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Intravenous diltiazem versus nitroglycerin for silent and symptomatic myocardial ischemia in unstable angina pectoris
Z Y Fang1, N Picart, M Abramowicz
1Division of Cardiology, Cliniques Universitaires de Bruxelles, Hôpital Académique Erasme, Belgium.
Insights
Intravenous diltiazem significantly reduced ischemic episodes in unstable angina patients compared to nitroglycerin. Most ischemic episodes were silent, highlighting the need for continuous ST-segment monitoring.
Area of Science:
- Cardiology
- Pharmacology
Background:
- Unstable angina requires effective treatment strategies.
- Monitoring ischemic episodes is crucial for patient management.
Purpose of the Study:
- To compare the efficacy of acetylsalicylic acid (ASA) with intravenous nitroglycerin versus ASA with intravenous diltiazem in treating unstable angina.
- To evaluate the role of ST-segment monitoring in assessing treatment outcomes.
Main Methods:
- 18 unstable angina patients were randomized into two single-blind treatment groups.
- 48-hour electrocardiographic Holter monitoring was used to track ischemic episodes.
- Treatments included ASA with intravenous nitroglycerin or ASA with intravenous diltiazem.
Main Results:
- The diltiazem group experienced significantly fewer ischemic episodes (17) compared to the nitroglycerin group (145).
- 100% of nitroglycerin patients had residual ischemic episodes, versus 11% in the diltiazem group.
- Maximal ST-segment depression varied significantly between symptomatic and asymptomatic episodes.
Conclusions:
- Continuous ST-segment monitoring is vital for managing unstable angina.
- A majority of ischemic episodes in unstable angina are silent.
- Intravenous diltiazem shows promise as a pretreatment for patients undergoing mechanical or surgical therapy.
Abstract:
For 18 patients consecutively admitted to the coronary care unit for unstable angina, 48-hour electrocardiographic Holter monitoring was performed after they were randomly assigned in a single-blind fashion to 1 of 2 treatment groups. The first group was treated with acetylsalicylic acid (ASA) and intravenous nitroglycerin, the second with ASA and intravenous diltiazem. All of the patients treated with nitroglycerin still had ischemic episodes after 48 hours (33% were symptomatic), in contrast with 11% of the diltiazem group (11% asymptomatic). Maximal ST-segment depressions of symptomatic and asymptomatic episodes were significantly different; and no significant increases in heart rate were observed either during the 15 seconds before ischemia began or during the ischemic episode. During the 48 hours, the diltiazem group had significantly fewer ischemic episodes (17) than did the nitroglycerin group (145). We concluded that "on-line" ST-segment observation is of prime importance for monitoring unstable angina; that the majority of the ischemic episodes associated with unstable angina are silent; and that intravenous diltiazem could be an effective pretreatment for patients who must undergo mechanical or surgical therapy.