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  • Title: Effort angina pectoris without electrocardiographic changes in coronary disease patients: correlations between scintigraphic and coronary angiographic findings.
    Author: Di Pasquale G, Pinelli G, Tartagni F, Manini GL, Dondi M.
    Journal: Int J Cardiol; 1986 Aug; 12(2):243-53. PubMed ID: 3744603.
    Abstract:
    The absence of electrocardiographic changes during angina is an unusual occurrence. In 15 male patients with exercise-induced angina, the electrocardiogram failed to show the usual ischemic ST-T changes. The exercise thallium-201 myocardial imaging was employed as indicator of the ischemia and the results were correlated with coronary angiographic findings. The exercise thallium-201 myocardial imaging showed an exercise-induced reversible defect in 14 patients and a fixed defect in the remaining 1. Out of 15 patients, 13 had defects involving the infero-apical, posterior and postero-lateral segments. The coronary angiography, performed in all patients but 2, showed single-vessel coronary artery disease in 8 patients and double-vessel disease in 5. A significant circumflex or right coronary artery stenosis was found in all cases except 1; 2 patients had a coexistent left anterior descending coronary artery stenosis and 1 an isolated stenosis of this vessel. It is concluded that the myocardial scintigraphy is useful to assess the ischemic myocardial origin of chest pain in the absence of ST-T changes. The silence of the electrocardiogram might be due to the production of ischemia in not well explored areas, such as the inferior and posterior myocardial segments, and possibly to a smaller extension of ischemia.
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