In July 2014 the American College of Cardiology, the American Heart Association and other cardiovascular organizations updated standards on the evaluation and treatment of stable ischemic heart disease. These guidelines apply to most patients, but also give your doctor the flexibility to tailor treatment to your specific clinical needs. Below is a summary of key information and recommendations.
Print this document and bring it with you to your next doctor visit so that you can ask questions and have a record of your treatment.
Ischemic heart disease means that the heart muscle is being deprived of the oxygen-rich blood it needs to function, as a result of clogged coronary arteries.
More than 13 million people in the United States have coronary artery disease, and nearly 9 million have chest pain (angina).
If you have ischemic heart disease you may experience chest pain when you put extra demands on your heart, such as during exercise or stress. However, arm pain during exercise and shortness of breath are also symptoms of ischemia.
The right treatment for you will depend on how high-risk your heart disease is and other factors, such as your age, other medical conditions, and personal preferences. It is essential that you play an active role in learning about your condition and weighing the treatment options your doctor will discuss with you.
In order to get a clear understanding about your heart disease and begin to estimate your risk of serious complications such as a heart attack, your doctor may:
To keep you healthy, your doctor may recommend:
Participation in a cardiac rehabilitation program, to support you in making healthy lifestyle changes and in managing medications.
A non-invasive therapy called enhanced external counterpulsation may also be used to relieve chest pain in certain patients. However, this therapy is not recommended for certain patients, including those with peripheral artery disease, severe heart failure and severe aortic regurgitation.
A procedure to restore good blood flow to your heart. This may be necessary if the build-up of cholesterol plaque (atherosclerosis) is causing severe and dangerous blockages in your arteries, or if medication alone is not enough to control your symptoms. The choice typically is between open-chest coronary artery bypass graft surgery (CABG) and minimally invasive percutaneous coronary intervention (PCI, also called angioplasty and stenting). CABG is recommended over PCI in patients with diabetes and complex multivessel disease and in some patients, doctors may use a “hybrid” combination of the two procedures to improve blood flow to the heart. The best approach will depend on where the blockages are, how severe they are, how many arteries are involved, and your overall health.
Healthy lifestyle habits that include:
Your doctor and heart care team will present all your options, and you will play a key role in making this important decision. This heart care team typically includes an interventional cardiologist and a cardiac surgeon who work with you to review your medical history and health status, discuss possible treatment options and select the best treatment strategy for you.
To help you stay healthy over the long run, your doctor may: