Ischemic Heart Disease – Chronic Stable Angina (10).

Vocabulary flashcards covering key terms, pathophysiology, diagnostics, risk factors, and management concepts for chronic stable angina and acute coronary syndromes as presented in the lecture.

Ischemic Heart Disease (IHD)

A spectrum of clinical conditions caused by imbalance between myocardial oxygen supply and demand, most commonly due to atherosclerotic coronary artery disease.

Typical (Cardiac) Chest Pain

Central, pressure-like discomfort precipitated by exertion or stress, relieved by rest or nitrates, often radiating to arm, neck, or jaw.

Atypical Chest Pain

Chest discomfort lacking one or more classic anginal features; may be sharp, pleuritic, positional, or reproducible with palpation.

Non-Cardiac Chest Pain

Chest discomfort arising from non-cardiac systems such as respiratory, gastrointestinal, musculoskeletal, neurologic (e.g., herpes zoster) or others.

Stable Angina (Chronic Coronary Syndrome)

Predictable transient chest pain due to fixed atheromatous coronary stenosis, precipitated by exertion and relieved by rest or nitrates.

Unstable Angina (UA)

Angina at rest, new-onset severe angina, or increasing angina due to dynamic coronary obstruction without myocardial necrosis (normal troponin).

NSTEMI

Non-ST-segment elevation myocardial infarction; myocardial necrosis (elevated troponin) without persistent ST-segment elevation on ECG.

STEMI

ST-segment elevation myocardial infarction caused by acute coronary occlusion with transmural ischemia producing ST elevation on ECG.

Canadian Cardiovascular Society (CCS) Angina Classification

Four-class grading system of angina severity from Class I (angina only with strenuous activity) to Class IV (angina at rest).

Modifiable Risk Factors for IHD

Lifestyle-related risks including smoking, hypertension, diabetes, dyslipidemia, obesity, and physical inactivity.

Non-Modifiable Risk Factors for IHD

Intrinsic risks such as advanced age, male sex, and positive family history of premature coronary disease.

Atherosclerotic Cause of IHD

Coronary artery lumen narrowing by cholesterol-rich plaque formation, accounting for most cases of ischemia.

Coronary Vasospasm

Transient focal spasm of coronary artery causing episodic ischemia, sometimes termed Prinzmetal (variant) angina.

Coronary Embolism

Obstruction of coronary blood flow by a clot or debris originating elsewhere (e.g., atrial thrombus, endocarditis).

Angina Pectoris

Chest discomfort resulting from transient myocardial ischemia; hallmark symptom of chronic stable angina.

Warm-Up Angina

Phenomenon where angina occurs at the start of exertion but improves as exercise continues due to collateral vasodilatation.

Angina Equivalent

Non-pain symptoms (e.g., dyspnea, fatigue) that represent myocardial ischemia, common in diabetics and elderly.

Exercise Stress Test

Treadmill or bicycle ECG test assessing inducible ischemia; positive when ≥1 mm horizontal or down-sloping ST depression develops.

Myocardial Stress Imaging

Imaging modalities (nuclear perfusion scan or stress echocardiography) performed with exercise or pharmacologic stress to detect ischemia with higher sensitivity than plain exercise ECG.

Coronary Angiography

Imaging of coronary anatomy by CT (non-invasive) or catheter-based (invasive) contrast study to define location and severity of stenosis.

High-Risk Stable Angina

Patients with factors such as post-infarct angina, poor effort tolerance, ischemia at low workload, left main or triple-vessel disease, or poor LV function.

Antiplatelet Therapy

Prevention of platelet aggregation with low-dose aspirin (81 mg) or clopidogrel 75 mg when aspirin-allergic to reduce coronary thrombosis risk.

Nitrates

Venous and arteriolar vasodilators (e.g., sublingual nitroglycerin) that decrease preload and relieve angina; avoid concomitant phosphodiesterase-5 inhibitors within 24-48 h.

Beta Blockers (BB)

First-line anti-anginals that lower heart rate and contractility, reducing myocardial oxygen demand and improving post-MI survival.

Calcium Channel Antagonists (CCB)

Drugs that reduce myocardial oxygen demand; DHP agents (amlodipine) combined with BB, non-DHP agents (verapamil/diltiazem) used when BB not tolerated.

Potassium Channel Activator (Nicorandil)

Vasodilator acting on arterial and venous beds without tolerance development; typical dose 10–20 mg twice daily.

If Channel Antagonist (Ivabradine)

Agent that selectively slows sinus node rate without affecting contractility; used when heart rate remains >80 bpm despite BB.

Ranolazine

Anti-ischemic drug that inhibits late sodium current to reduce myocardial wall tension; may prolong QT interval.

Percutaneous Coronary Intervention (PCI)

Catheter-based revascularization with drug-eluting stent deployment; improves symptoms but not long-term survival in stable disease.

Coronary Artery Bypass Graft (CABG)

Surgical revascularization using arterial or venous conduits; superior survival benefit in left main or triple-vessel disease with LV dysfunction.

Drug-Eluting Stent (DES)

Coronary stent coated with antiproliferative drug to reduce restenosis; requires dual antiplatelet therapy for ≥6 months.

Left Main Coronary Artery Stenosis

≥50 % narrowing of the left main artery, a strong indication for surgical revascularization (CABG).

Beta-Blocker Withdrawal Syndrome

Rebound tachycardia, hypertension, or ischemia after abrupt cessation of beta blockers; taper slowly.

Dual Antiplatelet Therapy (DAPT)

Combination of aspirin plus a P2Y12 inhibitor (clopidogrel, ticagrelor) to prevent stent thrombosis and acute coronary events.

Canadian Cardiovascular Society Class IV

Inability to perform any physical activity without angina or angina at rest; represents severe limitation.

Myocardial Necrosis

Irreversible death of myocardial tissue, detected by elevated cardiac troponins, characteristic of MI (NSTEMI or STEMI).

Fondaparinux

Synthetic factor Xa inhibitor used as parenteral anticoagulant alternative to heparin in acute coronary syndrome.