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Stable angina pectoris: 1. Clinical patterns.

C Shub
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Abstract

The symptoms of angina pectoris reflect transient inadequacy of myocardial oxygen supply as a consequence of decreased myocardial blood flow, increased myocardial oxygen demand, or both. The prognosis for patients with angina depends on the extent and severity of coronary artery disease, on left ventricular systolic function, and on the presence and severity of ischemia on exercise testing. The characteristics of angina may be variable, but certain clinical patterns are consistent and are helpful for diagnosis. Angina must be distinguished from various noncardiovascular and cardiovascular conditions; in most cases, the differences can be established by careful clinical assessment.

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BibTeXRIS

C Shub. 1990. Stable angina pectoris: 1. Clinical patterns.. https://doi.org/10.1016/s0025-6196(12)65018-6

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PubMed2007

Effect of a hypoglycemic agent on ischemic preconditioning in patients with type 2 diabetes and stable angina pectoris.

OBJECTIVE: Ischemic preconditioning is an increased tolerance to myocardial ischemia during the second of two consecutive exercise tests. ATP-sensitive K(+) channel blockers, such as glinides and sulfonylurea drugs, can induce loss of ischemic preconditioning. This study aimed to investigate the effects of repaglinide, a hypoglycemic agent with an affinity for myocardial ATP-sensitive K (+)channels, on the results of consecutive exercise tests in patients with diabetes and multivessel coronary artery disease. METHODS: Forty-two patients with type 2 diabetes and chronic stable angina pectoris, and two-vessel or three-vessel disease participated in this study. The patients underwent two consecutive treadmill exercise tests (phase 1). On the day after these exercise tests, 2 mg of oral repaglinide was given to the patients. One week later, two exercise tests were repeated consecutively (phase 2). RESULTS: All patients achieved 1.0-mm ST-segment depression during the four exercise tests (T1, T2, T3, and T4). In phase 2, seven patients improved in time to onset of 1.0-mm ST-segment depression. The worsening of the time to onset of 1.0-mm ST-segment depression in phase 2 demonstrated ischemic preconditioning block in 83.3% of patients (P=0.0001). Even the postexercise electrocardiographic parameters (ST-segment depression morphology and magnitude and arrhythmias) were significantly different between the groups with and without pharmacologic ischemic preconditioning block (P=0.031). CONCLUSIONS: Repaglinide, an oral hypoglycemic agent with ATP-sensitive K(+) channel-blocker activity, eliminated the myocardial ischemic preconditioning in patients with coronary disease and diabetes.

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