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. 1987 Aug;58(2):116–121. doi: 10.1136/hrt.58.2.116

Observations on the warm up phenomenon in angina pectoris.

M Joy, A W Cairns, D Sprigings
PMCID: PMC1277289  PMID: 3620250

Abstract

Adaptation to exercise was investigated in 14 men aged 34-69 years (mean 51) with stable exertional angina caused by occlusive coronary artery disease. All underwent exercise electrocardiography to symptom limitation according to the Bruce protocol (first effort), and exercise to the onset of angina (warm up) followed by four minutes' rest, followed by exercise to symptom limitation (second effort). This protocol was repeated after sequential treatment for one month each with nifedipine 10 mg three times a day and with timolol 10 mg twice a day. Warm up significantly increased walking time to the onset of angina by 34.5% and to maximal exercise by 29.5%. The heart rate and rate-pressure product were significantly higher on second effort both at the onset of angina (by 7.0% and 11.1% respectively) and at maximal exercise (by 10.5% and 15.4% respectively). ST segment displacement was not significantly different after warm up. The effect of warm up on walking time to the onset of angina was markedly reduced after treatment with nifedipine but little influenced by timolol. Mean (SE) walking time after warm up on no treatment was 10.1 (0.7) min; after treatment with nifedipine it was 10.0 (0.6) min and after treatment with timolol it was 9.7 (0.4) min. These data demonstrate a substantial improvement in exercise performance after warm up and are consistent with the hypothesis that submaximal exercise in angina pectoris facilitates myocardial oxygen uptake by coronary vasodilatation.

