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Stable Ischemic Heart Disease

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Handbook of Outpatient Cardiology

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Abstract

Stable ischemic heart disease is a morbid clinical syndrome stemming from an imbalance between the metabolic demands of the myocardium and its oxygen supply. The resulting symptoms are brought about reliably by physical or emotional stress. The canonical symptom is classic angina, but clinical presentation can vary greatly among patients (see Chap. 1). Outpatient management is focused on both reduction in adverse cardiovascular events and relief of symptoms.

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Abbreviations

ACS:

Acute coronary syndrome

BMI:

Body mass index

BNP:

B-type natriuretic peptide

BP:

Blood pressure

CABG:

Coronary artery bypass graft

CAD:

Coronary artery disease

CBC:

Complete blood count

CCTA:

Coronary computed tomography angiography

CK:

Creatinine kinase

CMP:

Complete metabolic panel

CMR:

Cardiac magnetic resonance imaging

CV:

Cardiovascular

ECG:

Electrocardiogram

EF:

Ejection fraction

GDMT:

Guideline directed medical therapy

GI:

Gastrointestinal

HbA1c:

Hemoglobin A1c

HMG-CoA:

3-hydroxy-3-methyl-glutaryl-CoA reductase

LDL-C:

Low density lipoprotein cholesterol

MI:

Myocardial infarction

NEJM:

New England Journal of Medicine

NNT:

Number needed to treat

PCI:

Percutaneous Coronary Intervention

PCSK9:

Proprotein convertase subtilisin/kexin type 9

PDE5:

Phosphodiesterase type 5

SARS-Cov-2:

Severe acute respiratory syndrome coronavirus 2

SGLT2:

Sodium-glucose co-transporter-2

SIHD:

Stable ischemic heart disease

SPECT:

Single photon Emission Computed Tomography

UA:

Unstable angina

References

  1. Pryor DB, Shaw L, Harrell FE, Lee KL, Hlatky MA, Mark DB, et al. Estimating the likelihood of severe coronary artery disease. Am J Med. 1991;90(5):553–62.

    Article  CAS  Google Scholar 

  2. Fihn SD, Gardin JM, Abrams J, Berra K, Blankenship JC, Dallas AP, et al. 2012 ACCF/AHA/ACP/AATS/PCNA/SCAI/STS guideline for the diagnosis and management of patients with stable ischemic heart disease. J Am Coll Cardiol. 2012;60(24):e44–164.

    Article  Google Scholar 

  3. Foldyna B, Udelson JE, Karády J, Banerji D, Lu MT, Mayrhofer T, et al. Pretest probability for patients with suspected obstructive coronary artery disease: re-evaluating Diamond-Forrester for the contemporary era and clinical implications: insights from the PROMISE trial. Eur Heart J Cardiovasc Imaging. 2019;20(5):574–81.

    Article  Google Scholar 

  4. Genders TSS, Steyerberg EW, Alkadhi H, Leschka S, Desbiolles L, Nieman K, et al. A clinical prediction rule for the diagnosis of coronary artery disease: validation, updating, and extension. Eur Heart J. 2011;32(11):1316–30.

    Article  Google Scholar 

  5. Knuuti J, Wijns W, Saraste A, Capodanno D, Barbato E, Funck-Brentano C, et al. 2019 ESC Guidelines for the diagnosis and management of chronic coronary syndromes. Eur Heart J. 2020;41(3):407–77.

    Article  Google Scholar 

  6. Moss AJ, Williams MC, Newby DE, Nicol ED. The updated NICE guidelines: cardiac CT as the first-line test for coronary artery disease. Curr Cardiovasc Imaging Rep [Internet]. 2017 [cited 2021 Jan 30];10(5). Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5368205/.

  7. Douglas PS, Hoffmann U, Patel MR, Mark DB, Al-Khalidi HR, Cavanaugh B, et al. Outcomes of anatomical versus functional testing for coronary artery disease. N Engl J Med. 2015;372(14):1291–300.

    Article  CAS  Google Scholar 

  8. Investigators SCOT-HEART, Newby DE, Adamson PD, Berry C, Boon NA, Dweck MR, et al. Coronary CT angiography and 5-year risk of myocardial infarction. N Engl J Med. 2018;379(10):924–33.

    Article  Google Scholar 

  9. Ferraro R, Latina JM, Alfaddagh A, Michos ED, Blaha MJ, Jones SR, et al. Evaluation and management of patients with stable angina: beyond the ischemia paradigm: JACC state-of-the-art review. J Am Coll Cardiol. 2020;76(19):2252–66.

