Sustained-release diltiazem in patients with effort angina and severe coronary artery sclerosis

Two case histories are presented. Patient 1 was an agricultural worker, aged 63 years, whose attacks of chest pain, diagnosed as effort angina, were relieved by sublingual nitroglycerin. An exercise test revealed ST segment depression of 2 mV in lead V5 of the electrocardiogram. Coronary arteriography disclosed 99% stenosis with delay in segments 7 and 14, 90% stenosis in segment 10, and 25% stenosis in segment 1. Treatment with 100 mg of sustained-release diltiazem relieved some of the symptoms; when the dose was increased to 200 mg daily, no further chest pains were experienced. Patient 2 was a restaurant owner, aged 61 years, who reported attacks of chest pain during physical work. An exercise test revealed ST segment depression of 2 mV in lead aVF; coronary arteriography showed 99% stenosis in segment 7, 75% stenosis in segment 9, and 50% stenosis in segment 10. No attacks of chest pain were experienced after treatment with 200 mg of sustained-release diltiazem daily. Blood pressure, heart rate, and the rate-pressure product fell in both patients after diltiazem treatment.