II. Risk Factors: Major Cardiovascular Risks - Unstable Coronary Syndromes

  1. Recent Myocardial Infarction (Within 30 days)
  2. Unstable Angina or severe Angina (Angina Class 3-4)
  3. Decompensated Congestive Heart Failure
  4. Severe valvular disease
    1. Severe Aortic Stenosis (mean gradient >40 mm Hg, area <1 cm)
    2. Symptomatic Mitral Stenosis
  5. Significant Arrhythmia
    1. High grade Atrioventricular Block
      1. Mobitz II Atrioventricular Block
      2. Third Degree Atrioventricular Block
    2. Symptomatic ventricular Arrhythmia
    3. Uncontrolled rate in supraventricular Arrhythmia with Heart Rate >100

III. Risk Factors: Intermediate Cardiovascular Risks

  1. Mild Angina Pectoris (Angina Class 1-2)
  2. Prior Myocardial Infarction (by history or EKG)
    1. Prior documented Myocardial Infarction
    2. Prior positive stress test
    3. EKG with pathological Q Waves
  3. Compensated or prior Congestive Heart Failure
  4. Renal Insufficiency (Serum Creatinine >2 mg/dl)
  5. Diabetes Mellitus

IV. Risk Factors: Minor Cardiovascular Risks

  1. Advanced age
  2. Abnormal Electrocardiogram
    1. Left Ventricular Hypertrophy
    2. Left Bundle Branch Block
    3. ST Segment abnormalities
    4. T Wave abnormalities
  3. Heart rhythm other than sinus rhythm (e.g. Atrial Fib)
  4. Low functional capacity (<4 METS)
    1. Unable to climb one flight of stairs holding a bag of groceries
    2. Unable to walk on level ground at 4 miles per hour (1 mile in 15 minutes)
  5. History of Cerebrovascular Accident
  6. Uncontrolled Hypertension (diastolic BP >110 mmHg)

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