MDNG Primary CareDecember 2010
Volume 12
Issue 12

//The Educated PatientTM

Facts About Angina

Are your patients aware of the difference between angina and myocardial infarction? Despite the fact that symptoms of angina will most likely alleviate within a matter of minutes, the experience could be enough to send patients into a panic, thinking that they’re having a heart attack. This guide from explains the difference between the two, what causes angina, how it is diagnosed and treated, what types of chest pain are considered angina, what level of exercise is safe, and the definitions of stable and unstable angina, and the two forms of angina pectoris.

//Online CME

Chronic Stable Angina: Disease Progression or Status Quo?

Credits: 1.00

Fee: $10.00

Expiration Date: March 30, 2011

Multimedia: None

This straightforward activity aims to educate practitioners about “the most up-to-date information regarding management of patients with chronic stable angina, including attention to escalating symptoms, atypical complaints, and the potential for a worsening clinical picture.”

Chronic Stable Angina: Then and Now

Credits: 1.00


Expiration Date:


Over the course of an hour you’ll be hearing from Eugene Braunwald, MD, Distinguished Hersey Professor of Medicine, Harvard Medical School; Carl Pepine, MD, Professor of Medicine, Professor and Chief, Division of Cardiovascular Medicine, University of Florida; and Peter Stone, MD, Associate Professor of Medicine, Harvard Medical School. Their three presentations focus on the evolution of “the field of angina” over the past 20 years, specifically dealing with medical interventions “and how this has affected the identification and evaluation of patients.” Further, participants will be asked to “identify treatment gaps” (ie, “what do patients still need in the age of revascularization?”) and “assess new medical approaches and how they differ from traditional agents.”

An Elderly Woman with Unstable Angina/Non-ST-Elevation Myocardial Infarction Presenting for Follow-up

Credits: 0.50


Expiration Date: October 13, 2011


The developers of this activity felt there was a significant opportunity to educate clinicians about three “major practice gaps [that] have been noted in the treatment approaches rendered by healthcare professionals…in the area of acute coronary syndromes.” All focus on the administration of antiplatelet therapy, about which it is recommended clinicians “increase their awareness of the options for dual antiplatelet therapy, including available agents, dosing regimens, and timing of administration, to come closer to achieving equilibrium between safety and efficacy in the context of acute and long-term care of patients with ACS.”


Angina and the COURAGE Study

This podcast, which introduced listeners to “CardioExchange, a joint effort by Journal Watch and the New England Journal of Medicine to create an online community of clinicians interested in cardiovascular diseases,” features, among other topics, an interview in which CardioExchange editors Drs. Richard Lange and L. David Hillis discuss the COURAGE study with Dr. Gregg Stone of Columbia University and Dr. William Bowden of the University of Buffalo. In the study, researchers compared medical therapy alone to medical therapy combined with PCI for the initial management of patients with stable coronary artery disease. They found that PCI reduced angina but didn’t reduce hard end points like death, myocardial infarction, and later hospitalizations for coronary disease.


Delay from Symptom Onset to Hospital Presentation for Patients with Non—ST-Segment Elevation Myocardial Infarction

Journal: Archives of Internal Medicine (November 8, 2010)

Authors: Ting H, Chen A, Roe M, et al

Purpose: Though “secular trends and factors associated with delay time from symptom onset to hospital presentation are known for patients with ST-segment elevation myocardial infarction,” they “are less well-described for non-STEMI.”

Results: The authors “studied 104,622 patients with non-STEMI enrolled at 568 hospitals participating in the Can Rapid Risk Stratification of Unstable Angina Patients Suppress Adverse Outcomes With Early Implementation of the American College of Cardiology/American Heart Association Guidelines” over a six-year period and found that “lond delay times are common and have not changed over time for patients with non-STEMI” in large part because “patients cannot differentiate whether symptoms are due to STEMI or non-STEMI.” This highlights the importance of “early presentation…in both instances.”

Impact of Therapy with Statins, Beta-blockers and Angiotensin-converting Enzyme Inhibitors on Plasma Myeloperoxidase in Patients with Coronary Artery Disease

Journal: Clinical Research in Cardiology (October 20, 2010)

Authors: Ndrepepa G, Braun S, Schömig A, Kastrati A

Purpose: The authors analyzed blood samples of a 680-patient cohort “with angiographically confirmed CAD: 382 patients with stable CAD, 107 patients with unstable angina and 191 patients with ST-segment elevation acute myocardial infarction” in order to investigate “whether therapy with statins, beta-blockers and angiotensin-converting enzyme inhibitors on admission affects the plasma level of myeloperoxidase in patients with coronary artery disease.”

