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Heart Disease And Angina (Chest Pain)

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Definition of Stage

Usual Treatments

Stage A

People at high risk of developing heart failure (pre-heart failure), including people with:

High blood pressure


Coronary artery disease

Metabolic syndrome

History of cardiotoxic drug therapy

History of alcohol abuse

History of rheumatic fever

Family history of cardiomyopathy

Exercise regularly.

Quit smoking.

Treat high blood pressure.

Treat lipid disorders.

Discontinue alcohol or illegal drug use.

An angiotensin converting enzyme inhibitor (ACE inhibitor) or an angiotensin II receptor blocker (ARB) is prescribed if you've had coronary artery disease or if you have diabetes, high blood pressure, or other vascular or cardiac conditions.

Beta-blockers may be prescribed if you have high blood pressure or if you've had a previous heart attack.

Stage B

People diagnosed with systolic left ventricular dysfunction but who have never had symptoms of heart failure (pre-heart failure), including people with:

Prior heart attack

Valve disease


The diagnosis is usually made when an ejection fraction of less than 40% is found during an echocardiogram test.

Treatment methods above for Stage A apply.

All patients should take an angiotensin converting enzyme inhibitor (ACE inhibitors) or angiotensin II receptor blocker (ARB).

Beta-blockers should be prescribed for patients after a heart attack.

An aldosterone inhibitor may be prescribed if the symptoms continue while on good doses of beta blockers and ACE/ARB medications.

Surgery options for coronary artery repair and valve repair or replacement (as appropriate) should be discussed.

If appropriate, surgery options should be discussed for patients who have had a heart attack.

Stage C

Patients with known systolic heart failure and current or prior symptoms. Most common symptoms include:

Shortness of breath


Reduced ability to exercise

Treatment methods above for Stage A apply.

All patients should take an angiotensin converting enzyme inhibitor (ACE inhibitors) and beta-blockers.

African-American patients may be prescribed a hydralazine/nitrate combination if symptoms persist.

Diuretics (water pills) and digoxin may be prescribed if symptoms persist.

An aldosterone inhibitor may be prescribed when symptoms remain severe with other therapies.

Restrict dietary sodium (salt)

Monitor weight

Restrict fluids (as appropriate)

Drugs that worsen the condition should be discontinued.

As appropriate, cardiac resynchronization therapy (biventricular pacemaker) may be recommended.

An implantable cardiac defibrillator (ICD) may be recommended.

Stage D

Patients with systolic heart failure and presence of advanced symptoms after receiving optimum medical care.

Treatment methods for Stages A, B ,& C apply.

Patient should be evaluated to determine if the following treatments are available options: heart transplant, ventricular assist devices, surgery options, research therapies, continuous infusion of intravenous inotropic drugs, and end-of-life (palliative or hospice) care

The symptoms in section C are the noes that normally let you and the doctors know you are in congestive heart failure, I had a VA doc put me on O2 in early June because my oxygen levels would not go higher than 88 and was normally in 84 for the hour I was there so rather than see if I had other symptoms of CHF they ordered oxygen all it did was mask the problem for a week by the time my wife took me to the ER I was in severe failure and was delirious for about 4 days on IV drips and then they had trouble getting me stabilized about the 17th they took me off the IVs and took me to a regular floor room that lasted 5 hours and I was back in ICU with new IVs hooked up where I was for another week the doctors there insist I get a bioventricular defib/pacemaker installed as soon as possible I see the VA cardiac people on Wednesday personally I hope they outsource it to Providence Heart Hospital in Columbia it would be easier on my wife and family.

There are many symptoms that need to be watched for

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