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Stable Ischemic Heart Disease

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MGH Cardiology Board Review

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Abstract

Over the last two decades, due to improved outcomes from acute coronary syndromes (ACS), aging of the population, the epidemics of diabetes and obesity, and advances in the diagnosis of coronary atherosclerosis, the management of patients with chronic coronary artery disease (CAD) has become an increasingly important part of clinical practice. The spectrum of stable ischemic heart disease includes patients who have subclinical atherosclerosis or nonobstructive CAD, asymptomatic myocardial ischemia, stable angina pectoris, or prior ACS with or without residual ischemia. Because patients with ischemic heart disease are at high risk of subsequent cardiovascular events, including myocardial infarction (MI), stroke and death, implementation of secondary prevention measures, including risk factor control, therapeutic lifestyle changes, and appropriate medical therapy is warranted in all patients with evidence of coronary atherosclerosis. New insights into the mechanisms underlying coronary disease and clinical trial data have led to the emergence of new anti-ischemic treatments, further refinement of the role for revascularization, and renewed emphasis on the critical role of aggressive lowering of LDL cholesterol, whether with high intensity statin or newer lipid-lowering agents, in secondary prevention.

The authors wish to acknowledge the contributions of Rodrigo M. Lago and Thomas A. LaMattina, who wrote the prior version of this chapter in the 2013 edition.

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Abbreviations

ACC:

American College of Cardiology

ACE:

Angiotensin converting enzyme

ACS:

Acute coronary syndromes

AHA:

American Heart Association

ARB:

Angiotensin receptor blockers

BMS:

Bare-Metal Stent

CABG:

Coronary artery bypass graft

CAD:

Coronary artery disease

CKD:

Chronic Kidney Disease

CVD:

Cardiovascular Disease

CCB:

Calcium channel blockers

CCS:

Canadian Cardiovascular Society

CCTA:

Coronary computed tomography angiography

DAPT:

Dual Antiplatelet Therapy

DES:

Drug-Eluting Stent

ECG:

Electrocardiogram

EBCT:

Electron beam computed tomography

FFR:

Fractional flow reserve

HeFH:

Heterozygous Familial Hypercholesterolemia

HCTZ:

Hydrochlorothiazide

iFR:

Instantaneous wave-free ratio

IHD:

Ischemic Heart Disease

IVUS:

Intravascular ultrasound

LAD:

Left anterior descending artery

LBBB:

Left bundle branch block

LM:

Left main artery

LV:

Left ventricle

MI:

Myocardial infarction

MRI:

Magnetic resonance imaging

OCT:

Optical coherence tomography

OMT:

Optimal Medical Therapy

PCI:

Percutaneous coronary intervention

SIHD:

Stable Ischemic Heart Disease

SPECT:

Single photon emission computed tomography

T2D:

Type-2 diabetes

WPW:

Wolff–Parkinson–White

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Fahed, A.C., Chae, C.U. (2021). Stable Ischemic Heart Disease. In: Gaggin, H.K., Januzzi Jr., J.L. (eds) MGH Cardiology Board Review. Springer, Cham. https://doi.org/10.1007/978-3-030-45792-1_6

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