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Strongly favor this test or intervention.

The Coronary Vasomotion Disorders International Study Group (COVADIS) criteria determine whether an individual meets the diagnostic criteria for vasospastic angina through an evaluation of three key aspects: nitrate-responsive angina, transient ischemic electrocardiogram (ECG) changes, and coronary artery spasm.

The evaluator chooses one description from each of these three categories:

- **Nitrate-responsive Angina**: 
  - Rest angina, often occurring between night and early morning
  - Marked diurnal variation in exercise tolerance, where tolerance is reduced in the morning
  - Hyperventilation triggers an episode
  - Episodes are suppressed by calcium channel blockers but not by beta-blockers

- **Transient Ischemic ECG Changes** (during spontaneous episodes, observed in at least two contiguous leads):
  - ST-segment elevation of 0.1 mV or more
  - ST-segment depression of 0.1 mV or more
  - Presence of new negative U waves

- **Coronary Artery Spasm**:
  - A transient total or subtotal coronary artery occlusion with more than 90% constriction
  - Occurrence of angina and ischemic ECG changes either spontaneously or in reaction to a provocative stimulus, such as acetylcholine, ergot, or hyperventilation

For a diagnosis of vasospastic angina, the assessment requires:
- One or more aspects from nitrate-responsive angina to be true.
- One or more ECG changes to be observed.
- Both coronary artery spasm criteria to be met.

If all these checks pass—meaning there is at least one confirmed symptom from nitrate-responsive angina and transient ischemic ECG changes, alongside both indicators for coronary artery spasm—the diagnostic criteria are considered to be met. If any of these condition checks fail, the diagnostic criteria are not met.

The interpretation is straightforward: presence of all necessary criteria combinations confirms a diagnosis of vasospastic angina; otherwise, the criteria are not satisfied.

The calculator in question is the COVADIS criteria, which stands for the Coronary Vasomotion Disorders International Study Group diagnostic criteria for vasospastic angina. This calculator is specifically applicable to patients who are suspected of having vasospastic angina, a condition characterized by spasms in the coronary arteries which can cause chest pain.

The clinical utility of the COVADIS criteria is to aid in the diagnosis of vasospastic angina. It does this by considering various factors such as the patient's symptoms, the results of coronary angiography, and the response to medications like calcium channel blockers. 

There are no specific exclusion criteria for the use of the COVADIS criteria. However, it should be noted that this calculator is intended to be used by healthcare professionals and should not replace clinical judgment. It is also important to consider other potential causes of chest pain when using this calculator.

Coronary Vasomotion Disorders International Study Group diagnostic criteria for vasospastic angina (COVADIS criteria)

The Japanese Coronary Spasm Association (JCSA) risk score is a clinical tool used to estimate the risk of major cardiac events in patients with vasospastic angina. This score is based on evaluating seven clinical factors, each contributing to a cumulative risk score. Here’s how the computation is done:

- History of out-of-hospital cardiac arrest contributes 4 points if present.
- Smoking adds 2 points if the patient is a smoker.
- Angina occurring solely at rest also adds 2 points if applicable.
- Significant organic coronary artery stenosis contributes another 2 points if present.
- Multivessel spasm is scored with 2 points.
- ST-segment elevation during angina is considered with 1 point if it occurs.
- The use of beta-blockers also contributes 1 point if the patient is taking them.

Each of these factors is assessed as a yes/no (boolean) response. If a factor is present (true), the specific number of points is added to the patient's total score. The potential scores range from a minimum of 0 to a maximum of 14, giving a snapshot of the patient’s cardiac risk profile.

Interpretation of the total score is categorized into three levels of risk:
- Low risk is assigned for scores ranging from 0 to 2.
- Intermediate risk corresponds to scores between 3 and 5.
- High risk is indicated by scores of 6 or higher.

This evaluation provides a straightforward and structured approach to assessing the risk of significant cardiac events, aiding medical professionals in treatment planning and patient management.

The Japanese Coronary Spasm Association (JCSA) risk score for major cardiac events in vasospastic angina is a clinical calculator used in cardiology. This scoring system is specifically designed for patients diagnosed with vasospastic angina, a condition characterized by spasms in the coronary arteries which can lead to chest pain, arrhythmias, and myocardial infarction.

The JCSA score is used to predict the risk of major cardiac events in these patients, including cardiac death, nonfatal myocardial infarction, and hospitalization due to unstable angina. The score is calculated based on several factors including age, smoking status, hypertension, dyslipidemia, diabetes mellitus, multi-vessel spasm, and ST-segment elevation during spasm.

The clinical utility of the JCSA score lies in its ability to stratify patients according to their risk level, thereby guiding clinicians in making informed decisions about the intensity of treatment and follow-up required. 

There are no specific exclusion criteria for the use of the JCSA score, but it is primarily intended for use in patients with a confirmed diagnosis of vasospastic angina. It may not be applicable or accurate in patients with other types of angina or coronary artery disease.

Japanese Coronary Spasm Association risk score for major cardiac events in vasospastic angina (JCSA score)

The calculator categorizes the severity of heart failure using the New York Heart Association (NYHA) functional classification system. It does this by analyzing a patient's reported physical abilities related to cardiac disease and matches them to one of the four NYHA classes.

Here's the breakdown of each class:

- Class I involves patients who have cardiac disease but do not experience any limitations in physical activity. Regular activities do not cause undue fatigue, palpitation, or shortness of breath.
  
- Class II fits patients who have a slight limitation in physical activity due to cardiac disease. They feel comfortable when at rest, but ordinary physical activities might lead to fatigue, palpitation, or breathlessness.
  
- Class III describes patients with a marked limitation in physical activity. These individuals are comfortable when resting, but even less than ordinary activities cause fatigue, palpitations, breathlessness, or chest pain.
  
- Class IV covers patients who cannot engage in any physical activity without experiencing discomfort. They exhibit symptoms of heart failure even when at rest, and any physical activity worsens these symptoms.

To determine the appropriate class for a patient, the calculator compares the user’s description of their physical ability with these four established patterns. Each condition is linked specifically to one of the NYHA classes, providing a clear pathway from symptom description to classification. For example, if a patient’s physical condition matches the criteria for Class I, then the result is "Class I." This comparison method efficiently identifies the level of heart failure severity based on self-reported abilities and symptoms.

The NYHA functional classification for heart failure, or New York Heart Association Functional Classification, is a scoring system used to quantify the severity of symptoms in patients with heart failure. This classification system is applicable to patients diagnosed with heart failure and is used to assess their functional capacity and limitations during physical activity. 

The NYHA classification is divided into four classes: Class I (no symptoms and no limitation in ordinary physical activity), Class II (mild symptoms and slight limitation during ordinary activity), Class III (marked limitation in activity due to symptoms, even during less-than-ordinary activity), and Class IV (severe limitations, experiences symptoms even while at rest).

The clinical utility of this calculator is to guide treatment decisions, assess prognosis, and evaluate the effectiveness of therapeutic interventions in patients with heart failure. It is also commonly used in clinical trials to stratify patients and measure outcomes. 

There are no specific exclusion criteria for its use, but it is subjective and relies on patient self-report, so it may not be as accurate in patients with cognitive impairment or communication difficulties.

Vasospastic angina

Guidelines

Key sources