Understanding Angina Pectoris and ECG Findings

Introduction

Angina pectoris is chest pain or discomfort caused by reduced blood flow to the heart muscle. It typically occurs due to coronary artery disease (CAD), where the arteries supplying blood to the heart become narrowed or blocked by plaque buildup.

Symptoms of Angina

• Chest pain (tightness, squeezing, or burning sensation)
• Radiating pain (to the arms, neck, jaw, or back)
• Shortness of breath
• Fatigue
• Nausea

Types of Angina:

1. Stable Angina: Triggered by exertion and relieved by rest or nitroglycerin.
2. Unstable Angina: Occurs unpredictably, may not be relieved by rest, and can indicate an impending heart attack.
3. Variant (Prinzmetal) Angina: Caused by a temporary spasm of the coronary arteries rather than a blockage.

ECG Changes in Angina

Electrocardiography (ECG) is an essential tool to diagnose and differentiate different forms of angina.

1. Stable Angina ECG Findings:

• Normal ECG at rest (in many cases)
• ST segment depression during an episode of chest pain or during an exercise stress test
• T-wave inversions may be present

2. Unstable Angina ECG Findings:

• May present ST-segment depression or T-wave inversion without elevation
• No significant biomarkers of myocardial infarction (differentiates it from NSTEMI)
• Changes may disappear after the episode resolves

3. Prinzmetal (Variant) Angina ECG Findings:

• ST-segment elevation (temporarily, unlike a heart attack)
• Resolves once the spasm stops
• Can be confirmed with provocative tests (ergonovine or acetylcholine challenge)

Additional Diagnostic Tools

• Stress ECG (Exercise or Pharmacologic Stress Test) helps assess ischemia.
• Coronary Angiography identifies blockages in arteries.
• Cardiac Biomarkers (Troponin, CK-MB) differentiate angina from myocardial infarction.

Treatment Approaches

• Medications: Nitroglycerin, beta-blockers, calcium channel blockers, and antiplatelet drugs.
• Lifestyle Changes: Healthy diet, regular exercise, quitting smoking.
• Invasive Options: Angioplasty with stent placement or bypass surgery for severe cases.

When to Seek Emergency Help

• If chest pain lasts more than 10 minutes
• If pain is new, severe, or does not improve with nitroglycerin
• If there are symptoms of a heart attack (severe pain, sweating, dizziness, fainting)

Understanding ECG patterns in angina is crucial for timely diagnosis and treatment, reducing the risk of heart attacks and ensuring a better outcome.

Source recommendations

1. American College of Cardiology/American Heart Association Guidelines on the Management of Stable Ischemic Heart Disease

1. https://www.ahajournals.org/doi/10.1161/CIR.0000000000001168
2. https://www.acc.org/Guidelines
3. https://www.ahajournals.org/doi/10.1161/cir.0000000000000095
4. https://www.acc.org/Clinical-Topics/Stable-Ischemic-Heart-Disease
5. https://pubmed.ncbi.nlm.nih.gov/25077860/

2. European Society of Cardiology Guidelines on the Diagnosis and Management of Chronic Coronary Syndromes

1. https://www.escardio.org/Guidelines/Clinical-Practice-Guidelines/Chronic-Coronary-Syndromes
2. https://pubmed.ncbi.nlm.nih.gov/31504439/
3. https://academic.oup.com/eurheartj/article/41/3/407/5556137
4. https://www.ahajournals.org/doi/10.1161/CIR.0000000000001168
5. https://academic.oup.com/eurheartj/article/45/36/3415/7743115