Management of stable ischemic heart disease involves tailoring antianginal therapy based on patient characteristics such as heart rate, blood pressure, and the underlying mechanism of angina.
Management of stable ischemic heart disease should be individualized based on patient hemodynamics and the specific pathophysiological mechanism of angina.
Management of stable coronary artery disease (CAD) has been based on the assumption that flow-limiting atherosclerotic obstructions are the proximate cause of angina and myocardial ischemia in most patients and represent an important target for revascularization. However, the role of revascularization in reducing long-term cardiac events in these patients has been limited mainly to those with left main disease, 3-vessel disease with diabetes, or decreased ejection fraction. Mounting evidence indicates that nonepicardial coronary causes of angina and ischemia, including coronary microvascular dysfunction, vasospastic disorders, and derangements of myocardial metabolism, are more prevalent than flow-limiting stenoses, raising concerns that many important causes other than epicardial CAD are neither considered nor probed diagnostically. There is a need for a more inclusive management paradigm that uncouples the singular association between epicardial CAD and revascularization and better aligns diagnostic approaches that tailor treatment to the underlying mechanisms and precipitants of angina and ischemia in contemporary clinical practice.
“The reason I say that is that the words that we use—coronary and disease—connote obstructive coronary disease. That has been in our vernacular for the better part of 35 or 40 years, and it underscores the fact that many people continue to believe that obstructive coronary disease has to be treated in a procedural fashion.”
Boden et al. (Mon,) conducted a review in Stable Ischemic Heart Disease. Antianginal medications was evaluated. Management of stable ischemic heart disease involves tailoring antianginal therapy based on patient characteristics such as heart rate, blood pressure, and the underlying mechanism of angina.