Document Detail


Recent advances in the management of chronic stable angina I: approach to the patient, diagnosis, pathophysiology, risk stratification, and gender disparities.
MedLine Citation:
PMID:  20730020     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
The potential importance of both prevention and personal responsibility in controlling heart disease, the leading cause of death in the USA and elsewhere, has attracted renewed attention. Coronary artery disease is preventable, using relatively simple and inexpensive lifestyle changes. The inexorable rise in the prevalence of obesity, diabetes, dyslipidemia, and hypertension, often in the risk cluster known as the metabolic syndrome, drives the ever-increasing incidence of heart disease. Population-wide improvements in personal health habits appear to be a fundamental, evidence based public health measure, yet numerous barriers prevent implementation. A common symptom in patients with coronary artery disease, classical angina refers to the typical chest pressure or discomfort that results when myocardial oxygen demand rises and coronary blood flow is reduced by fixed, atherosclerotic, obstructive lesions. Different forms of angina and diagnosis, with a short description of the significance of pain and silent ischemia, are discussed in this review. The well accepted concept of myocardial oxygen imbalance in the genesis of angina is presented with new data about clinical pathology of stable angina and acute coronary syndromes. The roles of stress electrocardiography and stress myocardial perfusion scintigraphic imaging are reviewed, along with the information these tests provide about risk and prognosis. Finally, the current status of gender disparities in heart disease is summarized. Enhanced risk stratification and identification of patients in whom procedures will meaningfully change management is an ongoing quest. Current guidelines emphasize efficient triage of patients with suspected coronary artery disease. Many experts believe the predictive value of current decision protocols for coronary artery disease still needs improvement in order to optimize outcomes, yet avoid unnecessary coronary angiograms and radiation exposure. Coronary angiography remains the gold standard in the diagnosis of coronary artery obstructive disease. Part II of this two part series will address anti-ischemic therapies, new agents, cardiovascular risk reduction, options to treat refractory angina, and revascularization.
Authors:
Richard Kones
Publication Detail:
Type:  Journal Article; Review     Date:  2010-08-09
Journal Detail:
Title:  Vascular health and risk management     Volume:  6     ISSN:  1178-2048     ISO Abbreviation:  Vasc Health Risk Manag     Publication Date:  2010  
Date Detail:
Created Date:  2010-08-23     Completed Date:  2010-12-03     Revised Date:  2013-05-29    
Medline Journal Info:
Nlm Unique ID:  101273479     Medline TA:  Vasc Health Risk Manag     Country:  New Zealand    
Other Details:
Languages:  eng     Pagination:  635-56     Citation Subset:  IM    
Affiliation:
The Cardiometabolic Research Institute, Houston, Texas 77054, USA. drrkones@comcast.net
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MeSH Terms
Descriptor/Qualifier:
Angina Pectoris / diagnosis,  pathology,  physiopathology,  therapy*
Asymptomatic Diseases
Chest Pain / diagnosis
Coronary Angiography
Coronary Circulation / physiology
Coronary Vessels / pathology,  physiopathology
Echocardiography
Exercise Test
Female
Healthcare Disparities
Humans
Male
Myocardial Ischemia / diagnosis,  physiopathology
Risk Factors
Sex Factors
Comments/Corrections

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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