Gibbons et al listed criteria for recognizing angina in a patient with chest pain.
Patient: chest pain
Clinical findings:
(1) substernal chest pain with characteristic quality and duration
(2) pain provoked by exertion or emotional stress
(3) pain relieved by rest or nitroglycerin
|
Number of Clinical Findings
|
Diagnosis
|
|
3
|
typical angina
|
|
2
|
atypical angina
|
|
0 or 1
|
noncardiac chest pain
|
Causes of "functional" angina (increased myocardial oxygen demand or reduced oxygen delivery):
(1) hyperthyroidism
(2) hyperthermia
(3) aortic stenosis or other valvular disease
(4) uncontrolled hypertension
(5) anemia
(6) hypoxemia
(7) hyperviscosity
The probability of coronary artery disease (CAD) should be determined based on age, sex, risk factors and clinical findings (smoking, hyperlipidemia, diabetes, hypertension). Further testing is indicated if there is intermediate or high probability of CAD. For a patient with a low probability the decision to test depends on a shared decision discussion between the clinician and patient.
Indications for measuring left ventricular function in a patient with chronic stable angina:
(1) history of myocardial infarction
(2) pathologic Q waves in the ECG
(3) signs and symptoms of heart failure
(4) presence of complex ventricular arrhythmias
Exercise ECG testing should be done for a patient:
(1) with symptomatic chronic angina or significant change in the anginal pattern
(2) who can exercise
(3) who is not taking digoxin
(4) does not have confounding factors in the resting ECG - complete left bundle branch block, Wolff-Parkinson-White syndrome (pre-excitation), electronically paced ventricular rhythm, more than 1 mm of ST segment depression at rest
