What Can Chest Pain Signal When You Exercise?

Stable ischemic heart disease gets new guidelines for better treatment and diagnosis

/ Author:  / Reviewed by: Robert Carlson, M.D

(RxWiki News) Ischemic heart disease (IHD) affects nearly one in three adults. Keeping it stable by managing symptoms can prevent worsening of the disease.

The survival rates for IHD patients are improving, but it is still a major health issue. Patients are at risk of heart attack and death. Preventing premature death and improving quality of life is the goal.

Treatment for IHD depends on whether the symptoms are considered stable or not. In the case of stable IHD, symptoms include chest pain during exertion and a decrease in exercise tolerance. Unstable IHD means ongoing or worsening of chest pain even during moments of rest. 

"Eat healthy, control blood pressure and quit smoking."

Two new clinical guidelines were issued on how to diagnose and treat stable IHD. Six different organizations were involved. They represented physicians, healthcare professionals and patients.

To develop the guidelines, the group did an extensive review of published research over several years. The studies were limited to those with human subjects and articles printed in English. Based on their findings, the guidelines were published to provide 48 recommendations to aid diagnosing and treating stable IHD.

The guidelines first address who should be tested. For example, a common symptom of IHD is chest pain or discomfort. The guidelines promote non-invasive testing whenever possible.

For those who have IHD, further diagnostic testing is recommended. Stress tests can be used to measure risks. Chronic risk can be tested during rest as well. A stress test can be done with chemicals in a patient who can not exercise.

The guidelines also suggest that the doctor and patient discuss testing and therapy options. The best plan of care should take into account the pros, cons and costs of treatment.

Teaching stable IHD patients about proper weight, nutrition, lipid (cholesterol) management and blood pressure control is important. If they smoke, stopping the habit would improve their health and risks. Follow-up visits with their doctor should be scheduled at least once a year.

Guidelines also discuss what medications are recommended and those that are not. Reasons for not prescribing a medication are because it has not been proven effective or it may cause negative reactions in some patients.

The guidelines - entitled 2012 ACCF/AHA/ACP/AATS/PCNA/SCAI/STS Guideline for the Diagnosis and Management of Patients with Stable Ischemic Heart Disease: Executive Summary - were published online by the Journal of the American College of Cardiology.

The organizations involved were the American College of Physicians, the American Association for Thoracic Surgery, the American College of Cardiology Foundation, the American Health Association, the Preventive Cardiovascular Nurses Association and the Society of Thoracic Surgeons.

Reviewed by: 
Review Date: 
January 2, 2013
Last Updated:
January 6, 2013