Stable Ischemic Heart Disease: Overview of Cardiac care

Definition:

Stable ischemic heart disease (SIHD) is most commonly caused by abnormal accumulation of material in the inner layer of the wall of coronary arteries that obstruct blood flow.

The three principal presentations of unstable angina

Rest Angina: Angina occurring at rest and usually for more than 20 minutes, and occurring within 1 week of presentation

New-onset angina: angina of at least Class III severity with onset within 2 months of initial presentation

Increasing angina: 1 or none of the above characteristics; previously diagnosed angina that is distinctly more frequent, longer in duration, or lower in threshold (i.e., increased by at least 1 CCS class within 2 months of initial presentation to at least CCS Class III severity).

Symptoms:

-     Chest discomfort

-     Emotional stress

-     Pain in the epigastrium, jaw, neck, or arms

-     Dyspnea,

-     Nausea,

-     Vomiting

-     Perspiration

-     Lightheadedness

-     Fatigue

Diagnosis:

-     Clinical history

-     Physical examination

-     Laboratory testing

-     Resting ECG

-     Resting echocardiography

-     Estimating pretest probability

Diagnostic Factors:

-     Typical angina symptoms

-     Atypical angina symptoms

-     Symptoms of low-risk unstable angina

-     Known medical history of exacerbating factor

-     Non-anginal chest pain

-     Epigastric discomfort

-     Jaw pain

-     Arm pain

-     Dyspnea on exertion

-     Nausea/vomiting

-     Perspiration (diaphoresis)

-     Fatigue

-     Hypoxia

-     Tachycardia

-     Mitral regurgitation murmur

-     Bibasilar rales

-     Aortic outflow murmur

-     Carotid bruit

-     Diminished peripheral pulses

-     Signs of abdominal aortic aneurysm

-     Retinopathy seen on fundoscopic examination

-     Xanthomas or xanthelasma

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Types of diagnostic test:

-     Functional tests

-     Anatomic tests

Risk Factors:

-     Advancing age

-     Smoking

-     Hypertension

-     Elevated LDL cholesterol

-     Isolated low HDL cholesterol

-     Diabetes

-     Inactivity

-     Obesity

-     Family history of premature ischemic heart disease

-     Illicit drug uses

-     Male sex

-     Hypertriglyceridemia

-     Mental stress/depression

-     Plasma biomarkers

-     Polluted air

Prevention Parameters:

Primary Prevention:

-     Diet and exercise to maintain ideal body weight

-     Smoking cessation

-     Statin therapy

-     Aspirin therapy

Secondary Prevention

-     Decreasing anginal symptoms

-     Blood pressure

-     Patient education is a continuous process to help patients achieve risk-factor reduction through weight management

-     Increased physical activity

-     Dietary modifications

-     Lipid management

-     Annual influenza immunizations are recommended for all patients.

Antiplatelet therapy