Highlights & Basics
- Chronic coronary disease (CCD) is initially evaluated with a thorough history, including chest discomfort and related symptoms, and assessment of risk factors. This is followed by appropriate noninvasive testing guided by the probability of disease.
- Management should focus on lifestyle modification, with emphasis on smoking cessation, physical activity, lipid control, and blood pressure control.
- Aspirin and statin therapy are also central to management and reducing adverse outcomes such as myocardial infarction and cardiac death. Additional antithrombotic, lipid-lowering, and other therapies may further reduce these risks in some patients.
- For symptomatic patients, beta-blockers, calcium-channel blockers, and nitrates reduce angina and increase exercise tolerance.
- Patients with persistent angina despite lifestyle modification and guideline-directed medical therapy may warrant percutaneous or surgical revascularization for reduction of symptoms.
Quick Reference
History & Exam
Key Factors
Other Factors
Diagnostics Tests
Treatment Options
Definition
Epidemiology
Etiology
Pathophysiology
Images
ECG showing nonspecific ST depressions in V5 and V6, which may indicate ischemia. There are nonspecific ST-segment changes in III and aVF
Normal ECG
Pretest probabilities of obstructive coronary artery disease in symptomatic patients according to age, sex, and nature of symptoms in pooled analysis
Sensitivity and specificity of tests for anatomically significant coronary artery disease
Baseline exercise ECG in a 55-year-old man with a 1-month history of angina on exertion
Maximal exercise ECG in a 55-year-old man with a 1-month history of angina on exertion with ST depressions in II, III, aVF diagnostic of ischemia, and normal ST changes in V4-6 (rapid upsloping)
Computerized summary of exercise ECG in a 55-year-old man with a 1-month history of angina on exertion
Angiogram (right anterior oblique caudal projection) in a 55-year-old man with a 1-month history of angina on exertion. A 90% proximal stenosis of obtuse marginal 1 is present, explaining the patient's lateral ischemia
Angiogram (right anterior oblique cranial projection) in a 55-year-old man with a 1-month history of angina on exertion. The image shows a 90% proximal stenosis of obtuse marginal 1 (explaining the patient's lateral ischemia), 90% proximal stenosis of the first diagonal, and 99% subtotal occlusion of the second diagonal (explaining the patient's anterior and anterolateral ischemia)
Citations
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