Electrocardiographic Changes during Bathing in Patients with Angina Pectoris by Bathing Holter Electrocardiographic Monitoring

• Published in: Japanese Journal of Cardiovascular Disease Prevention Vol. 38; no. 1; pp. 16 - 25
• Main Author: Igarashi Takeki
• Format: Journal Article
• Language: Japanese
• Published: The Japanese Association for Cerebro-cardiovascular Disease Control 2003; 社団法人 日本循環器管理研究協議会
• Subjects: Bathing Holler Electrocardiogram; Coronary Spasm; Hot Water Bathing; Rest Angina; Silent Myocardial Ischemia; 入浴ホルター心電図; 冠攣縮; 安静狭心症; 無痛性心筋虚血発作; 高温浴
• ISSN: 1346-6267
• DOI: 10.11381/jjcdp2001.38.16

Recently in Japan, cerebro-cardiovascular accidents during bathing have increased in the elderly. By habit most Japanese prefer hot water bathing to lukewarm bathing, and most of them usually bathe without immersion of their head. Bathing Holter Electrocardiographic examinations were performed in 60 patients with angina pectoris.The subjects were divided into 3 groups ; effort angina (n=28), rest angina (n=16) and effort-rest angina (n=16). Water-proof Holter Electrocardiographic recorders (Marquette) were attached to the subjects from three hours before bathing until about a half an hour after bathing.Behavior of bathing was arbitrary, but actions of the patient and water temperature of bath-tub were recorded in detail. Analyses were performed by SERIES 8200/T HOLTER ANALYSIS SYSTEM. Significant ischemic ST-T changes and prominent arrhythmias were considered positive on ECG. Positive ECG changes appeared in 7% of the patients with effort angina (2 out of 28), 38% of rest angina (6 out of 16) and 81% of effort-rest angina (13 out of 16). Positive ECG changes in the patients with rest angina occurred in the hot water during bathing and during the standing position immediately after they exited the bath-tub. To the contrary, all positive patients with effort angina and effort-rest angina, had ischemic changes recorded while in the bath-tub. Main cause of these ischemic changes on ECG in the patients with rest angina during bathing was speculated to be coronary spasm that might occur when the blood pressure abruptly dropped when in the standing position during the course of hot water bathing.In several positive cases of the rest angina, coronary spasms were detected by coronary angiography. The patients with effort angina seemed to get rid of ischemic changes on ECG in the bath-tub in contrast with the patients with effort-rest angina. While the cause of this difference is unclear, patients with effort angina may be able to manage the balance of oxygen demand and supply of the heart while in the bath-tub much more efficiently than the patients with effort-rest angina.An important observation is that none of the positive patients of angina complained of any chest pain during bathing, so they may be classified as having “Silent Myocardial Ischemia”. 人口の高齢化にしたがい入浴時の脳心事故が増加している。それで、狭心症患者 (60名) を対象に入浴ホルター心電図検査を実施した。対象は労作狭心症 (28名) 、安静狭心症 (16名) 、労作安静狭心症 (16名) の3群に分類した。この検査は「温泉浴入浴」、「一般病棟入浴」、「在宅入浴」において行われた。被験者に入浴3時間前から出浴30分後まで防水ホルターレコーダーを装着した。分析はマルケット解析装置により行われ、虚血性ST変化と著明な不整脈出現を陽性とした。対象は全身浴で自由な入浴条件下で行動したが、浴温と入浴行動は記録された。陽性率は、労作狭心症 (2/28 : 7%) <安静狭心症 (6/16 : 38%) <労作安静狭心症 (13/ 16 : 81%) であった。安静狭心症群の陽性者はすべて高温浴傾向下でかつ出浴起立時に出現し、労作狭心症および労作安静狭心症の陽性者は全員浴槽中の入浴時に陽性となった。なお、各群それぞれの典型的症例を呈示した。一般に浴槽内の全身浴で血圧が上昇し、出浴起立時に低下し、高温浴では温浴に比べてその程度が著しいことはすでに明らかにしている。安静狭心症では、この出浴時の起立性の血圧低下が誘因となり冠攣縮を惹起したものと思われる。冠動脈造影を実施しえた安静狭心症の陽性者で、冠動脈の攣縮を確認した。一方労作狭心症群および労作安静狭心症群における浴槽入浴中の虚血性変化の出現は、全身浴での静水圧などの心臓への負荷、高温浴下の酸素消費量の増加などが関与したものと思われる。労作狭心症群と労作安静狭心症群で陽性率に大きな相違があったが、前者で入浴条件の患者自身によるコントロールが容易であったと想像されるが、今後の検討が必要であろう。全群を通じて入浴時の心筋虚血発作は所謂「無症候性心筋虚血発作」の特徴を有した。