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Ischemic heart disease is the leading cause of death among adults in the U.S., accounting for more than 500,000 deaths annually. Atherosclerotic disease of the epicardial coronary arteries—termed coronary artery disease, or CAD—accounts for the vast majority of patients with ischemic heart disease. The predominant symptom of CAD is chest pain, and concern over potential CAD and myocardial ischemia contributes to the >8 million visits each year to U.S. EDs. In a typical adult ED population with acute chest pain, about 15% of patients will have an acute coronary syndrome (ACS). An consists of unstable angina and acute myocardial infarction (AMI). Of patients with an ACS, approximately one third have an AMI, and the remainder have unstable angina.

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The Canadian Cardiovascular Society has developed three schemes for categorizing angina. The first two categorize angina (Table 53-0.1) and unstable angina (Table 53-0.2).1 Both assume a diagnosis of ischemic heart disease but are not applicable to the ED when patients present with symptoms that may or may not be due to ischemic heart disease. The third categorization scheme assesses the short-term risk for patients with unstable angina (Table 53-1).

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Table Graphic Jump Location
Table 53-0.1 Canadian Cardiovascular Society Classification of Angina 
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Table Graphic Jump Location
Table 53-0.2 Principal Presentations of Unstable Angina 

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