The AHA Guidelines and Scientific Statements Handbook

The AHA Guidelines and Scientifi c Statements Handbook

oxygen consumption) and subsequent relief with
rest or NTG (Table 1.2).
The severity of angina pectoris is customarily
described using the Canadian Cardiovascular Society
Classifi cation System (Table 1.3).

Demographics of angina pectoris

Coronary artery disease, the principal cause of
angina pectoris, is thought to be present in 13,200,
American adults, about half of whom (6,500,000 or
3.8% of the population) have angina pectoris or
chest pain [4]. The incidence of stable angina is
about 400,000 persons per year and there are an
estimated 63,000 hospital discharges per year (2003)
[4]. The annual mortality rate is hard to assess in the
US since angina pectoris is rarely listed on death
certifi cates as the cause of death. Data from the
European Society of Cardiology estimates the annual

mortality rate ranges from 0.9–1.4 % and the annual

incidence of non-fatal MI ranges from 0.5–2.6% [3].

Only about 20% of cardiac events are preceded by

long-standing angina [4].

Table 1.1 Conditions provoking or exacerbating ischemia

Increased oxygen demand Decreased oxygen supply

Noncardiac
Hyperthermia
Hyperthyroidism
Sympathomimetic toxicity (e.g., cocaine use)
Hypertension
Anxiety
Arteriovenous fi stulae

Cardiac
Hypertrophic cardiomyopathy
Aortic stenosis
Dilated cardiomyopathy
Tachycardia
Ventricular
Supraventricular

Noncardiac

Anemia

Hypoxemia

Pneumonia

Asthma

Chronic obstructive pulmonary disease

Pulmonary hypertension

Interstitial pulmonary fi brosis

Obstructive sleep apnea

Sickle cell disease

Sympathomimetic toxicity (e.g., cocaine use)

Hyperviscosity

Polycythemia

Leukemia

Thrombocytosis

Hypergammaglobulinemia

Cardiac

Aortic stenosis

Hypertrophic cardiomyopathy

Table 1.2 Clinical classifi cation of chest pain

Typical angina (defi nite)

(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 NTG.

Atypical angina (probable)

Meets two of the above characteristics.

Noncardiac chest pain

Meets one or none of the typical anginal characteristics.

Modifi ed from Diamond, IACC, 1983.