The coronary circulation serves the purpose of matching myocardial oxygen
supply and consumption. A transient mismatch causing reversible myocardial
ischaemia is the dominant feature of chronic ischaemic heart disease (IHD),
which is also characterized by stable symptoms over a period of months, years,
or even decades. Stable angina is the most frequent presentation of chronic
IHD; other clinical presentations are microvascular angina, vasospastic angina,
and ischaemic cardiomyopathy. Stable angina is mainly caused by obstructive
coronary atherosclerosis. ECG exercise stress test is the first-line test for
diagnosis and risk stratification; when it cannot be performed or is not
interpretable imaging stress tests are indicated. The aims of treatment are to
improve prognosis and to reduce symptoms. Prognosis is improved by the
reduction of coronary risk factor burden, by the administration of antiplatelet
agents, and, in high risk patients, by myocardial revascularization. Symptoms
are improved by anti-anginal drugs which act through different mechanisms,
including reduction of myocardial oxygen consumption and improvement of
myocardial perfusion, and by myocardial revascularization in patients who do
not satisfactorily respond to drugs. Microvascular angina is caused by coronary
microvascular dysfunction; its prognosis is good, but symptoms can be
invalidating and frequently do not fully respond to conventional anti-anginal
drugs. Vasospastic angina is caused by coronary artery spasm; prognosis is good
if spasm is prevented by treatment with coronary vasodilators. Ischaemic
cardiomyopathy is dominated by symptoms and signs of left ventricular
dysfunction; prognosis is mainly determined by the degree of left ventricular
dysfunction and seems improved by myocardial revascularization in patients with
large areas of myocardial viability....