CHART 408

Term

Angina Classifications and Descriptors

Descriptor(s)/Definitions 1. Central/substernal chest or left arm pain, discomfort, pressure, tightness, heaviness 2. Provoked by exertion or emotional stress 3. Relieved by nitroglycerin 1. Jaw, neck, ear, arm, back 2. Weakness, dizziness, light-headedness, loss of consciousness, unexplained fatigue, diaphoresis 3. New or worsening dyspnea on exertion 4. Nausea/vomiting unexplained indigestion, belching, epigastric pain or discomfort 5. Burning, aching, cramping Occurs at night usually during sleep. May be relieved by sitting upright. Commonly associated with left venticular dysfunction. Angina while lying down. Prior to or after infarction. Preinfarction angina may precondition the heart for episodes of subsequent infarction, resulting in a reduction in infarct size. Postinfarction angina denotes increased risk for death or recurrent myocardial infarction (MI). Angina that comes and goes. Denotes instability, thrombus formation, and dissolution. Angina produced only with strenuous, rapid, or prolonged exertion. Patient is able to engage in ordinary physical activity such as walking and climbing stairs. Angina that occurs with mild exertion such as climbing stairs rapidly; walking uphill, in the cold, against the wind; walking or stair-climbing after a meal. Angina that occurs under emotional stress or in the first few hours after awakening. Results in slight limitation of ordinary activity. Angina that occurs during ordinary physical activities such as walking at a normal pace 12 blocks on level ground or climbing a flight of stairs under normal conditions. Results in marked limitation of ordinary physical activity. Angina at rest. Results in inability to carry on any physical activity without discomfort.

Typical angina, three key characteristics

Atypical angina or ischemic equivalents, any two of the characteristics for typical angina

Nocturnal angina Decubitus angina Preinfarction, postinfarction angina

Recurring/stuttering angina Class I angina Class II angina

Canadian Cardiovascular Society Classification for Angina Pectoris

Class III angina

Class IV angina

Source: Braunwald, E., Antman, E. M., Beasley, J. W., et al. (2002). ACC/AHA 2002 guideline update for the management of patients with unstable angina and non-ST-segment elevation myocardial infarction: A report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee on the Management of Patient with Unstable Angina). Journal of the American College of Cardiology, 40, 13661370. Retrieved July 15, 2008, from http://www.acc.org/clinical/guidelines/unstable/unstable.pdf. Retrieved July 15, 2008, from http://www.acc.org/ qualityandscience/clinical/guidelines/unstable/appendix2.htm.