STABLE ISCHEMIC HEART DISEASE. A REVISION OF MANAGEMENT AND CLASSIFICATION. WE ARE WAITING FOR CHANGES. CLINICAL CASES: BEST PRACTICE

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Abstract

The article discusses the main principles of approaching the personalization of stable angina symptomatic therapy with a rationale for the choice of antianginal medications depending on clinical and pathophysiological phenotypes of the patient. This article summarizes the determinants and control of coronary blood flow and heart rate influence. Increased heart rate reduces the duration of diastole and thus coronary blood flow when metabolic vasodilation is no longer able to increase coronary blood flow. Increased heart rate also reduces the collateral blood flow. Association myocardial ischemia and myocardial contractile function is analyzed: reversible ischemic contractile dysfunction, myocardial hibernation, irreversible loss of regional contractile function. The clinical cases and the treatment modification according clinical phenotypes of the patient (stable ischemic heart disease with sympathetic activation and stable ischemic heart disease with heart failure decompensation) are discussed. Aspects of monotherapy and combined therapy for heart rate control and use of fixed combinations of antianginal medications are presented.

About the authors

Tatiana V. Adasheva

Yevdokimov Moscow State University of Medicine and Dentistry

Email: adashtv@mail.ru
д-р мед. наук, проф., проф. каф. поликлинической терапии Москва, Россия

Elena I. Samorukova

Yevdokimov Moscow State University of Medicine and Dentistry

канд. мед. наук, ассистент каф. поликлинической терапии Москва, Россия

Leili B. Akhmedyarova

Centrosoyuz Hospital

канд. мед. наук, зав. отд-нием терапии Москва, Россия

Dina V. Odintsova

Centrosoyuz Hospital

канд. мед. наук, врач-кардиолог Москва, Россия

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