Cardiovascular System & Haematology: Stable Ischemic Heart Disease

Stable Ischemic Heart Disease (SIHD)

• SIHD is characterized by ischemia (reduced blood flow) but not infarction (heart tissue death)

Symptoms of SIHD

• Angina pectoris or stable angina
• Neck or jaw pain
• Shoulder or arm pain
• Fast heartbeat
• Shortness of breath (on exertion)
• Nausea and vomiting
• Sweating
• Fatigue
• Exclude: new chest pain, chest pain at rest, or positive biomarkers

Risk Factors for SIHD

• Atheroma in one or more coronary arteries
• BMI > 27.5 kg/m²
• Age and male sex
• Diabetes mellitus
• Smoking
• Family history
• Á LDL and/or â HDL
• Hypertension
• Alcohol abuse

Risk Stratification

• 2-3 modalities recommended for stratification

Treatment Outcomes and Approach

• Prevent acute coronary syndrome (MI) and death
• Alleviate acute symptoms of myocardial ischemia
• Prevent recurrent symptoms of myocardial ischemia
• Prevent disease progression
• Avoid or minimize adverse treatment effects

Pharmacotherapy

• Vasculoprotective therapy:
  • Behavioral modification therapy for all risks
  • Risk factor modification (ACEIs and statins)
  • Antiplatelet therapy
• Anti-ischemic pharmacotherapy:
  • Beta blockers, nitrates, calcium-channel blockers, and trimetazidine
  • Others: ivabradine, nicorandil, ranolazine, SGLT2, and GLP-1RA

Myocardial Revascularization

• Must be done in high-risk patients

Special Populations

• Chronic kidney disease:
  • Limited data on efficacy and role of pharmacotherapy and revascularization
  • Importance of lifestyle modification, good glycemic and blood pressure control to reduce CV events
  • Strict glycemic control may not benefit patients with advanced CKD
  • Benefit of statins in moderate CKD not RRT
  • Some evidence shows CV risk reduction with aspirin in individuals with eGFR < 30 mL/min/1.73m²

Stable Ischemic Heart Disease (SIHD)

• SIHD is characterized by ischemia (reduced blood flow) but not infarction (heart tissue death)

Symptoms of SIHD

• Angina pectoris or stable angina
• Neck or jaw pain
• Shoulder or arm pain
• Fast heartbeat
• Shortness of breath (on exertion)
• Nausea and vomiting
• Sweating
• Fatigue
• Exclude: new chest pain, chest pain at rest, or positive biomarkers

Risk Factors for SIHD

• Atheroma in one or more coronary arteries
• BMI > 27.5 kg/m²
• Age and male sex
• Diabetes mellitus
• Smoking
• Family history
• Á LDL and/or â HDL
• Hypertension
• Alcohol abuse

Risk Stratification

• 2-3 modalities recommended for stratification

Treatment Outcomes and Approach

• Prevent acute coronary syndrome (MI) and death
• Alleviate acute symptoms of myocardial ischemia
• Prevent recurrent symptoms of myocardial ischemia
• Prevent disease progression
• Avoid or minimize adverse treatment effects

Pharmacotherapy

• Vasculoprotective therapy:
  • Behavioral modification therapy for all risks
  • Risk factor modification (ACEIs and statins)
  • Antiplatelet therapy
• Anti-ischemic pharmacotherapy:
  • Beta blockers, nitrates, calcium-channel blockers, and trimetazidine
  • Others: ivabradine, nicorandil, ranolazine, SGLT2, and GLP-1RA

Myocardial Revascularization

• Must be done in high-risk patients

Special Populations

• Chronic kidney disease:
  • Limited data on efficacy and role of pharmacotherapy and revascularization
  • Importance of lifestyle modification, good glycemic and blood pressure control to reduce CV events
  • Strict glycemic control may not benefit patients with advanced CKD
  • Benefit of statins in moderate CKD not RRT
  • Some evidence shows CV risk reduction with aspirin in individuals with eGFR < 30 mL/min/1.73m²

This quiz assesses your understanding of stable ischemic heart disease, including treatment algorithms, interventions, and long-term treatment considerations.