Diagnosis of Angina Pectoris

Initial investigations done in a patient of Angina

#Full blood count - Anaemia can precipitate or exacerbate angina.

#Plasma glucose - A random plasma glucose should be obtained to screen for diabetes.

#Lipid profile - Serum cholesterol levels have important implications for therapy in primary and secondary prevention of coronary events.

#Resting electrocardiogram - The resting ECG in patients with chronic stable angina is normal in more than 50%. This does not exclude the presence of ischaemic heart disease. Evidence of Q waves from previous myocardial infarctions strongly supports the diagnosis of angina. The presence of arrhythmias such as atrial fibrillation may result from myocardial ischaemia.
In the presence of chest pain, however, the ECG is abnormal in more than 50% of patients with angina, with T wave inversion and ST segment depression being the usual findings.


#Chest X-ray - The chest film is often normal in patients with chronic stable angina and the clinical utility of this routine investigation is not well established. Characteristic X-ray features of heart failure from myocardial ischaemia may be present , and cardiomegaly secondary to valvular heart disease may point to the underlying causes.

#Echocardiography - Transthoracic echocardiography is not routinely indicated in patients with chronic stable angina. However, it is useful when features of valvular heart disease are present or to assess ventricular function in the presence of symptoms suggestive of congestive cardiac failure.

Specific investigations done in case of angina:

Non-invasive tests

#Exercise electrocardiogram - An exercise ECG is useful for the objective documentation of myocardial ischaemia and also to assess the functional capacity and prognosis of patients with established coronary disease.

#Stress imaging studies - The indications for imaging studies over exercise ECG are usually due to baseline ECG abnormalities such as complete left bundle branch block, pre-excitation (Wolff-Parkinson-White) and patients with pre-existing revascularization where localization of the area of ischaemia is important.

Invasive tests

#Coronary angiography

The coronary angiogram is the current gold standard to diagnose coronary artery disease. Currently it is indicated for diagnosis in patients with contraindications to stress testing, risk stratification in patients with angina refractory to medical therapy, diagnosis after successful resuscitation for sudden near cardiac death, patients with symptoms of congestive cardiac failure and high-risk patients identified on non-invasive testing.

Latest Diagnostic tool for Angina:

Imaging modalities that are currently under evaluation are ultra fast CT scanning and magnetic resonance coronary angiography. Intravascular ultrasonography has the ability to measure luminal dimensions and characterize plaque size and distribution.

What is angina?
Diagnosis of Angina.
Medical and Surgical Treatment of Angina.