Stable angina

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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

Emergent

Nonemergent

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

  1. Campeau, L. Grading of angina pectoris. Circulation 1976; 54:5223
  2. 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).
  3. 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).
  4. 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).,