Chronic stable angina differential diagnosis

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

For a full discussion of the differential diagnosis of chest pain, click here.

Overview

Stable angina must be differentiated from unstable angina and acute coronary syndromes. If the pattern of angina is stable, this is termed chronic stable angina. If the magnitude, threshold or frequency of chest pain accelerates, this is termed an acute coronary syndrome.

Differentiating Chronic Stable Angina from Urgent Conditions

• Angina pectoris is a sign of coronary heart disease. If chronic chest discomfort occurs it is termed chronic stable angina.
• If the chest discomfort occurs at rest or in an accelerating pattern this is called an acute coronary syndrome. An acute coronary syndrome is characterized by the following:

• The chest pain lasts at least 10 minutes at rest, or
• There are repeated episodes at rest lasting ≥5 minutes, or
• An accelerating pattern of ischemic discomfort (episodes that are more frequent, severe, longer in duration, and precipitated by minimal exertion).

• The presence of an acute coronary syndrome requires urgent evaluation and treatment and can present as either:

• Unstable angina: An open artery with insufficient blood flow to the heart but without irreversible damage present.
• Non ST elevation MI: An open or closed artery with insufficient blood flow to the heart with irreversible damage present.
• ST elevation MI: A closed artery with insufficient blood flow to the heart and irreversible damage present.

References

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