Chronic coronary disease

Chronic coronary disease (CCD) is initially evaluated with a thorough history, including chest discomfort and related symptoms, and assessment of risk factors. This is followed by appropriate non-invasive testing guided by the probability of disease.

Management should focus on lifestyle modification, with emphasis on smoking cessation, physical activity, lipid control, and blood pressure control.

Aspirin and statin therapy are also central to management and reducing adverse outcomes such as myocardial infarction and cardiac death. Additional antithrombotic, lipid-lowering, and other therapies may further reduce these risks in some patients.

For symptomatic patients, beta-blockers, calcium-channel blockers, and nitrates reduce angina and increase exercise tolerance.

Patients with persistent angina despite lifestyle modification and guideline-directed medical therapy may warrant percutaneous or surgical revascularisation for reduction of symptoms.

For some carefully selected patients, revascularisation (in addition to lifestyle modification and medical therapy) may improve survival.

In addition to hypertension and dyslipidaemia, comorbidities commonly associated with CCD include diabetes and chronic kidney disease.

Coronary heart disease, an inability to provide adequate blood supply to the myocardium, is primarily caused by atherosclerosis of the epicardial coronary arteries. For this reason the terms ischaemic heart disease, coronary artery disease, coronary heart disease, and coronary disease are often used interchangeably, although the true pathophysiology is more complex.[1]Marzilli M, Merz CN, Boden WE, et al. Obstructive coronary atherosclerosis and ischemic heart disease: an elusive link! J Am Coll Cardiol. 2012 Sep 11;60(11):951-6. https://www.sciencedirect.com/science/article/pii/S0735109712022929?via%3Dihub http://www.ncbi.nlm.nih.gov/pubmed/22954239?tool=bestpractice.com [2]Pepine CJ, Douglas PS. Rethinking stable ischemic heart disease: is this the beginning of a new era? J Am Coll Cardiol. 2012 Sep 11;60(11):957-9. https://www.sciencedirect.com/science/article/pii/S0735109712022930?via%3Dihub http://www.ncbi.nlm.nih.gov/pubmed/22954240?tool=bestpractice.com

Coronary disease is chronic and often progressive. Patients with stable or no symptoms managed in an outpatient setting are said to have CCD or chronic coronary syndrome. Some patients experience one or more episodes of myocardial infarction (MI) or unstable angina - together called acute coronary syndromes (ACS). Although part of the same overall disease process, ACS are managed very differently, usually in emergency and inpatient settings with different tools for risk stratification and a more aggressive approach to revascularisation. See Overview of acute coronary syndrome.

In addition to MI and unstable angina, complications of CCD include ischaemic cardiomyopathy and sudden cardiac death. Exertional angina is the classic symptom of CCD, but patients may experience dyspnoea or other symptoms. Although routine screening is discouraged, testing may reveal CCD in patients without any symptoms or complications.