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ischemic heart disease (IHD)

A form of heart disease whose primary manifestations result from myocardial ischemia. This term encompasses a spectrum of patients ranging from the asymptomatic preclinical phase to acute myocardial infarction & sudden cardiac death. See coronary artery disease. Etiology: - atherosclerotic coronary artery disease (CAD) - many women with myocardial ischemia have no obstructive coronary artery disease by angiography, but often have impaired microvascular function & abnormal coronary reactivity [10] Laboratory: - thyroid function testing may be indicated - see ARUP consult [1] Special laboratory: - coronary angiography* * baseline incidence of subclinical hyperthyroidism in patients withischemic heart disease undergoing coronary angiography high (7.2%) increased to 10% with iodine contrast [9] Management: - medical therapy vs myocardial reperfusion - initial revascularization does not reduce risk of cardiovascular events in patients with stable ischemic heart disease [12] - myocardial reperfusion - PCI vs CABG may benefit patients with LVEF of 35-45% [13] - CABG significantly outperforms medical therapy for all-cause mortality (59 vs 66% over 9.8 years) [2] - myocardial viability does not predict benefit from revascularization or mortality [3] Notes: - comprehensive guidelines for diagnosis & management of ischemic heart disease, including algorythms [2] - trans endocardial injection of ixmyelocel-T, a bone-marrow product with selective expansion of M2 macrophages & CD90+ mesenchymal stem cells resulted in some rather bewildering findings, but 6-minute walk distances, or improved NYHA heart failure classification were not among them [8]

Interactions

disease interactions

Related

coronary artery disease; coronary atherosclerosis (CAD)

Specific

ischemic cardiomyopathy myocardial ischemia

General

heart disease (cardiac disease) ischemia

References

  1. ARUP Consult: Acute Coronary Syndrome - Ischemic Heart Disease The Physician's Guide to Laboratory Test Selection & Interpretation https://www.arupconsult.com/content/acute-coronary-syndrome
  2. Qaseem A et al Diagnosis of Stable Ischemic Heart Disease: Summary of a Clinical Practice Guideline From the American College of Physicians/American College of Cardiology Foundation/American Heart Association/American Association for Thoracic Surgery/ Preventive Cardiovascular Nurses Association/Society of Thoracic Surgeons. Annals of Internal Medicine, Nov 20, 2012, 10(157) PMID: 23165676 http://annals.org/article.aspx?articleid=1392193 - Qaseem A et al Management of Stable Ischemic Heart Disease: Summary of a Clinical Practice Guideline From the American College of Physicians/American College of Cardiology Foundation/American Heart Association/American Association for Thoracic Surgery/ Preventive Cardiovascular Nurses Association/Society of Thoracic Surgeons Annals of Internal Medicine, Nov 20, 2012, 10(157) PMID: 23165677 http://annals.org/article.aspx?articleid=1392195 - Fihn SD et al 2012 ACCF/AHA/ACP/AATS/PCNA/SCAI/STS Guideline for the Diagnosis and Management of Patients With Stable Ischemic Heart Disease. J Am Coll Cardiol Nov 2012 PMID: 23182125 http://content.onlinejacc.org/article.aspx?articleid=1391404 (corresponding NGC guideline withdrawn Nov 2017)
  3. Shaw LJ, Bugiardini R, Merz CN. Women and ischemic heart disease: evolving knowledge. J Am Coll Cardiol. 2009 Oct 20;54(17):1561-75. PMID: 19833255
  4. Bonow RO, Maurer G, Lee KL et al Myocardial viability and survival in ischemic left ventricular dysfunction. N Engl J Med. 2011 Apr 28;364(17):1617-25 PMID: 21463153 PMCID: PMC3290901 Free PMC article
  5. Fihn SD et al 2014 ACC/AHA/AATS/PCNA/SCAI/STS Focused Update of the Guideline for the Diagnosis and Management of Patients With Stable Ischemic Heart Disease. A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines, and the American Association for Thoracic Surgery, Preventive Cardiovascular Nurses Association, Society for Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons. Circulation. 2014 Apr 22;129(16):e463. PMID: 25070666 Free full text http://content.onlinejacc.org/article.aspx?articleID=1891717 - Fihn SD, Gardin JM, Abrams J et al 2012 ACCF/AHA/ACP/AATS/PCNA/SCAI/STS guideline for the diagnosis and management of patients with stable ischemic heart disease: a report of the American College of Cardiology Foundation/ American Heart Association task force on practice guidelines, and the American College of Physicians, American Association for Thoracic Surgery, Preventive Cardiovascular Nurses Association, Society for Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons. Circulation. 2012 Dec 18;126(25):e354-471 PMID: 23166211 (corresponding NGC guideline withdrawn Nov 2017)
  6. Qaseem A, Fihn SD, Williams S, et al Diagnosis of stable ischemic heart disease: summary of a clinical practice guideline from the American College of Physicians/American College of Cardiology Foundation/American Heart Association/American Association for Thoracic Surgery/ Preventive Cardiovascular Nurses Association/Society of Thoracic Surgeons. Ann Intern Med. 2012 Nov 20;157(10):729-34 PMID: 23165664
  7. Qaseem A, Fihn SD, Dallas P et al Management of stable ischemic heart disease: summary of a clinical practice guideline from the American College of Physicians/American College of Cardiology Foundation/American Heart Association/American Association for Thoracic Surgery/ Preventive Cardiovascular Nurses Association/Society of Thoracic Surgeons. Ann Intern Med. 2012 Nov 20;157(10):735-43 PMID: 23165665
  8. Patel AN et al. Ixmyelocel-T for patients with ischaemic heart failure: A prospective randomised double-blind trial. Lancet 2016 Apr 5; [e-pub]. PMID: 27059887 - Povsic TJ, Zeiher AM. IxCELL-DCM: Rejuvenation for cardiac regenerative therapy? Lancet 2016 Apr 5 PMID: 27059889
  9. Bonelli N, Rossetto R, Castagno D Hyperthyroidism in patients with ischaemic heart disease after iodine load induced by coronary angiography: Long-term follow- up and influence of baseline thyroid functional status. Clin Endocrinol (Oxf). 2018 Feb;88(2):272-278. Epub 2017 Nov 20. PMID: 29023926 https://www.medscape.com/viewarticle/892230
  10. AlBadri A, Bairey Merz CN, Johnson BD et al. Impact of abnormal coronary reactivity on long-term clinical outcomes in women. J Am Coll Cardiol 2019 Feb 19; 73:68 PMID: 30765035 https://www.sciencedirect.com/science/article/pii/S0735109718394634
  11. Panza JA, Ellis AM, Al-Khalidi HR et al. Myocardial viability and long-term outcomes in ischemic cardiomyopathy. N Engl J Med 2019 Aug 22; 381:739 PMID: 31433921 https://www.nejm.org/doi/10.1056/NEJMoa1807365
  12. Chowdhury YS, Patel M American Heart Association 2019 Meeting. Professional Heart Daily ISCHEMIA https://professional.heart.org/professional/ScienceNews/UCM_505226_ISCHEMIA-Clinical-Trial-Details.jsp
  13. Lopes RD et al. Initial invasive versus conservative management of stable ischemic heart disease patients with a history of heart failure or left ventricular dysfunction: Insights from the ISCHEMIA trial. Circulation 2020 Aug 29; [e-pub]. PMID: 32862662 https://www.ahajournals.org/doi/10.1161/CIRCULATIONAHA.120.050304
  14. Antman EM, Braunwald E Managing Stable Ischemic Heart Disease. N Engl J Med. 2020 Apr 9;382(15):1468-1470. PMID: 32227752