[Protection of the ischemic myocardium]

The Authors review several pharmacological interventions aimed at protecting the ischemic myocardium. Drugs which have been widely used in the treatment of ischemic heart diseases, such as beta-blockers, nitrates and calcium-antagonists, are able to delay the development of ischemic injury if administered before the beginning of ischemia, but their clinical effectiveness is limited. The new drugs which are presently investigated are designed to counteract the molecular mechanisms which mediate irreversible tissue injury, namely cytosolic calcium overload, cellular hyperosmolarity, and free radical production. In particular, interventions able to interfere with the release of calcium from its intracellular stores would be of major importance. In this regards, it is interesting to point out that derivatives of phenylalkylamine calcium-antagonists have been reported to modulate the opening probability of sarcoplasmic reticulum calcium channels.