Chronic stable angina history and symptoms: Difference between revisions

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Latest revision as of 17:15, 28 October 2016

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1], Associate Editor-in-Chief: Lakshmi Gopalakrishnan, M.B.B.S.

Overview

The name 'angina pain' can be thought of as a misnomer as patients often describes the sensation as discomfort rather than physical pain. The best method to characterize this discomfort/pain is through the 'PQRST system'.

History and Symptoms

Provocation/Palliation (P)

The most common cause of anginal pain is exertion. Anginal discomfort is often relieved by rest or nitroglycerine. Usually relief from rest or nitroglycerine occurs in 2 to 3 minutes.
Less common precipitants of anginal discomfort include:

Emotional distress
A large meal
Cold weather
Cocaine
Anemia
Thyrotoxicosis

The discomfort is not precipitated by changes in position. This is in contrast to pericarditis which is relieved by sitting up or sitting forward.
In following the patient with chronic stable angina, the duration and or distance of exertion required to provoke the angina should be recorded to monitor the response to therapy.

Stable angina can be classified basing upon features.

Substernal chest pain.
Pain provocated by exertion and/or emotional stress.
Relieved with rest and/or nitroglycerin.

Typical angina - All the three features. Atypical angina - two features. Non-anginal chest pain - one feature.

Quality/Quantity (Q)

The nature of the sensation is usually not described as a "pain" but rather as a discomfort. It is often described as:

A sense of heaviness
Squeezing
Pressure
Choking
Strangling
Band like tightness
Or even as an "elephant sitting on my chest"

The pain is not sharp or pleuritic in nature. This is in contrast pericarditis which is described in this way.

Region/Radiation (R)

Typically the angina is located in the center of the chest or on the left side of the chest.
Less frequently the discomfort is predominantly in the epigastrum, the shoulders, neck or jaw.
In some patients, the pain may radiate to the inner aspect of the left arm, the neck or the jaw.

Severity Scale (S)

The patient should be asked to rank their pain on a scale of 0 - 10, zero being no pain at all and 10 being the worst pain ever.
The patient should be asked:

Does the discomfort interferes with activities?
How bad the discomfort is when it is at its worst?
Does it force the patient to sit down, lie down, or slow down?

Both the New York Heart Association functional classification scheme (NYHA) and the Canadian Cardiovascular Society functional classification (CCS) can be used to quantify the severity of anginal pain.

Timing (T)

Anginal discomfort usually lasts 1 to 5 minutes with a range from 1 minute to 30 minutes. Pain that lasts seconds is usually not anginal pain.
The pain is usually relieved in 2 to 3 minutes with rest or nitroglycerine. Anginal discomfort associated with emotional distress is usually relieved more slowly.
Angina that occurs at night (nocturnal angina) is characteristic of coronary spasm.
In following the patient with angina, the frequency and duration of pain, should be recorded to assess the response to therapy.

Associated Symptoms

There may be symptoms of systolic or diastolic left ventricular dysfunction that leads to shortness or breath or dyspnea.
In some patients, chest discomfort is not present, and dyspnea is the anginal equivalent.

Classifications of Functional Capacity and Severity in Chronic Stable Angina

Class	New York Heart Association Classification	Canadian Cardiovascular Society Classification
Class I	No limitation: Heart disease exists with no symptoms or limitation of physical activity. Ordinary physical activity does not cause angina, fatigue, palpitation, or dyspnea that limit activity.	Ordinary physical activity does not cause angina, such as walking, climbing stairs. Angina occurs with strenuous, rapid or prolonged exertion at work or recreation.
Class II	Minimal limitation: There is slight limitation of physical activity. Comfortable at rest, but ordinary physical activity results in angina, fatigue, palpitation, or dyspnea.	Slightly limited ordinary physical activities. Angina occurs on: walking or climbing stairs rapidly, walking uphill, walking or stair climbing after meals, or in cold, or in wind, or under emotional stress, or only during the few hours after awakening. Walking more than two blocks on the same level and climbing more than one flight of ordinary stairs at a normal pace and in normal condition.
Class III	Marked limitation: Patients have marked limitation of physical activity. Comfortable at rest, but less than ordinary activity, such as walking 20–100 m, causes fatigue, palpitation, or dyspnea.	Marked limitations of ordinary physical activity. Angina occurs on walking one to two blocks (equivalent to 100-200m) on the same level and climbing one flight of stairs at a normal pace under normal conditions.
Class IV	Extreme limitation: Severe limitation; unable to carry out any physical activity without discomfort. Angina and/or symptoms of cardiac insufficiency may be present at rest. If any physical activity is undertaken, discomfort is increased. Usually self-confined to bed or a chair.	Inability to carry on any physical activity without any discomfort. Angina occurs at rest.

