Algorithm for Initial Evaluation of Patients with Stable Chest Pain
(Modified from AHCPR Guidelines)

A. Classify the chest pain

1. definite angina

2. probably angina

3. probably not angina or uncertain

4. not angina

B. ASSESS RISK FACTORS

1. history of coronary artery disease and/or myocardial infarction

2. age

3. gender

4. cigarette smoking

5. diabetes mellitus

6. systemic arterial hypertension

7. family history for premature coronary artery disease

8. hypercholesterolemia

C. PERFORM A PHYSICAL EXAMINATION

1. elevated blood pressure

2. gallops

3. abnormal heart sounds

4. murmurs

5. evidence of atherosclerosis

D. PERFORM AN ECG

Perform an ECG as an objective addition to the database.

E. COMPLETE A PROBABILITY OF DISEASE STATEMENT

High chance of CAD �	Intermediate chance of CAD �	Low chance of CAD �
Any of the following:	Absence of high chance features and any of the following:	Absence of high or intermediate chance features but may have:
hx of CAD or diabetes or extracardiac atherosclerosis	definite angina: males <60, females<70	chest pain probably not angina or uncertain
definite angina: male>60, female>70	probable angina: males >60, females >70	one risk factor other than diabetes
transient hemodynamic or ECG changes during pain	chest pain probably not angina or uncertain and 2 or 3 risk factors other than diabetes	mild T wave changes in R dominant leads
variant angina	extracardiac atherosclerosis	normal ECG
ST segment deviation >1 mm	minimal ST depression or T wave inversions in dominant R wave leads
marked T wave inversion in multiple precordial leads

September 7, 1998; revised September 6, 2001