**Meet the editor**

Dr. Federico Piscione, MD, FESC, born in 1948, graduated in 1972 from School of Medicine, University of Naples, Italy. Since 2002, he is Associated Professor at the Department of Medicine, Division of Cardiology, and Head of Cardiac Catheterization Laboratory and Interventional Cardiology, Federico II University in Naples, Italy. Dr. Piscione has written almost 150 articles, 25

chapters in books, and participated in the organization of 18 national and international meetings and congresses. He is a member of Italian Society of Cardiology, Italian Society of Invasive and Interventional Cardiology, New York Academy of Sciences and European Society of Cardiology. Dr. Piscione has received research awards from Italo-American Medical Education Foundation, Clinical Medicine Curriculum, Loyola University, Rome (1976) and National Council of Research, NATO Junior fellowship scheme (1982).

Contents

**Preface VII** 

Maria Bucova

Chapter 2 **Angina-Like Chest Pain as** 

Jacek Budzyński

Solmaz Dehghan

Chapter 4 **Therapy for Angina Pectoris** 

Maurizio Galderisi

Ozlem Soran

Chapter 1 **Inflammation and Genetics** 

**of Inflammation in Cardiovascular Diseases 1** 

**a Symptom of Digestive Tract Disorders 35** 

Chapter 3 **Conventional and Novel Pharmacotherapy** 

**Secondary to Coronary Disease 89**  Antony Leslie Innasimuthu, Sanjay Kumar, Lei Gao, Melaku Demede and Jeffrey S. Borer

Chapter 5 **Beta-Blockers and Coronary Flow Reserve 129** 

Chapter 7 **Alternative Non-Medical, Non-Surgical Therapies for the Treatment of Angina Pectoris 159** 

Chapter 6 **The Role of Enhanced External Counterpulsation Therapy** 

**in the Management of Coronary Artery Disease 137** 

Maryam Esmaeilzadeh, Bahieh Moradi and Nasim Naderi

**of Angina Pectoris 71** 

## Contents

#### **Preface XI**


Chapter 2 **Angina-Like Chest Pain as a Symptom of Digestive Tract Disorders 35**  Jacek Budzyński


Preface

limitations.

medical students.

Angina is the most common disorder affecting patients with ischemic heart disease. Indeed, the reported prevalence of angina approximates 10.2 million patients in the USA and it has been estimated that 500,000 new cases of stable angina occur each year. In this book we reviewed the novel mechanisms, such as inflammation factors and genetic determinants, that play a pivotal role in the pathophysiology of angina and that might have potential therapeutic implications in the future (Chapter 1). In addition, because of its prevalence, it is important to distinguish angina due to ischemic heart disease from angina-like chest syndrome, due to digestive tract disorder. At this regard, the pathophisiology, the diagnosis and the treatment of

The treatment of angina is based on several conventional agents, nevertheless new drugs with novel mechanism of action, i.e. ranolazine, nicordandil, ivabradine, have been proposed in specific subsets (Chapter 3). However, nitrates, calcium channel blockers and beta adrenergic blockers are the most widely used and studied antianginal medications, representing the cornerstone in the treatment of angina secondary to coronary artery disease (Chapter 4 and Chapter 5). Finally, the role of enhanced external counterpulsation and alternative non-medical, non-surgical therapies were also reported, focusing on their potentials, as well as their current

Therefore, this book provides a thorough review of fundamental principles of diagnosis, pathophysiology and treatment of angina pectoris, representing an invaluable resource not only for cardiologists, but also for general practitioners and

Department of Clinical Medicine, Cardiovascular Sciences and Immunology

**Professor Federico Piscione** Federico II University

Naples - Italy

angina-like chest syndrome were carefully reviewed (Chapter 2).

## Preface

Angina is the most common disorder affecting patients with ischemic heart disease. Indeed, the reported prevalence of angina approximates 10.2 million patients in the USA and it has been estimated that 500,000 new cases of stable angina occur each year. In this book we reviewed the novel mechanisms, such as inflammation factors and genetic determinants, that play a pivotal role in the pathophysiology of angina and that might have potential therapeutic implications in the future (Chapter 1). In addition, because of its prevalence, it is important to distinguish angina due to ischemic heart disease from angina-like chest syndrome, due to digestive tract disorder. At this regard, the pathophisiology, the diagnosis and the treatment of angina-like chest syndrome were carefully reviewed (Chapter 2).

The treatment of angina is based on several conventional agents, nevertheless new drugs with novel mechanism of action, i.e. ranolazine, nicordandil, ivabradine, have been proposed in specific subsets (Chapter 3). However, nitrates, calcium channel blockers and beta adrenergic blockers are the most widely used and studied antianginal medications, representing the cornerstone in the treatment of angina secondary to coronary artery disease (Chapter 4 and Chapter 5). Finally, the role of enhanced external counterpulsation and alternative non-medical, non-surgical therapies were also reported, focusing on their potentials, as well as their current limitations.

Therefore, this book provides a thorough review of fundamental principles of diagnosis, pathophysiology and treatment of angina pectoris, representing an invaluable resource not only for cardiologists, but also for general practitioners and medical students.

> **Professor Federico Piscione** Federico II University Department of Clinical Medicine, Cardiovascular Sciences and Immunology Naples - Italy

**1** 

Maria Bucova

*Slovakia* 

**Inflammation and Genetics of Inflammation** 

*Institute of Immunology, School of Medicine Comenius University, Bratislava* 

Inflammation is a complex of defensive mechanisms reacting to the entry of harmful agents to the organism or cells in order to eliminate or at least to dilute the agent, repair damaged cells or tissue and restore homeostasis. From this definition it is clear, that inflammation does not accompany only infectious diseases but also others, causing cell, tissue or organ injury and serves primarily defensively (Table 1). An exaggerated, chronic long lasting or non-adequately regulated inflammatory response could be the cause of adverse reactions

Inflammation plays an important role also in the etiology of ischemic heart disease (IHD), myocardial infarction (MI), angina pectoris (AP) and hypertension, however, its mechanism in various stages of pathological process is not well understood (Bucova et al., 2008a; Itoh et al., 2007; Kuka et al., 2010; Li, 2005; Pickering et al., 2007, Ross 1999). If the cause of IHD is atherosclerosis or other, it is accompanied by inflammation. Various types of inflammatory cells, cytokines, chemokines and other soluble factors were confirmed to be involved in this process. (Armstrong et al 2006; Aukrust et al., 2001; Brunetti et al., 2006; Bucova et al., 2008a;

8. Nutritional disorders - hypoxia, lack of proteins, vitamins, etc.

**Inflammation** and **immune system activation** are strongly involved in the pathogenesis of atherosclerosis and cardiovascular diseases. Atherosclerosis is now considered to be a

**1. Introduction** 

Ferencik et al., 2007).

4. Allergic 5. Autoimmune

7. Cancer

9. Other causes

Table 1. Inflammation and its induction agents

and could lead to pathology (Bucova, 2002b).

1. Infectious - bacteria, fungi, viruses 2. Mechanical – scratching, cutting 3. Physical – burning, radiation

**2. Immune mechanisms and cardiovascular diseases** 

6. Atherosclerosis and cardiovascular diseases

**in Cardiovascular Diseases** 
