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SOURCE

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Source: Dobesh PP. Stable ischemic heart disease. In: DiPiro JT, Talbert RL, Yee GC, Matzke GR, Wells BG, Posey LM, eds. Pharmacotherapy: A Pathophysiologic Approach. 10th ed. New York, NY: McGraw-Hill; 2017. http://accesspharmacy.mhmedical.com/content.aspx?bookid=1861&sectionid=146056655. Accessed May 19, 2017.

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CONDITION/DISORDER SYNONYMS

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  • Angina pectoris.

  • Coronary artery disease.

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DEFINITION

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  • Lack of oxygen and decreased or no blood flow to myocardium resulting from coronary artery narrowing or obstruction.

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ETIOLOGY

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  • Angina pectoris.

  • Coronary atherosclerosis.

  • Coronary artery spasm.

  • Coronary artery embolism or thrombosis.

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PATHOPHYSIOLOGY

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  • Stable ischemic heart disease (SIHD) is driven by transient episodes of myocardial ischemia occur because of imbalance between myocardial oxygen supply and demand that result from increased oxygen demand (determined by heart rate, ventricular contractility, and ventricular wall tension) or decreased oxygen supply (primarily determined by coronary blood flow).

  • Progressive decrease in vessel radius associated with coronary atherosclerosis impairs coronary blood flow and causes angina pectoris when myocardial oxygen demand increases, as with exertion.

  • Angina pectoris may occur because of abrupt reduction in blood flow due to coronary thrombosis (unstable angina) or localized vasospasm (variant or Prinzmetal angina) without increased oxygen demand.

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EPIDEMIOLOGY

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  • According to AHA statistics in 2013, an estimated 85.6 million Americans had at least one form of cardiovascular disease (CVD), with more than 50% being 60 years of age or older.

  • Approximately 8.2 million Americans have angina pectoris.

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PREVENTION AND SCREENING

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  • Avoidance or cessation of smoking.

  • Treatment of dyslipidemia, hypertension, and diabetes mellitus.

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RISK FACTORS

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  • Age (55 years and older for men, 65 years and older for women)

  • Cigarette smoking.

  • Diabetes mellitus.

  • Dyslipidemia.

  • Family history of premature cardiovascular disease.

  • Hypertension.

  • Chronic kidney disease.

  • Obesity.

  • Physical inactivity.

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CLINICAL PRESENTATION

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SIGNS AND SYMPTOMS
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  • Chest pain described as squeezing, crushing, a heaviness, or tightness in the chest.

    • Can also be more vague and described as a numbness or burning in the chest.

  • Sensation of pressure or burning over sternum that may radiate to right or left shoulder, right or left arm, neck, back, or abdomen.

  • Other symptoms at the time of an episode:

    • Diaphoresis.

    • Nausea.

    • Vomiting.

    • Dyspnea.

  • Chest tightness and shortness of breath may occur and last less than 20 min, but is usually 5–10 min.

  • Precipitating factors include:

    • Exertion.

    • Exercise.

    • Cold environment.

    • Walking after a meal.

    • Emotional upset.

    • Fright.

    • Anger.

    • Sexual activity.

  • Relief occurs with rest and within 5–10 min of taking nitroglycerin.

  • Variant (Prinzmetal) angina may be associated with pain at rest and in early morning hours.

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DIAGNOSIS

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MEANS OF CONFIRMATION AND DIAGNOSIS
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  • Obtain medical history to determine:

    • Quality of chest pain.

    • Precipitating factors.

    • Duration.

    • Pain radiation.

    • Response to nitroglycerin or ...

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