Key Feature 2: Regularly reassess adherence (compliance) to the treatment plan (including medications).
Skill: Clinical Reasoning
Phase: History, Follow-up
Ischemic Heart Disease
Key Feature 4: In a patient with stable ischemic heart disease manage changes in symptoms with self-initiated adjustment of medication (ex: nitroglycerin) and appropriate physician contact (ex: office visits, phone calls, emergency department visits), depending on the nature an severity of symptoms.
Skill: Clinical Reasoning
Key Feature 5: In the regular follow-up care of patients with established ischemic heart disease, specifically verify the following to detect complications and suboptimal control:
Phase: History, Diagnosis
Once a patient has been diagnosed with ischemic heart disease, they have a chronic symptomatic disease that warrants ongoing treatment of the main symptom: angina. Many patients will be started on a daily beta-blocker because they work by decreasing the heart's effort and its subsequent oxygen requirement and associated angina when it is oxygen starved. Calcium channel blockers would be second-line if a beta-blocker is contraindicated or not sufficient for additional therapy.
Despite daily medications to help prevent cardiac ischemia, patients may still develop acute episode of cardiac ischemia pain or angina. For these, the patient needs to be advised to take a nitrate medication (usually a tab of sublingual nitroglycerin under the tongue, every 5 min as needed up to 3 doses) for relief of the acute symptoms. Alternatively, the patient can be advised to take a prophylactic dose before exertion to prevent the onset of angina.
Beyond having an understanding of how to take medications as indicated, another major component of patient education involves counselling about when and where to receive followup medical care. For the patient with stable ischemic heart disease, UpToDate suggests follow-up every 6 to 12 months for ischemic heart disease, which should include a review of:
For the patient experiencing acute angina that is either not responding to nitroglycerin or that is much more severe than typical episodes of angina for them, they should be advised to call an ambulance for emergency medical care of what could be a heart attack. Patients may also choose to attempt to call their clinician(s) or a medical information line if they have any uncertainty about what they ought to be doing should their symptoms change, but this should only be for situations that do not involve ongoing chest pain. Any acute episode of angina that is not going away despite abortive therapy warrants emergent medical attention in an emergency care setting.