ACC/AHA/ACP–ASIM Guidelines for the Management of Patients With Chronic Stable Angina (DO NOT EDIT)^[1]

Clinical Evaluation of Patients With Chest Pain (DO NOT EDIT)^[1]

Clinical Evaluation in the Initial Diagnosis of SIHD in Patients With Chest Pain

Class I
"1. Patients with chest pain should receive a thorough history and physical examination to assess the probability of IHD before additional testing.(Level of Evidence:C)"
"2. Patients who present with acute angina should be categorized as stable or unstable; patients with UA should be further categorized as being at high, moderate, or low risk.(Level of Evidence:C)"

ESC Guidelines- Clinical Evaluation (DO NOT EDIT)^[2]

Class I
"1. Detailed clinical history and physical examination including BMI and/or waist circumference in all patients, also including a full description of symptoms, quantification of functional impairment, past medical history, and cardiovascular risk profile. (Level of Evidence: B)"
"2. Resting ECG in all patients. (Level of Evidence: B)"

References

↑ ^1.0 ^1.1 Fihn SD, Gardin JM, Abrams J, Berra K, Blankenship JC, Dallas AP; et al. (2012). "2012 ACCF/AHA/ACP/AATS/PCNA/SCAI/STS guideline for the diagnosis and management of patients with stable ischemic heart disease: executive summary: a report of the American College of Cardiology Foundation/American Heart Association task force on practice guidelines, and the American College of Physicians, American Association for Thoracic Surgery, Preventive Cardiovascular Nurses Association, Society for Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons". Circulation. 126 (25): 3097–137. doi:10.1161/CIR.0b013e3182776f83. PMID 23166210.
↑ Fox K, Garcia MA, Ardissino D, Buszman P, Camici PG, Crea F; et al. (2006). "Guidelines on the management of stable angina pectoris: executive summary: The Task Force on the Management of Stable Angina Pectoris of the European Society of Cardiology". Eur Heart J. 27 (11): 1341–81. doi:10.1093/eurheartj/ehl001. PMID 16735367.

Template:WikiDoc Sources

[pmid23166210-1] 1.0 ^1.1 Fihn SD, Gardin JM, Abrams J, Berra K, Blankenship JC, Dallas AP; et al. (2012). "2012 ACCF/AHA/ACP/AATS/PCNA/SCAI/STS guideline for the diagnosis and management of patients with stable ischemic heart disease: executive summary: a report of the American College of Cardiology Foundation/American Heart Association task force on practice guidelines, and the American College of Physicians, American Association for Thoracic Surgery, Preventive Cardiovascular Nurses Association, Society for Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons". Circulation. 126 (25): 3097–137. doi:10.1161/CIR.0b013e3182776f83. PMID 23166210.

[pmid16735367-2] Fox K, Garcia MA, Ardissino D, Buszman P, Camici PG, Crea F; et al. (2006). "Guidelines on the management of stable angina pectoris: executive summary: The Task Force on the Management of Stable Angina Pectoris of the European Society of Cardiology". Eur Heart J. 27 (11): 1341–81. doi:10.1093/eurheartj/ehl001. PMID 16735367.

