Chronic stable angina risk stratification electrocardiogram/chest x-ray: Difference between revisions

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__NOTOC__
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{{Chronic stable angina}}
{{Chronic stable angina}}
{{CMG}}; '''Associate Editors-in-Chief:''' {{CZ}}; Smita Kohli, M.D.
{{CMG}}; '''Associate Editors-in-Chief:''' {{CZ}}; Smita Kohli, M.D.
==Overview==
The presence of [[ECG]] abnormalities at rest and pulmonary venous congestion on CXR are associated with reduced [[LVEF]] which remains an important prognostic factor in patients with chronic stable angina.


==ECG==
==ECG==
*The presence of [[ECG]] abnormalities at rest puts the patient at higher risk than the absence of ECG abnormalities at rest.<ref name="pmid761323">Hammermeister KE, DeRouen TA, Dodge HT (1979) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=761323 Variables predictive of survival in patients with coronary disease. Selection by univariate and multivariate analyses from the clinical, electrocardiographic, exercise, arteriographic, and quantitative angiographic evaluations.] ''Circulation'' 59 (3):421-30. PMID: [http://pubmed.gov/761323 761323]</ref>  
*The presence of [[ECG]] abnormalities at rest puts the patient at higher risk than the absence of ECG abnormalities at rest.<ref name="pmid761323">Hammermeister KE, DeRouen TA, Dodge HT (1979) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=761323 Variables predictive of survival in patients with coronary disease. Selection by univariate and multivariate analyses from the clinical, electrocardiographic, exercise, arteriographic, and quantitative angiographic evaluations.]''Circulation''59 (3):421-30. PMID: [http://pubmed.gov/761323 761323]</ref>


*Rest [[ECG]] abnormalities that are associated with poor outcomes include:
*Rest [[ECG]] abnormalities that are associated with poor outcomes include:
:*Left ventricular hypertrophy ([[LVH]]) by ECG criteria,  
:*Left ventricular hypertrophy ([[LVH]]) by ECG criteria,  
:*Persistent ST-T wave inversions in V1-V3, <ref name="pmid6105556"> (1980) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=6105556 Prospective randomised study of coronary artery bypass surgery in stable angina pectoris. Second interim report by the European Coronary Surgery Study Group.] ''Lancet'' 2 (8193):491-5. PMID: [http://pubmed.gov/6105556 6105556]</ref> <ref name="pmid331107">Murphy ML, Hultgren HN, Detre K, Thomsen J, Takaro T (1977) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=331107 Treatment of chronic stable angina. A preliminary report of survival data of the randomized Veterans Administration cooperative study.] ''N Engl J Med'' 297 (12):621-7. [http://dx.doi.org/10.1056/NEJM197709222971201 DOI:10.1056/NEJM197709222971201] PMID: [http://pubmed.gov/331107 331107]</ref> <ref name="pmid4632503">Frank CW, Weinblatt E, Shapiro S (1973) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=4632503 Angina pectoris in men. Prognostic significance of selected medical factors.] ''Circulation'' 47 (3):509-17. PMID: [http://pubmed.gov/4632503 4632503]</ref>
:*Persistent ST-T wave inversions in V1-V3, <ref name="pmid6105556"> (1980) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=6105556 Prospective randomised study of coronary artery bypass surgery in stable angina pectoris. Second interim report by the European Coronary Surgery Study Group.] ''Lancet'' 2 (8193):491-5. PMID: [http://pubmed.gov/6105556 6105556]</ref> <ref name="pmid331107">Murphy ML, Hultgren HN, Detre K, Thomsen J, Takaro T (1977) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=331107 Treatment of chronic stable angina. A preliminary report of survival data of the randomized Veterans Administration cooperative study.] ''N Engl J Med'' 297 (12):621-7. [http://dx.doi.org/10.1056/NEJM197709222971201DOI:10.1056/NEJM197709222971201] PMID: [http://pubmed.gov/331107 331107]</ref> <ref name="pmid4632503">Frank CW, Weinblatt E, Shapiro S (1973)[http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=4632503 Angina pectoris in men. Prognostic significance of selected medical factors.] ''Circulation'' 47 (3):509-17. PMID: [http://pubmed.gov/4632503 4632503]</ref>
:*[[Q waves]] in multiple leads,
:*[[Q waves]] in multiple leads,
:*[[R wave]] in V1 ('''a "posterior" q wave'''), <ref name="pmid14955434">BLOCK WJ, CRUMPACKER EL, DRY TJ, GAGE RP (1952) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=14955434 Prognosis of angina pectoris; observations in 6,882 cases.] ''J Am Med Assoc'' 150 (4):259-64. PMID: [http://pubmed.gov/14955434 14955434]</ref>
:*[[R wave]] in V1 ('''a "posterior" q wave'''), <ref name="pmid14955434">BLOCK WJ, CRUMPACKER EL, DRY TJ, GAGE RP (1952)[http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=14955434 Prognosis of angina pectoris; observations in 6,882 cases.] ''J Am Med Assoc'' 150 (4):259-64. PMID: [http://pubmed.gov/14955434 14955434]</ref>
:*[[Bundle branch block]]s and atrial, or
:*[[Bundle branch block]]s and atrial, or
:*Ventricular [[arrythmias]] <ref name="pmid7371129">Ruberman W, Weinblatt E, Goldberg JD, Frank CW, Shapiro S, Chaudhary BS (1980) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=7371129 Ventricular premature complexes in prognosis of angina.] ''Circulation'' 61 (6):1172-82. PMID: [http://pubmed.gov/7371129 7371129]</ref>.  
:*Ventricular [[arrythmias]] <ref name="pmid7371129">Ruberman W, Weinblatt E, Goldberg JD, Frank CW, Shapiro S, Chaudhary BS (1980)[http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=7371129 Ventricular premature complexes in prognosis of angina.] ''Circulation'' 61 (6):1172-82. PMID: [http://pubmed.gov/7371129 7371129]</ref>.  


