Cardiovascular Medicine Book

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Angina Diagnosis

Aka: Angina Diagnosis, Chest Pain Risk of Angina
  1. See Also
    1. Chest Pain
    2. Acute Coronary Syndrome
    3. Acute Coronary Syndrome Immediate Management
  2. Indications
    1. Likelihood of Angina as cause for Chest Pain
  3. Differential Diagnosis
    1. See Chest Pain
    2. See Chest Pain Causes
  4. Determining Cardiac Chest Pain
    1. Criteria
      1. Substernal Chest Pain
      2. Exertional Chest Pain
      3. Chest Pain relieved with rest
    2. Interpretation
      1. Typical Angina: 3 criteria from above
        1. Age 30-39: 76% likelihood (intermediate) in men and 26% in women (intermediate)
        2. Age 40-49: 87% likelihood (high) in men and 55% in women (intermediate)
        3. Age 50-59: 93% likelihood (high) in men and 73% in women (intermediate)
        4. Age 60-69: 94% likelihood (high) in men and 86% in women (high)
      2. Atypical Angina: 2 criteria from above
        1. Age 30-39: 34% likelihood (intermediate) in men and 12% in women (low)
        2. Age 40-49: 51% likelihood (intermediate) in men and 22% in women (low)
        3. Age 50-59: 65% likelihood (intermediate) in men and 31% in women (intermediate)
        4. Age 60-69: 72% likelihood (intermediate) in men and 51% in women (intermediate)
      3. Non-Anginal Chest Pain: 1 criteria from above
        1. Age 30-39: 4% likelihood (low) in men and 2% in women (low)
        2. Age 40-49: 13% likelihood (intermediate) in men and 3% in women (low)
        3. Age 50-59: 20% likelihood (intermediate) in men and 7% in women (low)
        4. Age 60-69: 27% likelihood (intermediate) in men and 14% in women (intermediate)
      4. No criteria present
        1. Risk is low to very low for both men and women
    3. Application
      1. Low risk patient: Avoid stress testing (higher risk of false positives)
      2. Intermediate risk patient: Stress Testing
        1. Exercise Stress Test is first-line for most men and women
        2. Stress Imaging test if abnormal baseline EKG, prior revascularization, or Diabetes Mellitus
        3. Pharmacologic Stress Test if unable to Exercise
      3. High risk patient: Consider coronary angiogram
    4. References
      1. Based on Diamond, Forrester and CASS data
  5. Criteria: High Likelihood
    1. Known Coronary Artery Disease history
    2. Typical Anginal symptoms
      1. Men over age 60
      2. Women over age 70
    3. History of variant Angina
    4. EKG in Cardiac Ischemia
      1. Transient Electrocardiogram changes
        1. Associated with pain or hemodynamic changes
      2. ST segment increase or decrease over 1 mm
      3. Deep symmetric T-wave inversion
        1. Occurs in multiple precordial leads
  6. Criteria: Intermediate Likelihood (high likelihood features absent)
    1. Typical Anginal symptoms
      1. Men under age 60
      2. Women under age 70
    2. Diabetes Mellitus and Chest Pain
    3. Cardiac Risk Factors (over 1) and Atypical Chest Pain
      1. Pleuritic Chest Pain
      2. Chest Pain primarily in lower or mid Abdomen
      3. Chest Pain localizable with one finger
      4. Reproducible Chest Pain
        1. Exacerbated by movement or palpation of chest wall
      5. Chest Pain is constant and lasts for days
      6. Chest Pain duration only for a few seconds
      7. Chest Pain radiates into legs
    4. Extra-cardiac vascular disease
    5. EKG in Cardiac Ischemia
      1. ST depression of 0.05-1mm
      2. T Wave inversion of over 1 mm
        1. Occurs in leads with dominant R-waves
  7. Criteria: Low Likelihood
    1. Can often be discharged from ER with recheck under 72h
    2. Absence of Intermediate likelihood symptoms AND
      1. Age under 60 years old
      2. Atypical Chest Pain
        1. No pressure sensation
        2. No radiation to arm, Shoulder, neck or jaw
      3. Only one Cardiac Risk Factor (not Diabetes Mellitus)
      4. Electrocardiogram normal
        1. T-waves flat or inversion of less than 1 mm
        2. Occurs in dominant R Waves leads
  8. Exam: Red Flag signs for Acute Coronary Syndrome
    1. Chest Pain radiating into both arms
    2. New Mitral Regurgitation murmur
    3. Hypotension
    4. Pulmonary Rales
    5. New S3 Gallop rhythm
    6. New Jugular Venous Distention
  9. Management
    1. See Acute Coronary Syndrome Immediate Management
  10. Evaluation: Testing
    1. Exercise Stress Tests
      1. Test Sensitivity: 55%
      2. Test Specificity: 70%
    2. Thallium Scan
      1. Test Sensitivity: 90%
      2. Test Specificity: 70%
    3. Stress Echocardiogram
      1. Test Sensitivity: 90%
      2. Test Specificity: 86%
    4. PET Scan
      1. Test Sensitivity: 94%
      2. Test Specificity: 92%