    Article  Google Scholar 

  10. Fihn SD, Blankenship JC, Alexander KP, Bittl JA, Byrne JG, Fletcher BJ, et al. 2014 ACC/AHA/AATS/PCNA/SCAI/STS focused update of the guideline for the diagnosis and management of patients with stable ischemic heart disease: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines, and the American Association for Thoracic Surgery, Preventive Cardiovascular Nurses Association, Society for Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons. J Am Coll Cardiol. 2014;64(18):1929–49.

    Article  Google Scholar 

  11. Gulati M, Shaw LJ, Bairey Merz CN. Myocardial ischemia in women: lessons from the NHLBI WISE study. Clin Cardiol. 2012;35(3):141–8.

    Article  Google Scholar 

  12. Hoffmann U, Ferencik M, Udelson JE, Picard MH, Truong QA, Patel MR, et al. Prognostic value of noninvasive cardiovascular testing in patients with stable chest pain: insights from the PROMISE trial (prospective multicenter imaging study for evaluation of chest pain). Circulation. 2017;135(24):2320–32.

    Article  Google Scholar 

  13. Chow BJW, Small G, Yam Y, Chen L, McPherson R, Achenbach S, et al. Prognostic and therapeutic implications of statin and aspirin therapy in individuals with nonobstructive coronary artery disease: results from the CONFIRM (COronary CT Angiography EvaluatioN For Clinical Outcomes: An InteRnational Multicenter registry) registry. Arterioscler Thromb Vasc Biol. 2015;35(4):981–9.

    Article  CAS  Google Scholar 

  14. Marinescu MA, Löffler AI, Ouellette M, Smith L, Kramer CM, Bourque JM. Coronary microvascular dysfunction, microvascular angina, and treatment strategies. JACC Cardiovasc Imaging. 2015;8(2):210–20.

    Article  Google Scholar 

  15. Arnett DK, Blumenthal RS, Albert MA, Buroker AB, Goldberger ZD, Hahn EJ, et al. 2019 ACC/AHA guideline on the primary prevention of cardiovascular disease. Circulation. 2019;13:E157–98.

    Google Scholar 

  16. Grundy SM, Stone NJ, Bailey AL, Beam C, Birtcher KK, Blumenthal RS, et al. AHA/ACC/AACVPR/AAPA/ABC/ACPM/ADA/AGS/APhA/ASPC/NLA/PCNA guideline on the management of blood cholesterol: a report of the American college of cardiology/American heart association task force on clinical practice guidelines. J Am Coll Cardiol. 2018;2018:25709.

    Google Scholar 

  17. McClelland RL, Bild DE, Burke GL, Mukamal KJ, Lima JA, Kronmal RA. Alcohol and coronary artery calcium prevalence, incidence and progression: results from the Multi-Ethnic Study of Atherosclerosis (MESA). Am J Clin Nutr. 2008;88(6):1593–601.

    Article  CAS  Google Scholar 

  18. Rossinen J, Partanen J, Koskinen P, Toivonen L, Kupari M, Nieminen MS. Acute heavy alcohol intake increases silent myocardial ischaemia in patients with stable angina pectoris. Heart Br Card Soc. 1996;75(6):563–7.

    Article  CAS  Google Scholar 

  19. Dimsdale JE. Psychological stress and cardiovascular disease. J Am Coll Cardiol. 2008;51(13):1237–46.

    Article  Google Scholar 

  20. Abdelhamid AS, Brown TJ, Brainard JS, Biswas P, Thorpe GC, Moore HJ, et al. Omega-3 fatty acids for the primary and secondary prevention of cardiovascular disease. Cochrane Database Syst Rev. 2018;7:CD003177.

    PubMed  Google Scholar 

  21. Bhatt DL, Steg PG, Miller M, Brinton EA, Jacobson TA, Ketchum SB, et al. Cardiovascular risk reduction with icosapent ethyl for hypertriglyceridemia. N Engl J Med. 2019;380(1):11–22.

    Article  CAS  Google Scholar 

  22. Whelton PK, Carey RM, Aronow WS, Casey DE, Collins KJ, Himmelfarb CD, et al. 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA guideline for the prevention, detection, evaluation, and management of high blood pressure in adults: a report of the American college of cardiology/American heart association task force on clinical practice guidelines. J Am Coll Cardiol. 2018;71(19):e127–248.

