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Ischemic preconditioning and preinfarction angina in the clinical arena

Abstract

In animals, brief episodes of ischemia before a total coronary occlusion protect the heart and result in a smaller myocardial infarct size. In humans, episodes of angina before acute myocardial infarction might also confer a preconditioning or protective effect; numerous studies show that preinfarction angina is associated with smaller infarcts. Preinfarction angina is also associated with reductions in ventricular dysfunction, arrhythmias and incidence of no-reflow phenomena, and, in some cases, improved survival. The protective effect of preconditioning in humans is characterized by marked individual variations and seems to be attenuated in women, people with diabetes and the elderly. Exercise seems to be an important way to induce preconditioning in humans and preserves it in the elderly.

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Acknowledgements

Thanks to Linda Weis and Alice Stargardt, Marshfield Clinic Research Foundation, for assistance in the preparation of this manuscript.

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Correspondence to Shereif H Rezkalla.

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Rezkalla, S., Kloner, R. Ischemic preconditioning and preinfarction angina in the clinical arena. Nat Rev Cardiol 1, 96–102 (2004). https://doi.org/10.1038/ncpcardio0047

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