Document Detail

Republished: 'Warm-up Angina': harnessing the benefits of exercise and myocardial ischaemia.
MedLine Citation:
PMID:  25335796     Owner:  NLM     Status:  Publisher    
The phenomenon of warm-up angina was first noted over 200 years ago. It describes the curious observation whereby exercise-induced ischaemia on second effort is significantly reduced or even abolished if separated from first effort by a brief rest period. However, the precise mechanism via which this cardio-protection occurs remains uncertain. Three possible explanations for reduced myocardial ischaemia on second effort include: first, an improvement in myocardial perfusion; second, increased myocardial resistance to ischaemia similar to ischaemic preconditioning; and third, reduced cardiac work through better ventricular-vascular coupling. Obtaining accurate coronary physiological measurements in the catheter laboratory throughout exercise demands a complex research protocol. In the 1980s, studies into warm-up angina relied on great cardiac vein thermo-dilution to estimate coronary blood flow. This technique has subsequently been shown to be inaccurate. However exercise physiology in the catheter laboratory has recently been resurrected with the advent of coronary artery wires that allow continuous measurement of distal coronary artery pressure and blood flow velocity. This review summarises the intriguing historical background to warm-up angina, and provides a concise critique of the important studies investigating mechanisms behind this captivating cardio-protective phenomenon.
Rupert P Williams; Vasiliki Manou-Stathopoulou; Simon R Redwood; Michael S Marber
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Publication Detail:
Type:  REVIEW    
Journal Detail:
Title:  Postgraduate medical journal     Volume:  90     ISSN:  1469-0756     ISO Abbreviation:  Postgrad Med J     Publication Date:  2014 Nov 
Date Detail:
Created Date:  2014-10-22     Completed Date:  -     Revised Date:  2014-10-23    
Medline Journal Info:
Nlm Unique ID:  0234135     Medline TA:  Postgrad Med J     Country:  -    
Other Details:
Languages:  ENG     Pagination:  648-656     Citation Subset:  -    
Copyright Information:
Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to
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