Chapter 43: The Evaluation and Management of Stable Ischemic Heart Disease
A 65-year-old man with a history of obstructive coronary artery disease (CAD) is evaluated in your clinic. He complains that he develops chest pain walking approximately one city block and climbing one flight of stairs. Which of the following Canadian Cardiovascular Society (CCS) angina classes best describes the patient’s symptoms?
E. None of the above are correct
The answer is C. (Hurst’s The Heart, 14th Edition, Chap. 43) Canadian Cardiovascular Society (CCS) angina classification is described in Table 43-1. This patient’s symptoms are most consistent with class III (option C).
Table 43-1. The Canadian Cardiovascular Society Angina Scale
|I ||II ||III ||IV |
Ordinary physical activity does not cause angina including:
Walking and climbing stairs
Slight limitation of ordinary activity including:
Walking stairs rapidly
Stair climbing after meals
|Marked limitation of ordinary physical activity. ||Inability to perform any physical activity without discomfort. |
Only with strenuous, rapid, or prolonged exertion at work or recreation
A few hours after awakening
Walking > 2 city blocks (level ground)
Walking 1 flight of ordinary stairs at a normal pace
Walking ≤ 1 city block (level ground)
Climbing one flight of stairs under normal conditions and at a normal pace
With minimal activity
May be present at rest
All of the following are criteria for defining vulnerable plaque except:
A. Active inflammation (eg, monocyte, macrophage, ± T-cell infiltration)
B. Thin cap with large lipid core
C. Endothelial denudation with superficial platelet aggregation
E. Luminal stenosis > 60%
The answer is E. (Hurst’s The Heart, 14th Edition, Chap. 43) Major criteria for the defining vulnerable plaque include options A through D.1 Additionally, luminal stenosis > 90% is also a major criterion. Minor criteria include: superficial calcified nodule, glistening yellow appearance (pathologic diagnosis), intraplaque hemorrhage, outward remodeling, and endothelial dysfunction.
A 64-year-old woman presents to your clinic with progressive exertional chest pressure over the past several months. All of the following are advantages of stress ...