Angina Symptoms and Normal ECG Readings: What You Need to Know

Angina, a common symptom of coronary artery disease, often presents with specific changes on an electrocardiogram (ECG). These changes typically reflect myocardial ischemia and may include transient horizontal or downsloping ST-segment depression of more than 0.1 mV. In some cases, patients may also experience alterations in the T wave, such as biphasic or inverted T waves. Additionally, certain individuals may display ECG patterns consistent with prior myocardial infarction, including pathological Q waves or QS waves.

Why Some Patients Show Normal ECG Results During Angina

Interestingly, not all patients experiencing angina will show abnormal results on an ECG. In some instances, the ECG may appear normal, especially if the test is performed after the angina episode has resolved. This can occur because the ischemic changes that cause ECG abnormalities may be temporary and only present during chest pain episodes.

Understanding Pseudonormalization of T Waves

What Is T Wave Pseudonormalization?

Another important phenomenon to consider is T wave pseudonormalization. In patients who normally have abnormal T waves due to underlying heart disease, an angina episode may paradoxically cause the T waves to appear normal on an ECG. This misleading "normalization" can complicate diagnosis and delay appropriate treatment.

Importance of Comparing Previous ECGs

To accurately interpret these findings, it is crucial to compare the current ECG with previous recordings. This comparison helps clinicians identify subtle changes that might otherwise be overlooked, especially in cases where the ECG appears normal despite ongoing angina symptoms. Early recognition of these patterns is essential for timely and effective management of coronary artery disease.