II. Criteria

  1. Substernal Chest Pain
  2. Exertional Chest Pain
  3. Chest Pain relieved with rest

III. 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

IV. 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

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