The ECG of patients with stable angina may occur only ventricular conduction disturbances (5-10%, based on some studies), increased left ventricular (5-25%) and P wave abnormalities (especially in coronary patients with changes in contractile function).
On the other hand, the ECG in patients with stable angina may remain unchanged for a long time or it may be subject to change without any connection with the development pattern of the disease in this patient.
In contrast, a small number of patients with significant ECG changes may be absent. Arrhythmia, usually ventricular extrasystoles often appear or are enhanced, but in patients with stable angina are more common primary ventricular fibrillation during the attacks and AV block than in patients with angina pectoris. Arrhythmias in all types of anginal attacks may be the result of ischemia associated with reperfusion. The latter is often observed in the remission phase of the attack, when the ST segment is reduced, which is observed in patients with primary angina in patients undergoing thrombolysis.
In 1959, Prinzmetal described a picture of atypical angina pectoris, which he called an inverted (or variant) angina (angina in the primary result of spasm described above). The main features of such a angina are:
On the other hand, the ECG in patients with stable angina may remain unchanged for a long time or it may be subject to change without any connection with the development pattern of the disease in this patient.
In contrast, a small number of patients with significant ECG changes may be absent. Arrhythmia, usually ventricular extrasystoles often appear or are enhanced, but in patients with stable angina are more common primary ventricular fibrillation during the attacks and AV block than in patients with angina pectoris. Arrhythmias in all types of anginal attacks may be the result of ischemia associated with reperfusion. The latter is often observed in the remission phase of the attack, when the ST segment is reduced, which is observed in patients with primary angina in patients undergoing thrombolysis.
In 1959, Prinzmetal described a picture of atypical angina pectoris, which he called an inverted (or variant) angina (angina in the primary result of spasm described above). The main features of such a angina are:
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| ECG during an attack of coronary artery disease. ECG phenomenon of Prinzmetal |
a) pain in prekardialnoy of prevailing in a state of rest, and sometimes occur at the same time every day;
b) The pain is often accompanied by a pronounced rise of the segment 57, and sometimes, when an intense ischemic ST segment changes and / or TQ. ST-segment elevation disappears within a few minutes or even seconds after the cessation of the attack (ECG phenomenon of Prinzmetal);
c) during the attack indicated a high incidence of serious ventricular arrhythmias and, rarely, significant AV block;
d) ergometric test is usually normal;
e) the ischemia that occurs as a result of coronary spasm. Only rarely observed transient abnormal Q waves in Prinzmetal angina. The diagnosis of variant angina, confirmed the existence of pain attacks in the resting state, accompanied by transient ST-segment elevation on ECG. Currently, many researchers prefer to use the term "ECG phenomenon of Prinzmetal '(transient-segment elevation ST) t instead of Prinzmetal angina.
In practice, at one and the same patient may occur this ECG phenomenon (segment elevation ST) suitable cases and segment depression ST - in other ac expression of various degrees of ischemia. On the other hand, some attacks in the resting state there is a steady rise in the ST segment is not necessarily as a result of spasm. In some patients with stable angina, the primary, usually with a spasm of distal vessels, which do not segment elevation ST, and noted his depression, there are minimal changes in T wave or negative T wave psevdonormalizatsiya However, it was confirmed that some minor changes of the T wave are the only ECG changes in patients with spasm of the anterior descending coronary artery.
Echocardiographic studies have shown that mechanical changes precede ECG signs of myocardial ischemia and allow us to understand the original, sometimes minimal, electrical changes, which may be the only pas all subsequent ECG.
b) The pain is often accompanied by a pronounced rise of the segment 57, and sometimes, when an intense ischemic ST segment changes and / or TQ. ST-segment elevation disappears within a few minutes or even seconds after the cessation of the attack (ECG phenomenon of Prinzmetal);
c) during the attack indicated a high incidence of serious ventricular arrhythmias and, rarely, significant AV block;
d) ergometric test is usually normal;
e) the ischemia that occurs as a result of coronary spasm. Only rarely observed transient abnormal Q waves in Prinzmetal angina. The diagnosis of variant angina, confirmed the existence of pain attacks in the resting state, accompanied by transient ST-segment elevation on ECG. Currently, many researchers prefer to use the term "ECG phenomenon of Prinzmetal '(transient-segment elevation ST) t instead of Prinzmetal angina.
In practice, at one and the same patient may occur this ECG phenomenon (segment elevation ST) suitable cases and segment depression ST - in other ac expression of various degrees of ischemia. On the other hand, some attacks in the resting state there is a steady rise in the ST segment is not necessarily as a result of spasm. In some patients with stable angina, the primary, usually with a spasm of distal vessels, which do not segment elevation ST, and noted his depression, there are minimal changes in T wave or negative T wave psevdonormalizatsiya However, it was confirmed that some minor changes of the T wave are the only ECG changes in patients with spasm of the anterior descending coronary artery.
Echocardiographic studies have shown that mechanical changes precede ECG signs of myocardial ischemia and allow us to understand the original, sometimes minimal, electrical changes, which may be the only pas all subsequent ECG.
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