How should I assess the severity of stable angina in a patient presenting with chest pain?

To assess the severity of stable angina in a patient presenting with chest pain, you should focus on a detailed clinical history and the impact of symptoms, while also being alert for signs of worsening or unstable angina:

• Clinical History: Take a detailed clinical history, documenting the characteristics of the pain, including its severity, duration, and frequency, as well as factors that provoke and relieve the pain ¹.
• Typicality of Pain: Assess the typicality of the chest pain. Anginal pain is defined by three features: constricting discomfort in the front of the chest, neck, shoulders, jaw, or arms; precipitated by physical exertion; and relieved by rest or glyceryl trinitrate (GTN) within about 5 minutes ¹. The presence of three features indicates typical angina, two features indicate atypical angina, and one or none indicates non-anginal chest pain ¹. The ease with which pain is provoked and the time it takes to be relieved can indicate severity.
• Impact on Quality of Life: Explore the impact of symptoms on the person's quality of life, especially if their stable angina has not responded to treatment ². This provides insight into the functional severity of their condition.
• Signs of Worsening Angina: Be aware of signs that may indicate a progression to unstable angina, which requires urgent attention. These include pain at rest (which may occur at night) or pain on minimal exertion ³. Angina that appears to be progressing rapidly despite increasing medical treatment, or persists despite optimal drug treatment (maximum therapeutic doses of two drugs) and lifestyle interventions, warrants referral to a cardiologist ³. Evidence of extensive ischaemia on an electrocardiograph (ECG) also indicates a need for specialist assessment ³.