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| | __NOTOC__ |
| '''For patient information on coronary heart disease click [[Coronary heart disease (patient information)|here]]''' | | '''For patient information on coronary heart disease click [[Coronary heart disease (patient information)|here]]''' |
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| '''For patient information on coronary risk profile click [[Coronary risk profile (patient information)|here]]''' | | '''For patient information on coronary risk profile click [[Coronary risk profile (patient information)|here]]''' |
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| {{DiseaseDisorder infobox |
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| Name = Coronary heart disease |
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| ICD10 = I20-I25 |
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| ICD9 = {{ICD9|410}}-{{ICD9|414}}, {{ICD9|429.2}} |
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| {{Coronary heart disease}} | | {{Coronary heart disease}} |
| {{CMG}} | | {{CMG}} |
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| ==[[Atherosclerosis Prevention and Risk Factor Modification]]== | | {{SK}} Coronary artery disease; arteriosclerotic heart disease; ischemic heart disease; myocardial ischemia; CHD; CAD |
| ==[[Chronic Stable Angina]]== | | |
| ==[[Unstable Angina]]== | | ==[[Coronary heart disease overview|Overview]]== |
| ==[[Non ST Elevation Myocardial Infarction]]== | | |
| ==[[ST Elevation Myocardial Infarction]]== | | ==[[Coronary heart disease historical perspective|Historical Perspective]]== |
| ==[[Cardiac Rehabilitation]]== | | |
| | ==[[Coronary heart disease classification|Classification]]== |
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| | ==[[Coronary heart disease pathophysiology|Pathophysiology]]== |
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| | ==[[Coronary heart disease differential diagnosis|Differentiating Coronary heart disease from other Diseases]]== |
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| | ==[[Coronary heart disease epidemiology and demographics|Epidemiology and Demographics]]== |
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| ==Angina== | | ==[[Coronary heart disease risk factors|Risk Factors]]== |
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| [[Angina pectoris|Angina]] that occurs regularly with activity, upon awakening, or at other predictable times is termed stable angina and is associated with high grade [[stenosis|narrowings]] of the [[heart]] [[artery|arteries]]. The symptoms of angina are often treated with nitrate preparations such as [[Glyceryl trinitrate (pharmacology)|nitroglycerin]], which come in short-acting and long-acting forms, and may be administered transdermally, sublingually or orally. Many other more effective treatments, especially of the underlying [[atheroma]]tous disease, have been developed. | | ==[[Coronary heart disease risk stratification|Screening and Risk Stratification]]== |
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| Angina that changes in intensity, character or frequency is termed unstable. Unstable angina may precede myocardial infarction, and requires urgent medical attention. It is treated with morphine, oxygen, intravenous nitroglycerin, and aspirin. Interventional procedures such as [[angioplasty]] may be done.
| | ==[[Coronary heart disease natural history, complications and prognosis|Natural History, Complications and Prognosis]]== |
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| ==Screening== | | ==Diagnosis== |
| Asymptomatic adults should not be screened for coronary artery disease with an [[electrocardiogram]].<ref name="pmid22847227">{{cite journal| author=Moyer VA, on behalf of the U.S. Preventive Services Task Force*| title=Screening for Coronary Heart Disease With Electrocardiography: U.S. Preventive Services Task Force Recommendation Statement. | journal=Ann Intern Med | year= 2012 | volume= | issue= | pages= | pmid=22847227 | doi=10.7326/0003-4819-157-7-201210020-00514 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22847227 }} </ref>
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| == Recent research ==
| | [[Coronary heart disease pretest probability|Pretest Probability]] | [[Coronary heart disease history and symptoms|History and Symptoms]] | [[Coronary heart disease physical examination|Physical Examination]] | [[Coronary heart disease laboratory findings|Laboratory Findings]] | [[Coronary heart disease electrocardiogram|Electrocardiogram]] | [[Coronary heart disease chest x ray|Chest X Ray]] | [[Coronary heart disease CT|CT]] | [[Coronary heart disease MRI|MRI]] | [[Coronary heart disease echocardiography or ultrasound|Echocardiography or Ultrasound]] | [[Coronary heart disease other imaging findings|Other Imaging Findings]] | [[Coronary heart disease other diagnostic studies|Other Diagnostic Studies]] |
| {{further|[[atheroma]] and [[atherosclerosis]]}}
