Pub Date : 2022-12-05DOI: 10.29381/0103-8559/20223204421-33
J. S. Soares Júnior, M. Izaki, M. C. Pinto Giorgi, Bruno Gomes Padilha, Daniela A. Ferraro
Nuclear Medicine, by integrating information on relative myocardial perfusion, ventricular function and absolute quantitative data such as myocardial blood flow and coronary flow reserve, expands and modifies the scope of evaluation of patients with chronic coronary insufficiency. These measures are producing a paradigm shift in the assessment and management of patients with CAD, allowing the definition of a broad spectrum of coronary vascular dysfunction. These quantitative tools provide a measure of the integrated effects of focal coronary stenoses, diffuse atherosclerosis, and microvascular dysfunction on myocardial perfusion. This data set allows improving the diagnosis and assessment of the extent of epicardial disease, reclassifying the prognosis, demonstrated through robust literature data that confirm the incremental value over other variables in the risk stratification of patients with ischemic heart disease, and allow to identify coronary microcirculatory disease with or without epicardial CAD. A more accurate and sensitive assessment of myocardial tissue ischemia is then obtained. This chapter explores these possibilities, the assessment of myocardial viability, and the future perspectives of Nuclear Medicine, which include the development of new radiopharmaceuticals focused on molecular imaging and the creation of new hybrid devices that combine functional and anatomical information in a single test
{"title":"INNOVATIONS IN DIAGNOSTIC METHODS: NUCLEAR MEDICINE — MYOCARDIAL PERFUSION, FLOW RESERVE AND MYOCARDIAL VIABILITY","authors":"J. S. Soares Júnior, M. Izaki, M. C. Pinto Giorgi, Bruno Gomes Padilha, Daniela A. Ferraro","doi":"10.29381/0103-8559/20223204421-33","DOIUrl":"https://doi.org/10.29381/0103-8559/20223204421-33","url":null,"abstract":"Nuclear Medicine, by integrating information on relative myocardial perfusion, ventricular function and absolute quantitative data such as myocardial blood flow and coronary flow reserve, expands and modifies the scope of evaluation of patients with chronic coronary insufficiency. These measures are producing a paradigm shift in the assessment and management of patients with CAD, allowing the definition of a broad spectrum of coronary vascular dysfunction. These quantitative tools provide a measure of the integrated effects of focal coronary stenoses, diffuse atherosclerosis, and microvascular dysfunction on myocardial perfusion. This data set allows improving the diagnosis and assessment of the extent of epicardial disease, reclassifying the prognosis, demonstrated through robust literature data that confirm the incremental value over other variables in the risk stratification of patients with ischemic heart disease, and allow to identify coronary microcirculatory disease with or without epicardial CAD. A more accurate and sensitive assessment of myocardial tissue ischemia is then obtained. This chapter explores these possibilities, the assessment of myocardial viability, and the future perspectives of Nuclear Medicine, which include the development of new radiopharmaceuticals focused on molecular imaging and the creation of new hybrid devices that combine functional and anatomical information in a single test","PeriodicalId":190881,"journal":{"name":"Revista da Sociedade de Cardiologia do Estado de São Paulo","volume":"33 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-12-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"121869140","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-12-05DOI: 10.29381/0103-8559/20223204440-4
Pedro Macedo Esmeraldo Barbosa, Adriano Camargo de Castro Carneiro
The identification of ischemic repercussion of coronary atherosclerotic disease (CAD) by non-invasive methods aims not only at diagnosis, but also at prognostic evaluation and adequate therapeutic guidance. Cardiac magnetic resonance (CMR) combines availabi-lity and multiparametric information superior to other methods. Combined with positron emission tomography, CMR has the best diagnostic accuracy statistics among ischemia research methods, making it a highly robust test in chronic CAD. Several prospective and comparative studies among ischemia research methods demonstrate the importance of CMR in optimizing management in the context of chronic CAD, and may even be superior to invasive fractional flow reserve (FFR). The investigation of ischemia under stress, combined with the identification of myocardial fibrosis using the delayed enhancement technique, is currently the core of CMR in the context of coronary insufficiency, but the new possibilities for assessments of cardiac mapping and coronary flow reserve extend the scope of the study even further, especially for the prognostic evaluation of CAD.
