Stable angina

Clinical Features

Classes (Canadian Cardiovascular Society Classification)

• 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)
  • STEMI
  • Non-STEMI
  • Unstable angina
• 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

Evaluation

Rule out unstable angina:

• New angina
• Angina at rest
• Accelerating frequency or severity

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

• Acute coronary syndrome (main)
• Unstable angina