Chronic stable angina physical examination: Difference between revisions

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(/* ACC / AHA Guidelines- History and Physical (DO NOT EDIT) Gibbons RJ, Chatterjee K, Daley J, et al. ACC/AHA/ACP–ASIM guidelines for the management of patients with chronic stable angina: executive summary and recommendations: a report of the A...)
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:* Palpation of the abdomen for aneurysm
:* Palpation of the abdomen for aneurysm


==ACC / AHA Guidelines- History and Physical (DO NOT EDIT)<ref name="Gibbons1"> Gibbons RJ, Chatterjee K, Daley J, et al. 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. 1999; 99: 2829–2848. PMID 10351980</ref>==
==ACC/AHA/ACP–ASIM Guidelines for the Management of Patients With Chronic Stable Angina (DO NOT EDIT)<ref name="pmid10351980">{{cite journal| author=Gibbons RJ, Chatterjee K, Daley J, Douglas JS, Fihn SD, Gardin JM et al.| title=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). | journal=Circulation | year= 1999 | volume= 99 | issue= 21 | pages= 2829-48 | pmid=10351980 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=10351980  }} </ref>==
{{cquote|
 
===Class I===
===History and Physical (DO NOT EDIT)<ref name="pmid10351980">{{cite journal| author=Gibbons RJ, Chatterjee K, Daley J, Douglas JS, Fihn SD, Gardin JM et al.| title=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). | journal=Circulation | year= 1999 | volume= 99 | issue= 21 | pages= 2829-48 | pmid=10351980 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=10351980 }} </ref>===
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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| colspan="1" style="text-align:center; background:LightGreen"|[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class I]]
 
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<nowiki>"</nowiki>'''1.''' In patients presenting with [[chest pain]], a detailed symptom history, focused physical examination, and directed [[Chronic stable angina risk stratification exercise testing|risk factor assessment]] should be performed. With this information, the clinician should estimate the [[Chronic stable angina assessing the pretest probability of coronary artery disease|probability]] of significant [[CAD]] (ie, low, intermediate, high). ''([[ACC AHA Guidelines Classification Scheme#Level of Evidence|Level of Evidence: B]])''<nowiki>"</nowiki>
|}


==References==
==References==

Revision as of 19:32, 21 November 2012

Chronic stable angina Microchapters

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Patient Information

Overview

Historical Perspective

Classification

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Chronic Stable Angina
Atypical
Walk through Angina
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Postprandial Angina
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Vasospastic Angina

Differentiating Chronic Stable Angina from Acute Coronary Syndromes

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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 asymptomatic or characteristically normal. Patients that present with left ventricular dysfunction are associated with a poorer prognosis than patients who do not present with dysfunction. All patients 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.
  • A patient may present with hypertension, a major risk factor for coronary artery disease.
  • 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
  • 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:
  • Examination of peripheral arterial pulses
  • Evaluation of retinal fundus for vascular changes
  • Screening for risk factors of coronary artery disease (CAD)
  • Stigmata of genetic dyslipidemia syndromes such as:
  • Tendon xanthomas
  • Xanthelasma
  • Corneal arcus, particularly in patients under 50 years of age.
  • Since the presence of non-coronary atherosclerotic disease increases the likelihood of the presence of coronary artery disease, a careful examination should include attention to:
  • Peripheral arterial pulses
  • Auscultation of the carotid arteries for bruits
  • Palpation of the abdomen for aneurysm

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)"

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.

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