Angina Pectoris (C0002962)

Definition (NCI) Previous or current symptoms described as chest pain or pressure, jaw pain, arm pain, or other equivalent discomfort suggestive of cardiac ischemia. (NIH Roadmap Cardiovascular Data Standards Working Group)
Definition (NCI) A disorder characterized by substernal discomfort due to insufficient myocardial oxygenation.
Definition (CHV) chest pain caused by coronary heart disease
Definition (CHV) chest pain caused by coronary heart disease
Definition (CHV) chest pain caused by coronary heart disease
Definition (CHV) chest pain caused by coronary heart disease
Definition (CHV) chest pain caused by coronary heart disease
Definition (CHV) chest pain caused by coronary heart disease
Definition (CHV) chest pain caused by coronary heart disease
Definition (CHV) chest pain caused by coronary heart disease
Definition (CHV) chest pain caused by coronary heart disease
Definition (CHV) chest pain caused by coronary heart disease
Definition (CHV) chest pain caused by coronary heart disease
Definition (CHV) chest pain caused by coronary heart disease
Definition (CHV) chest pain caused by coronary heart disease
Definition (CHV) chest pain caused by coronary heart disease
Definition (MEDLINEPLUS)

Angina is chest pain or discomfort you get when your heart muscle does not get enough blood. It may feel like pressure or a squeezing pain in your chest. It may feel like indigestion. You may also feel pain in your shoulders, arms, neck, jaw or back.

Angina is a symptom of coronary artery disease (CAD), the most common heart disease. CAD happens when a sticky substance called plaque builds up in the arteries that supply blood to the heart, reducing blood flow.

There are three types of angina: stable, unstable and variant. Unstable angina is the most dangerous. It does not follow a pattern and can happen without physical exertion. It does not go away with rest or medicine. It is a sign that you could have a heart attack soon.

Not all chest pain or discomfort is angina. If you have chest pain, you should see your health care provider.

