Can an ECG Detect Coronary Heart Disease

Whether an electrocardiogram (ECG) can detect coronary heart disease (CHD) depends on the specific circumstances and type of condition present. Coronary heart disease encompasses several different forms, including silent myocardial ischemia, angina pectoris, myocardial infarction, arrhythmias, sudden cardiac death, ischemic cardiomyopathy, and myocardial bridging.

ECG and Different Types of Coronary Heart Disease

In many cases, an ECG can help identify signs of CHD, particularly when a patient is experiencing symptoms such as angina. During episodes of angina, the ECG often reveals changes consistent with myocardial ischemia, such as ST-segment depression or T-wave inversion.

Diagnosing Myocardial Infarction with ECG

For patients experiencing a heart attack, especially ST-segment elevation myocardial infarction (STEMI), the ECG is a crucial diagnostic tool. This type of heart attack typically presents with characteristic ST-segment elevation on the ECG, allowing for rapid identification and prompt treatment.

Arrhythmias and ECG Findings

In cases where CHD presents primarily as arrhythmias, the ECG may show irregular heart rhythms or conduction abnormalities. These findings can help clinicians determine if ischemia is contributing to the arrhythmia.

Limitations of ECG in Detecting CHD

However, not all forms of coronary heart disease produce clear ECG abnormalities. In some patients—particularly those with mild or hidden forms of the disease—such as silent ischemia or three-vessel disease, the ECG may appear normal when the patient is not experiencing symptoms. In these cases, additional diagnostic tools, such as stress testing, echocardiography, or coronary angiography, may be necessary for an accurate diagnosis.

Therefore, while an ECG is a valuable initial screening tool for detecting coronary heart disease, it should be interpreted in the context of clinical symptoms, risk factors, and other diagnostic evaluations to ensure a comprehensive assessment.