Algorithm for Management of Ischemic Heart Disease - Flowchart
Algorithm for Management of Ischemic Heart Disease - Flowchart
«Flowchart»

MANAGEMENT OF THE PT WITH IHD

Initiate medical therapy:


    Decrease demand ischemia
    Minimize IHD risk factors
    ASA (clopidogrel if ASA intolerant)

MANAGEMENT OF THE PT WITH IHD

Initiate medical therapy:


    Decrease demand ischemia
    Minimize IHD risk factors
    ASA (clopidogrel if ASA intolerant)

MANAGEMENT OF THE PT WITH IHD

MANAGEMENT OF THE PT WITH IHD

Initiate medical therapy:

Initiate medical therapy:

    Decrease demand ischemia
    Minimize IHD risk factors
    ASA (clopidogrel if ASA intolerant)

Decrease demand ischemia
Minimize IHD risk factors
ASA (clopidogrel if ASA intolerant)

Refer for coronary arteriography

Refer for coronary arteriography

Refer for coronary arteriography

End

End

End

ACS, acute coronary syndrome; ASA, aspirin; EF, ejection fraction; IHD, ischemic heart disease; LM, left main.

ACS, acute coronary syndrome; ASA, aspirin; EF, ejection fraction; IHD, ischemic heart disease; LM, left main.

ACS, acute coronary syndrome; ASA, aspirin; EF, ejection fraction; IHD, ischemic heart disease; LM, left main.

Any high-risk features?

Low exercise capacity or ischemia at low workload, large area of ischemic myocardium, EF <40%, ACS presentation

Any high-risk features?

Low exercise capacity or ischemia at low workload, large area of ischemic myocardium, EF <40%, ACS presentation

Any high-risk features?

Any high-risk features?

Low exercise capacity or ischemia at low workload, large area of ischemic myocardium, EF <40%, ACS presentation

Yes

Yes

Yes

No

No

No

Continue medical therapy periodic stress assessment

Continue medical therapy periodic stress assessment

Continue medical therapy periodic stress assessment

Are exertional symptoms controlled?

Are exertional symptoms controlled?

Are exertional symptoms controlled?

Yes

Yes

Yes

No

No

No

Consider unconventional treatments

Consider unconventional treatments

Consider unconventional treatments

Anatomy suitable for revascularization?

Anatomy suitable for revascularization?

Anatomy suitable for revascularization?

Yes

Yes

Yes

No

No

No

PCI

PCI

PCI

Assess: PCI vs CABG

Assess: PCI vs CABG

Assess: PCI vs CABG

Single vessel disease

Single vessel disease

Single vessel disease

LM +/or multi-vessel disease

LM +/or multi-vessel disease

LM +/or multi-vessel disease