{"title":"CHRONIC CORONARY INSUFFICIENCY: INNOVATIONS IN CARDIACMAGNETIC RESONANCE","authors":"Pedro Macedo Esmeraldo Barbosa, Adriano Camargo de Castro Carneiro","doi":"10.29381/0103-8559/20223204440-4","DOIUrl":"https://doi.org/10.29381/0103-8559/20223204440-4","url":null,"abstract":"The identification of ischemic repercussion of coronary atherosclerotic disease (CAD) by non-invasive methods aims not only at diagnosis, but also at prognostic evaluation and adequate therapeutic guidance. Cardiac magnetic resonance (CMR) combines availabi-lity and multiparametric information superior to other methods. Combined with positron emission tomography, CMR has the best diagnostic accuracy statistics among ischemia research methods, making it a highly robust test in chronic CAD. Several prospective and comparative studies among ischemia research methods demonstrate the importance of CMR in optimizing management in the context of chronic CAD, and may even be superior to invasive fractional flow reserve (FFR). The investigation of ischemia under stress, combined with the identification of myocardial fibrosis using the delayed enhancement technique, is currently the core of CMR in the context of coronary insufficiency, but the new possibilities for assessments of cardiac mapping and coronary flow reserve extend the scope of the study even further, especially for the prognostic evaluation of CAD.","PeriodicalId":190881,"journal":{"name":"Revista da Sociedade de Cardiologia do Estado de São Paulo","volume":"1 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-12-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"130395239","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-12-05DOI: 10.29381/0103-8559/20223204523-31
Denise Kuhlmann Duques, Isabelle Evelyn Viana Borges, Julia Sumie Nakaima Fugita, Regina Queiroz Machtura, Alessandra Santos Menegon
Coronary artery disease (CAD) remains one of the main diseases of the 21st century for its morbidity and mortality. With the increase in life expectancy and reduction of deaths from acute coronary diseases, there is a significant increase in the disease in its chronic form, especially in the elderly. In these patients, angina pectoris represents the main presentation of the condition. This research is a narrative review carried out through bibliographic research in databases on drug treatment for CAD, and aims to describe the role of the clinical phar-macist in medication adherence. The treatment of CAD includes myocardial infarction (MI) prevention, reduction of mortality, and reduction of symptoms, improving the quality of life of patients. Beta-blockers, antiplatelet drugs, statins, and angiotensin-converting enzyme (ACE) inhibitors are the main pharmacological therapies that can reduce mortality and prevent MI, while some drugs, such as nitrates, ivabradine, trimetazidine, allopurinol, and ranolazine help minimize the occurrence of myocardial ischemia and associated symptoms. Health education focused on the importance of CAD treatment, especially in an individualized and accessible way, may favor long-term adherence. The pharmacist’s work, along with the multidisciplinary team, has the potential to help reduce hospitalizations, by rationalizing the therapy and diminishing the incidence of medication-related problems, which ultimately helps patients to have a more active life with fewer restrictions.
