angina pectoris
Enable an AI agent to recognise and describe angina pectoris, track its symptom pattern and diagnostic uncertainty, and identify when clinician assessment or an established escalation pathway is needed.
Research draft, second pass
A second pass drafted this model: the structure a model of this thing needs, and what is known about it in the world. The line under this one says how the second half was obtained - researched against sources, or recalled without web access, in which case nothing here was read anywhere and every claim is a lead to verify. Unreviewed either way.
recalled by Codex without web access - no source was read
Researched by: Codex
Purpose and description
Enable an AI agent to recognise and describe angina pectoris, track its symptom pattern and diagnostic uncertainty, and identify when clinician assessment or an established escalation pathway is needed.
Angina pectoris is a clinical syndrome of transient chest discomfort or equivalent symptoms caused by myocardial ischemia, typically reflecting an imbalance between myocardial oxygen supply and demand.
It can be Build an episode history that preserves patient descriptions, timing and information gaps.; Compare current symptoms with an explicitly dated baseline and flag material changes.; Assemble evidence for clinician review while separating symptoms, test observations and diagnostic interpretations.; Link the syndrome to independently maintained coronary disease or mechanism models.; Track symptom burden alongside activity exposure and documented treatment changes.; Identify when a documented escalation rule applies and record the resulting handoff..
Distinguishing features
Angina requires a symptom syndrome attributed to myocardial ischaemia; a coronary lesion without symptoms does not by itself establish angina.
Location, quality, radiation, triggers, duration and relief contribute to recognition, but no single symptom feature independently establishes or excludes angina.
Angina and myocardial infarction are not synonyms: an anginal presentation does not itself establish whether acute myocardial injury has occurred.
Absence of obstructive disease in major coronary arteries does not by itself exclude an anginal syndrome; the model must permit investigation of other coronary mechanisms.
A previously reproducible exertional pattern and new, worsening or rest symptoms must remain distinguishable rather than being collapsed into one stable label.
Scope
+ Chest discomfort and associated symptoms considered potentially anginal, with explicit attribution and uncertainty
+ Individual episodes and changes in their frequency, duration, triggers and relief
+ Clinical classification of angina patterns and suspected mechanisms
+ Evidence supporting or challenging an ischaemic explanation
+ Functional limitations, documented care plans and escalation status
- Coronary atherosclerosis and coronary anatomy as independently modelled diseases or structures
- Myocardial infarction and other acute coronary syndromes as complete diagnostic and treatment models
- Non-ischaemic causes of chest discomfort as independently modelled conditions
- Silent myocardial ischaemia without an anginal symptom syndrome
- Drug prescribing, revascularisation procedures and rehabilitation programme design
Characteristics
- Anginal attribution
- Suspected, clinician-established, disputed, alternative explanation favoured, unresolved; record assessor and date Separates observed symptoms from the clinical interpretation assigned to them.
- Discomfort phenotype
- Reported location, quality, radiation and associated symptoms, preserving the person's wording Supports comparison between episodes without reducing angina to the word pain.
- Episode duration
- Seconds or minutes per episode; approximate range and unknown permitted Helps characterise the presentation and detect changes from the person's established pattern.
- Episode frequency
- Episodes per stated observation period, with activity exposure and recording completeness A lower episode count may reflect reduced activity rather than improvement.
- Provocation threshold
- Specific activity and workload, emotional stress, cold exposure, other reported trigger, rest or unknown Records reproducibility and whether symptoms occur at progressively lower workloads.
- Relief pattern
- Rest, documented prescribed intervention, spontaneous resolution, no relief or unknown; include elapsed time Describes episode behaviour without treating relief as diagnostic proof.
- Clinical pattern
- Documented stable pattern, new onset, worsening pattern, rest symptoms, mixed or unclassified Makes changes relevant to reassessment visible without automatically assigning an acute diagnosis.
- Attributed mechanism
- Links to assessed obstructive coronary disease, vasospastic mechanism, microvascular dysfunction, mixed mechanism or unresolved mechanism Keeps symptoms distinct from their causes while allowing more than one contributing mechanism.
- Functional burden
- Named assessment instrument and score, or explicitly described activity limitations Captures consequences that episode counts alone miss.
- Assessment disposition
- Not assessed, assessment pending, urgent escalation initiated, under evaluation or follow-up plan documented Prevents incomplete evaluation from being represented as established reassurance.
