Chronic Stable Angina

Abstract

March 2007

Section 1 Cardiovascular Medicine

IX Chronic Stable Angina

Paul R. Sutton, M.D., Ph.D., F.A.C.P.
Associate Professor of Medicine, University of Washington School of Medicine, and Attending Physician, University of Washington Medical Center

Stephan D. Fihn, M.D., M.P.H., F.A.C.P.
Professor of Medicine, University of Washington School of Medicine, and Director, Health Services Research and Development, VA Puget Sound Health Care System

Angina pectoris is a consequence of cardiac ischemia, which results from an imbalance between coronary blood flow and myocardial oxygen demand. Chronic stable angina refers to a pattern of chest pain or discomfort that does not change appreciably in frequency or severity over 2 months or longer and in which the episodes of pain are provoked by exertions or stresses of similar intensity. Although angina is a cardinal symptom of ischemic heart disease (IHD), myocardial infarction (MI) or sudden death is the initial presentation of IHD in as many as half of patients. The major modifiable risk factors for IHD are cigarette smoking, hyperlipidemia, hypertension, and diabetes. Other important, but immutable, risk factors are increasing age, a family history of premature coronary disease, and male sex. Patients with combinations of risk factors may be at particular risk for developing IHD. This chapter discusses the clinical manifestations of IHD and risk stratification that identify patients who are at high risk for life-threatening disease; it also discusses management strategies, including lifestyle modification, medical therapy, and coronary angiography. The tables present a system of grading severity of angina pectoris; differential diagnosis of chest pain; factors that put patients at risk for death and nonfatal MI; features of typical angina; the Framingham risk equations for patients at cardiovascular risk; the likelihood of coronary artery disease in low-risk and high-risk patients; the posttest probability of significant IHD based on noninvasive studies; survival in risk groups stratified by treadmill exercise scores; and management guidelines for patients with chronic stable angina. Algorithms provide an approach to clinical assessment of patients with chest pain and an approach to the diagnosis and management of patients with suspected IHD. This chapter contains 131 references.

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