Stable ischaemic heart disease

Last reviewed: 23 Apr 2022
Last updated: 30 Nov 2021

Summary

Definition

History and exam

Key diagnostic factors

  • presence of risk factors
  • typical angina symptoms
  • atypical angina symptoms
  • symptoms of low-risk unstable angina
  • normal examination
More key diagnostic factors

Other diagnostic factors

  • known medical history of exacerbating factor
  • non-anginal chest pain
  • epigastric discomfort
  • jaw pain
  • arm pain
  • dyspnoea on exertion
  • nausea/vomiting
  • perspiration (diaphoresis)
  • fatigue
  • hypoxia
  • tachycardia
  • S3
  • 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
Other diagnostic factors

Risk factors

  • advancing age
  • smoking
  • hypertension
  • elevated LDL cholesterol
  • isolated low HDL cholesterol
  • diabetes
  • inactivity
  • obesity
  • illicit drug use
  • male sex
  • family history of ischaemic heart disease
  • hypertriglyceridaemia
  • mental stress/depression
  • plasma biomarkers
  • polluted air
More risk factors

Diagnostic investigations

1st investigations to order

  • resting ECG
  • haemoglobin
  • lipid profile
  • fasting blood glucose or HbA1c
More 1st investigations to order

Investigations to consider

  • exercise ECG (without imaging)
  • exercise or pharmacological stress with imaging
  • coronary CT angiography (CCTA)
  • invasive coronary angiography
  • thyroid-stimulating hormone
  • CXR
  • rest echocardiography
More investigations to consider

Emerging tests

  • CT myocardial perfusion (CTP) and fractional flow reserve CT (FFRCT)
  • coronary artery calcium (CAC) scoring
  • tests for vasospasm and microcirculatory dysfunction

Treatment algorithm

ONGOING

all patients

Contributors

Authors

Douglas Berger, MD, MLitt

General Medicine Service

Veterans Affairs (VA) Puget Sound Health Care System

Associate Professor

University of Washington

Seattle

WA

Disclosures

DB declares that he has no competing interests.

Stephan D. Fihn, MD, MPH

Professor of Medicine and Health Services

University of Washington

Seattle

WA

Disclosures

SDF declares that he has no competing interests.

Acknowledgements

Dr Douglas Berger and Dr Stephan D. Fihn would like to gratefully acknowledge Dr Karen E. Segerson, Dr Mark C. Zaros, Dr Joy Bucher, and Dr Steven M. Bradley, previous contributors to this topic.

Disclosures

KES, MCZ, JB, and SMB declare that they have no competing interests.

Peer reviewers

Syed Wamique Yusuf, MD, MRCPI, FACC

Associate Professor

University of Texas MD Anderson Cancer Center

Department of Cardiology

Houston

TX

Disclosures

SWY declares that he has no competing interests.

John R. Charpie, MD, PhD

Associate Professor of Pediatrics

Medical Director

Pediatric Cardiothoracic Intensive Care Unit

University of Michigan Congenital Heart Center

C.S. Mott Children's Hospital

Ann Arbor

MI

Disclosures

JRC declares that he has no competing interests.

Michael A. Spinelli, MD

Fellow

Albert Einstein College of Medicine

Montefiore Medical Center

Bronx

NY

Disclosures

MAS declares that he has no competing interests.

Katherine Wu, MD

Associate Professor of Medicine

Division of Cardiology

Johns Hopkins Medical Institutions

Baltimore

MD

Disclosures

KW declares that she has no competing interests.

Daniel Lenihan, MD

Professor of Cardiovascular Medicine

Director of Clinical Research

Vanderbilt University

Nashville

TN

Disclosures

DL declares that he has no competing interests.

Gianluca Rigatelli, MD, PhD, FACP, FACC, FESC, FSCAI

Director

Section of Transcatheter Treatment of Congenital Heart Disease in the Adult

Rovigo General Hospital

Rovigo

Italy

Disclosures

GR declares that he has no competing interests.

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