Skip to main content
SpringerLink
Log in

Betablocker: Wer soll behandelt werden?

  • Conference paper
Medikamentöse Behandlung des Postinfarktpatienten nach CAST

  • 19 Accesses

Zusammenfassung

Betarezeptorstimulation führt zu einer Aktivierung des membranständigen Enzyms Adenylatzyklase, welches durch Guaninnukleotid-stimulierende bzw. –inhibierende Faktoren moduliert wird und schließlich die Umwandlung von Adenosinphosphat (ATP) in zyklisches Adenosinmonophosphat (cAMP) induziert (6). Zyklisches AMP bewirkt 1. während der Systole eine Zunahme des freien intrazellulären Kalziums durch Phosphorylierung der Kalziumkanäle (positiv inotrope Wirkung), 2. Während der Diastole eine gesteigerte Wiederaufnahme von freiem Kalzium aus dem Zytosol des Myozyten in das sarkoplasmatische Retikulum (positiv lusitrope Wirkung) und 3. eine erhöhte Empfindlichkeit der kontraktilen Proteine für Kalzium (4, 17, 34). Alle Betablocker, die derzeit mit den verschiedensten klinischen Indikationsstellungen zur Behandlung von Bluthochdruck, koronarer Herzkrankheit, Rhythmusstörungen, Migräne oder Glaukom eingesetzt werden, entfalten ihre Wirkung über einen kompetitiven Antagonismus von ß-Adrenozeptoren. Die einzelnen Betablocker unterscheiden sich dabei in ihren pharmakologischen Eigenschaften, etwa der Selektivität für ß1bzw. ß2-Rezeptoren, dem möglichen Vorliegen einer intrinsischen sympathomimetischen Komponente (ISA), ihrer Fettlöslichkeit und/oder lokalanästhetischen Wirkung.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 54.99
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 69.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

Literatur

  1. Allen DG, Lee J A, Smith GL (1988) Changes in intracellular [Ca2+]i in heart muscle during ischemia — evidence for a role of [Ca2+]i in the generation of arrhythmias. J Moll Cell Cardiol 20 (Suppl IV): 9

    Article  Google Scholar 

  2. A multicentre international study (1975) Improvement in prognosis of myocardial infarction by long-term beta-adrenoceptor blockade using practolol. Brit Med J 3: 735–740

    Article  Google Scholar 

  3. Anderson JL (1990) Clinical implications of new studies in the treatment of benign, potentially malignant and malignant ventricular arrhythmias. Am J Cardiol 65: 36B–42B

    Article  PubMed  CAS  Google Scholar 

  4. Auffermann W, Stefenelli T, Wu ST, Parmley WW, Wikman-Coffelt J, Mason DT (1989) Influence of positive inotropic agents on intracellular calcium transients. Part I. Normal rat heart. Am Heart J 118: 1219–1227

    Article  PubMed  CAS  Google Scholar 

  5. Beta-Blocker Heart Attack Trial Research Group (1982) randomized trial of propranolol in patients with acute myocardial infarction. I. Mortality results. JAMA 247: 1707–1712

    Article  Google Scholar 

  6. Braunwald E, Sonnenblick EH, Ross J (1988) Mechanisms of cardiac contraction and relaxation. In: Braunwald E (ed) Heart disease. A textbook of cardiovascular medicine. Saunders Co, Philadelphia, pp 383–425

    Google Scholar 

  7. Clusin WT, Buchbinder M, Harrison DC (1983) Calcium overload. “Injury” current, and early ischaemic cardiac arrhythmias — a direct connection. Lancet I: 272–274

    Article  Google Scholar 

  8. Clusin WT (1987) What is the solution to sudden cardiac death: calcium modulation or arrhythmia clinics? Cardiovasc Drugs Ther 1: 335–342

    Article  PubMed  CAS  Google Scholar 

  9. Ferrier GR, Moffat MP, Lukas A (1985) Possible mechanisms of ventricular arrhythmias elicited by ischemia followed by reperfusion. Circles 56: 184–192

