Definition
- Ischaemic heart disease (IHD), or coronary artery disease (CAD): myocardial dysfunction or damage from an imbalance between myocardial oxygen supply and demand, in over 90% of cases due to atherosclerosis of the epicardial coronary arteries.
- Angina pectoris: the clinical expression of transient, reversible myocardial ischaemia.
- Chronic coronary syndromes (European Society of Cardiology, ESC 2024): presentations caused by chronic structural and/or functional changes of the coronary arteries and/or microcirculation, as opposed to the acute coronary syndromes (ACS) caused by a sudden plaque event (topics 26 and 27). A chronic syndrome can destabilise into an ACS, and after an ACS the disease becomes chronic again.
Etiology and risk factors
- Reduced supply: atherosclerotic stenosis (by far the commonest), vasospasm, microvascular dysfunction; rarely coronary embolism, spontaneous coronary dissection, arteritis (Takayasu, Kawasaki, syphilitic aortitis), congenital anomalies; low oxygen content (anaemia, hypoxaemia).
- Increased demand, unmasking a stenosis or causing ischaemia even with normal arteries: aortic stenosis, hypertrophic cardiomyopathy, hypertensive left ventricular (LV) hypertrophy, tachyarrhythmias, thyrotoxicosis.
Risk factors of coronary atherosclerosis (they apply to the acute coronary syndromes too):