10
Diagnosis
Clinical Evaluation in the Initial Diagnosis of SIHD in
Patients With Chest Pain
Î Patients with chest pain should receive a thorough history and
physical examination to assess the probability of IHD before additional
testing. (I-C)
Î Patients who present with acute angina should be categorized as
stable or unstable. Patients with unstable angina (UA) should be
further categorized as being at high, moderate, or low risk. (I-C)
Î A resting electrocardiogram (ECG) is recommended in patients
without an obvious, noncardiac cause of chest pain (I-B)
Figure 5. Revascularization to Improve Survival of Patients
with SIHD
Noninvasive testing suggests
high-risk coronary lesion(s)
from Figure 2
Perform coronary
angiography
YES
Potential revascularization
procedure warranted based on
assessment of coexisting cardiac
and noncardiac factors and
patient preferences?
Heart Team concludes that
anatomy and clinical factors
indicate revascularization may
improve survival (Table 12)
Determine optimal method of
revascularization based upon
patient preferences, anatomy, other
clinical factors, and local resources
and expertise (Table 12)
YES
Guideline-Directed Medical erapy
continued in all patients
Continued Guideline-
Directed Medical
erapy with
ongoing patient
education
Go to Figure 2
NO
