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Beneficial effects of diltiazem in coronary artery disease
Insights
Diltiazem, a calcium channel blocker, effectively treats stable angina pectoris by reducing blood pressure and improving myocardial function. This study confirms its antianginal effects, suggesting advantages in angina management.
Area of Science:
- Cardiology
- Pharmacology
Background:
- Stable angina pectoris is a common condition often managed with medication.
- Calcium channel blockers are a class of drugs used to treat cardiovascular conditions.
Purpose of the Study:
- To evaluate the effects of diltiazem, a novel calcium channel blocking agent, in patients with stable angina pectoris.
- To assess the symptomatic, metabolic, and hemodynamic effects of diltiazem at rest and during pacing-induced ischemia.
Main Methods:
- Eleven patients with stable angina pectoris and obstructive coronary artery disease were studied.
- Intravenous diltiazem was administered, and various indices were monitored at rest and during rapid atrial pacing.
- Hemodynamic parameters, symptomatic response, and myocardial lactate metabolism were assessed.
Main Results:
- Diltiazem demonstrated potent vasodilator effects at rest, significantly reducing mean blood pressure without increasing heart rate.
- During pacing, diltiazem decreased mean blood pressure and significantly increased the time to angina onset.
- Myocardial lactate extraction improved, shifting from production to extraction, indicating enhanced myocardial metabolism.
Conclusions:
- Diltiazem exhibits significant antianginal effects in patients with stable angina pectoris.
- The drug's benefits may stem from afterload reduction and a direct metabolic effect on the myocardium.
- Diltiazem presents potential advantages for the management of angina pectoris.
Abstract:
The effects of the new calcium channel blocking agent diltiazem were evaluated in 11 patients with stable angina pectoris and confirmed obstructive coronary artery disease at rest and during rapid atrial pacing. Symptomatic, metabolic, coronary, and systemic haemodynamic indices were monitored at rest and during pacing induced ischaemia. At rest, after the administration of intravenous diltiazem, potent vasodilator effects were observed with a significant fall in mean blood pressure and an increase in cardiac index. Importantly, however, the systemic vasodilator effect of diltiazem was associated with no significant increase in heart rate. During pacing there was similar decrease in mean blood pressure after diltiazem, and mean pacing time to angina increased significantly. Three patients did not develop angina on repeat pacing. Coupled with an improved pacing time to angina there was a significant improvement in myocardial lactate extraction during pacing, changing from lactate production to lactate extraction after diltiazem. This study confirms the antianginal effects of diltiazem and suggests that this agent may have advantages in the management of angina pectoris. The results suggest that diltiazem may exert its beneficial effect not only by reducing afterload reduction but also by a direct metabolic effect on the myocardium.