ACC GUIDELINES Bundle

Stable Ischemic Heart Disease

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1 Diagnosis Figure 1. Spectrum of Ischemic Heart Disease (IHD) Noncardiac Chest Pain Stable Angina or Low- Risk UA a (SIHD; PCI/CABG) Acute Coronary Syndromes (UA/NSTEMI; STEMI; PCI/CABG) Asymptomatic (SIHD) Patients with Known IHD Asymptomatic Persons Without Known IHD New Onset Chest Pain (SIHD; UA/NSTEMI; STEMI) Noninvasive Testing Sudden Cardiac Death (VA-SCD) Table 2. Three Principal Presentations of Unstable Angina (UA) Rest angina Angina occurring at rest and usually prolonged >20 min, occurring within 1 wk of presentation New-onset angina Angina of at least CCS Class III severity with onset within 2 mo of initial presentation Increasing angina Previously diagnosed angina that is distinctly more frequent, longer in duration, or lower in threshold (ie, increased by ≥1 CCS class within 2 mo of initial presentation to ≥CCS Class III severity) e Canadian Cardiovascular Society (CCS) grading of angina pectoris Class I – Angina only during strenuous or prolonged physical activity Class II – Slight limitation, with angina only during vigorous physical activity Class III – Symptoms with everyday living activities, ie, moderate limitation Class IV – Inability to perform any activity without angina or angina at rest, ie, severe limitation a Features of low risk unstable angina: • Age ≥70 y • Exertional pain lasting <20 min • Pain not rapidly accelerating • Normal or unchanged ECG • No elevation of cardiac markers ACCF/AHA guidelines relevant to the spectrum of IHD are in parentheses.

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