Chronic stable angina electrocardiography: Difference between revisions

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(/* ESC Guidelines- Resting ECG for Routine reassessment in patients with chronic stable angina (DO NOT EDIT) {{cite journal| author=Fox K, Garcia MA, Ardissino D, Buszman P, Camici PG, Crea F et al.| title=Guidelines on the management of stable an...)
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{{Chronic stable angina}}
{{Chronic stable angina}}


'''Editor-In-Chief:''' [[C. Michael Gibson, M.S., M.D.]] [mailto:charlesmichaelgibson@gmail.com] Phone:617-632-7753; '''Associate Editor(s)-in-Chief:''' {{CZ}}; Smita Kohli, M.D.; [[Lakshmi Gopalakrishnan|Lakshmi Gopalakrishnan, M.B.B.S.]]
'''Editor-In-Chief:''' [[C. Michael Gibson, M.S., M.D.]] [mailto:charlesmichaelgibson@gmail.com]; '''Associate Editor(s)-in-Chief:''' {{CZ}}; Smita Kohli, M.D.; [[Lakshmi Gopalakrishnan|Lakshmi Gopalakrishnan, M.B.B.S.]]; {{AA}}


==Overview==
==Overview==
A resting 12-lead ECG is performed and recorded in all patients with suspected angina pectoris. However, a normal resting ECG does not exclude the diagnosis of [[ischemia]]. Abnormalites commonly observed on resting ECG include: ST-segment changes, [[left ventricular hypertrophy|left ventricular hypertrophy (LVH)]], [[left branch bundle blockage|left branch bundle blockage (LBBB)]], signs of [[coronary artery disease|coronary artery disease (CAD)]] such as previous [[myocardial infarction|myocardial infarction (MI)]] or abnormal repolarization patterns.<ref name="pmid10728321">Kléber AG (2000) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=10728321 ST-segment elevation in the electrocardiogram: a sign of myocardial ischemia.] ''Cardiovasc Res'' 45 (1):111-8. PMID: [http://pubmed.gov/10728321 10728321]</ref> An ECG recorded during pain helps to identify an underlying [[Coronary vasospasm|vasospasm]].  
A resting 12-lead ECG is performed and recorded in all patients with suspected angina pectoris. However, a normal resting ECG does not exclude the diagnosis of [[ischemia]]. Abnormalites commonly observed on resting ECG include: ST-segment changes, [[left ventricular hypertrophy|left ventricular hypertrophy (LVH)]], left branch bundle blockage ([[LBBB]]), signs of [[coronary artery disease|coronary artery disease (CAD)]] such as previous [[myocardial infarction|myocardial infarction (MI)]] or abnormal repolarization patterns.<ref name="pmid10728321">Kléber AG (2000) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=10728321 ST-segment elevation in the electrocardiogram: a sign of myocardial ischemia.] ''Cardiovasc Res'' 45 (1):111-8. PMID: [http://pubmed.gov/10728321 10728321]</ref> An ECG recorded during pain helps to identify an underlying [[Coronary vasospasm|vasospasm]].


==Indication==
==Electrocardiography==
===Indication===
As a testing modality, electrocardiography (ECG) is critical not only to add support to the clinical suspicion of [[CAD]] but also to provide prognostic information based on the pattern and magnitude of the abnormalities.  
As a testing modality, electrocardiography (ECG) is critical not only to add support to the clinical suspicion of [[CAD]] but also to provide prognostic information based on the pattern and magnitude of the abnormalities.  


==Diagnostic criteria==
===Diagnostic Criteria===
*In approximately half of all patients with chronic stable angina withou a history of previous [[myocardial infarction]], ECG values may be within normal range. In others, a variety of ECG findings may be present and be suggestive of an [[ischemic heart disease]].
*In approximately half of all patients with chronic stable angina without a history of previous [[myocardial infarction]], ECG values may be within normal range. In others, a variety of ECG findings may be present and be suggestive of an [[ischemic heart disease]].


*Q waves may suggest prior [[myocardial infarction]], but in the absence of a clinical history of previous [[myocardial infarction]] or [[CAD]],  
*Q waves may suggest prior [[myocardial infarction]], but in the absence of a clinical history of previous [[myocardial infarction]] or [[CAD]],  
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*ST segment changes in [[angina]] can be seen as downsloping, upsloping or horizontal [[ST segment depression]].
*ST segment changes in [[angina]] can be seen as downsloping, upsloping or horizontal [[ST segment depression]].


