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Coronary Artery Disease: Causes, Symptoms and Treatments
Coronary Artery Disease: Causes, Symptoms and Treatments
iConcept Press

Chapter 6

Coronary Artery Disease: Causes, Symptoms and Treatments

Resting Heart Rate Significance in the Pathogenesis, Management and Prevention of Coronary Artery Disease

by Antoine Kossaify

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Increased heart rate is a risk factor for cardiovascular morbidity and mortality, whether in healthy people or in patients with established cardiac conditions. Moreover, heart rate values have been associated with longevity in many animal and human studies. The impact of resting heart rate in the pathogenesis of cardiac conditions has been referred to since more than 20 years ago, however the clinical use of resting heart rate as a clinical marker for prevention and management of cardiac conditions is still poorly implemented in clinical practice and we consider nowadays that resting heart rate is a relatively “neglected” parameter in the armamentarium used to decrease the burden of cardiovascular diseases. Many studies correlated increased resting heart rate with cardiovascular morbidity and mortality, essentially associated with conditions such as heart failure, coronary artery disease and hypertension. Classical values of heart rate imply a “normal” range between 60 and 100 bpm, and for rates above 100 bpm, the subject is considered having sinus tachycardia; herein we exclude pure rhythmic conditions associated with “sinus” or “parasinus” tachycardia such as inappropriate sinus tachycardia or postural orthostatic tachycardia syndrome and we address increased resting heart rate as a primary persistent entity without any secondary or paroxysmal dysrhythmic condition. In this regard, the definition of increased resting heart rate is still poorly established given the discrepancies in the limited studies that addressed this issue; however, many studies have set the value of 70 bpm as a threshold above which subjects are considered having an increased resting heart rate. The exact mechanism relating increased resting heart rate with cardiovascular morbidity/mortality is still difficult to identify. In this section, we will report on the physiology and physiopathology of heart rate value; in this view, we will try to re-define “values” considered physiological or pathological according to the recent data from the literature. Moreover, we will present as main topic the correlation between increased resting heart rate and coronary artery disease, while trying to differentiate a causal relationship from a potential epiphenomenon. Issues starting from molecular, to cellular levels (endothelial dysfunction), through plaque growth (from asymptomatic plaques until chronic coronary syndrome) and ending with plaque rupture (acute coronary syndrome) are discussed with a focus on heart rate values in each case. Different mechanisms of coronary artery disease related to increased resting heart rate are presented such as coronary shear stress and oxidative stress. Moreover, the dysfunction of autonomic nervous system and its related heart rate parameters (e.g. heart rate recovery, heart rate turbulence, heart rate variability…) are discussed along with their correlation with cardiac co-morbidities. Furthermore, the role of increased sympathetic tone in variable cardiac co-morbidities (e.g., hypertension, obesity, etc) is discussed. The main recent and semi-recent studies dealing with resting heart rate and its correlation with coronary artery disease are presented in this context. Finally, the clinical implications of the presented data are discussed with the perspective of primary and secondary prevention of coronary artery disease, while trying to establish heart rate value as one of the main therapeutic target and as a marker to assess efficacy of management. Issues such as physical fitness, cardiac rehabilitation, and functional capacity are discussed in the same perspective.

Author Details

Antoine Kossaify
Cardiology Department, University Hospital, Holy Spirit University of Kaslik (USEK), Lebanon


Antoine Kossaify. Resting Heart Rate Significance in the Pathogenesis, Management and Prevention of Coronary Artery Disease. In Coronary Artery Disease: Causes, Symptoms and Treatments. ISBN:978-1-922227-92-8. iConcept Press. 2016.