Severity and distribution of coronary artery disease in patients with normal resting electrocardiograms

Summary Sixty-three patients with angiographically established coronary artery disease presented with entirely normal resting electrocardiograms. Single vessel disease was present in 23 (35%), and double or triple disease in 40 (65%). The left ventriculogram was normal in 40 patients (65%) and abnormal in 23 (35%). The commonest left ventricular contractile defect noted was asyneresis (12) with akinesia noted in 8. The commonest location for left ventricular asynergy was the anteroapical segments of the left ventricle (17) with inferior posterior asynergy much less common (3). Multiple contractile defects were noted in 3 additional patients. The left anterior descending artery was the most frequently involved vessel (52) with the right coronary artery (33) and the left circumflex artery (29) somewhat less commonly affected. Widespread and severe coronary artery disease, usually involving two or three of the major coronary branches, is a very common finding in anginal patients presenting with entirely normal resting electrocardiograms. Left ventricular contractile defects are present in about one-third of such patients, but accumulating experience suggests that these may be reversible after surgical revascularization.