==ACC/AHA/ACP–ASIM Guidelines for the Management of Patients With Chronic Stable Angina (Do Not Edit)<ref name="pmid10351980">{{cite journal| author=Gibbons RJ, Chatterjee K, Daley J, Douglas JS, Fihn SD, Gardin JM et al.| title=ACC/AHA/ACP-ASIM guidelines for the management of patients with chronic stable angina: executive summary and recommendations. A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee on Management of Patients with Chronic Stable Angina). | journal=Circulation | year= 1999 | volume= 99 | issue= 21 | pages= 2829-48 | pmid=10351980 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=10351980  }} </ref>==
==ACC/AHA/ACP–ASIM Guidelines for the Management of Patients With Chronic Stable Angina (DO NOT EDIT)<ref name="pmid23166210">{{cite journal| author=Fihn SD, Gardin JM, Abrams J, Berra K, Blankenship JC, Dallas AP et al.| title=2012 ACCF/AHA/ACP/AATS/PCNA/SCAI/STS guideline for the diagnosis and management of patients with stable ischemic heart disease: executive summary: a report of the American College of Cardiology Foundation/American Heart Association task force on practice guidelines, and the American College of Physicians, American Association for Thoracic Surgery, Preventive Cardiovascular Nurses Association, Society for Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons. | journal=Circulation | year= 2012 | volume= 126 | issue= 25 | pages= 3097-137 | pmid=23166210 | doi=10.1161/CIR.0b013e3182776f83 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23166210 }} </ref>==
 
===Noninvasive Testing-ECG (Do Not Edit)<ref name="pmid10351980">{{cite journal| author=Gibbons RJ, Chatterjee K, Daley J, Douglas JS, Fihn SD, Gardin JM et al.| title=ACC/AHA/ACP-ASIM guidelines for the management of patients with chronic stable angina: executive summary and recommendations. A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee on Management of Patients with Chronic Stable Angina). | journal=Circulation | year= 1999 | volume= 99 | issue= 21 | pages= 2829-48 | pmid=10351980 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=10351980 }} </ref>===


===Noninvasive Testing-ECG (DO NOT EDIT)<ref name="pmid23166210">{{cite journal| author=Fihn SD, Gardin JM, Abrams J, Berra K, Blankenship JC, Dallas AP et al.| title=2012 ACCF/AHA/ACP/AATS/PCNA/SCAI/STS guideline for the diagnosis and management of patients with stable ischemic heart disease: executive summary: a report of the American College of Cardiology Foundation/American Heart Association task force on practice guidelines, and the American College of Physicians, American Association for Thoracic Surgery, Preventive Cardiovascular Nurses Association, Society for Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons. | journal=Circulation | year= 2012 | volume= 126 | issue= 25 | pages= 3097-137 | pmid=23166210 | doi=10.1161/CIR.0b013e3182776f83 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23166210  }} </ref>===
'''Resting electrocardiography to assess risk'''
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| bgcolor="LightGreen"|<nowiki>"</nowiki>'''1.''' Rest [[ECG]] in patients without an obvious noncardiac cause of [[chest pain]]. ''([[ACC AHA Guidelines Classification Scheme#Level of Evidence|Level of Evidence: B]])''<nowiki>"</nowiki>
| bgcolor="LightGreen"|<nowiki>"</nowiki>'''1.''' A resting ECG is recommended in patients without an obvious, noncardiac cause of chest pain. ''([[ACC AHA Guidelines Classification Scheme#Level of Evidence|Level of Evidence: B]])''<nowiki>"</nowiki>
|-
| bgcolor="LightGreen"|<nowiki>"</nowiki>'''2.''' Rest [[ECG]] during an episode of [[chest pain]]. ''([[ACC AHA Guidelines Classification Scheme#Level of Evidence|Level of Evidence: B]])''<nowiki>"</nowiki>
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==ESC Guidelines- Resting ECG for Initial diagnostic assessment of angina (DO NOT EDIT)<ref name="pmid16735367">{{cite journal| author=Fox K, Garcia MA, Ardissino D, Buszman P, Camici PG, Crea F et al.| title=Guidelines on the management of stable angina pectoris: executive summary: The Task Force on the Management of Stable Angina Pectoris of the European Society of Cardiology. | journal=Eur Heart J | year= 2006 | volume= 27 | issue= 11 | pages= 1341-81 | pmid=16735367 | doi=10.1093/eurheartj/ehl001 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16735367  }} </ref>==
==ESC Guidelines- Resting ECG for Initial Diagnostic Assessment of Angina (DO NOT EDIT)<ref name="pmid16735367">{{cite journal| author=Fox K, Garcia MA, Ardissino D, Buszman P, Camici PG, Crea F et al.| title=Guidelines on the management of stable angina pectoris: executive summary: The Task Force on the Management of Stable Angina Pectoris of the European Society of Cardiology. | journal=Eur Heart J | year= 2006 | volume= 27 | issue= 11 | pages= 1341-81 | pmid=16735367 | doi=10.1093/eurheartj/ehl001 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16735367  }} </ref>==


