GPAtlas🧭 When to suspect
Suspect stable angina in a patient with chest pain or discomfort that is typically described as constricting, dull, or heavy. The pain is usually retrosternal and may radiate to the neck, jaw, shoulders, or arms. It is characteristically precipitated by physical exertion or emotional stress and relieved within about 5 minutes by rest or glyceryl trinitrate (GTN).
The key diagnostic skill in primary care is to grade the pain against three characteristic features, because this drives whether and how to investigate:
• Constricting discomfort in the front of the chest, neck, shoulders, jaw, or arms.
• Precipitated by physical exertion.
• Relieved by rest or GTN within about 5 minutes.
| Features present | Classification | Interpretation |
|---|---|---|
| All 3 features | Typical angina | High likelihood of coronary artery disease – investigate |
| 2 of 3 features | Atypical angina | Investigate for coronary artery disease |
| 1 or none | Non-anginal chest pain | Most need no further cardiac testing – consider other causes |
The pre-test probability percentage score is no longer used; classification rests on the three features above together with clinical judgement. Raise suspicion in those with cardiovascular risk factors – smoking, hypertension, diabetes, hyperlipidaemia – and a family history of premature cardiovascular disease.
Source: NICE CG95
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