Browse
Topics & Collections
Search for a specific
disease or term
—  or  —
Learn more about ACP Smart Medicine

Dynamed

X
This content was provided by DynaMed (dynamed.ebscohost.com). For more information click here.
Last Updated: 12/30/2013  

Coronary Heart Disease

Prevention
  • Encourage smoking cessation, regular physical activity, and a diet rich in fresh fruits and vegetables and low in cholesterol, saturated fats, and refined sugars.

  • Screen for dyslipidemia in asymptomatic, average-risk men over age 35 and women over age 45 and use a risk calculator to identify patients that may benefit from statin therapy.

  • Treat hypertension to <140/90 mm Hg in most patients and <150/90 mm Hg in patients over age 60.

  • Assess the benefits and risks of aspirin for primary prevention in patients with multiple CHD risk factors.

Screening
  • Do not screen for CHD in low-risk asymptomatic persons.

Diagnosis
  • Determine the pretest probability of CHD based on the type of pain (angina, atypical angina, noncardiac chest pain) and the presence of cardiac risk factors.

  • Examine patients for signs of CHD and comorbid diseases that may precipitate angina (e.g., hypertrophic obstructive cardiomyopathy, aortic stenosis, anemia, hyperthyroidism, cocaine use).

  • Obtain a resting ECG in all patients without an obvious noncardiac cause of chest pain.

  • Obtain a chest X-ray in all patients with HF, valvular heart disease, pericardial disease, or aortic dissection or aneurysm.

  • Obtain echocardiography in patients with possible valvular disease or outflow obstruction, HF, or history of MI.

  • Perform an exercise treadmill test in patients who are able to exercise and do not have baseline abnormalities on their resting ECG.

Therapy
  • Encourage smoking cessation, regular physical activity, and a diet rich in fresh fruits and vegetables and low in cholesterol, saturated fats, and refined sugars.

  • Prescribe β-blockers as the first-line anti-anginal therapy and calcium-channel blockers as the second-line treatment.

  • Add long-acting nitrates to β-blockers or calcium-channel antagonists or as monotherapy in patients not tolerant of first-line agents.

  • Begin all patients on aspirin and high-intensity statin therapy, and most patients on an ACE inhibitor.

  • Refer patients at high risk for death due to CHD or with persistent symptoms despite maximal medical therapy for evaluation for revascularization, including those with left-main stenoses ≥50%; severely symptomatic patients with three-vessel disease (stenoses ≥70%); high-risk exercise treadmill scores; multiple moderate or single large anterior perfusion defect on stress imaging; and LV function ≤35% to 40%.

DOI: 10.7326/d032
The information included herein should never be used as a substitute for clinical judgment and does not represent an official position of ACP.
Disclosures:
Paul R. Sutton, MD, PhD has no financial relationships with pharmaceutical companies, biomedical device manufacturers, or health-care related organizations. Stephan D. Fihn, MD, MPH has no financial relationships with pharmaceutical companies, biomedical device manufacturers, or health-care related organizations. John F. Beltrame, BSc, BMBS, FRACP, PhD, FESC, FACC, FCSANZ was involved in a collaborative study that surveyed chronic stable angina patients with Servier Pharmaceuticals and Adelaide University, and reports that a consultancy fee was paid for Adelaide University, and will be supported by a grant to Adelaide University from Servier Pharmaceuticals..
Deborah Korenstein, MD, FACP, Editor in Chief, ACP Smart Medicine, has no relationships with any entity producing, marketing, re-selling, or distributing health care goods or services consumed by, or used on, patients. Richard B. Lynn, MD, FACP, Editor, ACP Smart Medicine, has no relationships with any entity producing, marketing, re-selling, or distributing health care goods or services consumed by, or used on, patients.
Related Content
Annals of Internal Medicine