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==ESC Guidelines- Resting ECG for Routine reassessment in patients with chronic stable angina (DO NOT EDIT)<ref name="pmid16735367">{{cite journal| author=Fox K, Garcia MA, Ardissino D, Buszman P, Camici PG, Crea F et al.| title=Guidelines on the management of stable angina pectoris: executive summary: The Task Force on the Management of Stable Angina Pectoris of the European Society of Cardiology. | journal=Eur Heart J | year= 2006 | volume= 27 | issue= 11 | pages= 1341-81 | pmid=16735367 | doi=10.1093/eurheartj/ehl001 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16735367  }} </ref>==
==ESC Guidelines- Resting ECG for Routine Reassessment in Patients with Chronic Stable Angina (DO NOT EDIT)<ref name="pmid16735367">{{cite journal| author=Fox K, Garcia MA, Ardissino D, Buszman P, Camici PG, Crea F et al.| title=Guidelines on the management of stable angina pectoris: executive summary: The Task Force on the Management of Stable Angina Pectoris of the European Society of Cardiology. | journal=Eur Heart J | year= 2006 | volume= 27 | issue= 11 | pages= 1341-81 | pmid=16735367 | doi=10.1093/eurheartj/ehl001 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16735367  }} </ref>==


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Latest revision as of 20:07, 28 October 2016

Chronic stable angina Microchapters

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Chronic Stable Angina
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Differentiating Chronic Stable Angina from Acute Coronary Syndromes

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Cafer Zorkun, M.D., Ph.D. [2]; Smita Kohli, M.D.; Lakshmi Gopalakrishnan, M.B.B.S.; Aysha Anwar, M.B.B.S[3]

Overview

A resting 12-lead ECG is performed and recorded in all patients with suspected angina pectoris. However, a normal resting ECG does not exclude the diagnosis of ischemia. Abnormalites commonly observed on resting ECG include: ST-segment changes, left ventricular hypertrophy (LVH), left branch bundle blockage (LBBB), signs of coronary artery disease (CAD) such as previous myocardial infarction (MI) or abnormal repolarization patterns.[1] An ECG recorded during pain helps to identify an underlying vasospasm.

Electrocardiography

Indication

As a testing modality, electrocardiography (ECG) is critical not only to add support to the clinical suspicion of CAD but also to provide prognostic information based on the pattern and magnitude of the abnormalities.

Diagnostic Criteria

  • In approximately half of all patients with chronic stable angina without a history of previous myocardial infarction, ECG values may be within normal range. In others, a variety of ECG findings may be present and be suggestive of an ischemic heart disease.
  • A physician should consider these abnormal ECG findings as indications for further evaluation.
  • Giant T-wave inversion in precordial leads can be an important indicator of severe Left Anterior Descending (LAD) artery stenosis.

ACC/AHA/ACP–ASIM Guidelines for the Management of Patients With Chronic Stable Angina (DO NOT EDIT)[2]

Noninvasive Testing-ECG (DO NOT EDIT)[2]

Resting electrocardiography to assess risk

Class I
"1. A resting ECG is recommended in patients without an obvious, noncardiac cause of chest pain. (Level of Evidence: B)"

ESC Guidelines- Resting ECG for Initial Diagnostic Assessment of Angina (DO NOT EDIT)[3]

Class I
"1. Resting ECG while pain free. (Level of Evidence: C)"
"1. Resting ECG during episode of angina. (Level of Evidence: B)"

ESC Guidelines- Resting ECG for Routine Reassessment in Patients with Chronic Stable Angina (DO NOT EDIT)[3]

Class IIb
"1. Routine periodic ECG in the absence of clinical change. (Level of Evidence: C)"

References

  1. Kléber AG (2000) ST-segment elevation in the electrocardiogram: a sign of myocardial ischemia. Cardiovasc Res 45 (1):111-8. PMID: 10728321
  2. 2.0 2.1 Fihn SD, Gardin JM, Abrams J, Berra K, Blankenship JC, Dallas AP; et al. (2012). "2012 ACCF/AHA/ACP/AATS/PCNA/SCAI/STS guideline for the diagnosis and management of patients with stable ischemic heart disease: executive summary: a report of the American College of Cardiology Foundation/American Heart Association task force on practice guidelines, and the American College of Physicians, American Association for Thoracic Surgery, Preventive Cardiovascular Nurses Association, Society for Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons". Circulation. 126 (25): 3097–137. doi:10.1161/CIR.0b013e3182776f83. PMID 23166210.
  3. 3.0 3.1 Fox K, Garcia MA, Ardissino D, Buszman P, Camici PG, Crea F; et al. (2006). "Guidelines on the management of stable angina pectoris: executive summary: The Task Force on the Management of Stable Angina Pectoris of the European Society of Cardiology". Eur Heart J. 27 (11): 1341–81. doi:10.1093/eurheartj/ehl001. PMID 16735367.


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