Diagnostic Procedures For Angina Pectoris

Ammar Sarwar
(Pharm-D)

Diagnostics Tests For Angina Pectoris

1- Signs & Symptoms 2-Chest X-Rays 3- Electrocardiography (ECG) 4- Holter 5- Exercise Tolerance Test (ETT) 6- Thalium Test ( TI-201 Scintigraphy ) 7- Echocardiography (Echo) 8- Angiography 9- Blood Tests

1- Signs & Symptoms

Typical: Crushing", "tight", "gripping" type chest pain Pain radiating down left arm, to jaw, neck or shoulder (Referred Pain). Atypical: Sweating, Breathlessness, Apprehension, Anxiety. Sometimes "autonomic symptoms" such as nausea, vomiting and pallor.

2-Chest X-Rays
A chest x-ray may be performed to rule out lung disease or other chest abnormalities that may be causing pain. In addition, a chest x-ray will reveal enlargement of the heart, which may be associated with heart muscle damage due to heart attack.

3- Electrocardiography (ECG)
Electrocardiography (EKG, ECG) measures the electrical activity of the heart. Normal ECG:

Waves & Intervals Of Normal ECG

P Wave: Depolarization Of Atria PR Interval: reflects the time the electrical impulse takes to travel from the sinus node through the AV node and entering the ventricles. QRS Complex: The QRS complex reflects the rapid depolarization of the right and left ventricles.

Waves & Intervals Of Normal ECG

The ST Interval: represents the period when the ventricles are depolarized. T wave: The T wave represents the repolarization (or recovery) of the ventricles. The interval from the beginning of the QRS complex to the apex of the T wave is referred to as the absolute refractory period. QT Interval: A prolonged QT interval is a risk factor for ventricular tachyarrhythmias and sudden death. It varies with heart rate.

ECG in Angina Pectoris

It can reveal previous damage of the heart muscle, such as a mild heart attack that a person may have had without even knowing it. Unfortunately, the EKG does not reliably detect narrowing of the coronary arteries. The EKG often is normal in people with angina when they are at rest, although it usually changes during an anginal attack.

4- Exercise Tolerance Test,

During this procedure, the individual is asked to ride a stationary bicycle or walk on a treadmill while a physician takes an electrocardiogram.

Thalium Test
In addition to ECG during ETT, the person may receive an injection of a radioisotope (a radioactive material) such as thallium, which makes the heart and its vessels visible to a special, computer-linked camera.

ETT

Abnormal ECG in Angina Pectoris

Abnormal ECG in Angina Pectoris

Diagnostic Value of ETT

The common approach for ETT by ACC and AHA indicates the following: Treadmill test: sensitivity 67%, specificity 70% Thalium test: sensitivity 81%, specificity 85-95% (Sensitivity is the percentage of sick people who are correctly identified as having the condition. Specificity indicates the percentage of healthy people who are correctly identified as not having the condition.)

5- Echocardiography
ECHO, is a sonogram of the heart, Also known as a cardiac ultrasound. 2D Imaging of the Heart. The latest ultrasound systems now employ 3D imaging. Doppler ultrasound:is an Echocardiogram which produce accurate assessment of the velocity of blood and cardiac tissue at any arbitrary point using pulsed or continuous wave.

Types of Echocardiography
1- Transthoracic echocardiogram: In this case, the echocardiography transducer (or probe) is placed on the chest wall (or thorax) of the subject, and images are taken through the chest wall. This is a non-invasive, highly accurate and quick assessment of the overall health of the heart.

Types of Echocardiography
2- Transesophageal echocardiogram A specialized probe containing an ultrasound transducer at its tip is passed into the patient's esophagus. This allows image and Doppler evaluation which can be recorded.

3D echocardiogram of a heart viewed from the apex

6- Angiography
Can pinpoint narrowing, obstruction, and other abnormalities of the coronary arteries. Takes about 30 minutes to perform, and it is quite safe. Performed under Local Anaesthesia. Most individuals are given antianxiety medication.

Procedure of Angiography
A catheter (fine tube) is inserted into an artery in the forearm or groin, and it is snaked through the blood vessels until it reaches the coronary arteries. Then, dye is pumped through the catheter, so that the heart itself and the coronary arteries are visible on a special video screen.

Ergonovine test
Also Known as a "provocation test" The procedure is conducted during coronary angiography. The artery-narrowing drug ergonovine (or, alternatively, acetylcholine) is injected to provoke coronary artery spasm. If the individual experiences severe arterial spasm, probably has variant angina.

7- Other Tests
Holter Blood Test: Lipid Profile ESR CRP