What has happened to risk stratification with noninvasive testing?

Several new pharmacotherapies, recent insights into pathophysiology of angina, and increased recognition of the role of the diseased endothelium in sequelae of coronary artery disease merit a review of primary care issues pertinent to management of angina in the office setting.“Angina” is defined as “spasmodic, choking, or suffocative pain,”2 and although this word has been applicable to a number of organ systems and clinical disorders, its current use is generally intended to indicate angina pectoris. The first English language report of angina (1772) by the English physician Heberden described it as a strangling sensation in the breast, and indeed Heberden had noted precipitation by physical exertion. Angina pectoris has been variously known as a cordis, angor pectoris, Elsner's asthma, Heberden's asthma, Rougnon-Heberden disease, and stenocardia,7 but the only term in current common usage is angina pectoris, generally shortened to simply angina. In the discussion of the ambulatory management of angina that follows, the convention is to indicate angina as that clinical syndrome of precordial chest pain most typically induced by exercise and relieved by rest, etiologically derived from atherosclerotic disease of the coronary arteries. Unstable angina, Prinzmetal's angina, angina variants, atypical angina, angina equivalents, and other angina-related clinical entities are not the primary focus of this discussion but when pertinent are specifically differentiated by name.