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Chest Pain / Angina Pectoris: Difference between revisions
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Stable angina (pectoris) is a clinical syndrome characterized by discomfort in the chest, jaw, shoulder, back, or arms, typically elicited by exertion or emotional stress and relieved | Stable angina (pectoris) is a clinical syndrome characterized by discomfort in the chest, jaw, shoulder, back, or arms, typically elicited by exertion or emotional stress and relieved | ||
by rest or nitroglycerin. It can be attributed to myocardial ischemia which is most commonly caused by atherosclerotic coronary artery disease or aortic valve stenosis. | by rest or nitroglycerin. It can be attributed to myocardial ischemia which is most commonly caused by atherosclerotic coronary artery disease or aortic valve stenosis. | ||
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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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| valign="top" align="left" | Typical angina (definite) | |valign="top" align="left"|Typical angina (definite) | ||
|Meets three of the following characteristics: | |||
* Substernal chest discomfort of characteristic quality and duration | *Substernal chest discomfort of characteristic quality and duration | ||
* Provoked by exertion or emotional stress | *Provoked by exertion or emotional stress | ||
* Relieved by rest and/or GTN | *Relieved by rest and/or GTN | ||
|- | |- | ||
| valign="top | | valign="top"|Atypical angina (probable) | ||
|Meets two of these characteristics | |||
|- | |- | ||
| valign="top | | valign="top"|Non-cardiac chest pain | ||
|Meets one or none of the characteristics | |||
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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 | 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 | ||
[[File:Figure_1_-_algorithm_for_the_initial_evaluation_of_patients_with_clinical_symptoms_of_angina.png|thumb|right|Figure 1. Algorithm for the initial evaluation of patients with clinical symptoms of angina]] | [[File:Figure_1_-_algorithm_for_the_initial_evaluation_of_patients_with_clinical_symptoms_of_angina.png|thumb|right|400px|Figure 1. Algorithm for the initial evaluation of patients with clinical symptoms of angina]] | ||
==Coronoary Angiography:== | ==Coronoary Angiography:== | ||