{"title":"CLINICAL PHARMACIST’S CONTRIBUTION TO PHARMACOTHERAPY FORCORONARY ARTERY DISEASE","authors":"Denise Kuhlmann Duques, Isabelle Evelyn Viana Borges, Julia Sumie Nakaima Fugita, Regina Queiroz Machtura, Alessandra Santos Menegon","doi":"10.29381/0103-8559/20223204523-31","DOIUrl":"https://doi.org/10.29381/0103-8559/20223204523-31","url":null,"abstract":"Coronary artery disease (CAD) remains one of the main diseases of the 21st century for its morbidity and mortality. With the increase in life expectancy and reduction of deaths from acute coronary diseases, there is a significant increase in the disease in its chronic form, especially in the elderly. In these patients, angina pectoris represents the main presentation of the condition. This research is a narrative review carried out through bibliographic research in databases on drug treatment for CAD, and aims to describe the role of the clinical phar-macist in medication adherence. The treatment of CAD includes myocardial infarction (MI) prevention, reduction of mortality, and reduction of symptoms, improving the quality of life of patients. Beta-blockers, antiplatelet drugs, statins, and angiotensin-converting enzyme (ACE) inhibitors are the main pharmacological therapies that can reduce mortality and prevent MI, while some drugs, such as nitrates, ivabradine, trimetazidine, allopurinol, and ranolazine help minimize the occurrence of myocardial ischemia and associated symptoms. Health education focused on the importance of CAD treatment, especially in an individualized and accessible way, may favor long-term adherence. The pharmacist’s work, along with the multidisciplinary team, has the potential to help reduce hospitalizations, by rationalizing the therapy and diminishing the incidence of medication-related problems, which ultimately helps patients to have a more active life with fewer restrictions.","PeriodicalId":190881,"journal":{"name":"Revista da Sociedade de Cardiologia do Estado de São Paulo","volume":"37 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-12-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"116967008","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
INOCA (ischemia with no obstructive arteries) is a heterogeneous condition clinically characterized by chest pain of ischemic etiology in the absence of obstructive coronary artery disease, which imposes significant impairment in quality of life, in addition to an increased risk of cardiovascular events. The mechanisms involved in the onset of symptoms and ischemia are not fully understood and appear to be multifactorial. Coronary microvascular dysfunction and epicardial coronary spasm, either alone or in combination, are well-docu-mented mechanisms. Confirmatory diagnosis can be performed through invasive tests for the characterization of INOCA endotypes, which are microvascular dysfunction and vasos-pasm. However, as it is an invasive evaluation of difficult access and high cost, diagnosis is presumptive in most cases. Treatment involves a multidisciplinary approach and should be guided by the pathophysiological mechanism involved and aims to improve symptoms, control cardiovascular risk factors, and identify precipitating factors.
{"title":"STABLE ANGINA IN SPECIAL SITUATIONS: INOCA","authors":"Luciana Oliveira Cascaes Dourado, Caio Menezes Machado de Mendonça, Renato Maluf Auge","doi":"10.29381/0103-8559/20223204486-91","DOIUrl":"https://doi.org/10.29381/0103-8559/20223204486-91","url":null,"abstract":"INOCA (ischemia with no obstructive arteries) is a heterogeneous condition clinically characterized by chest pain of ischemic etiology in the absence of obstructive coronary artery disease, which imposes significant impairment in quality of life, in addition to an increased risk of cardiovascular events. The mechanisms involved in the onset of symptoms and ischemia are not fully understood and appear to be multifactorial. Coronary microvascular dysfunction and epicardial coronary spasm, either alone or in combination, are well-docu-mented mechanisms. Confirmatory diagnosis can be performed through invasive tests for the characterization of INOCA endotypes, which are microvascular dysfunction and vasos-pasm. However, as it is an invasive evaluation of difficult access and high cost, diagnosis is presumptive in most cases. Treatment involves a multidisciplinary approach and should be guided by the pathophysiological mechanism involved and aims to improve symptoms, control cardiovascular risk factors, and identify precipitating factors.","PeriodicalId":190881,"journal":{"name":"Revista da Sociedade de Cardiologia do Estado de São Paulo","volume":"94 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-12-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"127072851","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-12-05DOI: 10.29381/0103-8559/20223204445-53
B. Mahler Mioto
Drug therapy aimed at the treatment of coronary artery disease (CAD) or chronic coronary syndrome (CCS) is the most important step to be taken after establishing the diagnosis.It is the only therapy aimed at the disease itself and not just the lesions in isolation. The core of therapy, consisting of aspirin (ASA), statins, beta-blockers and angiotensin converting enzyme (ACE) inhibitors, has been consolidated over the last 40 years and is associated with a relative risk reduction of about 70% compared to the complete absence of treatment. Prevention of cardiovascular events targets acute myocardial infarction (AMI) and CAD-as-sociated death and focuses primarily on reducing the incidence of acute thrombotic events and the development of ventricular dysfunction. More recently, the concept of residual risk emerged, with therapies that can potentially reduce additional risk to the established the-rapy. Efforts directed at this residual cardiovascular risk focus on addressing inadequately reduced LDL cholesterol, systemic inflammation, high lipoprotein (a), hypertriglyceridemia, increased thrombotic risk, and other mechanisms.
