[Actual and theoretical points of view in the application of coronary therapeutic agents]

The medicamentous therapy of the angina pectoris vera and of the chronic ischaemic heart disease is at present based on three groups of medicaments: nitrate compounds, beta-blocking agents and calcium antagonists. The underlying therapeutic principle which is common for them consists in the reduction of the oxygen requirement of the myocardium so that an improvement of the complaints and a larger load capacity may be achieved. The improvement may be objectified also at the behaviour of the haemodynamics and the ECG under load. The so-called coronary dilating remedies and the beta-stimulators did not prove clinically. In the acute attack rapidly acting nitroglycerin compounds remain the remedies of choice. Also the permanent treatment should at first again use longer acting nitrate preparations. When despite a sufficient dosage no satisfying improvement takes place an additional prescription of beta-blocking agents is recommended. Calcium antagonists are suitable particularly for the vasospastic form of the angina pectoris. They can be used also as basis medicaments, however, according to the hitherto yielded experiences they do not possess any advantages in contrast to the proved nitrates and beta-blocking agents. When apart from the ischaemic heart disease a hypertension exists, the beta-blocking agents are particularly indicated. This is further important for certain forms of tachycardiac disturbances of rhythm, which partly also well response to calcium antagonists. In patients with disturbances of conduction (sinus node and atrioventricular nodes, bifascicular block) beta-blocking agents are contraindicated. If there are no signs of cardiac decompensation and radiologically the heart proves to be normally large, so there is no indication for the prescription of glycosides.