Abstract
To elucidate various cardiac complaints in the nighttime, ECGs were taken through the night on hospitalized patients, and the relations between complaints and abnormal ECG findings were analyzed. Of 146 patients whose all-night ECGs were recorded. 66 cases were selected for detailed analyses. These were 37 patients with clinical diagnosis of angina pectoris and 29 patients who had neurocirculatory complaints in the night such as chest discomfort, palpitation, breathlessness, sensation of uneasiness, etc.Using Frank's lead system, ECG was continuously recorded in the magnetic tape through the night and reproduced later by use of an oscilloscope and amingograph recorder. In some cases, all-night polygrahic recordings including electroencephalogram, electrooculogram and electrocardiogram were also performed, and the relationship between an ischemic attack and the sleep stage was studied.In the total of 17 cases in which ischemic attacks in the night were recorded, attacks occurred in the following 2 types ; a repetitive type and a sporadic type. In repetitive type, more than 3 episodes occur in succession or 2 episodes occur in more than 2 trains, with the onset of the train often associated with the REM period. Attacks of sporadic type were much less associated with the sleep pattern. Out of 9 cases with varioant angina, 6 cases belonged to repetitive type, while all of the 8 cases with ST depression pattern were of sporadic type.A comparison made between the number of chest pain and the number of ischemic changes in individual patients, disclosed that the patients who showed a few ischemic changes in ECG became aware of most of their attacks, while the patients who had many ischemic changes complained only part of their attack.One such extreme case, whose ECGs were recorded for 3 successive nights, and who showed a marked repetition of ischemic attacks of variable degrees at various intervals throughout recording, complained only 7 attacks during the same periods.In one case with neurocirculatory asthenia, T wave changes occurred frequently, but not with regular repetition or in close relation to REM sleep. Nineteen out of 29 patients with neurocirculatory distress in the night, showed transient abnormal ECG findings which would explain their complaints. Four such cases are presented.