{"title":"OPTIMAL MEDICAL TREATMENT: FOR REDUCTION OF EVENTS AND NEW OPTIONS","authors":"B. Mahler Mioto","doi":"10.29381/0103-8559/20223204445-53","DOIUrl":"https://doi.org/10.29381/0103-8559/20223204445-53","url":null,"abstract":"Drug therapy aimed at the treatment of coronary artery disease (CAD) or chronic coronary syndrome (CCS) is the most important step to be taken after establishing the diagnosis.It is the only therapy aimed at the disease itself and not just the lesions in isolation. The core of therapy, consisting of aspirin (ASA), statins, beta-blockers and angiotensin converting enzyme (ACE) inhibitors, has been consolidated over the last 40 years and is associated with a relative risk reduction of about 70% compared to the complete absence of treatment. Prevention of cardiovascular events targets acute myocardial infarction (AMI) and CAD-as-sociated death and focuses primarily on reducing the incidence of acute thrombotic events and the development of ventricular dysfunction. More recently, the concept of residual risk emerged, with therapies that can potentially reduce additional risk to the established the-rapy. Efforts directed at this residual cardiovascular risk focus on addressing inadequately reduced LDL cholesterol, systemic inflammation, high lipoprotein (a), hypertriglyceridemia, increased thrombotic risk, and other mechanisms.","PeriodicalId":190881,"journal":{"name":"Revista da Sociedade de Cardiologia do Estado de São Paulo","volume":"1 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-12-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"129692463","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-12-05DOI: 10.29381/0103-8559/20223204434-9
Pedro Macedo Esmeraldo Barbosa, Adriano Camargo de Castro Carneiro
Cardiac tomography in chronic coronary atherosclerotic disease is based on the interpre-tation of two main parameters: coronary calcium score, for the definition of cardiovascular risk in asymptomatic patients, and anatomical evaluation of coronary stenosis by angiotomography, for the diagnosis of coronary atherosclerotic disease in symptomatic patients. Calcium score, combined with clinical evaluation of the patient, is the most accurate complementary method for stratification and restratification of cardiovascular risk, while angiotomography has become the preferred investigation method in patients with suspected stable angina, especially in those with pre-test intermediate probability. Angiotomography presents recent technological advances that have brought the capacity for functional and histological assessments of co-ronary atherosclerosis, such as fractional flow reserve by tomography (FFR-CT) and dynamic myocardial perfusion by tomography (PMD-CT), which optimize diagnostic accuracy by improving the specificity and positive predictive value of the test, as well as high-risk plaque (HRP) and analysis of the fat attenuation index, which provide more accurate prognostic information, especially for cases in which no significant stenoses are identified.