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| A 2006 study by the [[Cleveland Clinic]] found a region on Chromosome 17 was confined to families with multiple cases of myocardial infarction.<ref name="Farrall-2006">{{cite journal | author=Farrall M, Green FR, Peden JF, Olsson PG, Clarke R, Hellenius ML, Rust S, Lagercrantz J, Franzosi MG, Schulte H, Carey A, Olsson G, Assmann G, Tognoni G, Collins R, Hamsten A, Watkins H, on behalf of the PROCARDIS Consortium | title=Genome-Wide Mapping of Susceptibility to Coronary Artery Disease Identifies a Novel Replicated Locus on Chromosome 17 | journal=PLoS Genetics | year=2006 | volume=2 | issue=5 | pages=e72 | url=http://genetics.plosjournals.org/perlserv/?request=get-document&doi=10.1371%2Fjournal.pgen.0020072 | id=PMID 16710446}}</ref>
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| A more controversial link is that between ''[[Chlamydophila pneumoniae]]'' infection and atherosclerosis.<ref name="Saikku-1992">{{cite journal | author=Saikku P, Leinonen M, Tenkanen L, Linnanmaki E, Ekman MR, Manninen V, Manttari M, Frick MH, Huttunen JK. | title=Chronic Chlamydia pneumoniae infection as a risk factor for coronary heart disease in the Helsinki Heart Study. | journal=Ann Intern Med | year=1992 | volume=116 | issue=4 | pages=273-8 | id=PMID 1733381}}</ref> While this intracellular organism has been demonstrated in atherosclerotic plaques, evidence is inconclusive as to whether it can be considered a causative factor. Treatment with antibiotics in patients with proven atherosclerosis has not demonstrated a decreased risk of heart attacks or other coronary vascular diseases.<ref name="Andraws-2005">{{cite journal | author=Andraws R, Berger JS, Brown DL. | title=Effects of antibiotic therapy on outcomes of patients with coronary artery disease: a meta-analysis of randomized controlled trials. | journal=JAMA | year=2005 | volume=293 | issue=21 | pages=2641-7 | id=PMID 15928286}}</ref>
| | ==Treatment== |
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| On September 29, 2008, the American Heart Association Prevention Committee of the Council on Cardiovascular Nursing, Council on Clinical Cardiology, Council on Epidemiology and Prevention, and Interdisciplinary Council on Quality of Care and Outcomes Research released a science advisory outlining their recommendations for screening, referral and treatment of [[depression]] in patients with coronary heart disease (CHD). Their recommendations include: 1. CHD patients should be routinely screened for depression; 2. CHD patients with positive screens should be evaluated by professionals skilled in dealing with depression; 3. CHD patients with depression should be monitored for both cardiovascular and [[mental health]] issues; 4. Care for CHD patients with depression should be coordinated between cardiovascular and [[mental health professional]]s.<ref name="Lichtman-2008">{{cite journal | author=Lichtman JH, Bigger JT Jr, Blumenthal JA, Frasure-Smith N, Kaufmann PG, Lespérance F, Mark DB, Sheps DS, Taylor CB, Froelicher ES; American Heart Association Prevention Committee of the Council on Cardiovascular Nursing; American Heart Association Council on Clinical Cardiology; American Heart Association Council on Epidemiology and Prevention; American Heart Association Interdisciplinary Council on Quality of Care and Outcomes Research; American Psychiatric Association | title=Depression and coronary heart disease: recommendations for screening, referral, and treatment: a science advisory from the American Heart Association Prevention Committee of the Council on Cardiovascular Nursing, Council on Clinical Cardiology, Council on Epidemiology and Prevention, and Interdisciplinary Council on Quality of Care and Outcomes Research: endorsed by the American Psychiatric Association | journal=Circulation | year=2008 | volume=118 | issue=17 | pages=1768-1775 | url=http://circ.ahajournals.org/cgi/content/abstract/118/17/1768?etoc | id=PMID 18824640}}</ref>
| | [[Coronary heart disease medical therapy|Medical Therapy]] | [[Coronary heart disease surgery|Surgery]] | [[Coronary heart disease primary prevention|Primary Prevention]] | [[Coronary heart disease secondary prevention|Secondary Prevention]] | [[Coronary heart disease cost-effectiveness of therapy|Cost-Effectiveness of Therapy]] | [[Coronary heart disease future or investigational therapies|Future or Investigational Therapies]] |
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| ==References== | | ==Case Studies== |
| {{Reflist|2}}
| | [[Coronary heart disease case study one|Case #1]] |
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| ==See Also== | | ==Related Chapters== |
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| * [[Atherosclerosis]] | | *[[Atherosclerosis]] |
| | *[[Atherosclerosis Prevention and Risk Factor Modification]] |
| | *[[Chronic Stable Angina]] |
| | *[[Non ST Elevation Myocardial Infarction]] |
| | *[[ST Elevation Myocardial Infarction]] |
| | *[[Unstable Angina]] |
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| {{Circulatory system pathology}} | | {{Circulatory system pathology}} |