A COMPARISON OF CARDIAC RATE-PRESSURE PRODUCT AND PRESSURE-RATE QUOTIENT WITH HOLTER MONITORING IN PATIENTS WITH HYPERTENSION AND CARDIOVASCULAR-DISEASE - A FOLLOW-UP REPORT

Objectives. The purpose of this study was to evaluate patients with hy pertension or cardiovascular disease, or both, for myocardial ischemia and cardiac arrhythmias while undergoing minor oral surgery. Study de sign. Sixteen patients were studied with noninvasive monitoring includ ing heart rate, systolic, diastolic, and mean arterial blood pressure to calculate rate-pressure product (systolic blood pressure multiplied by heart rate) and pressure-rate quotient (mean arterial pressure div ided by heart rate). These calculated measures were compared with the incidence of cardiac arrhythmias and ST segment depression recorded on a continuous Holter monitoring system. Results. Nine of 16 (56%) deve loped supraventricular or ventricular ectopy during dental extractions or minor preprosthetic surgery performed with local anesthesia 2% xyl ocaine with 1/100,000 epinephrine dilution. Three of the nine patients who experienced these arrhythmias had coincident abnormal rate pressu re product and pressure-rate quotient values. None of these patients e xhibited ST-T wave changes suggestive of myocardial ischemia. Atrial o r ventricular ectopy suggests that myocardial irritability was more li kely to occur than ischemia as measured by Holler monitoring and compa red with abnormal rate pressure product and pressure-rate quotient val ues recorded.