Objective electrocardiographic documentation of ‘walk- through angina’ phenomenon during treadmill stress electrocardiography using Bruce protocol

Abstract

The term ‘walk through angina’ is used when angina is relieved inspite of continued exertion. Objective documentation of ‘walk-through angina’ is rare. Two cases of ‘walk - through angina’ phenomenon with objective electrocardiographic documentation during treadmill stress test are reported. In both cases relief in angina was associated with reduction in electrocardiographic signs of ischemia. In one case, relief of angina was associated with reduction in rate - pressure product. In the second case angina reduced even when the rate pressure product was higher than at the onset of angina. Several factors could reduce angina inspite of increase in work load. Relief in anxiety, reduction in stress of exercise testing, coronary vasodilation, increased flow through collaterals or some adaptive process, alone or in combination, could contribute to relief in angina. Treatment is similar to chronic stable angina.