NIH: National Heart, Lung, and Blood Institute

Definition (MSH) The symptom of paroxysmal pain consequent to MYOCARDIAL ISCHEMIA usually of distinctive character, location and radiation. It is thought to be provoked by a transient stressful situation during which the oxygen requirements of the MYOCARDIUM exceed that supplied by the CORONARY CIRCULATION.
Definition (CSP) recurring thoracic pain or discomfort which occurs when a part of the heart does not receive enough blood; usually caused by exertion or excitement.
Definition (NCI) A heart condition marked by paroxysms of chest pain due to reduced oxygen to the heart.
Concepts Sign or Symptom (T184)
MSH D000787
ICD9 413
ICD10 I20, I20.9, I20.8
SnomedCT 194835008, 17828002, 155307004, 194839002, 194830003, 194828000, 225566008, 194832006, 367416001
English Anginal pain, ANGINA, Angina Pectoris, Angor Pectoris, Stenocardia, Stenocardias, ANGINA PECTORIS, ANGINAL PAIN, ANGINAL SYNDROME, Angina pectoris syndrome, Cardiac angina syndrome, ANGINAL SYNDROMES, Angina of effort, Angina pectoris, NOS, Angina, NOS, Angina pectoris NOS, Ischaemic ht dis - angina, Ischemic ht dis - angina, Angina pectoris, unspecified, anginal pain, angina pectoris (diagnosis), angina, angor pectoris, angina pectoris, 3-12 ANGINAL SYNDROMES, Ischaemic chest pain (disorder), Angina pectoris NOS (disorder), Angina syndrome, Chest pain - cardiac, Angina NOS, Angina Pectoris [Disease/Finding], pectoris angina, Pain;angina, angina pectori, anginal syndrome, angina pectories, cardiac angina, ischemic chest pain, pain angina, anginas, Anginal discomfort, Angina, Angina pectoris, Anginal syndrome, Cardiac angina, Ischaemic heart disease - angina, Ischemic heart disease - angina, AP - Angina pectoris, Ischaemic chest pain, Ischemic chest pain, Ischemic chest pain (finding), Angina (disorder), Ischaemic heart dis with angina, Ischemic heart dis with angina, Ischemic heart disease with angina, Ischaemic heart disease with angina, stenocardia, chest; pain, ischemic, pain; chest, ischemic, syndrome; anginal, anginal; syndrome, Angina pectoris (disorder) [Ambiguous], Angina, cardiac, angina pain, Angina pectoris (disorder), Stenocardia (disorder)
Portuguese ANGINA PECTORIS, Angina, Dor anginosa, Dor torácica isquémica, Síndrome anginosa, Desconforto anginoso, DOR ANGINOSA, SINDROME ANGINOSO, Angina de peito, Angina Pectoris, Angor do Peito, Angor Pectoris, Estenocardia
German ANGINA PECTORIS, Anginabeschwerden, ischaemischer Brustschmerz, Anginasyndrom, Angina, Anginaschmerz, ANGINA PECTORIS SYNDROM, Angina pectoris, nicht naeher bezeichnet, HERZSCHMERZEN, Angina pectoris, Angor pectoris, Stenokardie
Dutch angineuze pijn, angineus ongemak, anginasyndroom, ischemische pijn op de borst, angina, ischemische pijn op borst, angineus syndroom, stenocardie, Ischemische hartziekte met angina, angineus; syndroom, borst; pijn, ischemisch, pijn; borst, ischemisch, syndroom; angineus, Angina pectoris, niet gespecificeerd, angina pectoris, Angina pectoris, Angor pectoris, Stenocardie
French Douleur angineuse, Syndrome d'angor, Douleur thoracique ischémique, Gêne angineuse, Angor, Maladie d'Heberden, Angine de poitrine, Sténocardie, Angor pectoris, ANGINE DE POITRINE, DOULEUR ANGINEUSE, SYNDROME ANGINEUX
Italian Angina, Sindrome anginosa, Dolore anginoso, Dolore toracico ischemico, Fastidio anginoso, Stenocardia, Angina pectoris
Spanish Síndrome anginoso, Dolor isquémico, Dolor isquémico del pecho, Dolor anginoso, Molestia angoroide, cardiopatía isquémica (trastorno), estenocardia (trastorno), estenocardia, Ischemic chest pain, Angina, Ischaemic chest pain, ANGINOSO, SINDROME, ANGOR, DOLOR ANGINOSO, cardiopatía isquémica, Angina pectoris NOS, angina cordis, angina de pecho (concepto no activo), angina de pecho (trastorno), angina de pecho, SAI (trastorno), angina de pecho, SAI, angina de pecho, angina pectoris, angina, angor pectoris, dolor torácico isquémico (hallazgo), dolor torácico isquémico, síndrome anginoso, Angina de pecho, angor, angor (trastorno), Estenocardia, Angina de Pecho, Angina Pectoris, Angor de Pecho
Japanese アンギナ, 狭心症性不快感, 狭心痛, 虚血性胸痛, 狭心症症候群, キョウシンショウ, キョウシンツウ, キョケツセイキョウツウ, アンギナ, キョウシンショウショウコウグン, キョウシンショウセイフカイカン, 狭心症, 胸部苦悶
Swedish Kärlkramp, ANGINA PECTORIS
Czech angina pectoris, Angina pectoris, Ischemická bolest na hrudi, Syndrom anginy pectoris, Stenokardie, Anginózní diskomfort, Anginózní bolest, stenokardie, AP
Finnish Rasitusrintakipu, RINTAKIPU/ANGINA PECTORIS
Russian STENOKARDIIA, GRUDNAIA ZHABA, ГРУДНАЯ ЖАБА, СТЕНОКАРДИЯ
Danish Angina pectoris
Norwegian HJERTEKRAMPE/ANGINA PECTORIS
Hungarian angina pectoris, Ischaemiás mellkasi fájdalom, Angina, Anginás fájdalom, Stenocardia, Angina pectoris, Angina syndroma, Ischaemiás mellkasfájdalom, Anginás discomfort
Korean 상세불명의 협심증, 협심증
Croatian ANGINA PEKTORIS
Basque BULARRALDEKO ANGINA
Hebrew teukat xaze
Polish Dusznica bolesna, Dławica piersiowa, Dławica stabilna
Sources
Derived from the NIH UMLS (Unified Medical Language System)


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