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.
