Skip to Main Content

Chapter 8: Stable Ischemic Heart Disease

Dejan Landup; Dawn Havrda

For instructor materials including Power Points, Answers to Clinical Encounter Questions, please contact userservices@mhprofessional.com.

Content Update

June 14, 2024

Stable Ischemic Heart Disease: A Focus on Novel Therapies for Lipid Management: Dyslipidemia is a major modifiable risk factor for the development of ischemic heart disease and its management is crucial to optimal medical therapy in this patient population. Statins remain the foundation of pharmacologic therapy in people with stable ischemic heart disease, and high-intensity statin therapy is indicated with the goal of achieving a greater than or equal to 50% reduction in low-density lipoprotein (LDL) cholesterol from baseline. The addition of ezetimibe, proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitors, bempedoic acid, or inclisiran can be considered if LDL remains above goal. Additionally, several clinical trials exploring new mechanisms for the management of dyslipidemia in this patient population are currently underway.

LEARNING OBJECTIVES

LEARNING OBJECTIVES

Upon completion of the chapter, the reader will be able to:

  1. Identify risk factors for the development of ischemic heart disease (IHD).

  2. Differentiate between the pathophysiology of chronic stable angina and acute coronary syndromes (ACS).

  3. Recognize symptoms and diagnostic criteria of IHD in a specific patient.

  4. Compare and contrast the diagnostic criteria of IHD and ACS.

  5. Identify treatment goals of stable ischemic heart disease (SIHD).

  6. Identify appropriate lifestyle modifications and pharmacologic therapy to address each treatment goal.

  7. Design an appropriate treatment regimen for the management of SIHD based on patient-specific information.

  8. Formulate a monitoring plan to assess effectiveness and adverse effects of a SIHD drug regimen.

INTRODUCTION

Ischemic heart disease (IHD) is also called coronary heart disease (CHD) or coronary artery disease (CAD). The term ischemic refers to a decreased supply of oxygenated blood to the heart muscle. IHD is caused by stenosis, or narrowing, in one or more of the major coronary arteries that supply blood to the heart, most commonly by atherosclerotic plaques. Atherosclerotic plaques may impede coronary blood flow to the extent that cardiac tissue distal to the coronary artery narrowing is deprived of sufficient oxygen to meet oxygen demand. image IHD results from an imbalance between myocardial oxygen supply and oxygen demand (Figure 8–1). Common clinical manifestations of IHD include chronic stable angina and the acute coronary syndromes (ACS) of unstable angina (UA), non–ST-segment elevation myocardial infarction (NSTEMI), and ST-segment elevation myocardial infarction (STEMI).

FIGURE 8–1.

This illustration depicts the balance between myocardial oxygen supply and demand and various factors that affect each. It should be noted that diastolic filling time is not an independent predictor of myocardial oxygen supply per se but rather a determinant of coronary blood flow. On the left is myocardial oxygen supply and demand under normal circumstances. On the right is the mismatch between oxygen supply and demand in patients with IHD. In patients without IHD, coronary blood flow increases in response to increases in myocardial oxygen demand. However, in patients ...

Pop-up div Successfully Displayed

This div only appears when the trigger link is hovered over. Otherwise it is hidden from view.

This site uses cookies to provide, maintain and improve your experience. MH Privacy Center Close