{"title":"CHRONIC CORONARY INSUFFICIENCY: INNOVATIONS IN CARDIAC TOMOGRAPHY","authors":"Pedro Macedo Esmeraldo Barbosa, Adriano Camargo de Castro Carneiro","doi":"10.29381/0103-8559/20223204434-9","DOIUrl":"https://doi.org/10.29381/0103-8559/20223204434-9","url":null,"abstract":"Cardiac tomography in chronic coronary atherosclerotic disease is based on the interpre-tation of two main parameters: coronary calcium score, for the definition of cardiovascular risk in asymptomatic patients, and anatomical evaluation of coronary stenosis by angiotomography, for the diagnosis of coronary atherosclerotic disease in symptomatic patients. Calcium score, combined with clinical evaluation of the patient, is the most accurate complementary method for stratification and restratification of cardiovascular risk, while angiotomography has become the preferred investigation method in patients with suspected stable angina, especially in those with pre-test intermediate probability. Angiotomography presents recent technological advances that have brought the capacity for functional and histological assessments of co-ronary atherosclerosis, such as fractional flow reserve by tomography (FFR-CT) and dynamic myocardial perfusion by tomography (PMD-CT), which optimize diagnostic accuracy by improving the specificity and positive predictive value of the test, as well as high-risk plaque (HRP) and analysis of the fat attenuation index, which provide more accurate prognostic information, especially for cases in which no significant stenoses are identified.","PeriodicalId":190881,"journal":{"name":"Revista da Sociedade de Cardiologia do Estado de São Paulo","volume":"7 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-12-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"130047365","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-12-05DOI: 10.29381/0103-8559/20223204519-22
Camila Paixão Jordão, Luciana Oliveira Cascaes Dourado, Camila Regina Alves de Assumpção, Luciana Diniz Nagem Janot de Matos
Refractory angina (RA) is a chronic clinical condition characterized by angina pectoris, which occurs as a result of myocardial ischemia, unresponsive to conventional medical treatment (i.e. control of cardiovascular risk factors and other clinical conditions, in addition to antianginal drugs), which is not eligible for coronary interventions. Patients with RA evolve with great functional limitation due to pain and consequent loss of quality of life, and their improvement is the focus of treatment. Exercise-based cardiac rehabilitation (CR) is an adjuvant therapy that effectively promotes secondary prevention in patients with coronary artery disease, but it is rarely prescribed for patients with refractory angina due to concerns about adverse events during exercise, related to triggering ischemia myocardial infarction at low thresholds. In this review, we address the experience obtained with the management of patients with RA in a reference center for the treatment of RA, especially related to exercise-based CR. Some peculiarities in the evaluation and prescription of training in patients with RA and their understanding are important to promote greater safety and efficacy of physical exercise in this population.
{"title":"EXERCISE-BASED CARDIAC REHABILITATION FOR PATIENTS WITH REFRACTORY ANGINA: SINGLE-CENTER EXPERIENCE","authors":"Camila Paixão Jordão, Luciana Oliveira Cascaes Dourado, Camila Regina Alves de Assumpção, Luciana Diniz Nagem Janot de Matos","doi":"10.29381/0103-8559/20223204519-22","DOIUrl":"https://doi.org/10.29381/0103-8559/20223204519-22","url":null,"abstract":"Refractory angina (RA) is a chronic clinical condition characterized by angina pectoris, which occurs as a result of myocardial ischemia, unresponsive to conventional medical treatment (i.e. control of cardiovascular risk factors and other clinical conditions, in addition to antianginal drugs), which is not eligible for coronary interventions. Patients with RA evolve with great functional limitation due to pain and consequent loss of quality of life, and their improvement is the focus of treatment. Exercise-based cardiac rehabilitation (CR) is an adjuvant therapy that effectively promotes secondary prevention in patients with coronary artery disease, but it is rarely prescribed for patients with refractory angina due to concerns about adverse events during exercise, related to triggering ischemia myocardial infarction at low thresholds. In this review, we address the experience obtained with the management of patients with RA in a reference center for the treatment of RA, especially related to exercise-based CR. Some peculiarities in the evaluation and prescription of training in patients with RA and their understanding are important to promote greater safety and efficacy of physical exercise in this population.","PeriodicalId":190881,"journal":{"name":"Revista da Sociedade de Cardiologia do Estado de São Paulo","volume":"8 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-12-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"127990793","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
The spectrum of clinical conditions associated with the presence of myocardial ischemia and related symptoms (angina pectoris or equivalent), regardless of the cau-sative mechanism (obstructive disease, microvascular dysfunction or coronary spasm) is called chronic coronary syndrome (CCS). Although the essence of the treatment of patients with SCC consists of changes in lifestyle and strict control of cardiovascular risk factors, in addition to antianginal therapy in maximally tolerated doses, surgical or percutaneous revascularization procedures are indicated when medical treatment fails to offer adequate symptoms control or in scenarios in which they provide a reduction in the risk of events compared to clinical therapy alone. Thus, patients with left main disease, multivessel disease (especially diabetics or those with high angiographic complexity), patients with HFrEF of ischemic etiology, and those with the last remaining patent vessel or proximal lesion of the anterior descending artery should be candidates for intervention. The choice of the intervention modality should be based on robust scientific evidence as proposed by current guidelines. In general terms, clinical parameters (patient frailty, comorbidities, and analysis of left ventricular function, for example), angiographic para-meters (anatomical complexity), and technical parameters (experience of the local team and availability of specific devices such as IVUS) are analyzed by the Heart Team in the decision-making process.
