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The American College of Cardiology, the American Heart Association, and the American College of Physicians-American Society of Internal Medicine have jointly issued a guideline for the management of chronic stable angina.1
The guideline’s recommendations are divided arbitrarily into four sections: diagnosis, risk stratification, treatment, and follow-up. For patients presenting with chest pain, the guideline recommends a "detailed symptom history, focused physical examination, and directed risk factor assessment." Then, based on findings, the clinician needs to estimate the probability of significant coronary artery disease — low, intermediate, or high.
Patients with angina may also need hemoglobin, fasting glucose, and fasting lipid panel tests. Resting EKG is indicated in patients without an obvious noncardiac cause of chest pain. It would be particularly useful during an episode of chest pain. Chest X-ray is recommended for patients with signs or symptoms of congestive heart failure, valvular heart disease, pericardial disease, or aortic dissection/aneurysm. The guideline also outlines cases in which exercise EKG testing and invasive testing might be warranted.
Easy to remember
The authors offer the following mnemonic for the 10 most important treatment elements of stable angina management:
A — Aspirin and anti-anginal therapy
B — Beta-blocker and blood pressure
C — Cigarettes and cholesterol
D — Diet and diabetes
E — Education and exercise.
The authors also call attention to lipid-lowering agents as a means of reducing risk of infarction or death in this patient population.
[Editor’s note: This document is available on the Web sites of the American College of Cardiology (www.acc.org) and the American Heart Association (www.americanheart.org). A single reprint of the executive summary and recommendations is available by calling (800) 242-8721 or writing the American Heart Association, 7272 Greenville Ave., Dallas, TX 75231-4596. Ask for reprint No. 71-0167. To obtain a reprint of the full text published in the June 1999 issue of the Journal of the American College of Cardiology, ask for reprint No. 71-0166. To purchase up to 999 reprints, call (800) 611-6083 or fax (413) 665-2671; 1,000 or more copies, call (214) 706-1466, fax (214) 691-6342.]
1. Gibbons RJ, Chatterjee K, Daley J, et al. ACC/AHA/ ACP-ASIM guidelines for the management of patients with chronic stable angina. Executive summary and recommendations: A report of the American College Of Cardiology/ American Heart Association Task Force On Practice Guidelines (Committee on management of patients with chronic stable angina). Circulation 1999; 99:2,829-2,848.