CHRONIC STABLE ANGINA-INVESTIGATION

SUMMARY

Evaluation of a patient with chest pain is a 3-step process:

1. Determine the probability of CAD - type of chest pain (typical, atypical, nonanginal), age, gender, risk factors (DM, smoking, HTN), comorbidities (anaemia, hyperthyroidism, AS, HCM) & ECG abnormalities (Q waves and ST abnormalities).

2) Noninvasive testing for diagnosis and risk stratification - ECG (ST-T wave changes that suggest ischemia, Q waves, and LVH), exercise testing is most important in risk stratification, echo (in prior MI, pathological Q waves, heart failure, murmur).

3) Additional workup based on estimated risk. High risk - coronary angiogram; low/intermediate risk - medical therapy to improve function.

Reference(s)

Wilkinson, I., Furmedge, D. and Sinharay, R. (2017). Oxford handbook of clinical medicine. Oxford: Oxford University Press. Get it on Amazon.
Feather, A., Randall, D. and Waterhouse, M. (2020). Kumar And Clark’s Clinical Medicine. 10th ed. S.L.: Elsevier Health Sciences. Get it on Amazon.
Hannaman, R. A., Bullock, L., Hatchell, C. A., & Yoffe, M. (2016). Internal medicine review core curriculum, 2017-2018. CO Springs, CO: MedStudy.
Therapeutic Guidelines. Melbourne: Therapeutic Guidelines Limited. https://www.tg.org.au [Accessed 2021].