Invasive Testing
When noninvasive testing for coronary artery disease (CAD) is inconclusive or suggests significant pathology, invasive testing is necessary. X-ray coronary angiography provides an overview of the coronary circulation and in…
Global Risk Assessment
Introduction This chapter is focused on tools for risk assessment in patients with stable coronary heart disease. In general, patients with stable ischemic heart disease have a good prognosis. However,…
Putting It All Together: Which Test for Which Patient?
The Challenge of Noninvasive Test Selection for Stable Chest Pain The prevalence of angina is high in the general population and increases with age in both sexes, from approximately 3%…
The Medical Treatment of Stable Angina
Introduction The Context Medical therapy of stable angina aims to address the key factor mediating myocardial ischemia: oxygen supply/demand imbalance. Pain is not the only symptom that a patient with…
Lifestyle Interventions
More than 90% of all cardiovascular disease (CVD) deaths are thought to be preventable through lifestyle changes. In the INTERHEART study, a case-control study of myocardial infarction (MI) in 52…
Obesity and the Obesity Paradox
Introduction After smoking, obesity is probably the second leading cause of preventable death in the United States and most of the westernized world. The estimated prevalence of obesity is almost…
Goals of Therapy
By its definition, chronic stable coronary artery disease (CAD) refers predominantly to patients who have a prior history of or current demonstrable obstructive atherosclerotic disease of the epicardial coronary arteries…
Lipid Measurements
Introduction Atheromatous plaque in arterial wall is the pathologic substrate for myocardial infarction and ischemic stroke and is intimately related to the deposition of oxidized lipids from the circulation into…
History and Physical Examination
Introduction Despite continuing technological advances in cardiovascular medicine, the history and physical examination remain vital to establish an accurate diagnosis of chronic coronary artery disease (CAD). Whereas many patients may…
ECG and Standard Exercise Stress Testing
Introduction The 12-lead electrocardiogram (ECG) has remained the standard initial evaluation tool in patients with suspected or known ischemic and electrophysiologic cardiac conditions for more than half a century. With…
