Stable Ischemic Heart Disease

Abstract

Ischemic heart disease (IHD) results from an inadequate supply of blood flow and oxygen to an area of myocardium, typically resulting from a mismatch of myocardial oxygen demand and supply. IHD may have either acute or chronic presentations, and most commonly results from a significant stenosis of greater than 70 % in one or more of the major epicardial coronary arteries secondary to an atherosclerotic plaque which, in acute disease expressions, may rupture or fissure, while in more chronic expressions, typically results from a slowly advancing constrictive process that compromises the arterial lumen. Increasingly, attention is being directed to IHD that may occur in the absence of epicardial coronary artery narrowing such as is observed in patients (most often women) who may exhibit so-called microvascular angina due to involvement of the arteriolar resistance vessels that results in impaired coronary vasodilator reserve. Other non-atherosclerotic causes of IHD include congenital anomalies of the coronary vessels, myocardial bridging, coronary arteritis in association with the systemic vasculitides, and radiation-induced coronary disease. Furthermore, IHD may also occur in the absence of obstructive coronary artery disease (CAD), as in the case of uncontrolled hypertension, aortic valve disease, hypertrophic cardiomyopathy, and idiopathic dilated cardiomyopathy. Moreover, CAD may coexist with these other forms of heart disease.

The term IHD encompasses a spectrum of manifestations that vary from asymptomatic/silent myocardial ischemia to stable (chronic) angina pectoris, as well as more acute manifestations that include Prinzmetal (variant) angina, unstable angina (UA), non-ST-segment elevation myocardial infarction (NSTEMI), and ST-segment elevation myocardial infarction (STEMI). In addition, individuals with IHD may initially present with signs and symptoms of heart failure, arrhythmias, and potentially sudden cardiac death.