F. Tubau, P. E. Puddu, R. B. Król, and J. de Champlain, “Increased plasma catecholamine levels in patients with symptomatic mitral valve prolapse,” American Journal of Medicine, vol. 73, no. 6, pp. 783–790, 1982. View at Google Scholar · View at Scopus
  20. H. Boudoulas, J. C. Reynolds, E. Mazzaferri, and C. F. Wooley, “Mitral valve prolapse syndrome: the effect of adrenergic stimulation,” Journal of the American College of Cardiology, vol. 2, no. 4, pp. 638–644, 1983. View at Google Scholar · View at Scopus
  21. A. A. Taylor, A. O. Davies, A. Mares et al., “Spectrum of dysautonomia in mitral valvular prolapse,” American Journal of Medicine, vol. 86, no. 3, pp. 267–274, 1989. View at Google Scholar · View at Scopus
  22. G. Micieli, A. Cavallini, G. V. Melzi d'Eril et al., “Haemodynamic and neurohormonal responsiveness to different stress tests in mitral valve prolapse,” Clinical Autonomic Research, vol. 1, no. 4, pp. 323–327, 1991. View at Publisher · View at Google Scholar · View at Scopus
  23. M. H. Ellestad, Stress Testing: Principles and Practice, Oxford University Press, Oxford, UK, 5th edition, 2003.
  24. W. F. Jacobs, W. E. Battle, and J. A. Ronan Jr., “False positive ST T wave changes secondary to hyperventilation and exercise. A cineangiographic correlation,” Annals of Internal Medicine, vol. 81, no. 4, pp. 479–482, 1974. View at Google Scholar · View at Scopus
  25. D. Lary and N. Goldschlager, “Electrocardiographic changes during hyperventilation resembling myocardial ischemia in patients with normal coronary arteriograms,” American Heart Journal, vol. 87, no. 3, pp. 383–390, 1974. View at Google Scholar · View at Scopus
  26. W. C. Lewis, K. L. Siebecker Jr., and R. H. Wasserburger, “The effect of hyperventilation on the normal adult electrocardiogram,” Circulation, vol. 13, no. 6, pp. 850–855, 1956. View at Google Scholar
  27. D. Ardissino, S. De Servi, P. Barberis et al., “Significance of hyperventilation-induced ST segment depression in patients with coronary artery disease,” Journal of the American College of Cardiology, vol. 13, no. 4, pp. 804–810, 1989. View at Google Scholar · View at Scopus
  28. M. J. Malkowski and A. C. Pearson, “The echocardiographic assessment of the floppy mitral valve: an integrated approach,” in Mitral Valve: Floppy Mitral Valve, Mitral Valve Prolapse, Mitral Valvular Regurgitation, H. Boudoulas and C. F. Wooley, Eds., pp. 231–252, Futura Publishing, Armonk, NY, USA, 2nd edition, 2000. View at Google Scholar
  29. H. Boudoulas and C. F. Wooley, Mitral Valve: Floppy Mitral Valve, Mitral Valve Prolapse, Mitral Valvular Regurgitation, Futura Publishing, Armonk, NY, USA, 2nd edition, 2000.
  30. S. Kim, T. Kuroda, M. Nishinaga et al., “Relation between severity of mitral regurgitation and prognosis of mitral valve prolapse: echocardiographic follow-up study,” American Heart Journal, vol. 132, no. 2, pp. 348–355, 1996. View at Publisher · View at Google Scholar
  31. R. J. Gibbons, G. J. Balady, J. T. Bricker et al., “ACC/AHA 2002 guideline update for exercise testing: summary article. A report of the American College of Cardiology/American Heart Association task force on practice guidelines (committee to update the 1997 exercise testing guidelines),” Circulation, vol. 106, no. 14, pp. 1883–1892, 2002. View at Publisher · View at Google Scholar · View at Scopus
  32. A. Adameova, Y. Abdellatif, and N. S. Dhalla, “Role of the excessive amounts of circulating catecholamines and glucocorticoids in stress-induced heart disease,” Canadian Journal of Physiology and Pharmacology, vol. 87, no. 7, pp. 493–514, 2009. View at Publisher · View at Google Scholar · View at Scopus
  33. C. L. Tommaso and J. M. Gardin, “Pseudo-ischemic ST-segment changes induced by hyperventilation,” Primary Cardiology, vol. 9, pp. 111–119, 1983. View at Google Scholar