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THU0207 Asymptomatic and symptomatic myocardial ischemia in patients with rheumatoid arthritis
  1. BV Obradovic-Tomasevic,
  2. L Radunovic,
  3. K Cobeljic,
  4. V Cvorovic,
  5. V Obradovic
  1. Rheumatology-Cardiology, Clinical Hospital Zemun, University Medical School, Belgrade, Belgrade, Yugoslavia


Background Holter electocardiography (Holter-ECG) is a useful uninvasive method with 24-hour-following of patients in hospital and especially out-of-hospital conditions. It was noticed that the ischaemic changes are noted on ECG and they can be without any subjective problems. Since the patients with rheumatoid arthritis have frequent chest pains, 24-hour-Holter ECG can indicate to whether those pains come from the heart.

Objectives The objective of the research was to place Holter ECG for 24 h to the out-patients with rheumatoid arthritis.

The objective was to follow ST-changes on Holter ECG with noting of the daily activities and subjective discomfort during those activities.

It was also important to examine the possible ischemias and the time of their appearance.

Methods 50 patients were examined, 30 females and 20 males, with the average age of 58 ± 3.

All the patients were after the medical check-up placed Holter ECG and given the paper for notes. It was advised that they should do all the activities and note all the difficulties 24 h a day. The analysis of Holter ECG and the notes were done separately by two different doctors.

Results Out of the 50 examined patients,30 patients had 3 risk factors (hypertension, diabetes mellitus and hyperlipidaemia). 20 patients out of 50 examined had the risk factor – smoking. Episodes of symptomatic ischemia were noted in 20 patients and those were in the group which had all the three risk factors. Asymptomatic ischemia was noted in 15 patients and all of them had diabetes. Episodes of asyptomatic and symptomatic ischemia were noted in 15 patients. Asymptomatic and symptomatic ischemia occurred most frequently in the early morning hours, between 6 and 9 am, and 3 and 5 pm.

Conclusion The examination showed that the patients with rheumatoid arthritis had ST segment changes on Holter ECG. Episodes of symptomatic ischemia were more frequent, though special attention was paid to the episodes of asymptomatic ischemia as well, which most often appeared in early morning hours.

Episodes of asymptomatic ischemia were followed by complicated ventricular arrhythmias. Holter ECG is a useful method for following the patient with RA, because in this group the patients with the coronar diseases can be found. This is essential for the choice and dosage of a medicine.


  1. Crawford M, DiMarco J. Cardiology, Mosby 2001, section 2:9.1‑12

  2. Tlustochowicz W, Piotrowicz R, Cwetsch A, et al. 24-h-ECG monitoring in patients with rheumatoid arthritis. Eur Heart J. 1995;16(6):848–51

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