scholarly journals Trimetazidine and Other Metabolic Modifiers

2018 ◽  
Vol 13 (2) ◽  
pp. 1 ◽  
Author(s):  
Giacinta Guarini ◽  
Alda Huqi ◽  
Doralisa Morrone ◽  
Paola Francesca Giuseppina Capozza ◽  
Mario Marzilli ◽  
...  
Keyword(s):  
Heart Disease ◽  
Ischaemic Heart Disease ◽  
Stable Angina ◽  
Symptom Relief ◽  
Chronic Stable Angina ◽  
Clinical Manifestations ◽  
Oxygen Demand ◽  
Microvascular Disease ◽  
Coronary Intervention ◽  
Cardiac Metabolism

Treatment goals for people with chronic angina should focus on the relief of symptoms and improving mortality rates so the patient can feel better and live longer. The traditional haemodynamic approach to ischaemic heart disease was based on the assumption that increasing oxygen supply and decreasing oxygen demand would improve symptoms. However, data from clinical trials, show that about one third of people continue to have angina despite a successful percutaneous coronary intervention (PCI) and medical therapy. Moreover, several trials on chronic stable angina therapy and revascularisation have failed to show benefits in terms of primary outcome (survival, cardiovascular death, all-cause mortality), symptom relief or echocardiographic parameters. Failure to significantly improve quality of life and prognosis may be attributed in part to a limited understanding of ischaemic heart disease, by neglecting the fact that ischaemia is a metabolic disorder. Shifting cardiac metabolism from free fatty acids towards glucose is a promising approach for the treatment of patients with stable angina, independent of the underlying disease (macrovascular and/or microvascular disease). Cardiac metabolic modulators open the way to a greater understanding of ischaemic heart disease and its common clinical manifestations as an energetic disorder rather than an imbalance between the demand and supply of oxygen and metabolites.

Chronic Stable Angina

2017 ◽  
Author(s):  
Benjamin J Scirica ◽  
J. Antonio T. Gutierrez
Keyword(s):  
Coronary Artery Disease ◽  
Coronary Heart Disease ◽  
Percutaneous Coronary Intervention ◽  
Heart Disease ◽  
Coronary Artery ◽  
Stable Angina ◽  
Chronic Stable Angina ◽  
Coronary Intervention ◽  
Percutaneous Coronary ◽  
Artery Disease

By definition, chronic stable angina is angina that has been stable with regard to frequency and severity for at least 2 months. Chronic stable angina is the initial manifestation of coronary heart disease in approximately 50% of patients. Typically, this type of angina occurs in the setting of atherosclerotic coronary arterial narrowing, although other causes are possible. This review covers the epidemiology, pathophysiology, initial evaluation, differential diagnosis, management, and treatment of patients with chronic stable angina. Figures show noninvasive testing and the probability of coronary artery disease; diagnosis of patients with suspected ischemic heart disease; probability of severe coronary artery disease; coronary outcomes for high- versus low-intensity statin therapy; optimal medical therapy (OMT) versus OMT and percutaneous coronary intervention for chronic angina; OMT versus percutaneous coronary intervention for stable coronary heart disease; and coronary artery bypass grafting versus percutaneous coronary intervention for diabetes and coronary artery disease. Tables list the grading of angina pectoris by the Canadian Cardiovascular Society classification system, the differential diagnosis of chest pain, conditions promoting myocardial oxygen supply and demand mismatch, the features of typical angina, the classification of chest pain, a comparison of the pretest likelihood of coronary heart disease (CHD) in low-risk and high-risk symptomatic patients, the posttest probability of significant CHD based on pretest probabilities of CHD and normal or abnormal results of noninvasive studies, survival according to risk groups based on Duke treadmill scores, high- and moderate-intensity statin therapy, revascularization to improve survival compared with medical therapy, revascularization to improve symptoms with significant anatomic (≥ 50% left main or ≥ 70% nonleft main coronary artery disease) or physiologic (fractional flow reserve ≤ 0.80) coronary artery stenoses, and questions recommended by an expert panel for patients with chronic stable angina at follow-up visits. This review contains 7 highly rendered figures, 13 tables, and 109 references.

