Chronic stable angina physical examination

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor-In-Chief: Cafer Zorkun, M.D., Ph.D. [2]

Overview

Among patients with chronic stable angina, the physical examination may be normal, but the presence of left ventricular dysfunction is associated with a poorer prognosis, and the patient should be examined carefully for the presence of rales and other signs of heart failure.

Physical examination

The physical examination may be entirely normal in patients with stable angina pectoris, although hypertension, a major risk factor for coronary artery disease (CAD) may be present.

Examination of the cardiovascular system during ischemia, however, may reveal elevated blood pressure, transient third heart sound (S3 - ventricular filling sound) and fourth heart sound (S4 - atrial filling sound), a sustained outward (dyskinetic) systolic movement of the left ventricular apex, a murmur of mitral regurgitation, and paradoxical splitting of the second heard sound bibasilar lung crackles and chest wall heave.

The physical examination should also focus on the detection of abnormal findings which might be suggestive of left and right heart failure and of non ischemic causes of angina pectoris (valvular aortic stenosis, cardiomyopathy and pulmonary hypertension).

Cardiovascular assessment should also include the examination of peripheral arterial pulses, evaluation of retinal fundus for vascular changes and screening for risk factors of coronary artery disease (CAD), stigmata of genetic dyslipidemia syndromes such as tendon xanthomas, xanthelasma, and corneal arcus, particularly in patients under 50 years of age.

Since the presence of noncoronary atherosclerotic disease increases the likelihood of the presence of coronary artery disease, a careful examination of peripheral arterial pulses, auscultation of the carotid arteries for bruits and palpation of the abdomen for aneurysm are important in clinical evaluation.

ACC / AHA Guidelines- History and Physical (DO NOT EDIT)

“

Class I 1. In patients presenting with chest pain, a detailed symptom history, focused physical examination, and directed risk factor assessment should be performed. With this information, the clinician should estimate the probability of significant CAD (ie, low, intermediate, high). (Level of Evidence: B)

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