Stable angina: Difference between revisions
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| align="center" style="background:#f0f0f0;"|'''Classification''' | | align="center" style="background:#f0f0f0;"|'''Classification''' | ||
| align="center" style="background:#f0f0f0;"|'''Symptoms''' | | align="center" style="background:#f0f0f0;"|'''Symptoms''' | ||
| align="center" style="background:#f0f0f0;"|'''Limitation''' | | align="center" style="background:#f0f0f0;"|'''Limitation of Ordinary Activities''' | ||
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| Grade I||With prolonged exertion|| | | Grade I||With prolonged exertion||None | ||
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| Grade II||Walking >2 blocks or climbing >1 flight of stairs||Slight | | Grade II||Walking >2 blocks or climbing >1 flight of stairs||Slight | ||
|- | |- | ||
| Grade III||Walking <2 blocks||Marked | | Grade III||Walking <2 blocks||Marked | ||
|- | |- | ||
| Grade IV||With minimal activity or at rest||Cannot do any | | Grade IV||With minimal activity or at rest||Cannot do any without symptoms | ||
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Revision as of 03:56, 5 March 2019
Background
Clinical Features
Classes (Canadian Cardiovascular Society Classification)[1]
| Classification | Symptoms | Limitation of Ordinary Activities |
| Grade I | With prolonged exertion | None |
| Grade II | Walking >2 blocks or climbing >1 flight of stairs | Slight |
| Grade III | Walking <2 blocks | Marked |
| Grade IV | With minimal activity or at rest | Cannot do any 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
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).,