Angina Pectoris: Diagnostic Tests

Medical device diagnostics are based on the patient’s history, any symptoms, and the results of laboratory diagnostics

Obligatory diagnostics

  • Resting electrocardiogram (resting ECG with 12 leads) – Indications:

    [Myocardial infarction/heart attack: new pathologic Q-spikes? ST-segment elevation?; complex ventricular arrhythmias?]Wg. transient ST-segment elevation see below “Further notes”.

  • Exercise ECG (electrocardiogram during exercise, that is, under physical activity/exercise ergometry) – Indications: For intermediate pretest probability (VTW; 15-85%) of coronary artery disease (CAD) based on sex, age, and clinical symptoms; before starting a fitness program; do not use the procedure if VTW for the presence of stenosing CAD exceeds 65%Contraindications: patients with WPW syndrome, pacemaker pacing (VVI /DDD), ST-segment depression at rest > 1 mm, or left bundle branch block (due tolimited assessability of ST segments) → perform imaging here[evidence of coronary artery disease (CAD) in exercise ECG:
    • ST-segment:
      • Newly occurring descending or horizontal ST dips (≥ 0.1 mV, 80 msec after the J-point).
      • Ascending ST segment (depression ≥ 0.15 mV, 80 msec after the J point).
    • Clinical symptoms of CHD: angina (chest tightness, heart pain) and/or dyspnea (shortness of breath).

    Duration of the examination: depending on the level of stress up to 15 minutes.

  • Echocardiography (echo; cardiac ultrasound) – indications:
    • Evidence of left ventricular hypertrophy (class IIb).
    • Pathological resting ECG
    • Vitium suspicious heart murmur (heart defect)
    • Indication of heart failure (cardiac insufficiency)

    [CHD: evidence of exercise-inducible, reversible regional wall motion abnormality secondary to myocardial ischemia/poor perfusion of the myocardium]Duration of examination: 20 to 30 minutes.

Optional diagnostics (according to symptomatology or pre-test probability).

See u. Coronary artery disease (CAD) for the following topics:

  • Eligibility criteria for the different noninvasive procedures.
  • CT angiography versus conventional functional testing.
  • Risk assessment criteria of various noninvasive imaging modalities.