CCS Angina Grading

Name: CCS Angina Grading calculator — MedScore
Creator: Nabil Alzein

Canadian Cardiovascular Society grading of angina pectoris by the activity that provokes it

CCS class

Tap the one that applies — its meaning opens right below.

I — ordinary activity (walking, climbing stairs) does not cause angina; only strenuous, rapid or prolonged exertion

II — slight limitation: angina walking or climbing stairs rapidly, uphill, after meals, in cold or wind, under emotional stress; or walking > ~200 m on the level or more than one flight of stairs at a normal pace

III — marked limitation: angina walking 100–200 m on the level or climbing one flight of stairs at a normal pace

IV — unable to carry on any physical activity without discomfort; angina may be present at rest

About this score

When to use

Grades angina pectoris into four classes by the level of activity that provokes it, from class I (only strenuous exertion) to class IV (any activity or at rest). ⁦[1]⁩

Pearls and pitfalls

• The Canadian Cardiovascular Society committee developed it in 1972 to standardise terms used in reporting studies of coronary artery disease and bypass surgery. ⁦[2]⁩

• Thirty years later, its author reviewed its worldwide acceptance together with its critiques, perceived limitations and alternative systems. ⁦[2]⁩

Summarised from the numbered sources under Evidence. Check the source before relying on a statement.

Evidence

[1] Original publication

Campeau L. Grading of angina pectoris (letter). Proposed the four-class Canadian Cardiovascular Society grading.

Circulation, 1976

Open source

[2] Validation

Campeau L. The Canadian Cardiovascular Society grading of angina pectoris revisited 30 years later.

Canadian Journal of Cardiology, 2002

Open source

Last reviewed: 2026-10

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MedScore is an educational and clinical decision-support tool. It does not provide a diagnosis, a treatment, or a drug-dosing recommendation, and it does not replace clinical judgement or local guidelines. Confirm every result against the original source before acting on it. The treating clinician remains responsible for all decisions.