{"title":"INVASIVE MANAGEMENT: BASIS FOR DECISION-MAKING","authors":"Luhanda Leonora Cardoso Monti Sousa, Luís Henrique Wolff Gowdak","doi":"10.29381/0103-8559/20223204460-6","DOIUrl":"https://doi.org/10.29381/0103-8559/20223204460-6","url":null,"abstract":"The spectrum of clinical conditions associated with the presence of myocardial ischemia and related symptoms (angina pectoris or equivalent), regardless of the cau-sative mechanism (obstructive disease, microvascular dysfunction or coronary spasm) is called chronic coronary syndrome (CCS). Although the essence of the treatment of patients with SCC consists of changes in lifestyle and strict control of cardiovascular risk factors, in addition to antianginal therapy in maximally tolerated doses, surgical or percutaneous revascularization procedures are indicated when medical treatment fails to offer adequate symptoms control or in scenarios in which they provide a reduction in the risk of events compared to clinical therapy alone. Thus, patients with left main disease, multivessel disease (especially diabetics or those with high angiographic complexity), patients with HFrEF of ischemic etiology, and those with the last remaining patent vessel or proximal lesion of the anterior descending artery should be candidates for intervention. The choice of the intervention modality should be based on robust scientific evidence as proposed by current guidelines. In general terms, clinical parameters (patient frailty, comorbidities, and analysis of left ventricular function, for example), angiographic para-meters (anatomical complexity), and technical parameters (experience of the local team and availability of specific devices such as IVUS) are analyzed by the Heart Team in the decision-making process.","PeriodicalId":190881,"journal":{"name":"Revista da Sociedade de Cardiologia do Estado de São Paulo","volume":"27 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-12-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"127223632","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-12-05DOI: 10.29381/0103-8559/20223204408-11
Vivian Lerner Amato, Pedro Silvio Farsky
Classical angina pectoris is the main clinical manifestation of coronary artery disease, although other symptoms may be observed, such as dyspnea (anginal equivalent). Other conditions may also occur as a form of presentation, either alone or in association with classic angina, such as silent ischemia, vasospastic angina, microvascular dysfunction, heart failure and arrhythmias. In addition to the clinical picture, the assessment of risk factors as well as vasculopathy in other territories increase pre-test probability of this pathology. Attention should always be paid to possible differential diagnoses.
