Kaplinsky E
Heart Institute, Sheba Medical Center, Tel-Hashomer, Israel.
Drugs. 1992;43 Suppl 1:9-14. doi: 10.2165/00003495-199200431-00004.
While William Heberden gave us an excellent clinical description of angina pectoris more than 200 years ago, the understanding and management of this disorder have undergone major development since then, and especially so in recent years. The pathological basis for the disease was established shortly after Heberden's account. The concept of the imbalance between supply and demand was postulated in the nineteenth century. Recent progress has been made in mainly three areas: the better definition of prognosis, new insights into pathophysiology, and newer management modalities and aims. Today, the combination of the patient's functional state (exercise test), his heart (ventricular function) and coronary anatomy (angiography) enables us to accurately define the prognosis of the disease. Sophisticated studies have now demonstrated that during an exercise-induced angina attack there is a reduction in coronary blood flow and an increase in coronary resistance. Mechanisms associated with the angina attack involve the sclerotic epicardial arteries and the microcirculation. Further major advances in the medical management of angina pectoris now depend on our ability to improve prognosis and retard the development of the atherosclerotic process.
200多年前，威廉·赫伯登就对心绞痛进行了出色的临床描述，从那时起，人们对这种疾病的认识和治疗方法有了重大发展，近年来尤其如此。在赫伯登描述之后不久就确立了该病的病理基础。供需失衡的概念在19世纪被提出。最近主要在三个方面取得了进展：对预后的更精确界定、对病理生理学的新认识以及更新的治疗方式和目标。如今，结合患者的功能状态（运动试验）、心脏（心室功能）和冠状动脉解剖结构（血管造影），我们能够准确界定该病的预后。精密研究现已表明，在运动诱发的心绞痛发作期间，冠状动脉血流量减少，冠状动脉阻力增加。与心绞痛发作相关的机制涉及硬化的心外膜动脉和微循环。心绞痛药物治疗的进一步重大进展现在取决于我们改善预后和延缓动脉粥样硬化进程发展的能力。
