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  • CARDIOPATIA ISCHEMICA CRONICA

    Terapia anti-ischemica ottimale nel paziente con ischemia residua

    Fabio Barlocco

    Cardiologia interventistica

    Legnano

  • Definizione operativa di cardiopatia ischemica cronica.

    • Pazienti sintomatici con angina pectoris (o suoi equivalenti) stabile.

    • Pazienti asintomatici, ma con evidenza clinico-strumentale di pregresso infarto

    miocardico o sindrome coronarica acuta (da oltre 1 anno).

    • Pazienti asintomatici ma portatori di patologia ostruttiva coronarica accertata (es.

    pazienti già sottoposti a procedura coronarica percutanea o intervento di bypass

    aortocoronarico o con riscontro coronarografico di stenosi significative o con

    evidenza di ischemia ai test provocativi).

    http://www.google.it/url?sa=i&rct=j&q=&esrc=s&source=images&cd=&cad=rja&uact=8&ved=0ahUKEwjIsKyVpqnQAhWHyRQKHS4AAYkQjRwIBw&url=http://slideplayer.it/slide/3747893/&psig=AFQjCNEbSfLOizPCbfntMQLf0hsPngjROA&ust=1479249011279187

  • Thus prolonged therapy

    with isosorbide dinitrate

    is not evidence-based.

    Organic nitrates are among the

    oldest drugs, but they still remain a

    widely used adjuvant in the

    treatment of symptomatic coronary

    artery disease. While their efficacy

    in relieving angina pectoris

    symptoms in acute settings and in

    preventing angina before physical

    or emotional stress is undisputed,

    the chronic use of nitrates has

    been associated with potentially

    important side effects such as

    tolerance and endothelial

    dysfunction.

    Classe IIb

  • CCB Effect of amlodipine, atenolol and their combination on myocardial ischemia

    during treadmill exercise and ambulatory monitoring. Canadian

    Amlodipine/Atenolol in Silent Ischemia Study (CASIS) Investigators.

    CONCLUSIONS:

    Ischemia during treadmill testing was more effectively suppressed by amlodipine,

    whereas ischemia during ambulatory monitoring was more effectively suppressed by

    atenolol. The combination was more effective than either single drug in both settings.

    J Am Coll Cardiol.1995 Mar 1;25(3):619-25.

    Favourable long term prognosis in stable angina pectoris: an extended follow

    up of the angina prognosis study in Stockholm (APSIS) Verapamil

    Heart 2006 Feb; 92(2): 177–182.

  • REDRAWN FROM LEVINE HJ. REST HEART RATE AND LIFE EXPECTANCY. J AM COLL CARDIOL 1997

    Humans are outliers relative to other mammals when comparing lifespan to heartbeat.

  • Resting heart rate and all-cause mortality in the

    Framingham Study.

    Jeffrey S. Borer Eur Heart J Suppl 2008;10:F2-F6

    Published on behalf of the European Society of Cardiology. All rights reserved. © The Author

    2008. For permissions please email: journals.permissions@oxfordjournals.org

  • Resting heart rate and mortality in the general population:

    epidemiological studies

    Jeffrey S. Borer Eur Heart J Suppl 2008;10:F2-F6

    Published on behalf of the European Society of Cardiology. All rights reserved. © The Author

    2008. For permissions please email: journals.permissions@oxfordjournals.org

  • Meccanismi sfavorevoli della frequenza cardiaca elevata

  • Beta Bloccanti

  • http://www.google.it/url?sa=i&rct=j&q=&esrc=s&source=images&cd=&ved=0ahUKEwiyw6yFgOzLAhXFwxQKHXLZD2sQjRwIBw&url=http://www.medscape.org/viewarticle/762608_transcript&bvm=bv.118443451,d.bGs&psig=AFQjCNEBDUVKWJTUX5Bk-MChKth16syb-g&ust=1459550616955033

  • SINUS NODE INHIBITION:

    http://www.google.it/url?sa=i&rct=j&q=&esrc=s&source=images&cd=&cad=rja&uact=8&ved=0ahUKEwiX7ZeXgezLAhWEsxQKHRpeDPgQjRwIBw&url=http://www.slideshare.net/DukeHeartCenter/update-in-heart-failure-management&bvm=bv.118443451,d.bGs&psig=AFQjCNHYvE_0fGGhTD523KwjZFFrpsahfQ&ust=1459550881455283

  • Changes in heart rate at rest (A) and at peak exercise (B) in the

    different treatment groups during double-blind dose-ranging.

    Jeffrey S. Borer et al. Circulation. 2003;107:817-823

  • “Chi va piano, va sano e va lontano”

    Tartaruga: 6 bpm 150 anni di vita

    http://www.google.it/url?sa=i&rct=j&q=&esrc=s&source=images&cd=&cad=rja&uact=8&ved=0ahUKEwieh6iWivDLAhXCOBQKHa8sB7YQjRwIBw&url=http://www.sognandonewyork.it/&psig=AFQjCNH-Kpd7bxwnEX9yBresWrXRzNPu5w&ust=1459690791086274

  • Ranolazina

    Ranolazina inibisce

    selettivamente la

    corrente tardiva del

    sodio nel miocardiocita

    ischemico senza

    alterare frequenza

    cardiaca e pressione

    arteriosa in maniera

    significativa

  • Studio CARISA N

    u m

    e ro

    p e

    r se

    tt im

    an e

    6

    5

    4

    3

    2

    1

    0

    Basale A 12 sett.

    Fase dello studio

    Basale A 12 sett.

    Attacchi di angina Consumo di nitroglicerina

    p

  • MERLIN – TIMI 36:

    efficacia nei pazienti con angina cronica

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