Canadian Cardiovascular Society (CCS) grading of Angina Pectoris

Canadian Cardiovascular Society (CCS) grading of Angina Pectoris

• Grade 1
  • Ordinary physical activity does no cause angina, such as walking and climbing stairs. Angina with strenuous or rapid or prolonged exertion at work or recreation
    
    
• Grade 2
  • Slight limitation of ordinary activity. Walking or climbing stairs rapidly, walking uphill, walking or stair climbing after meals, or in cold, in wind or under emotional stress, or only during the few hours after awakening. Walking more than two blocks on the level and climbing more than one flight of ordinary stairs at a normal pace and in normal conditions
    
    
• Grade 3
  • Marked limitation of ordinary physical activity. Walking one or two blocks on the level and climbing one flight of stairs in normal conditions and at normal pace
    
    
• Grade 4
  • Inability to carry out any physical activity without discomfort; angina may be present at rest. There are four sub-groups in CCS Grade 4. Groups A to D:
    
    
    • A: Admitted to hospital, becomes relatively asymptomatic with aggressive medical therapy, and may be managed on an outpatient basis
      
      
    • B: Admitted to hospital, continues to have angina despite aggressive medical therapy and cannot be safely discharged home, but does not require IV nitroglycerin
      
      
    • C: Admitted to hospital and maximal medical therapy, including IV nitroglycerin, fails to control symptoms
      
      
    • D: Patient in shock.

Reference:

• 1) Canadian Cardiovascular Society (www.ccs.ca)