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Chest Pain / Angina Pectoris: Difference between revisions
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Depending on the characteristics, chest pain can be identified as typical angina, atypical angina or non-cardiac chest pain, see Table 1. | Depending on the characteristics, chest pain can be identified as typical angina, atypical angina or non-cardiac chest pain, see Table 1. | ||
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! align="center" colspan="2" | Table 1. Clinical classification of chest pain <Cite>REFNAME17</Cite> | ! align="center" colspan="2" | Table 1. Clinical classification of chest pain <Cite>REFNAME17</Cite> | ||
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! align="left" colspan = "7" | Table 2. Clinical pre-test probabilities<sup>a</sup> in patients with stable chest pain symptoms. <Cite>REFNAME20</Cite> | ! align="left" colspan = "7" | Table 2. Clinical pre-test probabilities <sup>a</sup> in patients with stable chest pain symptoms. <Cite>REFNAME20</Cite> | ||
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The severity of complaints can be classified according to the Canadian Cardiovascular Society as shown in Table 3 | The severity of complaints can be classified according to the Canadian Cardiovascular Society as shown in Table 3 | ||
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! colspan="2" | Table 3. Classification of angina severity according to the Canadian Cardiovascular Society | ! colspan="2" | Table 3. Classification of angina severity according to the Canadian Cardiovascular Society | ||
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! width="100"| ''Class'' | |||
| ''Level of Symptoms'' | |||
|- | |- | ||
! valign="top"| Class I | |||
| 'Ordinary activity does not cause angina' | |||
Angina with strenuous or rapid or prolonged exertion only | Angina with strenuous or rapid or prolonged exertion only | ||
|- | |- | ||
! valign="top"| Class II | |||
| 'Slight limitation of ordinary activity' | |||
Angina on walking or climbing stairs rapidly, walking uphill or exertion after meals, in cold weather, when under emotional stress, or only during the first few hours after awakening | Angina on walking or climbing stairs rapidly, walking uphill or exertion after meals, in cold weather, when under emotional stress, or only during the first few hours after awakening | ||
|- | |- | ||
! valign="top"| Class III | |||
| 'Marked limitation of ordinary physical activity' | |||
Angina on walking one or two blocks on the level or one flight of stairs at a normal pace under normal conditions | Angina on walking one or two blocks on the level or one flight of stairs at a normal pace under normal conditions | ||
|- | |- | ||
! valign="top"| Class IV | |||
| 'Inability to carry out physical activity without discomfort' or 'angina at rest' | |||
|} | |} | ||
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#Magnetic Resonance Imaging can be done with vasodilatory adenosine or stimulating dobutamine to detect wall motion abnormalities induced by ischemia during pharmacological stress. <Cite>REFNAME14</Cite> | #Magnetic Resonance Imaging can be done with vasodilatory adenosine or stimulating dobutamine to detect wall motion abnormalities induced by ischemia during pharmacological stress. <Cite>REFNAME14</Cite> | ||
The findings on stress testing can be used to determine the choice between medical therapy only or medical therapy and invasive assessment of the coronary anatomy in patients with stable angina. Coronary angiography is recommended based upon the severity of symptoms, likelihood of ischemic disease, and risk of the patient for subsequent complications including mortality based on risk scores. <Cite>REFNAME15</Cite> For the algorithm for the initial evaluation of patients with clinical symptoms of angina | The findings on stress testing can be used to determine the choice between medical therapy only or medical therapy and invasive assessment of the coronary anatomy in patients with stable angina. Coronary angiography is recommended based upon the severity of symptoms, likelihood of ischemic disease, and risk of the patient for subsequent complications including mortality based on risk scores. <Cite>REFNAME15</Cite> For the algorithm for the initial evaluation of patients with clinical symptoms of angina see Figure 1. | ||
==Coronoary Angiography== | ==Coronoary Angiography== | ||