Dr Kola Tytler MBBS CertHE MBA MRCGPClinical Lead • iatroX
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 NICE CG95.
- 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 NICE CG95. The presence of three features indicates typical angina, two features indicate atypical angina, and one or none indicates non-anginal chest pain NICE CG95. 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 NICE CG126. 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 NICE CKS. 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 NICE CKS. Evidence of extensive ischaemia on an electrocardiograph (ECG) also indicates a need for specialist assessment NICE CKS.