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ClearRounds Health · Cardiology · Quick Reference
Stable Angina / Chronic Coronary Disease
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Ischemic Heart DiseaseIntermediateIn progressOne-page PDF
Antianginal meds, ischemic testing, CTA/stress/cath considerations, risk reduction, and escalation.
Last reviewed
June 12, 2026
Sources / guidelines to verify
- 2023 AHA/ACC Chronic Coronary Disease Guideline
Disclaimer: Educational reference only. Not a substitute for clinician judgment, local protocols, or current guideline review.
One-page reference
Clinically reviewed by the site owner. Still verify against the sources above and local protocol before clinical use.
1
What it is / why it matters
- Stable, predictable ischemia from fixed obstructive CAD — part of the chronic coronary disease (CCD) spectrum.
- Goal: control symptoms AND prevent events (MI, death).
- Consider microvascular or vasospastic angina (INOCA) when symptoms persist with non-obstructive arteries.
2
Key diagnostic clues
- Exertional chest pressure relieved by rest or nitroglycerin, with a predictable threshold.
- Classic triad: substernal, provoked by exertion/stress, relieved by rest/nitrates.
- Risk factors: age, smoking, diabetes, HTN, dyslipidemia, family history.
3
Initial workup
- Resting 12-lead ECG.
- Core labs: fasting lipid panel, HbA1c (or fasting glucose), CBC, metabolic panel/renal function; TSH if clinically indicated.
- Risk-refinement labs: Lp(a) once in adulthood (esp. premature/familial ASCVD or risk out of proportion to traditional factors); hs-CRP for residual inflammatory risk.
- NT-proBNP/BNP if heart-failure symptoms; troponin only if the presentation suggests ACS.
- TTE to assess LV function and wall motion (esp. prior MI, HF symptoms, or murmur).
- Functional stress testing OR coronary CTA (good for low–intermediate risk).
- Invasive angiography for high-risk findings or refractory symptoms.
4
Management framework
Event prevention (foundation)
- High-intensity statin (LDL <55 in established CAD)
- Antiplatelet: aspirin 81 mg (or clopidogrel)
- ACEi/ARB if HTN, diabetes, CKD, or low EF
- SGLT2i / GLP-1 RA if diabetes; smoking cessation; lifestyle
Antianginal therapy
- Beta-blocker and/or calcium channel blocker first-line (avoid non-dihydropyridine CCBs — verapamil/diltiazem — in HFrEF)
- Add long-acting nitrate (e.g., isosorbide mononitrate / Imdur); ranolazine (Ranexa) as add-on
Revascularization (PCI/CABG)
- For lifestyle-limiting symptoms refractory to optimal medical therapy
- CABG prognostic benefit in left main / multivessel disease with low EF (heart-team decision)
5
Red flags / escalate now
- New-onset, rest, or crescendo (accelerating) angina → treat as acute coronary syndrome.
- Angina at a low threshold, exertional syncope, or heart-failure symptoms.
6
Follow-up / monitoring
- Track anginal frequency, LDL goal, BP, and adherence.
- Re-evaluate (and consider ACS pathway) whenever the pattern changes.
7
Clinic pearls
- "Stable" means predictable — any acceleration triggers an ACS workup.
- Optimal medical therapy is the backbone; revascularization mainly relieves symptoms.
- Don’t miss microvascular/vasospastic angina in patients with symptoms but non-obstructive coronaries.
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