[1]

[2]

@@ Line 1: / Line 1: @@
+__NOTOC__
 {{Chronic stable angina}}
-{{CMG}}, '''Associate Editor-in-Chief:''' [[Lakshmi Gopalakrishnan]], M.B.B.S.
+{{CMG}}, '''Associate Editor-in-Chief:''' [[Lakshmi Gopalakrishnan|Lakshmi Gopalakrishnan, M.B.B.S.]]
 ==Overview==
-The name angina "pain" is somewhat of a misnomer in so far as patients often describe the sensation as a discomfort rather than a "pain". We will use the PQRST system to characterize that pain.
+The name 'angina pain' can be thought of as a misnomer as patients often describes the sensation as discomfort rather than physical pain. The best method to characterize this discomfort/pain is through the 'PQRST system'.
-==P =  provocation / palliation==
+==History and Symptoms==
-The most common cause of anginal pain is exertion.  Anginal discomfort is often relieved by rest or [[nitroglycerine]].  Usually relief from rest or nitroglycerine occurs in 2 to 3 minutes.
+===Provocation/Palliation (P)===
+* The most common cause of anginal pain is exertion.  Anginal discomfort is often relieved by rest or [[nitroglycerine]].  Usually relief from rest or nitroglycerine occurs in 2 to 3 minutes.
+* Less common precipitants of anginal discomfort include:
+:*Emotional distress
+:* A large meal
+:* Cold weather
+:* Cocaine
+:*[[Anemia]]
+:*[[Thyrotoxicosis]]
+* The discomfort is not precipitated by changes in position. This is in contrast to [[pericarditis]] which is relieved by sitting up or sitting forward.
+* In following the patient with chronic stable angina, the duration and or distance of exertion required to provoke the angina should be recorded to monitor the response to therapy.
-Less common precipitants of anginal discomfort include emotional distress, a large meal, cold weather, cocaine, [[anemia]], and [[thyrotoxicosis]].
+Stable angina can be classified basing upon features.
+* Substernal [[chest pain]].
-The discomfort is not precipitated by changes in position. This is in contrast to [[pericarditis]] which is relieved by sitting up or sitting forward.
+* Pain provocated by exertion and/or emotional stress.
+* Relieved with rest and/or [[nitroglycerin]].
-In following the patient with chronic stable angina, the duration and or distance of exertion required to provoke the angina should be recorded to monitor the response to therapy.
+Typical angina - All the three features.
+Atypical angina - two features.
+Non-anginal chest pain - one feature.
-==Q = quality / quantity==
+===Quality/Quantity (Q)===
-The nature of the sensation is usually not described as a "pain" but rather as a discomfort.  It is often described a sense of heaviness, squeezing, pressure, choking, strangling, band like tightness, or even as an "elephant sitting on my chest".
+* The nature of the sensation is usually not described as a "pain" but rather as a discomfort.  It is often described as:
+:* A sense of heaviness
+:* Squeezing
+:* Pressure
+:* Choking
+:* Strangling
+:* Band like tightness
+:* Or even as an "elephant sitting on my chest"
+* The pain is not sharp or [[pleuritic]] in nature. This is in contrast [[pericarditis]] which is described in this way.
-The pain is not sharp or [[pleuritic]] in nature. This is in contrast [[pericarditis]] which is described in this way.
+===Region/Radiation (R)===
+* Typically the angina is located in the center of the chest or on the left side of the chest.
+* Less frequently the discomfort is predominantly in the [[epigastrum]], the shoulders, neck or jaw.
+* In some patients, the pain may radiate to the inner aspect of the left arm, the neck or the jaw.
-==R = region / radiation==
+===Severity Scale (S)===
-typically the angina is located in the center of the chest or on the left side of the chest.  Less frequently the discomfort is predominantly in the [[epigastrum]], the shoulders, neck or jaw.
+* The patient should be asked to rank their pain on a scale of 0 - 10, zero being no pain at all and 10 being the worst pain ever.
+* The patient should be asked:
+:* Does the discomfort interferes with activities?
+:* How bad the discomfort is when it is at its worst?
+:* Does it force the patient to sit down, lie down, or slow down?
+* Both the [[ New york heart association functional classification|New York Heart Association functional classification scheme]] (NYHA) and the [[Canadian Cardiovascular Society Classifications of Angina Pectoris|Canadian Cardiovascular Society functional classification]] (CCS) can be used to quantify the severity of anginal pain.
-In some patients, the pain may radiate to the inner aspect of the left arm, the neck or the jaw.
+===Timing (T)===
