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GOOD BYE TO ST - T CHANGES
O P Kapoor
Hon. Visiting Physician, Jaslok Hospital and Bombay Hospital, Mumbai, Ex. Hon. Prof. of Medicine, Grant Medical College and JJ Hospital, Mumbai 400 008.
In my 40 years of practice I have seen thousands of patients who have been labelled as ischaemic heart disease because of so-called "ST-T changes". All over India this concept and report of "ST-T changes" is strongly embedded in the minds of the doctors and specialists. After taking lakhs of ECGs in my clinic, I have come to the conclusion that most of the patients of "stable" angina pectoris have not only a normal resting ECG but have "plum normal" ECG with upright and well shaped T-waves. This is true in patients having 1 or 2 vessel disease confirmed on angiography. Some of the patients having even 3 vessel disease have a "plum normal" resting ECG.
Vice versa most of the functional patients showed ST- T changes. Patients of hypertension showing left ventricular strain (ST changes L1, AVL, V5, V6) are becoming rarer in practice because they start taking drugs at an early stage. Electrolyte imbalance causing ST-T changes is becoming a rare diagnostic investigation because of the excellent reports of electrolytes from various pathological laboratories.
Yes, I do keep on picking up hypothyroidism from the ECGs with the help of low voltage and flat T-waves. One thing is definite that the time has come that we should say good-bye to ST-T changes in the diagnosis of IHD. Spend time in taking the history and you will not miss angina pectoris!
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