Читать книгу Practical Cardiovascular Medicine - Elias B. Hanna - Страница 188

The presence of all three features defines typical (definite) angina, while two features define possible angina, and chest pain without any additional feature defines non-anginal chest pain. The combination of (1) angina features, (2) age and sex, and (3) risk factors establishes the probability of CAD (Diamond-Forrester and Duke classifications, combined in Figure 3.1).^11-13 Note that typical angina is defined by its relation to exertion, not by a description of “chest heaviness” or arm radiation.

In addition, primary ST-T changes or Q waves on the resting ECG imply a higher probability of CAD and a higher-risk CAD, even out- side unstable angina.¹³

Only 50% of women with classic angina have CAD (as opposed to ~90% of men). The WISE registry shows that ~40% of women undergoing coronary angiography for suspected myocardial ischemia have CAD; the remaining patients likely have macrovascular spasm or microvascular dysfunction without obstructive CAD. While fewer women have obstructive CAD than men, women without obstructive CAD who continue to have chest pain have a worrisome ~9% risk of death/MI at 4 years.¹⁴