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Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Bagger J. P., Nielsen T. T. Influence of nifedipine on coronary haemodynamics and myocardial metabolism in coronary artery disease. Eur Heart J. 1985 Jan;6(1):75–84. doi: 10.1093/oxfordjournals.eurheartj.a061757. [DOI] [PubMed] [Google Scholar]
  2. Detry J. M., Bruce R. A. Effects of physical training on exertional S-T-segment depression in coronary heart disease. Circulation. 1971 Sep;44(3):390–396. doi: 10.1161/01.cir.44.3.390. [DOI] [PubMed] [Google Scholar]
  3. Epstein S. E., Talbot T. L. Dynamic coronary tone in precipitation, exacerbation and relief of angina pectoris. Am J Cardiol. 1981 Oct;48(4):797–803. doi: 10.1016/0002-9149(81)90160-0. [DOI] [PubMed] [Google Scholar]
  4. Fabián J., Stolz I., Janota M., Rohác J. Reproducibility of exercise tests in patients with symptomatic ischaemic heart disease. Br Heart J. 1975 Aug;37(8):785–789. doi: 10.1136/hrt.37.8.785. [DOI] [PMC free article] [PubMed] [Google Scholar]
  5. Feigl E. O. Coronary physiology. Physiol Rev. 1983 Jan;63(1):1–205. doi: 10.1152/physrev.1983.63.1.1. [DOI] [PubMed] [Google Scholar]
  6. Gobel F. L., Norstrom L. A., Nelson R. R., Jorgensen C. R., Wang Y. The rate-pressure product as an index of myocardial oxygen consumption during exercise in patients with angina pectoris. Circulation. 1978 Mar;57(3):549–556. doi: 10.1161/01.cir.57.3.549. [DOI] [PubMed] [Google Scholar]
  7. Gould K. L., Lipscomb K. Effects of coronary stenoses on coronary flow reserve and resistance. Am J Cardiol. 1974 Jul;34(1):48–55. doi: 10.1016/0002-9149(74)90092-7. [DOI] [PubMed] [Google Scholar]
  8. Harris F. J., Low R. I., Paumer L., Amsterdam E. A., Mason D. T. Antianginal efficacy and improved exercise performance with timolol. Twice-daily beta blockade in ischemic heart disease. Am J Cardiol. 1983 Jan 1;51(1):13–18. doi: 10.1016/s0002-9149(83)80004-6. [DOI] [PubMed] [Google Scholar]
  9. Jaffe M. D., Quinn N. K. Warm-up phenomenon in angina pectoris. Lancet. 1980 Nov 1;2(8201):934–936. doi: 10.1016/s0140-6736(80)92101-7. [DOI] [PubMed] [Google Scholar]
  10. Joy M., Pollard C. M., Nunan T. O. Diurnal variation in exercise responses in angina pectoris. Br Heart J. 1982 Aug;48(2):156–160. doi: 10.1136/hrt.48.2.156. [DOI] [PMC free article] [PubMed] [Google Scholar]
  11. Kattus A. A., Alvaro A. B., Zohman L. R., Coulson A. H. Comparison of placebo, nitroglycerin, and isosorbide dinitrate for effectiveness of relief of angina and duration of action. Chest. 1979 Jan;75(1):17–23. doi: 10.1378/chest.75.1.17. [DOI] [PubMed] [Google Scholar]
  12. Kern M. J., Ganz P., Horowitz J. D., Gaspar J., Barry W. H., Lorell B. H., Grossman W., Mudge G. H., Jr Potentiation of coronary vasoconstriction by beta-adrenergic blockade in patients with coronary artery disease. Circulation. 1983 Jun;67(6):1178–1185. doi: 10.1161/01.cir.67.6.1178. [DOI] [PubMed] [Google Scholar]
  13. Kurnik P. B., Tiefenbrunn A. J., Ludbrook P. A. The dependence of the cardiac effects of nifedipine on the responses of the peripheral vascular system. Circulation. 1984 May;69(5):963–972. doi: 10.1161/01.cir.69.5.963. [DOI] [PubMed] [Google Scholar]
  14. Moskowitz R. M., Piccini P. A., Nacarelli G. V., Zelis R. Nifedipine therapy for stable angina pectoris: preliminary results of effects on angina frequency and treadmill exercise response. Am J Cardiol. 1979 Oct 22;44(5):811–816. doi: 10.1016/0002-9149(79)90202-9. [DOI] [PubMed] [Google Scholar]
  15. PRICE R. K. First effort angina; second wind in angina pectoris. Br Heart J. 1951 Apr;13(2):197–202. doi: 10.1136/hrt.13.2.197. [DOI] [PMC free article] [PubMed] [Google Scholar]
  16. Redwood D. R., Rosing D. R., Goldstein R. E., Beiser G. D., Epstein S. E. Importance of the design of an exercise protocol in the evaluation of patients with angina pectoris. Circulation. 1971 May;43(5):618–628. doi: 10.1161/01.cir.43.5.618. [DOI] [PubMed] [Google Scholar]
  17. Robinson B. F. Relation of heart rate and systolic blood pressure to the onset of pain in angina pectoris. Circulation. 1967 Jun;35(6):1073–1083. doi: 10.1161/01.cir.35.6.1073. [DOI] [PubMed] [Google Scholar]
  18. Rutenberg H. L. Of pre-loads, afterloads and warm-ups. Lancet. 1981 Jan 31;1(8214):272–272. doi: 10.1016/s0140-6736(81)92106-1. [DOI] [PubMed] [Google Scholar]
  19. Schulz W., Jost S., Kober G., Kaltenbach M. Relation of antianginal efficacy of nifedipine to degree of coronary arterial narrowing and to presence of coronary collateral vessels. Am J Cardiol. 1985 Jan 1;55(1):26–32. doi: 10.1016/0002-9149(85)90293-0. [DOI] [PubMed] [Google Scholar]
  20. Sim D. N., Neill W. A. Investigation of the physiological basis for increased exercise threshold for angina pectoris after physical conditioning. J Clin Invest. 1974 Sep;54(3):763–770. doi: 10.1172/JCI107814. [DOI] [PMC free article] [PubMed] [Google Scholar]
  21. Specchia G., de Servi S., Falcone C., Angoli L., Gavazzi A., Bramucci E., Mussini A., Ferrario M., Salerno J., Montemartini C. Effects of nifedipine on coronary hemodynamic findings during exercise in patients with stable exertional angina. Circulation. 1983 Nov;68(5):1035–1043. doi: 10.1161/01.cir.68.5.1035. [DOI] [PubMed] [Google Scholar]
  22. Starling M. R., Moody M., Crawford M. H., Levi B., O'Rourke R. A. Repeat treadmill exercise testing: variability of results in patients with angina pectoris. Am Heart J. 1984 Feb;107(2):298–303. doi: 10.1016/0002-8703(84)90378-8. [DOI] [PubMed] [Google Scholar]
  23. Stone P. H., Antman E. M., Muller J. E., Braunwald E. Calcium channel blocking agents in the treatment of cardiovascular disorders. Part II: Hemodynamic effects and clinical applications. Ann Intern Med. 1980 Dec;93(6):886–904. doi: 10.7326/0003-4819-93-6-886. [DOI] [PubMed] [Google Scholar]
  24. Thadani U., Lewis J. R., Manyari D., Boroomand K., Cohen J., West R. O., Parker J. O. Are the clinical and hemodynamic events during exercise stress testing in invasive studies in patients with angina pectoris reproducible? Circulation. 1980 Apr;61(4):744–750. doi: 10.1161/01.cir.61.4.744. [DOI] [PubMed] [Google Scholar]
  25. Thadani U., Sharma B., Meeran M. K., Majid P. A., Whitaker W., Taylor S. H. Comparison of adrenergic beta-receptor antagonists in angina pectoris. Br Med J. 1973 Jan 20;1(5846):138–142. doi: 10.1136/bmj.1.5846.138. [DOI] [PMC free article] [PubMed] [Google Scholar]
  26. Williams D. O., Bass T. A., Gewirtz H., Most A. S. Adaptation to the stress of tachycardia in patients with coronary artery disease: insight into the mechanism of the warm-up phenomenon. Circulation. 1985 Apr;71(4):687–692. doi: 10.1161/01.cir.71.4.687. [DOI] [PubMed] [Google Scholar]
  27. de Servi S., Specchia G., Falcone C., Gavazzi A., Mussini A., Angoli L., Bramucci E., Ardissino D., Vaccari L., Salerno J. Variable threshold exertional angina in patients with transient vasospastic myocardial ischemia. Repeat exercise test results and therapeutic implications. Am J Cardiol. 1983 Feb;51(3):397–402. doi: 10.1016/s0002-9149(83)80071-x. [DOI] [PubMed] [Google Scholar]

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