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

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(/* ESC Guidelines- Clinical Evaluation and ECG for Risk Stratification (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 ...)
 
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__NOTOC__
{{Chronic stable angina}}
{{Chronic stable angina}}
{{CMG}}; '''Associate Editor(s)-in-Chief:''' {{CZ}}; Smita Kohli, M.D.; [[Lakshmi Gopalakrishnan|Lakshmi Gopalakrishnan, M.B.B.S.]]
{{CMG}}; '''Associate Editor(s)-in-Chief:''' {{CZ}}; Smita Kohli, M.D.; [[Lakshmi Gopalakrishnan|Lakshmi Gopalakrishnan, M.B.B.S.]]
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*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/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>
:*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==
The presence of [[cardiomegaly]] or pulmonary vascular congestion on chest X-ray is also associated with a poor prognosis.
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) <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=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16735367  }} </ref>==
==ESC Guidelines- Clinical Evaluation and ECG for Risk Stratification (DO NOT EDIT)<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=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16735367  }} </ref>==
{{cquote|
===[[European society of cardiology#Classes of Recommendations|Class I]]===
'''1.''' Detailed [[Chronic stable angina symptoms|clinical history]] and [[Physical examination|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. ''([[European society of cardiology#Level of Evidence|Level of Evidence: B]])''


'''2.''' Resting [[ECG]] in all patients. ''([[European society of cardiology#Level of Evidence|Level of Evidence: B]])''}}
{|class="wikitable"
|-
| colspan="1" style="text-align:center; background:LightGreen"|[[European society of cardiology#Classes of Recommendations|Class I]]


==Vote on and Suggest Revisions to the Current Guidelines==
|-
*[[The Living Guidelines: Chronic Stable Angina Pectoris | The Chronic Stable Angina Living Guidelines: Vote on current recommendations and suggest revisions to the guidelines]]
| bgcolor="LightGreen"|<nowiki>"</nowiki>'''1.''' Detailed [[Chronic stable angina symptoms|clinical history]] and [[Physical examination|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. ''([[European society of cardiology#Level of Evidence|Level of Evidence: B]])''<nowiki>"</nowiki>
 
|-
==Guidelines Resources==
| bgcolor="LightGreen"|<nowiki>"</nowiki>'''2.''' Resting [[ECG]] in all patients. ''([[European society of cardiology#Level of Evidence|Level of Evidence: B]])''<nowiki>"</nowiki>
*[http://www.escardio.org/guidelines-surveys/esc-guidelines/GuidelinesDocuments/guidelines-angina-FT.pdf 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>
|}
 
*[http://circ.ahajournals.org/content/99/21/2829.full.pdf 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>
 
*[http://content.onlinejacc.org/cgi/reprint/41/1/159.pdf The ACC/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>
 
*[http://content.onlinejacc.org/cgi/reprint/50/23/2264.pdf 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==
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Latest revision as of 16:36, 29 January 2013

Chronic stable angina Microchapters

Acute Coronary Syndrome Main Page

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Classification

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Chronic Stable Angina
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Differentiating Chronic Stable Angina from Acute Coronary Syndromes

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [2]; Associate Editor(s)-in-Chief: Cafer Zorkun, M.D., Ph.D. [3]; Smita Kohli, M.D.; Lakshmi Gopalakrishnan, M.B.B.S.

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)"

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. 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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