Ischemia and Angina

Myocardial ischemia (reduced blood flow to the heart) usually occurs as a result of coronary atherosclerosis, but it may also reflect dynamic components of coronary vascular resistance.1 The reduced flow of oxygen-rich blood may cause cardiac dysfunction which may manifest as angina.2

Angina can be either stable or unstable.3-5

  • Stable angina is induced by physical exertion or emotional stress and commonly relieved by rest or nitroglycerin.
  • Unstable angina is defined as rest angina, severe new-onset angina, or increasing angina. (ACC-AHA guidelines 9)

The following graph illustrates the temporal sequence of the ischemic cascade leading to angina.



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Fact

88% of patients with coronary artery disease had angina at baseline in the COURAGE trial.7

References

  • Cannon CP, Lee TH. Approach to the patient with chest pain. In: Braunwald E, Libby P, Bonow RO, Mann DL, Zipes DP, eds. Braunwald's Heart Disease: A Textbook of Cardiovascular Medicine. 8th ed. Philadelphia, PA: Saunders Elsevier; 2008:1195.

  • Morrow DA, Gersh BJ. Chronic coronary artery disease. In: Braunwald E, Libby P, Bonow RO, Mann DL, Zipes DP, eds. Braunwald's Heart Disease: A Textbook of Cardiovascular Medicine. 8th ed. Philadelphia, PA: Saunders Elsevier; 2008:1353.

  • American Heart Association. Angina pectoris. http://www.americanheart.org/presenter.jhtml?identifier=4472. Accessed June 25, 2009.

  • National Heart Lung and Blood Institute. What is angina? http://www.nhlbi.nih.gov/health/dci/Diseases/Angina/Angina_WhatIs.html. Accessed June 26, 2009.

  • American College of Cardiology and the American Heart Association. ACC/AHA 2002 guideline update for the management of patients with chronic stable angina. http://www.acc.org/qualityandscience/clinical/guidelines/stable/IV_treatment.htm#IV_B. Accessed June 26, 2009.

  • Kern MJ. Coronary blood flow and myocardial ischemia. In: Zipes DP, Libby P, Bonow RO, Braunwald E, eds. Braunwald's Heart Disease: A Textbook of Cardiovascular Medicine. 7th ed. Philadelphia, PA: Elsevier Saunders; 2005:1103-1128.

  • Boden WE, O'Rourke RA, Teo KK, et al; COURAGE Trial Research Group. Optimal medical therapy with or without PCI for stable coronary disease. N Engl J Med. 2007;356:1503-1516.

  • Data on file, Gilead Sciences, Inc.

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