Key Points
Î It is estimated that 1 in 3 adults in the United States (about 81 million)
has some form of cardiovascular disease, including >17 million with
ischemic heart disease and nearly 10 million with angina pectoris.
Î Among persons 60-79 years of age, approximately 25% of men and
16% of women have ischemic heart disease, and these figures rise to
37% and 23% among men and women >80 years of age, respectively.
Î Ischemic Heart Disease (IHD) is the number one cause of death in both
men and women. It was responsible for nearly 380,000 deaths in the
United States during 2010, with an age-adjusted mortality rate of 113
per 100,000 population.
Î The total estimated cost for heart disease in the US in 2010 was
$316 billion.
Î Angina pectoris is the initial manifestation of IHD in approximately
50% of patients.
Î Choices about diagnostic and therapeutic options should be made
through a process of shared decision making involving the patient
and provider, with the provider explaining information about risks,
benefits, and costs to the patient. (I-C)
Table 1. Clinical Classification of Chest Pain
Typical angina (definite) 1) Substernal chest discomfort with a characteristic
quality and duration that is:
2) provoked by exertion or emotional stress and
3) relieved by rest or nitroglycerin
Atypical angina (probable) Meets 2 of the above characteristics
Noncardiac chest pain Meets 1 or none of the typical anginal characteristics
Diagnosis