+* Anginal discomfort usually lasts 1 to 5 minutes with a range from 1 minute to 30 minutes.  Pain that lasts seconds is usually not anginal pain.
+* The pain is usually relieved in 2 to 3 minutes with rest or nitroglycerine. Anginal discomfort associated with emotional distress is usually relieved more slowly.
+* Angina that occurs at night ([[Nocturnal angina pectoris|nocturnal angina]]) is characteristic of [[Coronary Vasospasm|coronary spasm]].
+* In following the patient with angina, the frequency and duration of pain, should be recorded to assess the response to therapy.
-==S = severity scale==
+===Associated Symptoms===
-The patient should be asked to rank their pain on a scale of 0 - 10, zero being no pain at all and 10 being the worst pain ever. The patient should be asked if the discomfort interferes with activities, how bad the discomfort is when it is at its worst, and whether it forces the patient to sit down, lie down, or slow down.  Both the New York Heart Association (NYHA) functional classification scheme and the Canadian Cardiovascular Society (CCS) functional classification can be used to quantitate the severity of anginal pain.
+*There may be symptoms of systolic or diastolic left ventricular dysfunction that leads to shortness or breath or [[dyspnea]].
+*In some patients, chest discomfort is not present, and [[dyspnea]] is the anginal equivalent.
-==T = timing==
+<center>
-Anginal discomfort usually lasts 1 to 5 minutes with a range from 1 minute to 30 minutes.  Pain that lasts seconds is usually not anginal pain.
+==Classifications of Functional Capacity and Severity in Chronic Stable Angina==
-The pain is usually relieved in 2 to 3 minutes with rest or nitroglycerine. Anginal discomfort associated with emotional distress is usually relieved more slowly.
+{| border="1" align="center" style="background:lightskyblue"
+|-
+|  bgcolor="CornFlowerBlue" |'''Class'''
+|  bgcolor="CornFlowerBlue" |'''[[NYHA classification|New York Heart Association Classification]]'''
+|  bgcolor="CornFlowerBlue" |'''[[CCS classification|Canadian Cardiovascular Society Classification]]'''
+|-
+| '''Class I'''
+|'''No limitation:'''
+*Heart disease exists with no symptoms or limitation of physical activity.
-Angina that occurs at night (nocturnal angina) is characteristic of coronary spasm.
+*Ordinary physical activity does not cause [[Chronic stable angina|angina]], [[fatigue]], [[palpitation]], or [[dyspnea]] that limit activity.
+|
-In following the patient with angina, the frequency and duration of pain, should be recorded to assess the response to therapy.
+*Ordinary physical activity does not cause angina, such as walking, climbing stairs.
+*Angina occurs with strenuous, rapid or prolonged exertion at work or recreation.
-==Associated Symptoms==
+|-
-There may be symptoms of systolic or diastolic left ventricular dysfunction that leads to shortness or breath or [[dyspnea]].  In some patients, chest discomfort is not present, and [[dyspnea]] is the anginal equivalent.
+| '''Class II'''
+| '''Minimal limitation:'''
+*There is slight limitation of physical activity.
+*Comfortable at rest, but ordinary physical activity results in [[Chronic stable angina|angina]], [[fatigue]], [[palpitation]], or [[dyspnea]].
+|
+*Slightly limited ordinary physical activities.
+*Angina occurs on:
+:*walking or climbing stairs rapidly,
+:*walking uphill, walking or stair climbing after meals, or in cold, or in wind, or
+:*under emotional stress, or
+:*only during the few hours after awakening.
+*Walking more than two blocks on the same level and climbing more than one flight of ordinary stairs at a normal pace and in normal condition.
+|-
+| '''Class III'''
+| '''Marked limitation:'''
+*Patients have marked limitation of physical activity.
+*Comfortable at rest, but less than ordinary activity, such as walking 20–100 m, causes [[fatigue]], [[palpitation]], or [[dyspnea]].
+|
+*Marked limitations of ordinary physical activity.
+*Angina occurs on walking one to two blocks (equivalent to 100-200m) on the same level and climbing one flight of stairs at a normal pace under normal conditions.
+|-
+| '''Class IV'''
+| '''Extreme limitation:'''
+*Severe limitation; unable to carry out any physical activity without discomfort.
+*[[chronic stable angina|Angina]] and/or symptoms of cardiac insufficiency may be present at rest.
+*If any physical activity is undertaken, discomfort is increased.
+*Usually self-confined to bed or a chair.
+|
+*Inability to carry on any physical activity without any discomfort.
+*Angina occurs at rest.
+|}</center>
