A 62-year-old female patient was admitted to the cardiology department with a 3-month history of exertional chest pain during moderate to high-intensity physical activity. Resting electrocardiogram (ECG) and echocardiographic assessments were unremarkable. However, during a stress test at 100 W (7 METs) with a double product of 23,000, the patient experienced angina and a 1.25 mm ST-segment depression. This ischemic response was corroborated by 24-h ambulatory ECG monitoring. Coronary angiography identified a 75% stenosis of the circumflex artery, with a stable atherosclerotic plaque confirmed via intravascular ultrasound (IVUS). The patient also presented with metabolic syndrome. The therapeutic strategy raised significant considerations, particularly whether to commence exclusively with guideline-directed medical therapy (GDMT) or to pursue myocardial revascularization. Following current guidelines and the patient’s preference, GDMT was implemented. The prescribed regimen included beta-blockers, statins, antiplatelet agents, and angiotensin-converting enzyme inhibitors. The patient was also enrolled in a rehabilitation program emphasizing lifestyle modification and structured physical training. Exercise and physical activity are universally recommended for patients with ischemic heart disease to enhance functional capacity and achieve pleiotropic benefits, including late-phase ischemic preconditioning mediated by nitric oxide (NO). These interventions contribute to improved exercise tolerance, quality of life, and, in some cases, survival. Given the patient’s favorable exercise capacity, outpatient rehabilitation was selected as the primary recovery modality, but home-based telerehabilitation is also considered a viable alternative. The structured physical rehabilitation program covered 8 weeks, comprising five training sessions per week, with an emphasis on daily physical activity at home. The exercise protocol included aerobic (endurance) training, supplemented by resistance training twice weekly. Aerobic training was conducted at high intensity (75–85% of peak VO2 achieved during the stress test), while resistance training was performed at 50–80% of one-repetition maximum (1RM). After 8 weeks, the patient demonstrated a 25-W (25%) improvement in exercise capacity, without exacerbation of electrocardiographic ischemia or recurrence of angina. Long-term continuation of physical activity and training at home was recommended. This case underscores, in alignment with existing literature, that for a substantial subset of patients with chronic ischemic heart disease and exertional angina, GDMT coupled with physical rehabilitation represents a viable alternative to myocardial revascularization, yielding significant improvements in exercise capacity, quality of life, and overall outcomes.

Angina Pectoris

章节
发表日期：

2025年

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Dumitru Zdrenghea,
Dana Pop,
Raluca Tomoaia

摘要

A 62-year-old female patient was admitted to the cardiology department with a 3-month history of exertional chest pain during moderate to high-intensity physical activity. Resting electrocardiogram (ECG) and echocardiographic assessments were unremarkable. However, during a stress test at 100 W (7 METs) with a double product of 23,000, the patient experienced angina and a 1.25 mm ST-segment depression. This ischemic response was corroborated by 24-h ambulatory ECG monitoring. Coronary angiography identified a 75% stenosis of the circumflex artery, with a stable atherosclerotic plaque confirmed via intravascular ultrasound (IVUS). The patient also presented with metabolic syndrome. The therapeutic strategy raised significant considerations, particularly whether to commence exclusively with guideline-directed medical therapy (GDMT) or to pursue myocardial revascularization. Following current guidelines and the patient’s preference, GDMT was implemented. The prescribed regimen included beta-blockers, statins, antiplatelet agents, and angiotensin-converting enzyme inhibitors. The patient was also enrolled in a rehabilitation program emphasizing lifestyle modification and structured physical training. Exercise and physical activity are universally recommended for patients with ischemic heart disease to enhance functional capacity and achieve pleiotropic benefits, including late-phase ischemic preconditioning mediated by nitric oxide (NO). These interventions contribute to improved exercise tolerance, quality of life, and, in some cases, survival. Given the patient’s favorable exercise capacity, outpatient rehabilitation was selected as the primary recovery modality, but home-based telerehabilitation is also considered a viable alternative. The structured physical rehabilitation program covered 8 weeks, comprising five training sessions per week, with an emphasis on daily physical activity at home. The exercise protocol included aerobic (endurance) training, supplemented by resistance training twice weekly. Aerobic training was conducted at high intensity (75–85% of peak VO2 achieved during the stress test), while resistance training was performed at 50–80% of one-repetition maximum (1RM). After 8 weeks, the patient demonstrated a 25-W (25%) improvement in exercise capacity, without exacerbation of electrocardiographic ischemia or recurrence of angina. Long-term continuation of physical activity and training at home was recommended. This case underscores, in alignment with existing literature, that for a substantial subset of patients with chronic ischemic heart disease and exertional angina, GDMT coupled with physical rehabilitation represents a viable alternative to myocardial revascularization, yielding significant improvements in exercise capacity, quality of life, and overall outcomes.