    Article  Google Scholar 

  23. The SPRINT Research Group. A randomized trial of intensive versus standard blood-pressure control. N Engl J Med. 2015;373(22):2103–16.

    Article  Google Scholar 

  24. Association, American Medical. Cardiovascular benefits of SGLT2 inhibitors and GLP-1 receptor agonists in type 2 diabetes. JAMA J Am Med Assoc. 2019;321(17):1720–1.

    Article  Google Scholar 

  25. American Diabetes Association. Pharmacologic approaches to glycemic treatment: standards of medical care in diabetes-2019. Diabetes Care. 2019;42(Suppl 1):S90–102.

    Article  Google Scholar 

  26. Fisher DP, Johnson E, Haneuse S, Arterburn D, Coleman KJ, O’Connor PJ, et al. Association between bariatric surgery and macrovascular disease outcomes in patients with type 2 diabetes and severe obesity. JAMA. 2018;320(15):1570–82.

    Article  Google Scholar 

  27. Eikelboom JW, Connolly SJ, Bosch J, Dagenais GR, Hart RG, Shestakovska O, et al. Rivaroxaban with or without aspirin in stable cardiovascular disease. N Engl J Med. 2017;377(14):1319–30.

    Article  CAS  Google Scholar 

  28. Nidorf SM, Fiolet ATL, Mosterd A, Eikelboom JW, Schut A, Opstal TSJ, et al. Colchicine in patients with chronic coronary disease. N Engl J Med. 2020;383(19):1838–47.

    Article  CAS  Google Scholar 

  29. de Diego C, Vila-Córcoles A, Ochoa O, Rodriguez-Blanco T, Salsench E, Hospital I, et al. Effects of annual influenza vaccination on winter mortality in elderly people with chronic heart disease. Eur Heart J. 2009;30(2):209–16.

    Article  Google Scholar 

  30. CDC. COVID-19 and Your Health [Internet]. Centers for Disease Control and Prevention. 2020 [cited 2021 Jan 30]. Available from: https://www.cdc.gov/coronavirus/2019-ncov/need-extra-precautions/people-with-medical-conditions.html.

  31. Yancy CW, Jessup M, Bozkurt B, Butler J, Casey DE, Colvin MM, et al. 2017 ACC/AHA/HFSA Focused Update of the 2013 ACCF/AHA guideline for the management of heart failure: a report of the American college of cardiology/American heart association task force on clinical practice guidelines and the heart failure society of America. J Am Coll Cardiol. 2017;70(6):776–803.

    Article  Google Scholar 

  32. Hachamovitch R, Hayes SW, Friedman JD, Cohen I, Berman DS. Comparison of the short-term survival benefit associated with revascularization compared with medical therapy in patients with no prior coronary artery disease undergoing stress myocardial perfusion single photon emission computed tomography. Circulation. 2003;107(23):2900–7.

    Article  Google Scholar 

  33. Windecker S, Stortecky S, Stefanini GG, da Costa BR, Rutjes AW, et al. Revascularisation versus medical treatment in patients with stable coronary artery disease: network meta-analysis. BMJ. 2014;348(8):g3859.

    Article  Google Scholar 

  34. Katz D, Gavin MC. Stable ischemic heart disease. Ann Intern Med. 2019;171(3):ITC17.

    Article  Google Scholar 

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Authors and Affiliations

  1. Department of Medicine, Division of Cardiology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA

    Daniel Katz & Michael C. Gavin

Authors
  1. Daniel Katz
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  2. Michael C. Gavin
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Corresponding author

Correspondence to Daniel Katz .

Editor information

Editors and Affiliations

  1. Department of Medicine, Division of Cardiology, Emory University School of Medicine, Atlanta, GA, USA

    Ankit A. Bhargava

  2. Department of Medicine, Division of Cardiology, Emory University School of Medicine, Atlanta, GA, USA

    Bryan J. Wells

  3. Department of Medicine, Division of Cardiology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA

    Pablo A. Quintero

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Katz, D., Gavin, M.C. (2022). Stable Ischemic Heart Disease. In: Bhargava, A.A., Wells, B.J., Quintero, P.A. (eds) Handbook of Outpatient Cardiology . Springer, Cham. https://doi.org/10.1007/978-3-030-88953-1_13

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  • DOI: https://doi.org/10.1007/978-3-030-88953-1_13

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  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-030-88952-4

  • Online ISBN: 978-3-030-88953-1

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