The normal shape of the T wave on the standard 12-lead electrocardiogram (ECG) is asymmetrical. The spatial velocity electrocardiogram (SVECG) is a method of recording the slope of the wave of the ECG and makes it possible to quantify the symmetry of the ECG-T wave. The aim of this study was to diagnose resting effort angina pectoris not detectable by conventional resting ECG using SVECG. We studied SVECG-T waves in effort angina pectoris patients with significant coronary artery stenosis but with normal resting ECG (AP group: 50 subjects) and in an age- and sex-matched normal controls (N group: 30 subjects). The SVECG is depicted as a simple differential wave, and all SVECG-T waves had two peaks. The first peak of the SVECG-T wave was designated as the 'a' wave and the second peak as the 'c' wave. The heights (a wave-mag, c wave-mag) and c wave-mag/a wave-mag ratio (c/a ratio) were calculated. The c/a ratio was significantly decreased in the AP group (1.52±0.29 vs 1.87±0.27, p<0.0001). In cases below the cut off c/a ratio of 1.7, the diagnostic sensitivity, specificity and accuracy for effort angina pectoris were retrospectively evaluated to be 82%, 70% and 78%, respectively. The heights of the 'a' and 'c' waves correspond to the maximum slope of the ascending and descending limbs of the T wave on ECG. The symmetrization of the T wave on ECG is considered to occur when the c/a ratio decreases and approaches 1.0. In conclusion, the c/a ratio of the SVECG-T wave is a useful index to diagnose effort angina pectoris at rest when the resting ECG is normal.