Ischaemic heart disease: stable angina

• Autores: Andrew Whittaker, Percy Jokhi, Nicholas Curzen
• Localización: Medicine, ISSN-e 1357-3039, Vol. 42, Nº. 9, 2014, págs. 495-501
• Idioma: inglés
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• Resumen

  • Stable angina is a clinical syndrome reflecting inadequate myocardial perfusion. This is typically, but not always, caused by atherosclerotic coronary artery disease. A detailed history is important to establish the diagnosis, presence of risk factors and unstable symptoms. Stress ECG or stress imaging techniques should ideally be used to determine the presence and extent of myocardial ischaemia. The gold standard test to detect coronary disease remains invasive coronary angiography. Appropriate drug therapy significantly improves symptoms and prognosis, and should be started in all patients. Risk stratification should be performed by clinical evaluation, assessment of the presence and extent of myocardial ischaemia, quantification of left ventricular function, and coronary angiography where appropriate. Revascularization improves symptoms in the majority of patients, and improves prognosis in those with a high ischaemic burden. The choice of revascularization method (percutaneous coronary intervention or coronary artery bypass graft) is influenced by the extent and complexity of disease; presence of diabetes mellitus; co-morbidities that increase surgical risk; ability to take dual antiplatelet therapy; and patient preference.