{"title":"CHRONIC CORONARY INSUFFICIENCY: CLINICAL PRESENTATION","authors":"Vivian Lerner Amato, Pedro Silvio Farsky","doi":"10.29381/0103-8559/20223204408-11","DOIUrl":"https://doi.org/10.29381/0103-8559/20223204408-11","url":null,"abstract":"Classical angina pectoris is the main clinical manifestation of coronary artery disease, although other symptoms may be observed, such as dyspnea (anginal equivalent). Other conditions may also occur as a form of presentation, either alone or in association with classic angina, such as silent ischemia, vasospastic angina, microvascular dysfunction, heart failure and arrhythmias. In addition to the clinical picture, the assessment of risk factors as well as vasculopathy in other territories increase pre-test probability of this pathology. Attention should always be paid to possible differential diagnoses.","PeriodicalId":190881,"journal":{"name":"Revista da Sociedade de Cardiologia do Estado de São Paulo","volume":"1 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-12-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"129384004","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-12-05DOI: 10.29381/0103-8559/20223204475-85
Otávio Rizzi Coelho-Filho, Otávio Rizzi Coelho
In the next two decades, the epidemic of type 2 diabetes (T2DM), which is often accompanied by other comorbidities, such as hypertension, obesity and dyslipidemia, is expected to affect more than 600 million people. T2DM has a great impact on the survival and quality of life of patients with stable angina, especially in younger patients and in those with multiple comorbidities. Although all T2DM complications are equally relevant, cardio-vascular disease and coronary artery disease (CAD) are especially important, as they are the main causes of morbidity and mortality in this group of patients. Despite the fact that in the last 15 years there has been a significant decline in the rates of acute myocardial infarction, stroke and amputations in patients with T2DM, ischemic complications have reappeared, especially in younger and middle-aged individuals. These data reveal the need for increased attention to the implementation of cardiovascular risk control measures in patients with T2DM, especially in those with established CAD. Thus, in order to improve the survival and quality of life of diabetic patients, the most diverse national and international societies recognize the prevention of vascular ischemic events as one of their main priorities. Although comprehensive strategies to control cardiovascular risk have been shown to be efficient in patients with T2DM, rates of cardiovascular events remain high among these individuals, even with adequate control of modifiable risk factors — as seen in recent clinical studies. This reinforces the need for additional measures to control events in this population. Fortunately, several recent therapeutic strategies have become available in recent years, including advances in anticoagulation and antiplatelet therapy, new cholesterol-lowering drugs, and new agents to control blood glucose with potential cardiovascular benefits.This chapter discusses the main therapeutic strategies to be implemented in patients with T2DM and stable angina, in order to optimize the reduction of cardiovascular events, control of symptoms and improvement of quality of life.
{"title":"STABLE ANGINA IN SPECIAL SITUATIONS: DIABETES","authors":"Otávio Rizzi Coelho-Filho, Otávio Rizzi Coelho","doi":"10.29381/0103-8559/20223204475-85","DOIUrl":"https://doi.org/10.29381/0103-8559/20223204475-85","url":null,"abstract":"In the next two decades, the epidemic of type 2 diabetes (T2DM), which is often accompanied by other comorbidities, such as hypertension, obesity and dyslipidemia, is expected to affect more than 600 million people. T2DM has a great impact on the survival and quality of life of patients with stable angina, especially in younger patients and in those with multiple comorbidities. Although all T2DM complications are equally relevant, cardio-vascular disease and coronary artery disease (CAD) are especially important, as they are the main causes of morbidity and mortality in this group of patients. Despite the fact that in the last 15 years there has been a significant decline in the rates of acute myocardial infarction, stroke and amputations in patients with T2DM, ischemic complications have reappeared, especially in younger and middle-aged individuals. These data reveal the need for increased attention to the implementation of cardiovascular risk control measures in patients with T2DM, especially in those with established CAD. Thus, in order to improve the survival and quality of life of diabetic patients, the most diverse national and international societies recognize the prevention of vascular ischemic events as one of their main priorities. Although comprehensive strategies to control cardiovascular risk have been shown to be efficient in patients with T2DM, rates of cardiovascular events remain high among these individuals, even with adequate control of modifiable risk factors — as seen in recent clinical studies. This reinforces the need for additional measures to control events in this population. Fortunately, several recent therapeutic strategies have become available in recent years, including advances in anticoagulation and antiplatelet therapy, new cholesterol-lowering drugs, and new agents to control blood glucose with potential cardiovascular benefits.This chapter discusses the main therapeutic strategies to be implemented in patients with T2DM and stable angina, in order to optimize the reduction of cardiovascular events, control of symptoms and improvement of quality of life.","PeriodicalId":190881,"journal":{"name":"Revista da Sociedade de Cardiologia do Estado de São Paulo","volume":"70 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-12-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"126047601","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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