Table 1.
Treatment of ischemic heart disease
| Epicardial coronary atherosclerosis | ||
| Medications | Antiplatelet Agent | Recommended for all patients with CAD unless contraindicated |
| ACE-I | Recommended for all patients with left ventricular ejection fraction <40 % and in those with hypertension, diabetes, or chronic kidney disease, unless contraindicated. | |
| Beta blockers | Therapy should be started and continued for 3 years in all patients with who have had a myocardial infarction or acute coronary syndrome | |
| Statin | Statin therapy should be initiated in all patients with established CAD | |
| Lifestyle changes | BP Control | Patients with blood pressure >140/90 mmHg should be treated with lifestyle changes and medications |
| Smoking Cessation | Complete cessation is recommended | |
| Weight Management | Goal BMI is 18.5 to 24.9 kg/m2 | |
| Physical Activity | Recommendation is 30 min of moderate intensity activity at least 5 days a week | |
| Other | Influenza Vaccine | Patients with cardiovascular disease should have an annual influenza vaccination. |
| Cardiac Rehabilitation | Patients with the diagnosis of ACS, coronary artery bypass surgery or PCI, chronic angina and/or PAD within the past year should be referred to a cardiovascular rehabilitation program | |
| Invasive | Possible PCI or CABG | |
| Vasospastic diseasea | ||
| Conservative | Smoking Cessation, Calcium Channel Antagonists, Long-Acting Nitrates, Magnesium, Statin | |
| Invasive | Possible PCI or CABGb | |
| Spontaneous coronary artery dissectiona | ||
| Conservative | Medical management is similar to that used in ACS and secondary prevention of epicardial coronary atherosclerosisc | |
| Invasive | Possible PCI or CABGc | |
| Microvascular dysfunction | ||
| Conservative | Medical and lifestyle recommendations are similar to those for epicardial coronary atherosclerosis. Can also consider ranolazine for ischemic symptoms or tricyclic antidepressants for hypersensitivity to pain seen in female-specific IHD. | |
CAD coronary artery disease, ACE-I angiotensin converting enzyme inhibitors, BP blood pressure, BMI body mass index, ACS acute coronary syndrome, PCI percutaneous coronary intervention, PAD peripheral artery disease, CABG coronary artery bypass grafting
a No established guidelines
b Adapted from Coronary Artery Spasm A 2009 Update [81]
c Adapted from Spontaneous Coronary Artery Dissection [82]