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Stable Ischemic Heart Disease

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10 Diagnosis Clinical Evaluation in the Initial Diagnosis of SIHD in Patients With Chest Pain Î Patients with chest pain should receive a thorough history and physical examination to assess the probability of IHD before additional testing. (I-C) Î Patients who present with acute angina should be categorized as stable or unstable. Patients with unstable angina (UA) should be further categorized as being at high, moderate, or low risk. (I-C) Î A resting electrocardiogram (ECG) is recommended in patients without an obvious, noncardiac cause of chest pain (I-B) Figure 5. Revascularization to Improve Survival of Patients with SIHD Noninvasive testing suggests high-risk coronary lesion(s) from Figure 2 Perform coronary angiography YES Potential revascularization procedure warranted based on assessment of coexisting cardiac and noncardiac factors and patient preferences? Heart Team concludes that anatomy and clinical factors indicate revascularization may improve survival (Table 12) Determine optimal method of revascularization based upon patient preferences, anatomy, other clinical factors, and local resources and expertise (Table 12) YES Guideline-Directed Medical erapy continued in all patients Continued Guideline- Directed Medical erapy with ongoing patient education Go to Figure 2 NO

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