Chronic Stable Angina

2015 ◽  
Author(s):  
Benjamin J Scirica ◽  
J. Antonio T. Gutierrez
Keyword(s):  
Coronary Artery Disease ◽  
Coronary Heart Disease ◽  
Percutaneous Coronary Intervention ◽  
Heart Disease ◽  
Coronary Artery ◽  
Stable Angina ◽  
Chronic Stable Angina ◽  
Coronary Intervention ◽  
Percutaneous Coronary ◽  
Artery Disease

By definition, chronic stable angina is angina that has been stable with regard to frequency and severity for at least 2 months. Chronic stable angina is the initial manifestation of coronary heart disease in approximately 50% of patients. Typically, this type of angina occurs in the setting of atherosclerotic coronary arterial narrowing, although other causes are possible. This review covers the epidemiology, pathophysiology, initial evaluation, differential diagnosis, management, and treatment of patients with chronic stable angina. Figures show noninvasive testing and the probability of coronary artery disease; diagnosis of patients with suspected ischemic heart disease; probability of severe coronary artery disease; coronary outcomes for high- versus low-intensity statin therapy; optimal medical therapy (OMT) versus OMT and percutaneous coronary intervention for chronic angina; OMT versus percutaneous coronary intervention for stable coronary heart disease; and coronary artery bypass grafting versus percutaneous coronary intervention for diabetes and coronary artery disease. Tables list the grading of angina pectoris by the Canadian Cardiovascular Society classification system, the differential diagnosis of chest pain, conditions promoting myocardial oxygen supply and demand mismatch, the features of typical angina, the classification of chest pain, a comparison of the pretest likelihood of coronary heart disease (CHD) in low-risk and high-risk symptomatic patients, the posttest probability of significant CHD based on pretest probabilities of CHD and normal or abnormal results of noninvasive studies, survival according to risk groups based on Duke treadmill scores, high- and moderate-intensity statin therapy, revascularization to improve survival compared with medical therapy, revascularization to improve symptoms with significant anatomic (≥ 50% left main or ≥ 70% nonleft main coronary artery disease) or physiologic (fractional flow reserve ≤ 0.80) coronary artery stenoses, and questions recommended by an expert panel for patients with chronic stable angina at follow-up visits. This review contains 7 highly rendered figures, 12 tables, and 109 references.

Chronic Stable Angina

2018 ◽  
Author(s):  
Benjamin J Scirica ◽  
J. Antonio T. Gutierrez
Keyword(s):  
Coronary Artery Disease ◽  
Coronary Heart Disease ◽  
Percutaneous Coronary Intervention ◽  
Heart Disease ◽  
Coronary Artery ◽  
Stable Angina ◽  
Chronic Stable Angina ◽  
Coronary Intervention ◽  
Percutaneous Coronary ◽  
Artery Disease

By definition, chronic stable angina is angina that has been stable with regard to frequency and severity for at least 2 months. Chronic stable angina is the initial manifestation of coronary heart disease in approximately 50% of patients. Typically, this type of angina occurs in the setting of atherosclerotic coronary arterial narrowing, although other causes are possible. This review covers the epidemiology, pathophysiology, initial evaluation, differential diagnosis, management, and treatment of patients with chronic stable angina. Figures show noninvasive testing and the probability of coronary artery disease; diagnosis of patients with suspected ischemic heart disease; probability of severe coronary artery disease; coronary outcomes for high- versus low-intensity statin therapy; optimal medical therapy (OMT) versus OMT and percutaneous coronary intervention for chronic angina; OMT versus percutaneous coronary intervention for stable coronary heart disease; and coronary artery bypass grafting versus percutaneous coronary intervention for diabetes and coronary artery disease. Tables list the grading of angina pectoris by the Canadian Cardiovascular Society classification system, the differential diagnosis of chest pain, conditions promoting myocardial oxygen supply and demand mismatch, the features of typical angina, the classification of chest pain, a comparison of the pretest likelihood of coronary heart disease (CHD) in low-risk and high-risk symptomatic patients, the posttest probability of significant CHD based on pretest probabilities of CHD and normal or abnormal results of noninvasive studies, survival according to risk groups based on Duke treadmill scores, high- and moderate-intensity statin therapy, revascularization to improve survival compared with medical therapy, revascularization to improve symptoms with significant anatomic (≥ 50% left main or ≥ 70% nonleft main coronary artery disease) or physiologic (fractional flow reserve ≤ 0.80) coronary artery stenoses, and questions recommended by an expert panel for patients with chronic stable angina at follow-up visits. This review contains 7 highly rendered figures, 13 tables, and 109 references.

