Chronic Ischemic Heart Disease

The pathophysiology of myocardial ischemia is related to a mismatch between coronary blood flow and myocardial oxygen requirements. In most patients with coronary artery disease, the angina threshold is not fixed but varies throughout the day. The exercise test is probably still the most important noninvasive diagnostic test. Patients with chronic ischemia may or may not demonstrate painful symptoms during ischemic episodes. Prognosis in patients with chronic ischemia relates to the severity of coronary artery disease and the degree of left ventricular dysfunction plus objective documentation of ischemia. Major therapeutic agents for patients with chronic ischemia are antianginal drugs (nitrates, β-blockers, calcium blockers), antiplatelet drugs (aspirin), and revascularization procedures (coronary angioplasty, coronary artery surgery).