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[Angina with long-standing coronary T waves]
N Hamashige1, Y Doi, H Odawara
1Department of Medicine and Geriatrics, Kochi Medical School, Nankoku.
Insights
Long-standing coronary T waves, especially alone, indicate significant coronary artery stenosis and unstable angina. Cardiac events occurred only when patients stopped medication, irrespective of stenosis severity.
Area of Science:
- Cardiology
- Clinical Electrocardiography
- Ischemic Heart Disease
Background:
- This study evaluates the clinical significance of persistent coronary T waves (≥24 hours) without abnormal Q waves in patients experiencing angina.
- The research categorizes patients into two groups: Group A (ST elevation followed by coronary T waves) and Group B (coronary T waves alone).
Observation:
- Patients presented with rest angina, often indicative of unstable angina, and a history of effort angina was common.
- Elevated serum creatine phosphokinase (CPK) levels were observed in a significant percentage of both groups, with no correlation to T wave changes.
- Coronary angiography revealed a higher incidence of severe coronary artery stenosis (>50%) in Group B compared to Group A.
Findings:
- Group B, characterized by coronary T waves alone, showed a greater prevalence of significant coronary artery stenosis (77%) than Group A (27%).
- Angioplasty was more frequently performed in Group B (38%) than in Group A (9%).
- During a 27-month follow-up, cardiac events (unstable angina, sudden death) occurred only in patients who discontinued their medications, regardless of stenosis severity.
Implications:
- Coronary T waves alone may be a stronger indicator of severe coronary artery disease than when preceded by ST elevation.
- Medication adherence is critical for preventing adverse cardiac events in patients with these electrocardiographic findings.
- Further research may refine risk stratification and management strategies for patients with persistent coronary T waves.
Abstract:
The clinical significance of long-standing (greater than or equal to 24 hours) coronary T waves without abnormal Q waves was evaluated in 24 patients with angina. They were categorized in two groups; 11 with ST elevation followed by coronary T waves (Group A), and 13 with coronary T waves alone (Group B). 1. The patients had long-standing or repetitive episodes of rest angina, with clinical features of unstable angina in all but one. Fifty-five % of patients in Group A and 85% in Group B had histories of effort angina. 2. Significant (greater than or equal to twice the upper normal) elevation of serum CPK value was observed in 36% of patients in Group A and in 46% in Group B. There was no correlation between the maximum CPK value and the number of leads with the coronary T wave. 3. Coronary angiography demonstrated significant (greater than 50%) coronary artery stenosis in 27% of patients in Group A and in 77% in Group B. The incidence of severe stenosis was greater in Group B than in Group A. Angioplasty was performed in 9% of patients in Group A and in 38% in Group B. 4. During the average follow-up period of 27 months, there was one cardiac event (unstable angina) in Group A, two events (one sudden death and one unstable angina) in Group B. Each cardiac event occurred after the patients themselves discontinued their medications. This was not related to the severity of coronary artery stenosis.(ABSTRACT TRUNCATED AT 250 WORDS)