Chronic Stable Angina

2018 ◽  
Author(s):  
Benjamin J Scirica ◽  
J. Antonio T. Gutierrez
Keyword(s):  
Coronary Artery Disease ◽  
Coronary Heart Disease ◽  
Percutaneous Coronary Intervention ◽  
Heart Disease ◽  
Coronary Artery ◽  
Stable Angina ◽  
Chronic Stable Angina ◽  
Coronary Intervention ◽  
Percutaneous Coronary ◽  
Artery Disease

By definition, chronic stable angina is angina that has been stable with regard to frequency and severity for at least 2 months. Chronic stable angina is the initial manifestation of coronary heart disease in approximately 50% of patients. Typically, this type of angina occurs in the setting of atherosclerotic coronary arterial narrowing, although other causes are possible. This review covers the epidemiology, pathophysiology, initial evaluation, differential diagnosis, management, and treatment of patients with chronic stable angina. Figures show noninvasive testing and the probability of coronary artery disease; diagnosis of patients with suspected ischemic heart disease; probability of severe coronary artery disease; coronary outcomes for high- versus low-intensity statin therapy; optimal medical therapy (OMT) versus OMT and percutaneous coronary intervention for chronic angina; OMT versus percutaneous coronary intervention for stable coronary heart disease; and coronary artery bypass grafting versus percutaneous coronary intervention for diabetes and coronary artery disease. Tables list the grading of angina pectoris by the Canadian Cardiovascular Society classification system, the differential diagnosis of chest pain, conditions promoting myocardial oxygen supply and demand mismatch, the features of typical angina, the classification of chest pain, a comparison of the pretest likelihood of coronary heart disease (CHD) in low-risk and high-risk symptomatic patients, the posttest probability of significant CHD based on pretest probabilities of CHD and normal or abnormal results of noninvasive studies, survival according to risk groups based on Duke treadmill scores, high- and moderate-intensity statin therapy, revascularization to improve survival compared with medical therapy, revascularization to improve symptoms with significant anatomic (≥ 50% left main or ≥ 70% nonleft main coronary artery disease) or physiologic (fractional flow reserve ≤ 0.80) coronary artery stenoses, and questions recommended by an expert panel for patients with chronic stable angina at follow-up visits. This review contains 7 highly rendered figures, 13 tables, and 109 references.

A study on the clinical profile and risk factors of ischemic heart disease in women

2021 ◽  
Vol 19 (3) ◽  
pp. 130-132
Author(s):  
Sarath Kumar Reddy B ◽  
Keyword(s):  
Risk Factors ◽  
Heart Disease ◽  
Chest Pain ◽  
Ischemic Heart Disease ◽  
Stable Angina ◽  
Heart Diseases ◽  
Chronic Stable Angina ◽  
Clinical Profile ◽  
Ischemic Heart ◽  
Ischemic Heart Diseases

Background: Ischemic heart disease (IHD) is one of the principle causes of morbidity and of mortality in women1. Ischemic heart disease may manifest clinically as either chronic stable angina or acute coronary syndrome2 (ACS). Traditional risk factors (hypertension, diabetes, etc.) contribute to the development of IHD in both women and men. Some risk factors are unique to women (e.g., pregnancy-related complications, menopause), which cause increased mortality in women Aim: To study the risk factors and clinical profile of ischemic heart disease in women. Materials And Methods: Hospital-based prospective, cross-sectional study done in 50 patients with ischemic heart disease. Patients with a history of Chest pain suggestive of ischemic heart diseases and Electrocardiogram and cardiac biomarkers suggestive of ischemic heart disease were included in the study. Results: Maximum incidence of ischemic heart diseases is seen in the 6th decade. Mean age is 58.92 + 2.8years. 64%of the patients presented with chest pain, and 36% patients presented without any chest pain. After chest pain, the most common symptom was palpitations, seen in 56% patients, followed by sweating (44%). 30% presented to the medical facility within 3hours. 88% were diagnosed with acute coronary syndrome, and 12% were diagnosed with chronic stable angina. Women specific risk factors include the pregnancy-related complications seen in 10% patients, menopause attained in 86% patients, PCOS seen in 08% patients, use of oral contraceptive pills noticed in 08% patients, Other risk factors identified were hypothyroidism in 16% patients, connective tissue disorders like rheumatoid arthritis seen in 12% of the patients. Conclusion: Awareness regarding atypical symptoms as well as other symptoms of IHD should be created among women to avoid delayed complications. Simple lifestyle modifications like physical activity, diet modifications, etc., will reduce the number of women at risk for IHD.

scholarly journals Effect of Ticagrerol versus Clopidogrel on Oxidative Stress Bio-markers in Patients with Chronic Stable Angina after Percutaneous Coronary Intervention

2017 ◽  
Vol 12 (1) ◽  
pp. 26-30
Author(s):  
Elora Sharmin ◽  
Jasmine Fauzia Dewan ◽  
Syed Ali Ahsan ◽  
Harisul Hoque ◽  
Sheikh Foyez Ahmed ◽  
...  
Keyword(s):  
Oxidative Stress ◽  
Percutaneous Coronary Intervention ◽  
Stable Angina ◽  
Chronic Stable Angina ◽  
Coronary Intervention ◽  
P2y12 Receptor ◽  
Oxidative Stress Markers ◽  
Stress Markers ◽  
Percutaneous Coronary

