Angina With “Normal” Coronary Arteries

doi:10.1001/jama.293.20.2468-b

Cited by 2 publications

(1 citation statement)

References 3 publications

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“…The amount of flow entering the coronary circulation during diastole is the result of the pressure gradient between the epicardial coronary artery and the subendocardium. Elevation of the LVEDP as in DD patients can reduce this gradient significantly, and hence, decreasing the coronary blood flow and myocardial perfusion [49]. The oxygen cost of “pressure work” is greater than “volume work”, with the area-under-the-curve for LV pressure closely correlating with myocardial oxygen demand [50].…”

Section: Isolated Systolic Hypertension As a Cardiovascular Risk Factormentioning

confidence: 99%

Is Peri-Operative Isolated Systolic Hypertension (ISH) a Cardiac Risk Factor?

Fayad¹,

Yang

2008

CCR

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We are presenting a review of Isolated Systolic Hypertension (ISH) as a cardiovascular risk factor with emphasis on the perioperative period.Isolated systolic hypertension is associated with aging and is the most frequent subtype (65%) among patients with uncontrolled hypertension. ISH is strongly associated with increased risks of cardiac and cerebrovascular events exceeding those in comparably aged individuals with diastolic hypertension. Patients with ISH show an increase in left ventricular (LV) mass and an increase in the prevalence of left ventricular hypertrophy (LVH). These LV changes increase cardiovascular events and frequently lead to diastolic dysfunction (DD). Treatment to reduce elevated systolic blood pressure has been shown to reduce the risk of cardiovascular events.In the perioperative setting, essential hypertension has not been found to be a significant risk factor for cardiac complications. Most of the studies were based on the definition of essential hypertension and underpowered in sample size. The significance of perioperative ISH, however, is not well studied, partly due to its recognition only fairly recently as a cardiovascular risk factor in the non-surgical setting, and partly due to the evolving definition of ISH.Perioperative cardiac complications remain a significant problem to the healthcare system and to the patient. Although the incidence of perioperative cardiac complications is prominent in high-risk patients as defined by the Revised Cardiac Risk Index (RCRI), the bulk of the cardiac complications actually occur in low-risk group. Currently, little understanding exists on the occurrence of perioperative cardiac complications in low- risk patients. A factor such as ISH, with its known pathophysiological changes, is a potential perioperative risk factor.We believe ISH is an under-recognized perioperative risk factor and deserves further studying. Our research group has recently been funded by the Heart Stroke Foundation (HSF) to examine ISH as a perioperative risk factor (PROMISE Study).

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Section: Isolated Systolic Hypertension As a Cardiovascular Risk Factormentioning

confidence: 99%