SYMPOSIUM ON CARDIOVASCULAR DISEASESChronic Coronary Artery Disease: Diagnosis and Management
Section snippets
DIAGNOSIS OF CHRONIC CAD
Chronic stable angina, the initial manifestation of CAD in approximately 50% of all patients,6 is usually caused by the obstruction of at least 1 large epicardial coronary artery by atheromatous plaque. Angina is due to the mismatch between myocardial oxygen demand and supply, resulting in myocardial ischemia. Angina pectoris is characterized by substernal discomfort, heaviness, or a pressure-like feeling, which may radiate to the jaw, shoulder, back, or arm and which typically lasts several
MANAGEMENT OF CHRONIC CAD
Management of CAD has 2 main goals: to reduce symptoms and ischemia and to prevent MI and death. These are modulated by different mechanisms: symptoms and ischemia, by the insufficient oxygen supply/demand ratio(usually due to coronary atherosclerosis); and MI and death, usually by unstable coronary artery plaque rupture. Medical management is pivotal in all patients with CAD. The first step is to identify and treat any associated diseases that can precipitate angina by increasing myocardial
CONCLUSION
All patients with stable CAD require comprehensive and aggressive control of risk factors. An initial trial of medical therapy alone is appropriate in most patients with chronic stable angina and is the cornerstone of treatment for chronic CAD. Persistent symptoms, the magnitude of the ischemic burden, or drug intolerance should drive decision making regarding subsequent revascularization. Ischemia should be established with a noninvasive stress test before angiography. In patients undergoing
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Dr Gersh is an advisory board member with Boston Scientific and a stock shareholder for CV Therapeutics.