EDITORIAL

Warm up phenomenon and preconditioning in clinical practice

F Tomai

Correspondence to:
Correspondence to:
Dr Fabrizio Tomai, Divisione di Cardiochirurgia, Università di Roma Tor Vergata, European Hospital, via Portuense 700, 00149 Rome, Italy

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More than half of all patients with coronary artery disease exhibit an improvement in performance following their first exercise test—the warm up phenomenon.

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Keywords: warm up phenomenon; adenosine; ischaemic preconditioning; K_ATP channel

The warm up phenomenon, first described more that 50 years ago in patients with effort angina, refers to the improved performance exhibited by more than half of all patients with coronary artery disease following their first exercise test.¹

There are several potential causes of the warm up phenomenon including: (1) an improvement in oxygen supply, which, in turn, may be caused by stenosis dilation, collateral recruitment or myocardial perfusion redistribution; (2) a reduction in oxygen consumption caused by an adaptive down regulation or stunning of regional myocardial contractile function in the ischaemic region; and (3) a form of myocardial adaptation to ischaemia akin to ischaemic preconditioning.

It has been shown that in patients with a single lesion of the left anterior descending coronary artery, great cardiac vein flow is similar during the first and second exercise stress test, thus suggesting that the warm up phenomenon is not accompanied by an . . . [Full text of this article]

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