Understanding Angina Pectoris and Its ECG Features

Introduction

Angina pectoris is a condition characterized by chest pain due to reduced blood flow to the heart muscle, commonly caused by coronary artery disease (CAD). Recognizing angina on an electrocardiogram (ECG) is crucial for diagnosis and timely treatment.

Types of Angina

  1. Stable Angina – Occurs during exertion or emotional stress and is relieved by rest or nitroglycerin.
  2. Unstable Angina – More severe, occurs unpredictably, and may indicate an impending heart attack.
  3. Variant (Prinzmetal’s) Angina – Caused by coronary artery spasm and often occurs at rest.

ECG Findings in Angina Pectoris

  • ST-Segment Depression: Indicates subendocardial ischemia, common in stable angina.
  • T-Wave Inversions: May suggest ongoing ischemia.
  • ST-Segment Elevation (Transient): Seen in variant angina due to coronary artery spasm.
  • Normal ECG: Some patients with angina may have a normal ECG, but stress testing can reveal ischemic changes.

Why ECG is Important

  • Helps differentiate between stable and unstable angina.
  • Crucial for detecting acute coronary syndromes.
  • Important for monitoring patients with known coronary artery disease.

What to Do Next?

If you experience chest pain, especially with exertion, seek medical attention. A doctor may order an ECG, blood tests, or a stress test to evaluate your heart condition.

Summary

  • Angina results from reduced heart blood flow.
  • ECG findings include ST-segment depression, T-wave inversions, and transient ST-segment elevation.
  • A normal ECG does not rule out angina, so further testing may be required.
  • Immediate medical evaluation is essential if you experience symptoms.

Source recommendations

1. American Heart Association Guidelines for the Management of Stable Ischemic Heart Disease

  1. https://www.ahajournals.org/doi/10.1161/CIR.0000000000001168
  2. https://professional.heart.org/en/science-news/2023-guideline-for-the-management-of-patients-with-chronic-coronary-disease
  3. https://www.ahajournals.org/doi/10.1161/cir.0000000000000095
  4. https://pubmed.ncbi.nlm.nih.gov/25077860/
  5. https://www.heart.org/en/health-topics/heart-attack/about-heart-attacks/silent-ischemia-and-ischemic-heart-disease

2. European Society of Cardiology Guidelines on Chronic Coronary Syndromes

  1. https://www.escardio.org/Guidelines/Clinical-Practice-Guidelines/Chronic-Coronary-Syndromes
  2. https://academic.oup.com/eurheartj/article/45/36/3415/7743115
  3. https://pubmed.ncbi.nlm.nih.gov/31504439/
  4. https://academic.oup.com/eurheartj/article/41/3/407/5556137
  5. https://pubmed.ncbi.nlm.nih.gov/39210710/

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