-==ACC / AHA Guidelines- History and Physical examination Recommendations (DO NOT EDIT)<ref name="pmid10351980">Gibbons RJ, Chatterjee K, Daley J, Douglas JS, Fihn SD, Gardin JM et al. (1999) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=10351980 ACC/AHA/ACP-ASIM guidelines for the management of patients with chronic stable angina: executive summary and recommendations. A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee on Management of Patients with Chronic Stable Angina).] ''Circulation'' 99 (21):2829-48. PMID: [http://pubmed.gov/10351980 10351980]</ref>==
+==ACC/AHA/ACP–ASIM Guidelines for the Management of Patients With Chronic Stable Angina (DO NOT EDIT)<ref name="pmid23166210">{{cite journal| author=Fihn SD, Gardin JM, Abrams J, Berra K, Blankenship JC, Dallas AP et al.| title=2012 ACCF/AHA/ACP/AATS/PCNA/SCAI/STS guideline for the diagnosis and management of patients with stable ischemic heart disease: executive summary: a report of the American College of Cardiology Foundation/American Heart Association task force on practice guidelines, and the American College of Physicians, American Association for Thoracic Surgery, Preventive Cardiovascular Nurses Association, Society for Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons. | journal=Circulation | year= 2012 | volume= 126 | issue= 25 | pages= 3097-137 | pmid=23166210 | doi=10.1161/CIR.0b013e3182776f83 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23166210  }} </ref>==
-{{cquote|
-===Class I===
-'''1.''' In patients presenting with [[chest pain]], a detailed symptom history, focused physical examination, and directed [[Chronic stable angina risk stratification exercise testing|risk factor assessment]] should be performed. With this information, the clinician should estimate the [[Chronic stable angina assessing the pretest probability of coronary artery disease|probability]] of significant [[CAD]] (ie, low, intermediate, high). ''(Level of Evidence: B)''}}
-==ESC Guidelines- Clinical Evaluation and ECG for Risk Stratification (DO NOT EDIT)<ref name="pmid16735367">{{cite journal| author=Fox K, Garcia MA, Ardissino D, Buszman P, Camici PG, Crea F et al.| title=Guidelines on the management of stable angina pectoris: executive summary: The Task Force on the Management of Stable Angina Pectoris of the European Society of Cardiology. | journal=Eur Heart J | year= 2006 | volume= 27 | issue= 11 | pages= 1341-81 | pmid=16735367 | doi=10.1093/eurheartj/ehl001 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16735367  }} </ref>==
+===Clinical Evaluation of Patients With Chest Pain (DO NOT EDIT)<ref name="pmid23166210">{{cite journal| author=Fihn SD, Gardin JM, Abrams J, Berra K, Blankenship JC, Dallas AP et al.| title=2012 ACCF/AHA/ACP/AATS/PCNA/SCAI/STS guideline for the diagnosis and management of patients with stable ischemic heart disease: executive summary: a report of the American College of Cardiology Foundation/American Heart Association task force on practice guidelines, and the American College of Physicians, American Association for Thoracic Surgery, Preventive Cardiovascular Nurses Association, Society for Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons. | journal=Circulation | year= 2012 | volume= 126 | issue= 25 | pages= 3097-137 | pmid=23166210 | doi=10.1161/CIR.0b013e3182776f83 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23166210  }} </ref>===
-{{cquote|
+'''Clinical Evaluation in the Initial Diagnosis of SIHD in Patients With Chest Pain'''
-===Class I===
-'''1.''' Detailed clinical history and physical examination including BMI and/or waist circumference in all patients, also including a full description of symptoms, quantification of functional impairment, past medical history, and cardiovascular risk profile. ''(Level of Evidence: B)''
-'''2.''' Resting [[ECG]] in all patients. ''(Level of Evidence: B)''}}
+{|class="wikitable"
+|-
+| colspan="1" style="text-align:center; background:LightGreen"|[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class I]]
-==Vote on and Suggest Revisions to the Current Guidelines==
+|-
-*[[The Living Guidelines: Chronic Stable Angina Pectoris | The Chronic Stable Angina Living Guidelines: Vote on current recommendations and suggest revisions to the guidelines]]
+| bgcolor="LightGreen"|
+<nowiki>"</nowiki>'''1.''' Patients with chest pain should receive a thorough history and physical examination to assess the probability of IHD before additional
+testing.''([[ACC AHA Guidelines Classification Scheme#Level of Evidence|Level of Evidence:C]])''<nowiki>"</nowiki>
-==Sources==
+|-
