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Total ischemic burden: definition, mechanisms, and therapeutic implications
Insights
The total ischemic burden concept re-evaluates coronary heart disease therapy. Calcium antagonists may treat angina by addressing vasoconstriction
Area of Science:
- Cardiology
- Ischemic Heart Disease Pathophysiology
Background:
- The total ischemic burden encompasses all ischemic episodes, both silent and symptomatic.
- This broadens the understanding of ischemia beyond symptomatic events in coronary heart disease (CHD).
Purpose of the Study:
- To re-evaluate current therapeutic goals for patients with coronary heart disease based on the total ischemic burden.
- To explore the pathophysiologic mechanisms of ischemia, including supply-demand imbalances.
Main Methods:
- Conceptual review of ischemia and its implications for CHD therapy.
- Analysis of pathophysiologic mechanisms: primary (reduced supply), secondary (increased demand), and mixed ischemia.
Main Results:
- Ischemia can result from reduced supply, increased demand, or both.
- Vasoconstriction appears to play a role in supply/demand imbalance, especially during everyday activities, indicated by lower heart rates during ischemic episodes.
Conclusions:
- The concept of total ischemic burden necessitates a re-evaluation of therapeutic strategies in CHD.
- Calcium antagonists show promise for treating angina by targeting vasoconstriction and improving the supply/demand balance.
Abstract:
The concept of the total ischemic burden includes all types of ischemia encompassing both silent and symptomatic ischemic episodes. This concept is currently causing a re-evaluation of current therapeutic goals for patients with coronary heart disease. Although the mechanism of cardiac pain is still unclear, we do have some information about other pathophysiologic mechanisms at work in this disorder. We think of ischemia as occurring secondary to reduced supply (primary ischemia), increased demand (secondary ischemia), or a combination of the two (mixed ischemia). Because of the lower heart rate associated with many episodes of ischemia during everyday activities, suggesting that vasoconstriction is playing a role in the patient's supply/demand imbalance, calcium antagonists appear to be particularly useful agents for the treatment of vasoconstriction in patients with angina.