Also called
Where this came from
wikidata · CC0 1.0
Drafted structure
Bundle to layer to finding to question, as the second pass will find it: 5 bundles · 9 layers · 17 findings · 26 questions.
Anginal symptom identity Represent what was experienced and why it is being considered angina.
The model must distinguish a symptom report from an established ischaemic attribution.
Episode phenotype
Describe discomfort and accompanying symptoms at the episode level.
Reported discomfort
Record location, quality, radiation and associated symptoms without imposing a stereotyped presentation.
- How does the person describe the discomfort, where is it felt, and does it radiate? measurement
- Which associated symptoms occurred during the same episode, and which were present independently? boundary
Syndrome attribution
Identify the basis and limits of calling the presentation angina.
Ischaemic attribution
Keep the angina label linked to its assessor, evidence and degree of certainty.
- Who attributed these symptoms to myocardial ischaemia, when, and on what evidence? provenance
- Is this an established anginal syndrome, suspected angina, or a symptom presentation with competing explanations? definition
Episode pattern and change Describe provocation, relief and evolution relative to an established baseline.
The clinical meaning of angina depends on when it occurs and how its pattern changes.
Provocation and resolution
Relate episodes to workload, context and the circumstances of relief.
Trigger and relief sequence
Capture the sequence from activity or rest through onset to resolution.
- What activity, workload or resting context preceded onset, and how reproducible is that association? measurement
- How long did symptoms last, and what happened before they resolved or persisted? measurement
Baseline deviation
Compare current symptoms with a dated and adequately observed prior pattern.
Changing anginal pattern
Make new onset, increasing burden, lower provocation thresholds and rest symptoms explicit.
- Compared with the documented baseline, have frequency, duration, intensity or provocation threshold changed? measurement
- Are rest symptoms new, longstanding or of uncertain onset, and has a clinician assessed the change? provenance
Ischaemic evidence and mechanism Connect the symptom syndrome to investigations, proposed mechanisms and unresolved alternatives.
Neither symptoms nor coronary anatomy alone provide a complete account of angina.
Investigation interpretation
Preserve relevant investigation results together with timing and clinical interpretation.
Symptom and evidence alignment
Distinguish observed test results from claims about what explains the symptoms.
- Which investigations informed the assessment, and were they performed during symptoms, after symptoms or under provocation? provenance
- What does each result support, leave unresolved or fail to exclude according to its documented interpretation? boundary
Mechanism and alternatives
Represent possible coronary mechanisms and competing explanations without forcing exclusivity.
Mechanism confidence
Link each proposed mechanism to supporting evidence and retain uncertainty where attribution is incomplete.
- Which obstructive, vasospastic or microvascular mechanisms have been assessed, and which remain hypotheses? provenance
- Which alternative or coexisting causes could explain some episodes, and what evidence distinguishes them? boundary
Burden and care response Represent effects on daily life and the documented response to ongoing or changing symptoms.
An actionable model must connect symptom history to lived limitations and accountable clinical follow-up.
Activity and symptom burden
Assess limitations while accounting for avoidance of symptom-provoking activity.
Functional impact
Record restricted activities, patient priorities and interpretable burden assessments.
- Which activities are limited or avoided because of symptoms or fear of symptoms? measurement
- Does a reported improvement reflect greater activity tolerance, fewer symptoms at comparable activity, or reduced exposure to activity? boundary
Documented management and escalation
Track the applicable clinician-authored plan, observed response and reassessment status.
Care plan response
Connect symptom changes to documented interventions and identify required clinical handoffs.
- What current clinician-authored symptom and escalation plan applies, and where is its authoritative record? provenance
- Do the recorded symptoms meet an applicable escalation rule, and has the required assessment or handoff occurred? action
- Following a documented intervention, what changed in symptoms and activity tolerance, and what uncertainty remains about causation? measurement
Evidence and external alignment What the world already says about this thing, gathered so the model can be checked against it.
A model that cannot be lined up against existing standards, identifiers and practice cannot be adopted by anyone who already uses them.
Reported evidence
Findings from the breadth pass, kept separate from the structural claims.
Check these first
Recalled without web access and unsourced; every item is a lead to verify.
- This describes the cardiovascular clinical syndrome; no narrower registry sense was supplied.
- The listed kinds overlap: refractory describes treatment resistance, whereas vasospastic and microvascular describe mechanisms.
- Guideline editions, national coding details, and formal diagnostic criteria require verification; these statements are recalled knowledge, not newly researched findings.