-*Guidelines on the management of stable angina pectoris: The Task Force on the Management of Stable Angina Pectoris of the European Society of Cardiology <ref name="pmid16735367">{{cite journal| author=Fox K, Garcia MA, Ardissino D, Buszman P, Camici PG, Crea F et al.| title=Guidelines on the management of stable angina pectoris: executive summary: The Task Force on the Management of Stable Angina Pectoris of the European Society of Cardiology. | journal=Eur Heart J | year= 2006 | volume= 27 | issue= 11 | pages= 1341-81 | pmid=16735367 | doi=10.1093/eurheartj/ehl001 | pmc= |url=url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16735367 [http://www.escardio.org/guidelines-surveys/esc-guidelines/GuidelinesDocuments/guidelines-angina-FT.pdf]}} </ref>
+| bgcolor="LightGreen"|
+<nowiki>"</nowiki>'''2.''' Patients who present with acute angina should be categorized as stable or unstable; patients with UA should be further categorized as
+being at high, moderate, or low risk.''([[ACC AHA Guidelines Classification Scheme#Level of Evidence|Level of Evidence:C]])''<nowiki>"</nowiki>
+|}
-*The ACC/AHA/ACP–ASIM Guidelines for the Management of Patients With Chronic Stable Angina <ref name="pmid10351980">Gibbons RJ, Chatterjee K, Daley J, Douglas JS, Fihn SD, Gardin JM et al. (1999) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=10351980 ACC/AHA/ACP-ASIM guidelines for the management of patients with chronic stable angina: executive summary and recommendations. A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee on Management of Patients with Chronic Stable Angina).] ''Circulation'' 99 (21):2829-48. [http://circ.ahajournals.org/content/99/21/2829.full.pdf] PMID: [http://pubmed.gov/10351980 10351980]</ref>
+==ESC Guidelines- Clinical Evaluation (DO NOT EDIT)<ref name="pmid16735367">{{cite journal| author=Fox K, Garcia MA, Ardissino D, Buszman P, Camici PG, Crea F et al.| title=Guidelines on the management of stable angina pectoris: executive summary: The Task Force on the Management of Stable Angina Pectoris of the European Society of Cardiology. | journal=Eur Heart J | year= 2006 | volume= 27 | issue= 11 | pages= 1341-81 | pmid=16735367 | doi=10.1093/eurheartj/ehl001 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16735367  }} </ref>==
-*TheACC/AHA 2002 Guideline Update for the Management of Patients With Chronic Stable Angina <ref name="pmid12515758">Gibbons RJ, Abrams J, Chatterjee K, Daley J, Deedwania PC, Douglas JS et al. (2003) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=12515758 ACC/AHA 2002 guideline update for the management of patients with chronic stable angina--summary article: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee on the Management of Patients With Chronic Stable Angina).] ''Circulation'' 107 (1):149-58.[http://content.onlinejacc.org/cgi/reprint/41/1/159.pdf] PMID: [http://pubmed.gov/12515758 12515758]</ref>
+{|class="wikitable"
+|-
+| colspan="1" style="text-align:center; background:LightGreen"|[[European society of cardiology#Classes of Recommendations|Class I]]
-*The 2007 Chronic Angina Focused Update of the ACC/AHA 2002 Guidelines for the Management of Patients With Chronic Stable Angina <ref name="pmid17998462">Fraker TD, Fihn SD, Gibbons RJ, Abrams J, Chatterjee K, Daley J et al. (2007)[http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=17998462 2007 chronic angina focused update of the ACC/AHA 2002 Guidelines for the management of patients with chronic stable angina: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines Writing Group to develop the focused update of the 2002 Guidelines for the management of patients with chronic stable angina.] ''Circulation'' 116 (23):2762-72.[http://content.onlinejacc.org/cgi/reprint/50/23/2264.pdf] PMID: [http://pubmed.gov/17998462 17998462]</ref>
+|-
+| bgcolor="LightGreen"|<nowiki>"</nowiki>'''1.''' Detailed clinical history and [[physical examination]] including [[BMI]] and/or waist circumference in all patients, also including a full description of symptoms, quantification of functional impairment, past medical history, and [[Coronary risk profile (patient information)|cardiovascular risk profile]]. ''([[European society of cardiology#Level of Evidence|Level of Evidence: B]])''<nowiki>"</nowiki>
+|-
+| bgcolor="LightGreen"|<nowiki>"</nowiki>'''2.''' [[Chronic stable angina electrocardiography|Resting ECG]] in all patients. ''([[European society of cardiology#Level of Evidence|Level of Evidence: B]])''<nowiki>"</nowiki>
+|}
 ==References==
-{{Reflist|2}}
+{{reflist|2}}
+{{WikiDoc Help Menu}}
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Chronic stable angina Microchapters
Acute Coronary Syndrome Main Page

