Stable angina: Difference between revisions
| Line 20: | Line 20: | ||
==Evaluation== | ==Evaluation== | ||
===History<ref>Mancini, G et al. (2014) Canadian Cardiovascular Society guidelines for the diagnosis and management of stable ischemic heart disease. Canadian Journal of Cardiology, 30(8).</ref>=== | ===Work-Up=== | ||
*ECG +/- telemetry | |||
*Troponin if possible acute event | |||
===Diagnosis=== | |||
Rule out [[unstable angina|unstable angina]]: | |||
*New angina | |||
*Angina at rest | |||
*Accelerating frequency or severity | |||
====History<ref>Mancini, G et al. (2014) Canadian Cardiovascular Society guidelines for the diagnosis and management of stable ischemic heart disease. Canadian Journal of Cardiology, 30(8).</ref>==== | |||
*Assess: | *Assess: | ||
**Changes in angina or heart failure symptoms | **Changes in angina or heart failure symptoms | ||
| Line 27: | Line 37: | ||
**Medication side effects | **Medication side effects | ||
===Physical Examination<ref>Mancini, G et al. (2014) Canadian Cardiovascular Society guidelines for the diagnosis and management of stable ischemic heart disease. Canadian Journal of Cardiology, 30(8).</ref>=== | ====Physical Examination<ref>Mancini, G et al. (2014) Canadian Cardiovascular Society guidelines for the diagnosis and management of stable ischemic heart disease. Canadian Journal of Cardiology, 30(8).</ref>==== | ||
*Resting heart rate and blood pressure | *Resting heart rate and blood pressure | ||
*Signs of heart failure | *Signs of heart failure | ||
| Line 33: | Line 43: | ||
*New or worsening vascular bruits or murmurs | *New or worsening vascular bruits or murmurs | ||
*Status of abdominal aorta | *Status of abdominal aorta | ||
==Management<ref>Mancini, G et al. Canadian Cardiovascular Society guidelines for the diagnosis and management of stable ischemic heart disease (2014). Canadian Journal of Cardiology, 30(8).,</ref>== | ==Management<ref>Mancini, G et al. Canadian Cardiovascular Society guidelines for the diagnosis and management of stable ischemic heart disease (2014). Canadian Journal of Cardiology, 30(8).,</ref>== | ||
Revision as of 03:48, 5 March 2019
Background
Clinical Features
Classes (Canadian Cardiovascular Society Classification)[1]
- Grade I
- Symptoms with prolonged exertion
- No limitation of ordinary activities
- Grade II
- Symptoms walking >2 blocks or climbing >1 flight of stairs
- Slight limitation of ordinary activities
- Grade III
- Symptoms walking <2 blocks
- Marked limitation of ordinary activities
- Grade IV
- Symptoms with minimal activity or at rest
- Cannot do any ordinary physical activity without symptoms
Differential Diagnosis
Chest pain
Critical
- Acute coronary syndromes (ACS)
- Aortic dissection
- Cardiac tamponade
- Coronary artery dissection
- Esophageal perforation (Boerhhaave's syndrome)
- Pulmonary embolism
- Tension pneumothorax
Emergent
- Cholecystitis
- Cocaine-associated chest pain
- Mediastinitis
- Myocardial rupture
- Myocarditis
- Pancreatitis
- Pericarditis
- Pneumothorax
Nonemergent
- Aortic stenosis
- Arthritis
- Asthma exacerbation
- Biliary colic
- Costochondritis
- Esophageal spasm
- Gastroesophageal reflux disease
- Herpes zoster / Postherpetic Neuralgia
- Hypertrophic cardiomyopathy
- Hyperventilation
- Mitral valve prolapse
- Panic attack
- Peptic ulcer disease
- Pleuritis
- Pneumomediastinum
- Pneumonia
- Rib fracture
- Stable angina
- Thoracic outlet syndrome
- Valvular heart disease
- Muscle sprain
- Psychologic / Somatic Chest Pain
- Spinal Root Compression
- Tumor
Evaluation
Work-Up
- ECG +/- telemetry
- Troponin if possible acute event
Diagnosis
Rule out unstable angina:
- New angina
- Angina at rest
- Accelerating frequency or severity
History[2]
- Assess:
- Changes in angina or heart failure symptoms
- Adherence to prescribed medications
- Changes in medications
- Medication side effects
Physical Examination[3]
- Resting heart rate and blood pressure
- Signs of heart failure
- New dysrhythmia
- New or worsening vascular bruits or murmurs
- Status of abdominal aorta
Management[4]
- Counsel regarding appropriate use of medications, nutrition, weight optimization, smoking cessation
Disposition
- If angina is stable and there is no other reason for admission, may discharge home for further management by family physician or cardiologist
See Also
External Links
References
- ↑ Campeau, L. Grading of angina pectoris. Circulation 1976; 54:5223
- ↑ Mancini, G et al. (2014) Canadian Cardiovascular Society guidelines for the diagnosis and management of stable ischemic heart disease. Canadian Journal of Cardiology, 30(8).
- ↑ Mancini, G et al. (2014) Canadian Cardiovascular Society guidelines for the diagnosis and management of stable ischemic heart disease. Canadian Journal of Cardiology, 30(8).
- ↑ Mancini, G et al. Canadian Cardiovascular Society guidelines for the diagnosis and management of stable ischemic heart disease (2014). Canadian Journal of Cardiology, 30(8).,