Results: “On admission, 316 patients were receiving statins, 432 patients were receiving beta-blockers and 354 patients were receiving ACE inhibitors.” Though beta-blockers were “independently associated with lower levels of plasma myeloperoxidase,” researchers found that “pre-admission therapy with statins, beta-blockers or ACE inhibitors reduced MPO levels in patients with acute coronary syndromes, but not in patients with stable CAD.”

Incidence and Prognosis of Angina Pectoris in South Asians and Whites

Journal: Journal of Public Health (September 2010)

Authors: Zaman M, Shipley M, Stafford M, et al

Purpose: Because the causes of “higher coronary mortality in South Asians compared with White populations” are unknown, researchers examined the “cumulative incidence of chest pain…and prognosis of chest pain” in the two groups.

Results: “Over seven phases of 18-year follow-up of the Whitehall-II study…chest pain was assessed using the Rose questionnaire. Coronary death/non-fatal myocardial infarction was examined comparing those with chest pain to those with no chest pain at baseline.” An analysis of the data obtained revealed that “South Asians had higher cumulative frequencies of typical angina by Phase 7…and exertional chest pain…compared with Whites.” Overall, prognosis was worse in South Asians.

The Relationship between Early Left Ventricular Myocardial Alterations and Reduced Coronary Flow Reserve in Non-Insulin-Dependent Diabetic Patients with Microvascular Angina

Journal:International Journal of Cardiology (October 29, 2010)

Authors: D’Andrea A, Nistri S, Castaldo F, et al

Purpose:Researchers selected “a population of 45 normotensive patients with non-insulin dependent diabetes mellitus…with left ventricular ejection fraction > 50% and microvascular angina…[and] thirty-five age-and sex-matched healthy controls” to take part in a study that would help them “evaluate left ventricular systolic and diastolic myocardial function, and their relation to coronary flow reserve…”

Results:“All the patients underwent standard echocardiography, Tissue Doppler (TDI), two-dimensional strain (2DSE) imaging, and coronary flow reserve (CFR) measurement.” The authors found all tests to be “valuable non-invasive and easy-repeatable tools for detecting LV myocardial and coronary function in DM patients with microvascular angina.”

Pharma Focus


Improvement in Left Ventricular Systolic and Diastolic Performance During Ranolazine Treatment in Patients With Stable Angina

Journal: Journal of Cardiovascular Pharmacology and Therapeutics (October 5, 2010)

Authors: Figueredo V, Pressman G, Romero-Corral A, et al

Purpose: “By preventing myocyte sodium and calcium overload, ranolazine also have potential beneficial effects on myocardial function.” Because previous research “support[s] this concept,” researchers sought to evaluate “changes in parameters of left ventricular function in stable angina patients treated with oral ranolazine.”

Results: “Global left ventricular function, as assessed by the myocardial performance index, was significantly improved on drug therapy…due to improvement in both diastolic and systolic parameters.” Out of 21 total patients, “17 reported less angina and 8 patients reported an increase in activity level.”

//Clinical Trials

Ranolazineand Pulmonary Hypertension

Study Type: Interventional

Age/Gender Requirements: 18-80 years (male/female)

Sponsor: Northwestern University

Purpose: Individuals with angina, right ventricular ischemia, and pulmonary arterial hypertension are eligible to participate in this study which will “determine if the medication, ranolazine (study drug), can help improve blood flow to your heart, increase your exercise capacity and improve your quality of life.”

From the Network

Generic Product News: Enozaparin Sodium Injection

Enoxaparin sodium injection is indicated for the prevention and treatment of deep vein thrombosis, the prevention of ischemic complications of unstable angina and myocardial infarction (MI), and the treatment of acute ST-segment elevation MI, and was the first generic version of Lovenox to receive FDA approval.

Paramedic Defibrillator/Monitors to Transmit Cardiac Data to Physician iPhones/iPads

Medtronic's Physio-Control has partnered with AirStrip Technologies to bring real-time monitoring of cardiac data from the ambulance straight to a physician's iPhone or iPad. Physio-Control's LIFEPAK monitor/defibrillators will transmit ECG data via the firm's LIFENET system to AirStrip's CARDIOLOGY app.

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