Chronic stable angina history and symptoms: Difference between revisions

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(/* ESC Guidelines- Clinical Evaluation (DO NOT EDIT) {{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 ...)
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* Substernal [[chest pain]].
* Substernal [[chest pain]].
* Pain provocated by exertion and/or emotional stress.
* Pain provocated by exertion and/or emotional stress.
* Relieved with rest and /or [[nitroglycerin]].
* Relieved with rest and/or [[nitroglycerin]].


Typical angina - All the three features.
Typical angina - All the three features.

Revision as of 15:47, 18 January 2013

Chronic stable angina Microchapters

Acute Coronary Syndrome Main Page

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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

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Coronary Angiography

Treatment

Medical Therapy

Revascularization

PCI
CABG
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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

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Guidelines for Asymptomatic Patients

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

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Chronic stable angina history and symptoms On the Web

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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 describe 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:
  • 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?

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, 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.
  • 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]

History and Physical (DO NOT EDIT)[1]

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)"

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. 1.0 1.1 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. PMID 10351980.
  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.


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