Chronic stable angina ambulatory ST segment monitoring

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [mailto:mgibson@perfuse.org] Phone:617-632-7753; Associate Editor(s)-In-Chief: ; Smita Kohli, M.D.; Lakshmi Gopalakrishnan, M.B.B.S.

Overview
Ambulatory ECG monitoring (Holter monitor) is used to detect major arrhythmias and myocardial ischemia occurring during normal activities. Ambulatory ECG monitoring adds very little prognostic value in patients with chronic stable angina, however, does play a role in the detection of major arrhythmias in patients with chronic stable angina and  suspected vasospastic angina.

Indications

 * Many patients with CAD experience episodes of asymptomatic myocardial ischemia detectable by ST segment monitoring whether or not they have angina pectoris. Patients with symptomatic angina also often have multiple additional episodes of asymptomatic ischemia, and the frequency and severity of these episodes correlate with prognosis.


 * In patients with suspected vasospastic angina that may not be provoked by effort or by pharmacologic agents such as dipyridamole, adenosine or dobutamine, ambulatory ST segment monitoring is the preferred test.


 * In patients who cannot exercise, ambulatory ST segment monitoring is an alternative.


 * Exercise electrocardiography, perfusion scintigraphy with pharmacologic stress or with thallium and echocardiography are generally preferable to ambulatory ST segment monitoring in patients with effort angina.

==ESC Guidelines- Ambulatory ECG for initial diagnostic assessment of angina (DO NOT EDIT) == {{cquote|

Class I
1. Angina with suspected arrhythmia. (Level of Evidence: B)

Class IIa
1. Suspected vasospastic angina. (Level of Evidence: C)}}

Vote on and Suggest Revisions to the Current Guidelines

 * The Chronic Stable Angina Living Guidelines: Vote on current recommendations and suggest revisions to the guidelines

Guidelines Resources

 * Guidelines on the management of stable angina pectoris: The Task Force on the Management of Stable Angina Pectoris of the European Society of Cardiology


 * The ACC/AHA/ACP–ASIM Guidelines for the Management of Patients With Chronic Stable Angina


 * The ACC/AHA 2002 Guideline Update for the Management of Patients With Chronic Stable Angina


 * The 2007 Chronic Angina Focused Update of the ACC/AHA 2002 Guidelines for the Management of Patients With Chronic Stable Angina