Editing Coronary artery disease (section)

===Stable angina===
{{main|Angina#Stable angina}}
[[Stable angina]] is the most common manifestation of ischemic heart disease, and is associated with reduced quality of life and increased mortality. It is caused by epicardial coronary stenosis which results in reduced blood flow and oxygen supply to the myocardium.<ref>{{cite web |title=Angina – Symptoms and causes |url=https://www.mayoclinic.org/diseases-conditions/angina/symptoms-causes/syc-20369373 |website=Mayo Clinic |language=en}}</ref>
Stable angina is short-term chest pain during physical exertion caused by an imbalance between myocardial oxygen supply and metabolic oxygen demand. Various forms of [[cardiac stress test]]s may be used to induce both symptoms and detect changes by way of electrocardiography (using an ECG), [[echocardiography]] (using [[medical ultrasonography|ultrasound]] of the heart) or [[scintigraphy]] (using uptake of [[radionuclide]] by the heart muscle). If part of the heart seems to receive an insufficient blood supply, [[Coronary catheterization|coronary angiography]] may be used to identify [[stenosis]] of the coronary arteries and suitability for [[angioplasty]] or [[Coronary artery bypass surgery|bypass surgery]].<ref>{{cite web|title=Coronary Angiography|url=https://www.nhlbi.nih.gov/health/health-topics/topics/ca|website=National Heart, Blood, and Lung Institute|access-date=10 December 2017}}</ref>

In minor to moderate cases, nitroglycerine may be used to alleviate acute symptoms of stable angina or may be used immediately before exertion to prevent the onset of angina. Sublingual nitroglycerine is most commonly used to provide rapid relief for acute angina attacks and as a complement to anti-anginal treatments in patients with refractory and recurrent angina.<ref>{{cite journal |last1=Tarkin |first1=Jason M |last2=Kaski |first2=Juan Carlos |title=Pharmacological treatment of chronic stable angina pectoris |journal=Clinical Medicine |pages=63–70 |doi=10.7861/clinmedicine.13-1-63 |date=February 2013|volume=13 |issue=1 |pmid=23472498 |pmc=5873712 }}</ref> When nitroglycerine enters the bloodstream, it forms free radical nitric oxide, or NO, which activates guanylate cyclase and in turn stimulates the release of cyclic GMP. This molecular signaling stimulates smooth muscle relaxation, resulting in vasodilation and consequently improved blood flow to heart regions affected by atherosclerotic plaque.<ref>{{cite web |url=https://www.accessdata.fda.gov/drugsatfda_docs/label/2010/021134s004lbl.pdf |archive-url=https://web.archive.org/web/20140419045424/http://www.accessdata.fda.gov/drugsatfda_docs/label/2010/021134s004lbl.pdf |archive-date=2014-04-19 |url-status=live |title=Nitrostat® (Nitroglycerin Sublingual Tablets, USP) |publisher=United States Food and Drug Administration}}</ref>

Stable coronary artery disease (SCAD) is also often called stable ischemic heart disease (SIHD).<ref name="Li 2015 Overview of ischemic heart disease">{{cite book | vauthors = Li YR |chapter=Overview of ischemic heart disease, stable angina, and drug therapy |pages=245–53 |chapter-url=https://books.google.com/books?id=rXy0BgAAQBAJ&pg=PA245 |title=Cardiovascular Diseases: From Molecular Pharmacology to Evidence-Based Therapeutics |date=2015 |publisher=John Wiley & Sons |isbn=978-0-470-91537-0 }}</ref> A 2015 monograph explains that "Regardless of the nomenclature, stable angina is the chief manifestation of SIHD or SCAD."<ref name="Li 2015 Overview of ischemic heart disease"/> There are U.S. and European [[medical guideline|clinical practice guidelines]] for SIHD/SCAD.<ref name="pmid_25070666">{{cite journal | vauthors = Fihn SD, Blankenship JC, Alexander KP, Bittl JA, Byrne JG, Fletcher BJ, Fonarow GC, Lange RA, Levine GN, Maddox TM, Naidu SS, Ohman EM, Smith PK | display-authors = 6 | title = 2014 ACC/AHA/AATS/PCNA/SCAI/STS focused update of the guideline for the diagnosis and management of patients with stable ischemic heart disease: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines, and the American Association for Thoracic Surgery, Preventive Cardiovascular Nurses Association, Society for Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons | journal = Circulation | volume = 130 | issue = 19 | pages = 1749–67 | date = November 2014 | pmid = 25070666 | doi = 10.1161/CIR.0000000000000095 | doi-access = free }}</ref><ref name="ESC">{{cite web |title=ESC Guidelines on Chronic Coronary Syndromes (Previously titled Stable Coronary Artery Disease) |url=https://www.escardio.org/Guidelines/Clinical-Practice-Guidelines/Chronic-Coronary-Syndromes |website=European Society of Cardiology }}</ref><ref name="Knuuti-2019" /> In patients with non-severe asymptomatic [[Aortic stenosis|aortic valve stenosis]] and no overt coronary artery disease, the increased [[troponin T]] (above 14 pg/mL) was found associated with an increased 5-year event rate of [[Coronary ischemia|ischemic cardiac events]] ([[myocardial infarction]], [[percutaneous coronary intervention]], or [[coronary artery bypass surgery]]).<ref>{{Cite journal |last1=Hadziselimovic |first1=Edina |last2=Greve |first2=Anders M. |last3=Sajadieh |first3=Ahmad |last4=Olsen |first4=Michael H. |last5=Kesäniemi |first5=Y. Antero |last6=Nienaber |first6=Christoph A. |last7=Ray |first7=Simon G. |last8=Rossebø |first8=Anne B. |last9=Wachtell |first9=Kristian |last10=Nielsen |first10=Olav W. |date=April 2023 |title=Association of high-sensitivity troponin T with outcomes in asymptomatic non-severe aortic stenosis: a post-hoc substudy of the SEAS trial |url=|journal=eClinicalMedicine |volume=58 |pages=101875 |doi=10.1016/j.eclinm.2023.101875 |issn=2589-5370 |pmc=10006443 |pmid=36915288}}</ref>