- Which of these check these first hold for the sense of angina pectoris this model covers, and on what evidence? provenance
Kinds and varieties
Recalled without web access and unsourced; every item is a lead to verify.
- Stable angina
- Unstable angina
- Vasospastic angina (variant or Prinzmetal angina)
- Microvascular angina
- Refractory angina
- Which of these kinds and varieties hold for the sense of angina pectoris this model covers, and on what evidence? provenance
Identifiers and schemes
Recalled without web access and unsourced; every item is a lead to verify.
- ICD-10 - I20 - WHO category for angina pectoris; subcategories distinguish unstable angina, angina with documented spasm, other forms, and unspecified angina.
- Which of these identifiers and schemes hold for the sense of angina pectoris this model covers, and on what evidence? provenance
Standards and regulation
Recalled without web access and unsourced; every item is a lead to verify.
- European Society of Cardiology guidelines for chronic coronary syndromes.
- European Society of Cardiology guidelines for acute coronary syndromes, including unstable angina.
- American Heart Association and American College of Cardiology multisociety guideline for chronic coronary disease.
- Canadian Cardiovascular Society classification of angina severity.
- Which of these standards and regulation hold for the sense of angina pectoris this model covers, and on what evidence? provenance
Real-world use
Recalled without web access and unsourced; every item is a lead to verify.
- Describing ischemic symptoms in clinical assessment and medical records.
- Classifying symptom burden and limitation of ordinary physical activity.
- Informing investigation of obstructive coronary disease, coronary spasm, and coronary microvascular dysfunction.
- Assessing symptom response to antianginal treatment and coronary revascularization.
- Which of these real-world use hold for the sense of angina pectoris this model covers, and on what evidence? provenance
Typical measurements
Recalled without web access and unsourced; every item is a lead to verify.
- Functional limitation using the Canadian Cardiovascular Society angina classification - I-IV, from symptoms only with strenuous activity to inability to undertake physical activity without discomfort, with possible symptoms at rest - Ordinal class
- Which of these typical measurements hold for the sense of angina pectoris this model covers, and on what evidence? provenance
Failure modes and hazards
Recalled without web access and unsourced; every item is a lead to verify.
- New, worsening, or rest symptoms can reflect an acute coronary syndrome.
- Associated coronary disease can lead to myocardial infarction, serious arrhythmias, or death; symptom intensity alone does not establish risk.
- Ischemic symptoms can be mistaken for gastrointestinal, musculoskeletal, or anxiety-related discomfort.
- Absence of obstructive coronary disease does not exclude microvascular or vasospastic angina.
- A normal resting electrocardiogram does not exclude angina.
- Which of these failure modes and hazards hold for the sense of angina pectoris this model covers, and on what evidence? provenance
Regional variation
Recalled without web access and unsourced; every item is a lead to verify.
- ICD-10 national modifications differ in coding detail and may combine angina with documented coronary atherosclerosis.
- Which of these regional variation hold for the sense of angina pectoris this model covers, and on what evidence? provenance
Neighbouring kinds and how to tell them apart
Recalled without web access and unsourced; every item is a lead to verify.
- Myocardial ischemia - Ischemia is the underlying physiological disturbance and may be silent; angina is its symptomatic clinical expression.
- Myocardial infarction - Infarction requires acute myocardial injury with evidence of ischemia; angina does not itself establish myocardial necrosis.
- Coronary artery disease - Coronary disease is an underlying disease process that may occur without angina, while angina can occur without obstructive epicardial coronary disease.
- Noncardiac chest pain - The discomfort arises from causes other than myocardial ischemia; symptom description alone may not reliably distinguish it.
- Which of these neighbouring kinds and how to tell them apart hold for the sense of angina pectoris this model covers, and on what evidence? provenance
What the second pass must settle
- Which authoritative clinical definitions should govern inclusion of anginal equivalents without chest discomfort, and how should these presentations be labelled?
- How should stable or unstable clinical patterns be represented alongside vasospastic and microvascular mechanisms without treating them as mutually exclusive categories?
- Which validated burden instruments and meaningful-change thresholds are appropriate for the intended population and setting?
- Which jurisdiction-specific escalation pathways should the agent reference, and who is responsible for maintaining them?
- Does an existing Vercy world model already own this syndrome or any proposed bundle, requiring a registry link or shared component instead of a duplicate publication?