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Hemodynamic factors associated with the production of pain in angina pectoris

B Sharma, P A Majid, S H Taylor

    European Journal of Cardiology
    |January 1, 1978
    PubMed

    Insights

    Heart rate is the primary factor triggering angina pectoris. Other hemodynamic factors like blood pressure and heart contractility do not significantly impact angina, suggesting targeted treatments focusing on heart rate control are most effective.

    Area of Science:

    • Cardiology
    • Clinical Investigation
    • Pharmacology

    Background:

    • Angina pectoris is a condition characterized by chest pain due to myocardial ischemia.
    • Understanding the specific hemodynamic factors influencing angina onset and duration is crucial for effective treatment strategies.

    Purpose of the Study:

    • To determine the relative significance of individual hemodynamic factors in the production of angina pectoris.
    • To investigate the correlation between myocardial oxygen consumption determinants and anginal pain.

    Main Methods:

    • Studied 18 patients with uncomplicated angina pectoris.
    • Manipulated myocardial oxygen consumption determinants: heart rate (via right atrial pacing), systemic arterial pressure, left ventricular end-diastolic pressure (LVEDP), and left ventricular dp/dt max (using propranolol, phentolamine, and ouabain).
    • Observed the effects on the onset and duration of anginal pain.

    Main Results:

    • Heart rate showed a close correlation with the precipitation of angina.
    • Systemic arterial pressure, LVEDP, and LV dp/dt max did not correlate with the production or abolition of angina pectoris.
    • Phentolamine did not ameliorate angina pain, questioning nitroglycerin's mechanism of action.

    Conclusions:

    • Heart rate is the dominant hemodynamic factor in angina pectoris.
    • Therapies targeting sympathetic stimulation of the sinus node may offer significant advantages in managing angina.
    • The findings challenge the assumption that nitroglycerin relieves angina solely by reducing systemic arterial pressure.

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