Which of the following tests is used most often to diagnose angina?
A. Chest x-ray
B. Echocardiogram
C. Cardiac catheterization
D. 12-lead electrocardiogram (ECG)
Correct Answer: D. 12-lead electrocardiogram (ECG)
The 12-lead ECG will indicate ischemia, showing T-wave inversion. In addition, with variant angina, the ECG shows ST-segment elevation. ECG may not show any abnormalities in the cases of stable angina, unstable angina, or NSTEMI. ECG findings of myocardial ischemia include T-wave flattening or inversions, or ST-segment depressions. ECG changes will appear in STEMIs and prompt immediate need for coronary revascularization.
Option A: A chest x-ray will show heart enlargement or signs of heart failure, but isn’t used to diagnose angina. Chest x-ray characteristic findings are cardiac-to-thoracic width ratio above 50%, cephalization of the pulmonary vessels, Kerley B-lines, and pleural effusions.
Option B: Echocardiography is one of the most commonly used, non-invasive methods for looking at cardiac anatomy. Echocardiography is used to provide thin cross-sections of cardiac structures, this includes; left and right atrium, left and right ventricles, valves, and associated valvular structures.
Option C: Further testing may include exercise or pharmacologic stress testing with or without nuclear perfusion imaging, and diagnostic heart catheterization. In patients presenting with angina, the value of cardiac testing is determined by the patient’s pretest, probably of ACS. Pretest probably is evaluated by considering the patient’s presentation, along with their cardiac risk factors.
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