==Chest X-ray==
==Chest X-ray==
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==Sources==
==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>
*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>


*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>
*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>


*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>
*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>


*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>
*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>


==References==
==References==

Revision as of 22:16, 23 July 2011


Chronic stable angina Microchapters

Acute Coronary Syndrome Main Page

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Overview

Historical Perspective

Classification

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Differentiating Chronic Stable Angina from Acute Coronary Syndromes

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Pretest Probability of CAD in a Patient with Angina

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [5]; Associate Editors-in-Chief: Cafer Zorkun, M.D., Ph.D. [6]; Smita Kohli, M.D.

Overview

The presence of ECG abnormalities at rest and pulmonary venous congestion on CXR are associated with reduced LVEF which remains an important prognostic factor in patients with chronic stable angina.

ECG

  • The presence of ECG abnormalities at rest puts the patient at higher risk than the absence of ECG abnormalities at rest.[1]
  • Rest ECG abnormalities that are associated with poor outcomes include:

Chest X-ray

The presence of cardiomegaly or pulmonary vascular congestion on chest X-ray is also associated with a poor prognosis.

ESC Guidelines- Clinical Evaluation and ECG for Risk Stratification (DO NOT EDIT)[7]

“

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)

”

Vote on and Suggest Revisions to the Current Guidelines

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 [7]
  • The ACC/AHA/ACP–ASIM Guidelines for the Management of Patients With Chronic Stable Angina [8]
  • TheACC/AHA 2002 Guideline Update for the Management of Patients With Chronic Stable Angina [9]
  • The 2007 Chronic Angina Focused Update of the ACC/AHA 2002 Guidelines for the Management of Patients With Chronic Stable Angina [10]

References

  1. ↑ Hammermeister KE, DeRouen TA, Dodge HT (1979) Variables predictive of survival in patients with coronary disease. Selection by univariate and multivariate analyses from the clinical, electrocardiographic, exercise, arteriographic, and quantitative angiographic evaluations.Circulation59 (3):421-30. PMID: 761323
  2. ↑ (1980) Prospective randomised study of coronary artery bypass surgery in stable angina pectoris. Second interim report by the European Coronary Surgery Study Group. Lancet 2 (8193):491-5. PMID: 6105556
  3. ↑ Murphy ML, Hultgren HN, Detre K, Thomsen J, Takaro T (1977) Treatment of chronic stable angina. A preliminary report of survival data of the randomized Veterans Administration cooperative study. N Engl J Med 297 (12):621-7. [1] PMID: 331107
  4. ↑ Frank CW, Weinblatt E, Shapiro S (1973)Angina pectoris in men. Prognostic significance of selected medical factors. Circulation 47 (3):509-17. PMID: 4632503
  5. ↑ BLOCK WJ, CRUMPACKER EL, DRY TJ, GAGE RP (1952)Prognosis of angina pectoris; observations in 6,882 cases. J Am Med Assoc 150 (4):259-64. PMID: 14955434
  6. ↑ Ruberman W, Weinblatt E, Goldberg JD, Frank CW, Shapiro S, Chaudhary BS (1980)Ventricular premature complexes in prognosis of angina. Circulation 61 (6):1172-82. PMID: 7371129
  7. ↑ 7.0 7.1 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.
  8. ↑ Gibbons RJ, Chatterjee K, Daley J, Douglas JS, Fihn SD, Gardin JM et al. (1999) 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. [2]PMID: 10351980
  9. ↑ Gibbons RJ, Abrams J, Chatterjee K, Daley J, Deedwania PC, Douglas JS et al. (2003) 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.[3] PMID:12515758
  10. ↑ Fraker TD, Fihn SD, Gibbons RJ, Abrams J, Chatterjee K, Daley J et al. (2007)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.[4] PMID:17998462


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