Overview of the care of patients with stable ischemic heart disease

INTRODUCTION

Ischemic heart disease, also referred to as coronary heart disease, is present when a patient has one or more symptoms, signs, or complications from an inadequate supply of blood to the myocardium. This is most commonly due to obstruction of the epicardial coronary arteries due to atherosclerosis. (See "Pathogenesis of atherosclerosis".) Patients are referred to as stable when symptoms, if present, are manageable with either medical or revascularization therapy.

Angina pectoris, or angina for short, occurs when myocardial oxygen demand exceeds oxygen supply; the clinical manifestation is often chest discomfort. (See "Pathophysiology and clinical presentation of ischemic chest pain".) Stable angina pectoris, or stable angina, refers to chest discomfort that occurs predictably and reproducibly at a certain level of exertion and is relieved with rest or nitroglycerin. Most patients with ischemic heart disease will experience angina as part of the clinical manifestations of the disease. (See "Pathophysiology and clinical presentation of ischemic chest pain", section on 'History'.)

The care of patients with ischemic heart disease includes ascertainment of the diagnosis and its severity, control of symptoms, and therapies to improve survival. This topic will provide an overview of these issues and will direct the reader to more detailed discussions when appropriate. In particular, this topic will focus on patients with stable ischemic heart disease (SIHD). The care of patients with unstable ischemic heart disease is discussed elsewhere. (See "Overview of the acute management of unstable angina and non-ST elevation myocardial infarction" and "Classification of unstable angina and non-ST elevation myocardial infarction" and "Overview of the non-acute management of unstable angina and non-ST elevation myocardial infarction" and "Risk stratification after non-ST elevation acute coronary syndrome" and "Evaluation of patients with chest pain at low or intermediate risk for acute coronary syndrome" and "Initial evaluation and management of suspected acute coronary syndrome in the emergency department" and "Overview of the acute management of ST elevation myocardial infarction" and "Overview of the non-acute management of ST elevation myocardial infarction".)

DIAGNOSIS

Many patients can be given the diagnosis of SIHD based on a classic history of angina pectoris in the presence of one or more risk factors for atherosclerotic cardiovascular disease. When first evaluated for possible SIHD patients should receive a thorough physical examination in addition to a complete history. (See "Pathophysiology and clinical presentation of ischemic chest pain", section on 'History' and "Overview of the risk equivalents and established risk factors for cardiovascular disease".)

An electrocardiogram should be performed in all patients. However, most patients will require diagnostic testing either to secure the diagnosis or to evaluate the extent of disease.