Canadian Cardiovascular Society (CCS) grading of Angina Pectoris
Last reviewed 01/2018
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
- 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
- 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
- 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.
- A: Admitted to hospital, becomes relatively asymptomatic with aggressive
medical therapy, and may be managed on an outpatient basis
- 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:
Reference: