Pharmacological agents to aid the clinician in combating myocardial ischaemia

This paper summarizes the effects of various drugs (sodium channel inhibitors, alpha and beta-adrenoceptor blocking agents, calcium antagonists and substances that interfere in various ways with the metabolism of arachidonic acid (e.g. aspirin, dazoxiben, nafazatrom) on the early consequences of experimental acute myocardial ischaemia. Particular attention is paid to effects on the serious early arrhythmias that arise within a few minutes of the onset of ischaemia, on those ventricular arrhythmias that result from the subsequent reperfusion of the ischaemic myocardium and on the severity and extent of myocardial ischaemic damage. From these experimental studies conclusions are drawn regarding possible approaches to early intervention with drugs in clinical myocardial infarction. Among those agents where, based on results from studies in animals, early administration should prove beneficial are beta-adrenoceptor blocking drugs, calcium antagonists, drugs that inhibit thromboxane synthesis or its effects at receptor level, agents that 'promote' prostacyclin, nitroglycerin and analgesics with marked antiarrhythmic properties (e.g. meptazinol). However, the answer to the question as to which (if any) of these drugs should be given early in clinical infarction is still dependent upon the results of considerably more experimental and clinical studies.