'Warm-up Angina': harnessing the benefits of exercise and myocardial ischaemia

TY - JOUR

T1 - 'Warm-up Angina'

T2 - harnessing the benefits of exercise and myocardial ischaemia

AU - Williams, Rupert P.

AU - Manou-Stathopoulou, Vasiliki

AU - Redwood, Simon R.

AU - Marber, Michael S.

PY - 2014/1/15

Y1 - 2014/1/15

N2 - 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.

AB - 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.

KW - CORONARY-ARTERY-DISEASE

KW - CHRONIC STABLE ANGINA

KW - CONVERTING ENZYME-INHIBITOR

KW - ATP CHANNEL BLOCKER

KW - BLOOD-FLOW

KW - COLLATERAL CIRCULATION

KW - CARDIOVASCULAR RISK

KW - DIABETIC-PATIENTS

KW - HEART-DISEASE

KW - PECTORIS

U2 - 10.1136/heartjnl-2013-304187

DO - 10.1136/heartjnl-2013-304187

M3 - Literature review

SN - 1355-6037

VL - 100

SP - 106

EP - 114

JO - Heart

JF - Heart

IS - 2

ER -