    CAS  Google Scholar 

  10. Goldstein S (1983) Propranolol therapy in patients with acute myocardial infarction: the betablocker heart attack trial. Circulation 67: 53

    Google Scholar 

  11. Guth BD, Heusch G, Seitelberger R, Ross J (1987) Mechanism of beneficial effect of betaadrenergic blockade on exercise-induced myocardial ischemia in conscious dogs. Circ Res 60: 738–746

    PubMed  CAS  Google Scholar 

  12. Hamra M, Rosen MR (1988) Alpha-adrenergic receptor stimulation during simulated ischemia and reperfusion in canine cardiac purkinje fibers. Circulation 78: 1495–1502

    Article  PubMed  CAS  Google Scholar 

  13. Held PH, Yusuf S, Furgerg CD (1989) Calcium channel blockers in acute myocardial infarction and unstable angina: an overview. Br Med J 299: 1187–1192

    Article  CAS  Google Scholar 

  14. Herlitz J, Hjalmarson A, Swedberg K, et al (1986) The influence of early intervention in acute myocardial infarction o long-term mortality and morbidity as assessed in the Göteborg metroprolol trial. Int J Cardiol 10: 291–301

    Article  PubMed  CAS  Google Scholar 

  15. ISIS-I (First International Study of Infarct Survival) Collaborative Group (1986) Randomised trial of intravenous atenolol among 16,027 cases of suspected acute myocardial infarction: ISISI. Lancet II: 57–66

    Google Scholar 

  16. Julian DG (1987) Quality of life after myocardial infarction. Am Heart J 114: 241–244

    Article  PubMed  CAS  Google Scholar 

  17. Katz AM (1983) Cyclic adenosine monophosphate effects on the myocardium: a man, who blows hot and cold with one breath. J Am Coll Cardiol 2: 143–149

    Article  PubMed  CAS  Google Scholar 

  18. Lee H-C, Mohabir R, Smith N, Franz MR, Clusin WT (1988) Effect of ischemia on calciumdependent fluorescence transients in rabbit hearts containing Indo 1. Correlation with monophasic action potentials and contraction. Circulation 78: 1047–1059

    Google Scholar 

  19. Lubsen J (1990) Calcium antagonists and beta-blockers in the treatment of unstable angina. In:Hrg.: Bleifeld W, Hamm CW, Braunwald E (eds) Unstable angina. Springer, Berlin, pp 177–185

    Google Scholar 

  20. Lynch J J, Coskey LA, Montgomery DG, Lucchesi BR (1985) Prevention of ventricular fibrillation by dextrorotatory sotalol in a conscious canine model of sudden coronary death. Am Heart J 109: 949–958

    Article  PubMed  CAS  Google Scholar 

  21. Maisel AS, Motulsky HJ, Ziegler MG, Insel PA (1987) Ischemia- and agonist-induced changes in alpha- and beta-adrenergic receptor traffic in guinea pig hearts. Am J Physiol 253 (Heart Circ Physiol 22): H1159–H1166

    PubMed  CAS  Google Scholar 

  22. May GS, Eberlein KA, Furberg CD, Passamani ER, DeMets DL (1982) Secondary prevention after myocardial infarction: a review of long-term trials. Progr Cardiovasc Dis 24: 331–337

    Article  CAS  Google Scholar 

  23. Morganroth J, Bigger JT, Anderson JL (1990) Treatment of ventricular arrhythmias by United States cardiologists: a survey before the Cardiac Arrhythmia Suppression Trial ( CAST) results were available. Am J Cardiol 65: 40–48

    Google Scholar 

  24. Nabel E, Selwyn AP, Ganz P (1990) Paradoxical narrowing of atherosclerotic coronary arteries induced by increases in heart rate. Circulation 81: 850–859

    Article  PubMed  CAS  Google Scholar 

  25. Opie LH, Coetzee WA, Dennis SC, Thandroyen FT (1988) A potential role of calcium ions in early ischemic and reperfusion arrhythmias. Ann NY Acad Sci 522: 464–477

