Therapeutic Modalities in Patients with Ischemic Heart Disease

Objective: Analysis of application of contemporary therapeutic modalities in patients with ischemic heart disease (IHD).
Background: Acute Coronary Syndrome (Acs) Is One Of A Number Of Syndromes In A Range Of Clinical Manifestations Of Atherosclerosis Of The Coronary Arteries Or Ischemic Heart Disease, Along With Other Clinical Manifestations Such As Angina Pectoris, Chronic Myocardial Infarction, Valvular Disease, And Eventually Cardiac Failure. Access to the management of ischemic heart disease depending on symptoms, functional and anatomical complexity, includes a variety of therapeutic modalities beginning from medical treatment until emergent treatment using percutaneous coronary interventions or aortocoronary bypass surgery. All patients with ischemic heart disease, for the prevention of disease progression and recurrence of cardiovascular events, should be managed by Guideline directed medical therapy (GDMT). The most important groups of drugs are anti-ischemic drugs, antithrombotic (antiplatelet) drugs, anticoagulants and statins. Even revascularization is indicated in patients with IHD and progressive or refractory symptoms, regardless of the management of medicament. In our patient after admission and during hospitalization there was no progression of symptoms. Abrupt cessation and pain relief, rapid return of ST-segment according to the isoelectric line, with optimal pharmacotherapeutic management led to the stabilization of the patient. If there is an occlusion of the coronary artery, the most important is to establish reperfusion as soon as possible. In our patient reperfusion assessment is determined really fast (coronary angiography), and according to the TIMI (Thrombolysis In Myocardial Infarction) levels are classified in the TIMI 2 (there was no thrombotic occlusion of coronary arteries and a partial reperfusion is established). Despite the fact that percutaneous coronary intervention (PCI) is the method of choice in the treatment of ACS, positive effect of antiischemic drug therapy in our patients influenced the decision to cancel the emergency treatment and continue the treatment only by using medical therapy.
Conclusion: The initial therapeutic approach by GDMT (Guideline directed medical therapy) for patients with ischemic heart disease (IHD) reduces the progression of atherosclerosis and prevent coronary thrombosis. In patients with ischemia, routine revascularization (with percutaneous coronary intervention or coronary artery bypass graft surgery) plus GDMT improve prognosis and reduce complications and improve quality of life compared to treatment only by using GDMT. The optimal drug therapy, primary and secondary prevention of IHD by the European Society of Cardiology (ESC) guidelines have almost the
same prognostic significance as revascularization