Background: Ischemic heart disease remains the leading cause of death in both developed and under developed countries. The use of antiplatelet drugs specifically the thienopyridine has become a standard for the treatment of acute coronary syndrome. These drugs irreversibly inhibit the platelet aggregation by blocking the P2Y12 receptor. But currently this therapeutic choice has become limited due to potential interaction with other drugs, slow hepatic conversion, genetic resistance and narrow therapeutic safety margin. Ticagrerol, a reversible P2Y12 receptor inhibitor may represent a significant advancement over currently available oral antiplatelet drugs.Objectives: The study was intended to compare the effect of Ticagrelor and Clopidogrel on oxidative stress markers in patients of chronic stable angina (CSA) following percutaneous coronary intervention (PCI).Materials & Methods: The present prospective observational study was carried out in the Department of Pharmacology, Cardiology and Microbiology, BSMMU, Dhaka from September 2014 to February 2016. The study included a total of 100 CSA patients. Patients were divided into two groups, Ticagrelor and Clopidogrel treated groups (each having 50 patients). The baseline laboratory parameters-Malondihyde (MDA), Reduced glutathione (GSH), bleeding time, clotting time and platelet count, were measured and then patients of both groups underwent PCI. The same parameters were again assessed at follow up after 4 weeks of intervention. Total 12 patients from Ticagrelor and 14 patients from Clopidogrel groups were dropped out. Comparisons of the laboratory parameters were made between two groups at baseline and at follow up and also within group before and after intervention.Result: In the present study at baseline characteristics of patients treated with ticagrelor and clopidogrel were almost identical in terms of age, sex, diabetes and hypertension. The level of plasma MDA in ticagrelor group was significantly reduced from baseline to follow up(4.5 ± 1.8 to 1.4 ± 0.7, p <0.001) and in clopidogrel group (4.2 ± 1.2 to 1.3 ± 0.7, p <0.001). GSH level was increased from 0.7 mg/dl to 2.5 mg/dl (p <0.001) in ticagrerol group and in clopidogrel group 0.6 mg/dl to 1.4 mg/dl, p <0.001).Conclusion: The study concluded that both ticagrelor and clopidogrel are similar effect on oxidative stress markers, resulting from oxidative injury processes in patients of chronic stable angina.University Heart Journal Vol. 12, No. 1, January 2016; 26-30

Pre-procedural fasting for coronary interventions: is it time to change practice?

Heart ◽  
2014 ◽  
Vol 100 (8) ◽  
pp. 658-661 ◽  
Author(s):  
Tahir Hamid ◽  
Qaiser Aleem ◽  
Yeecheng Lau ◽  
Ravi Singh ◽  
John McDonald ◽  
...  
Keyword(s):  
Stable Angina ◽  
Chronic Stable Angina ◽  
Coronary Intervention ◽  
Coronary Syndrome ◽  
Cardiac Procedures ◽  
Data Registry ◽  
Percutaneous Coronary ◽  
Coronary Procedures ◽  
Data Source ◽  
The Uk

IntroductionTraditionally, patients are kept nil-per-os/nil-by-mouth (NPO/NBM) prior to invasive cardiac procedures, yet there exists neither evidence nor clear guidance about the benefits of this practice.ObjectivesTo demonstrate that percutaneous cardiac catheterisation does not require prior fasting.MethodsThe data source is a retrospective analysis of data registry of consecutive patients who underwent percutaneous coronary intervention (PCI) for acute coronary syndrome (ACS) and stable angina at two district general hospitals in the UK with no on-site cardiac surgery services.ResultsA total of 1916 PCI procedures were performed over a 3-year period. None of the patients were kept NPO/NBM prior to their coronary procedures. The mean age was 67±16 years. 1349 (70%) were men; 38.5% (738/1916) had chronic stable angina, while the rest had ACS. 21% (398/1916) were diabetics while 53% (1017/1916) were hypertensive. PCI was technically successful in 95% (1821/1916) patients. 88.5% (1697/1916) had transradial approach. 77% (570/738) of elective PCI patients were discharged within 6 h postprocedure. No patients required emergency endotracheal intubation and there were no occurrences of intraprocedural or postprocedural aspiration pneumonia.ConclusionsOur observational study demonstrates that patients undergoing PCI do not need to be fasted prior to their procedures.

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