Home

Patient Information

Overview

Historical Perspective

Classification
Classic Chronic Stable Angina
Atypical Walk through Angina Mixed Angina Nocturnal Angina Postprandial Angina Cardiac Syndrome X Vasospastic Angina

Differentiating Chronic Stable Angina from Acute Coronary Syndromes

Pathophysiology

Epidemiology and Demographics

Risk Stratification

Pretest Probability of CAD in a Patient with Angina

Prognosis

Diagnosis

History and Symptoms

Physical Examination

Test Selection Guideline for the Individual Basis

Laboratory Findings

Electrocardiogram

Exercise ECG

Chest X Ray

Myocardial Perfusion Scintigraphy with Pharmacologic Stress

Myocardial Perfusion Scintigraphy with Thallium

Echocardiography

Exercise Echocardiography

Computed coronary tomography angiography(CCTA)

Positron Emission Tomography

Ambulatory ST Segment Monitoring

Electron Beam Tomography

Cardiac Magnetic Resonance Imaging

Coronary Angiography

Treatment

Medical Therapy

Revascularization
PCI
CABG

Hybrid Coronary Revascularization

Alternative Therapies for Refractory Angina
Transmyocardial Revascularization (TMR)
Spinal Cord Stimulation (SCS)
Enhanced External Counter Pulsation (EECP)
ACC/AHA Guidelines for Alternative Therapies in patients with Refractory Angina

Discharge Care
Patient Follow-Up
Rehabilitation

Secondary Prevention

Guidelines for Asymptomatic Patients
Noninvasive Testing in Asymptomatic Patients
Risk Stratification by Coronary Angiography
Pharmacotherapy to Prevent MI and Death in Asymptomatic Patients

Landmark Trials

Case Studies

Case #1

Chronic stable angina history and symptoms On the Web

Most recent articles

Most cited articles

Review articles

CME Programs

Powerpoint slides

Images

Ongoing Trials at Clinical Trials.gov

US National Guidelines Clearinghouse

NICE Guidance

FDA on Chronic stable angina history and symptoms

CDC onChronic stable angina history and symptoms

Chronic stable angina history and symptoms in the news

Blogs on Chronic stable angina history and symptoms

to Hospitals Treating Chronic stable angina history and symptoms

Risk calculators and risk factors for Chronic stable angina history and symptoms