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Clinical research into IHD is providing new insights into the pathophysiology, epidemiology and treatment of this condition. The major endotypes of IHD include coronary heart disease (CHD) and vasomotor disorders, including microvascular angina and vasospastic angina. Considering unselected patients presenting with stable chest pain, the pre-test probability of CHD is higher in men whereas the pre-test probability of a vasomotor disorder is higher in women. The diagnostic accuracy of diagnostic tests designed to assess coronary anatomy and disease and\/or coronary vascular function (functional tests) differ for coronary endotypes. Clinical management should therefore be personalized and take account of sex-related factors. In this review, we consider the definitions of angina and myocardial ischemia. We then appraise the mechanistic links between myocardial ischemia and anginal symptoms and the relative merits of non-invasive and invasive diagnostic tests and related clinical management. 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C.B. is employed by the University of Glasgow which holds consultancy and\/or research agreements with companies that have commercial interests in the diagnosis and treatment of ischemic heart disease. The companies include Abbott Vascular, AstraZeneca, Boehringer Ingelheim, GSK, HeartFlow, Menarini Farmaceutica, Opsens, Philips and Siemens Healthcare.MM declares \u2013 CJP declares research funding from\u00a0NHLBI grant nos. R01 HL 132448, R01 HL091005, U01 HL064924, U01 HL087366, UM1 HL087366; UM1 HL087366, UM1 HL087364; NIH\/National Center for Advancing Translational Sciences UL1 TR001427; US Department of Defencse grant nos. W81XWH1720030, ; NIH\/Brigham and Women\u2019s Hospital 5U01 HL130163-02; GE Healthcare GE-265-303; ; University of Florida Office of Research AGR DTD 04-26-2018; CSL Behring, LLC. CSL112-3001; BioCardia BC-14-001-02; Mesoblast, Inc. MSB-MPC-CHF001; Ventrix, Inc.; Athersys Inc. AMI MultiStem; Verily Life Sciences LLC-Project Baseline OSMB; Ironwood MSB-MPC-CHF00-DMC, Imbria Pharmaceuticals Inc.; Milestone Pharmaceuticals Inc.; Caladrius Biosciences, Inc.; and the\u00a0Gatorade Trust.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Conflict of Interest"}}]}}