RESEARCH PAPER
Cardiac rehabilitation: a good measure to improve quality of life in peri- and postmenopausal women with microvascular angina
Wojciech Szot 1, 2  
,  
Joanna Zając 1
,  
Jakub Owoc 4
,  
 
 
More details
Hide details
1
Hygiene and Dietetics Dept, Jagiellonian University Medical College, Cracow, Poland
2
Nuclear Medicine Dept, John Paul II Hospital, Cracow, Poland
3
Cardiovascular Diseases Clinic, Jagiellonian University Medical College, Cracow, Poland
4
College of Public Health, Zielona Góra, Poland
5
Department for Health Problems of Ageing, Institute of Rural Health in Lublin, Poland
 
Ann Agric Environ Med. 2015;22(2):390–395
KEYWORDS
ABSTRACT
Cardiac Syndrome X (CSX) was considered a stable coronary syndrome, yet due to its nature, CSX symptoms often have a great impact on patients’ Quality of Life (QoL). According to ESC 2013 stable coronary artery disease criteria, CSX was replaced by Microvascular Angina (MA).Unfortunately, most CSX or MA patients, after classical angina (involving main coronary vessels) has been ruled out, often do not receive proper treatment. Indications for pharmacological treatment of MA patients were introduced only recently. Another problematic issue is that scientists describing the pathophysiology of both CSX and MA stress a lack of a deeper insight into the multifactorial etiology of the source of pain associated with this disease. In the presented article we have attempted to study the influence of cardiac rehabilitation (3 months programme) on the QoL of patients recognized as suffering from MA, as well as to check if changes in myocardial perfusion in these patients at baseline and after completion of cardiac rehabilitation match changes in their QoL. Therefore, after screening 436 women for MA, we studied 55 of them who were confirmed as having MA and who agreed to participate in the study. Exercise tests, Myocardial Perfusion Imaging, and QoL questionnaires were studied at baseline and after completing 3 months period of cardiac rehabilitation. Results were subsequently compared, which showed a link between improved perfusion score in SPECT study and improved overall physical capacity, on one hand, and improved QoL score on the other. These results confirm that cardiac rehabilitation is a very useful treatment option for MA patients. It seems that training during cardiac rehabilitation is a very important factor (improved physical efficiency –> increase in self-belief), and that taking into consideration the multifactor pathophysiology of pain, it is connected with a better quality of life for MA patients.
 
REFERENCES (25)
1.
2013 ESC guidelines on the management of stable coronary artery disease. The Task Force on the management of stable coronary artery disease of the European Society of Cardiology. Eur Heart J. 2013; 34: 2949–3003.
 
2.
Kemp HG. Left ventricular function in patients with the angina syndrome and normal coronary arteriograms. Am J Cardiol. 1973; 32: 375–376.
 
3.
Cannon RO, Epstein SE. ‘Microvascular angina’ as a cause of chest pain with angiographically normal coronary arteries. Am J Cardiol. 1988; 61: 1338–1343.
 
4.
Singh M, Singh S, Arora R, Khosla S. Cardiac syndrome X: current concepts. Int J Cardiol. 2010; 142: 113–119.
 
5.
Samim A, Nugent L, Mehta PK, Shufelt C, Bairey Merz CN. Treatment of angina and microvascular coronary dysfunction. Curr Treat Options Cardiovasc Med. 2010; 12(4): 355‒364.
 
6.
Pries AR, Habazettl H, Ambrosio G, Hansen PR, Kaski JC, Schachinger V, Tillmanns H, Vassalli G, Tritto I, Weis M, de Wit C, Bugiardini R. A review of methods for assessment of coronary microvascular disease in both clinical and experimental settings. Cardiovasc Res. 2008; 80: 165‒174.
 
7.
Rukholm E, McGirr M, Potts J. Measuring quality of life in cardiac rehabilitation clients. Int J Nurs Stud. 1998; 35(4): 210‒216.
 
8.
Deshotels A, Planchock N, Dech Z, Prevost S. Gender differences in perceptions of quality of life in cardiac rehabilitation patients. J Cardiopulm Rehabil. 1995; 15: 143‒148.
 
9.
Guidelines for cardiac exercise testing. ESC Working Group on Exercise Physiology, Physiopathology and Electrocardiography. Eur Heart J. 1993; 14(7): 969‒988.
 
10.
Hesse B, Lindhardt TB, Acampa W, Anagnostopoulos C, Ballinger J, Bax JJ, Edenbrandt L, Flotats A, Germano G, Stopar TG, Franken P, Kelion A, Kjaer A, Le Guludec D, Ljungberg M, Maenhout AF, Marcassa C, Marving J, McKiddie F, Schaefer WM, Stegger L, Underwood R. European Association of Nuclear Medicine/European Society of Cardiology guidelines for radionuclide imaging of cardiac function. Eur J Nucl Med Mol Imaging. 2008; 35(4): 851‒885.
 
