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Chronic Ischaemic Heart Disease 

Chronic Ischaemic Heart Disease
Chapter:
Chronic Ischaemic Heart Disease
Author(s):

Filippo Crea

, Paolo G. Camici

, Raffaele De Caterina

, and Gaetano A. Lanza

DOI:
10.1093/med/9780199566990.003.017
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date: 22 August 2019

The coronary circulation serves the purpose of matching myocardial oxygen supply and consumption. A transient mismatch causing reversible myocardial ischaemia is the dominant feature of chronic ischaemic heart disease (IHD), which is also characterized by stable symptoms over a period of months, years, or even decades. Stable angina is the most frequent presentation of chronic IHD; other clinical presentations are microvascular angina, vasospastic angina, and ischaemic cardiomyopathy. Stable angina is mainly caused by obstructive coronary atherosclerosis. ECG exercise stress test is the first-line test for diagnosis and risk stratification; when it cannot be performed or is not interpretable imaging stress tests are indicated. The aims of treatment are to improve prognosis and to reduce symptoms. Prognosis is improved by the reduction of coronary risk factor burden, by the administration of antiplatelet agents, and, in high risk patients, by myocardial revascularization. Symptoms are improved by anti-anginal drugs which act through different mechanisms, including reduction of myocardial oxygen consumption and improvement of myocardial perfusion, and by myocardial revascularization in patients who do not satisfactorily respond to drugs. Microvascular angina is caused by coronary microvascular dysfunction; its prognosis is good, but symptoms can be invalidating and frequently do not fully respond to conventional anti-anginal drugs. Vasospastic angina is caused by coronary artery spasm; prognosis is good if spasm is prevented by treatment with coronary vasodilators. Ischaemic cardiomyopathy is dominated by symptoms and signs of left ventricular dysfunction; prognosis is mainly determined by the degree of left ventricular dysfunction and seems improved by myocardial revascularization in patients with large areas of myocardial viability....

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