Problems in interpreting electrocardiograms (ECGs) and questionnaires for effort pain in rural Jamaica

ABSTRACT

In a rural area in Jamaica, 522 men aged 35-64 years participated in a cardiovascular survey and were followed-up for 13 years. The results revealed the difficulties encountered in evaluating ECGs and questionnaires for effort pain in the diagnosis of ischaemic heart disease in a community. ECG patterns involving Q/QS, ST or T-items were at first interpreted as evidence of myocardial ischaemia. Further studies showed that most of these ECGs were associated with hypertension or may have been normal variants. Some were related to other abnormalities but few could be confidently ascribed to cardiac ischaemia. A questionnaire for chest pain on effort administered at the first survey appeared to have suggested a high prevalence of angina pectoris. Subsequent questionnaires, exercise tolerance tests, examination of medical records and mortality rates demonstrated that a apositive response to the questionnaire was seldom diagnostic of angina, which was rarely seen clinically. Valvular and coronary heart disease, and idiopathic cardiomegaly were much less important in this community than hypertension which was a major risk factor for overall mortality (AU)