11.
Wu EB. Microvascular dysfunction in patients with cardiac syndrome X. Heart. 2009; 95: 521.
 
12.
Adams JL, Nuss TMS, Banks C, et al. Risk Factor Outcome Comparison Between Exercise-Based Cardiac Rehabilitation, Traditional Care, and an Educational Workshop. J Contin Educ Nurs. 2007; 38(2): 83‒88.
 
13.
Fletcher GF. Cardiac Rehabilitation: Something old‒something new‒ more to do. J Cardiopulm Rehabil Prev. 2007; 27(1): 21‒23.
 
14.
Dutkiewicz J. Comprehensive rehabilitation in chronic heart failure. Ann Agric Environ Med. 2013; 20(3): 606–612.
 
15.
Dutkiewicz J. Weight training and appropriate nutrient supplementation as an alternative method to pharmacological treatment in rehabilitation of post-myocardial infarction patients. Ann Agric Environ Med. 2012;19(3): 333–338.
 
16.
Bairey Merz CN, Shaw LJ, Reis SE, Bittner V, Kelsey SF, Olson M, Johnson BD, Pepine CJ, Mankad S, Sharaf BL, Rogers WJ, Pohost GM, Lerman A, Quyyumi AA, Sopko G. Insights from the NHLBIsponsored Women’s Ischemia Syndrome Evaluation (WISE) study, part II: gender differences in presentation, diagnosis, and outcome with regard to gender-based pathophysiology of atherosclerosis and macrovascular and microvascular coronary disease. J Am Coll Cardiol. 2006; 47: S21-S29.
 
17.
Khuddus MA, Pepine CJ, Handberg EM, Bairey Merz CN, Sopko G, Bavry AA, Denardo SJ, McGorray SP, Smith KM, Sharaf BL, Nicholls SJ, Nissen SE, Anderson RD. An intravascular ultrasound analysis in women experiencing chest pain in the absence of obstructive coronary artery disease: a substudy from the National Heart, Lung, and Blood Institute-sponsored Women’s Ischemia Syndrome Evaluation (WISE). J Interv Cardiol. 2010; 23: 511–519.
 
18.
Pepine CJ, Anderson RD, Sharaf BL, Reis SE, Smith KM, Handberg EM, Johnson BD, Sopko G, Bairey Merz CN. Coronary microvascular reactivity to adenosine predicts adverse outcome in women evaluated for suspected ischemia: results from the National Heart, Lung, and Blood Institute WISE (Women’s Ischemia Syndrome Evaluation) study. J Am Coll Cardiol. 2010; 55: 2825–2832.
 
19.
Fihn SD, Gardin JM, Abrams J, Berra K, Blankenship JC, Dallas AP, Douglas PS, Foody JM, Gerber TC, Hinderliter AL, King SB 3rd, Kligfield PD, Krumholz HM, Kwong RY, Lim MJ, Linderbaum JA, Mack MJ, Munger MA, Prager RL, Sabik JF, Shaw LJ, Sikkema JD, Smith CR Jr, Smith SC Jr, Spertus JA, Williams SV, American College of Cardiology Foundation; American Heart Association Task Force on Practice Guidelines; American College of Physicians; American Association for Thoracic Surgery; Preventive Cardiovascular Nurses Association; Society for Cardiovascular Angiography and Interventions; Society of Thoracic Surgeons. 2012 ACCF/AHA/ACP/ AATS/PCNA/SCAI/STS Guideline for the diagnosis and management of patients with stable ischemic heart disease: a report of the American College of Cardiology Foundation/American Heart Association Task. Force on Practice Guidelines, and the American College of Physicians, American Association for Thoracic Surgery, Preventive Cardiovascular Nurses Association, Society for Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons. J Am Coll Cardiol. 2012; 60(24): e44‒e164
 
20.
Arthur HM, Campbell P, Harvey PJ, McGillion M, Oh P, Woodburn E, Hodgson C. Women, cardiac syndrome X, and microvascular heart disease. Can J Cardiol. 2012;28: 42‒49.
 
21.
Lanza GA, Sestito A, Sgueglia GA, Infusino F, et al. Effect of spinal cord stimulation on spontaneous and stress-induced angina and ‘ischemialike’ ST-segment depression in patients with cardiac syndrome X. Eur. Heart J. 2005; 26(10): 983‒989.
 
22.
Valeriani M, Sestito A, Le Pera D, et al. Abnormal cortical pain processing in patients with cardiac syndrome X. Eur Heart J. 2005; 26: 975–982.
 
23.
Camici PG, Gistri R, Lorenzoni R, et al. Coronary reserve and exercise ECG in patients with chest pain and normal coronary angiograms. Circulation. 1992; 86: 179‒186.
 
24.
Eriksson B, Svedenhag J, Martinsson A, et al. Effect of epinephrine infusion on chest pain in syndrome X in the absence of signs of myocardial ischaemia. Am J Cardiol. 1995; 75: 241‒245.
 
25.
Bugiardini R. Women, ‘non-specific’ chest pain, and normal or nearnormal coronary angiograms are not synonymous with favourable outcome. Eur Heart J. 2006; 27: 1387‒1389.
 
eISSN:1898-2263
ISSN:1232-1966