EKG

Chronic Stable Angina Pectoris

• The resting ECG is often normal in patients with angina.

• Abnormalities include old myocardial infarction, nonspecific ST–T changes, and
changes of LVH.
• During anginal episodes, as well as during asymptomatic ischemia, the
characteristic ECG change is horizontal or downsloping ST-segment depression that
reverses after the ischemia disappears .T wave flattening or inversion may also
occur. Less frequently, transient ST-segment elevation is observed; this finding
suggests severe (transmural) ischemia and often occurs with coronary spasm.
A: Tracing taken during an episode of anginal pain that occurred while the
patient was at bed rest in the hospital. There is marked ST elevation in leads V 2-5
with ST depression in aVF.
B: Tracing taken 30 minutes after A when the patient was pain-free and asymptomatic. The
ST segments are isoelectric, and the ECG is normal. Subsequent evaluation, including serial
ECGs and enzyme determinations, revealed no evidence of acute myocardial infarction.
Although tracing A is quite typical of early infarction, the rapid disappearance of the ST
elevation and the absence of clinical and ECG evidence of infarction on subsequent
examinations indicate that tracing A represents severe acute but reversible ischemia.
Abnormal exercise ECG in a patient with severe three-vessel coronary artery disease and
chest pain. The resting ECG shows horizontal ST depression in leads II, aVF, and V 3, and
downsloping ST depression in lead V1. After exercise, downsloping ST depression is present
in leads II, aVF, and V2-5. The additional 1 or more mm of J point depression as well as the
changes in ST-segment configuration constitute an ischemic response, despite the baseline
ECG abnormalities.