Typical angina is present when all three of the following characteristics are met:
- Retrosternal symptoms/pain of short duration.
- Triggered by physical or psychological stress
- Decrease at rest and/or within a few minutes after nitrate application
If only two of these three characteristics are met, it is called “atypical angina“. If only one or none of these three points apply, one speaks of non-anginal thoracic symptoms.Stable angina pectoris is divided into different degrees of severity using the CCS classification (classification of the Canadian Cardiovascular Society).
Definition:Thoracic pain (chest pain) reproducible by physical or mental exertion that resolves at rest or after administration of nitroglycerin.
Canadian Cardiovascular Society (CCS): staging of stable angina pectoris.
| CCS stage | Definition |
| 0 | Silent ischemia without any symptoms (= no restriction of physical activity)Angina pectoris only with severe, rapid or sustained exertion |
| I | Symptomatology only with severe physical exertion (= mild limitation of physical activity)Angina pectoris when walking or climbing stairs at increased speed or after meals,walking more than 100 m or climbing stairs more than 1 floor at normal speedwalking uphill, cold, emotional stress |
| II | Minor discomfort with normal physical activity (= marked limitation of physical activity)Angina pectoris on walking less than 100 m or after climbing stairs of 1 floor at a normal speed |
| III | Angina pectoris even with mild physical exertion or already at rest |
| IV | Angina pectoris on any physical exertion or already at rest |
Classification of unstable angina (UA)
| Severity | Clinical situation | ||
| Class A | Class B | Class C | |
| Class I: new-onset severe or worsening angina pectoris (AP), no resting AP. | IA | IB | IC |
| Class II: resting AP in the past month but not in the past 48 h (subacute AP). | IIA | IIB | IIC |
| Class III: resting AP within the past 48 h (acute resting AP). | IIIA | IIIC | |
Legend
- Class A: patients with an extracardiac cause (cause located outside the heart/secondary angina, AP).
- Class B: patients without an extracardiac cause (primary unstable AP).
- Class C: patients 2 weeks after myocardial infarction (postinfarction AP).