Internal Diseases and Therapy · MU Sofia

25. Ischemic heart disease. Stable Angina pectoris

Covers the definition of ischaemic heart disease and angina, its causes and risk factors, and how the ischaemic cascade produces pain. It then sets out the WHO and ESC classifications, the clinical features with CCS grading, and the diagnostic pathway with likelihood table and stress tests. Treatment, including nitrates, anti-anginal drugs, event prevention and revascularisation, closes the note, followed by prognosis.

Inside: 9 sections · 2 labelled pictures · 7 tables · 14 flashcards · 14 min

Topic 25 of 139 in the MU Sofia syllabus for Internal Diseases and Therapy (Medicine, Years 4 and 5). The free AceMed note covers it in 9 sections, about 1,592 words (14 min of reading), with 14 flashcards.

In this note

  1. Definition
  2. Etiology and risk factors
  3. Pathogenesis
  4. Classification
  5. Clinical features of stable angina
  6. Diagnosis
  7. Differential diagnosis
  8. Treatment
  9. Complications and prognosis

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):

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