Lopera Gustavo, Castellanos Agustin, Moleiro Federico, Huikuri Heikki V, Myerburg Robert J
University of Miami School of Medicine, Division of Cardiology, Miami, Florida 33101, USA.
Ann Noninvasive Electrocardiol. 2003 Apr;8(2):139-43. doi: 10.1046/j.1542-474x.2003.08208.x.
The vast majority of reports of inappropriate sinus tachycardia (IST) had included predominantly young females with ages ranging between 15 and 46 years. In contrast, the present study presents the findings in four elderly females (aged 61-71 years) with long-standing symptoms of palpitations, more than 15 years, in whom IST was diagnosed in their 6th or 7th decade.
Clinical and laboratory examinations including electrocardiograms, echocardiograms, and heart rate variability studies were retrospectively reviewed in four of the nine elderly female patients with long-standing cardiac symptoms. Indices of heart rate variability were compared to four age-matched asymptomatic elderly females with no structural heart disease.
The resting electrocardiograms were normal but one had voltage criteria for left ventricular hypertrophy. All traditional time- and frequency-domain indices were significantly decreased in the symptomatic elderly females as compared to the controls. Echocardiograms showed normal ejection fraction, and in three patients evidence of diastolic dysfunction and mild left ventricular hypertrophy. Blood pressures were elevated, with systolic blood pressure ranging from 170 to 190 and diastolic blood pressure ranging from 94 to 106. Anxiety disorders were diagnosed in all patients.
This study demonstrates that IST can be present in a wide spectrum of patient populations, including elderly populations. It seems that some cases of IST can become chronic if not treated adequately. Apparently, earlier identification and treatment could have improved the quality of life of the patients. Traditional HRV indices may not be valuable to support either a sympathetic or parasympathetic mechanism. Therefore, further studies should consider the potential usefulness of the nonlinear method such as, for example, approximate entropy and detrended fluctuation analysis.
绝大多数关于不适当窦性心动过速（IST）的报告主要涉及年龄在15至46岁之间的年轻女性。相比之下，本研究呈现了4例老年女性（年龄61 - 71岁）的研究结果，她们有超过15年的心悸长期症状，在60多岁或70多岁时被诊断为IST。
回顾性分析9例有长期心脏症状的老年女性患者中的4例的临床和实验室检查结果，包括心电图、超声心动图和心率变异性研究。将心率变异性指标与4例年龄匹配、无结构性心脏病的无症状老年女性进行比较。
静息心电图正常，但有1例符合左心室肥厚的电压标准。与对照组相比，有症状的老年女性所有传统时域和频域指标均显著降低。超声心动图显示射血分数正常，3例患者有舒张功能障碍和轻度左心室肥厚的证据。血压升高，收缩压范围为170至190，舒张压范围为94至106。所有患者均被诊断为焦虑症。
本研究表明，IST可存在于广泛的患者群体中，包括老年人群。似乎有些IST病例若未得到充分治疗可能会变成慢性。显然，早期识别和治疗本可改善患者的生活质量。传统的心率变异性指标可能对支持交感或副交感神经机制无价值。因此，进一步的研究应考虑非线性方法如近似熵和去趋势波动分析的潜在有用性。