    Article  PubMed  CAS  Google Scholar 

  26. Paricipatians in CAST (1989) Preliminary report: effect of encainide and flecainide on mortality in a randomized trial of arrhythmia suppression after myocardial infarction. N Engl J Med 321: 406–412

    Article  Google Scholar 

  27. Patterson E, Lucchesi BR (1983) Antifibrillatory actions of d, 1—nadolol in a conscious canine model of sudden coronary death. J Cardiovasc Pharmacol 5: 737–744

    Article  PubMed  CAS  Google Scholar 

  28. Patterson E, Eller B, Abrams G, Vasiliades J, Lucchesi B (1983) Ventricular fibrillation in a conscious canine model of sudden coronary death: prevention of acute and chronic amiodarone administration. Circulation 68: 857–864

    Article  PubMed  CAS  Google Scholar 

  29. Prichard BN (1988) Beta-blockade therapy and cardiovascular disease. Past, present, and future. Postgrad Med II: 8 - 18

    Google Scholar 

  30. Sacks HS, Berrier J, Reitman D (1987) Meta-analyses of randomized controlled trials. N Engl J Med 316: 450–455

    Article  PubMed  CAS  Google Scholar 

  31. Senges J, Lengfelder W, Jackson FS, Czygan E, Brachmann J, Rizos I, Cobbe S, Kubler W (1984) Electrophysiologic testing in assessment of therapy with sotalol for sustained ventricular tachycardia. Circulation 69: 577–584

    Article  PubMed  CAS  Google Scholar 

  32. Spielman SR, Kay HR, Morganroth J, Horowitz LN, Greenspan AM (1985) Drug therapy in high risk patients following acute myocardial infarction: the results of the timolol, encainide, sotalol trial. Circulation 72 (Suppl III): III–15

    Google Scholar 

  33. Steenbergen C, Murphy E, Levy L, London RE (1987) Elevation of cytosolic free calcium concentration early in myocardial ischemia in perfused rat heart. Circ Res 60: 700–707

    PubMed  CAS  Google Scholar 

  34. Stefenelli T, Wu ST, Parmley WW, Mason DT, Wikman-Coffelt J (1989) Influence of positive inotropic agents on intracellular calcium transients. Part II. Cardiomyopathic hamster hearts. Am Heart J 118: 1228–1236

    Google Scholar 

  35. Stefenelli T, Wikman-Coffelt J, Wu ST, Parley WW (1990) Calcium-dependent fluorescence transients during ventricular fibrillation. Am Heart J 120: 590–597

    Article  PubMed  CAS  Google Scholar 

  36. The MIAMI Trial Research Group (1985) Metoprolol in acute myocardial infarction (MIAMI): a randomised placebo-controlled international trial. Eur Heart J 6: 199–226

    Google Scholar 

  37. The Norwegian multicenter study group (1981) Timolol-induced reduction in mortality and reinfarction in patients surviving acute myocardial infarction. N Engl J Med 304: 801–805

    Article  Google Scholar 

  38. Vatner DE, Knight DR, Shen Y-T, Thomas Jr JX, Homey CJ, Vatner SF (1988) One hour of myocardial ischemia in conscious dogs increases beta-adrenergic receptors, but decreases adenylate cyclase activity. J Moll Cell Cardiol 20: 75–82

    Article  CAS  Google Scholar 

  39. Willerson JT, Buja LM (1988) Beta-adrenergic mechanisms during severe myocardial ischemia and evolving infarction. In: Gorling R (ed) A quater-century of beta-blockade: lessons from the past, an eye to the future. BMI/McGraw-Hill, New York, pp 27–32

    Google Scholar 

  40. Yusuf S, Sleight P (1983) Limitation of myocardial infarct size: present status. Drugs 25: 441 –450

    PubMed  Google Scholar 

  41. Yusuf S (1988) Early intravenous beta blockade in acute myocardial infarction. In: Gorlin R (ed) A quater-century of beta-blockade: lessons from the past, an eye to the future. BMI/Mc- Graw-Hill, New York, pp 92–95

    Google Scholar 

  42. Yusuf S, Wittes J, Friedman L (1988) Overview of results of randomized clinical trials in heart disease. II. Unstable angina, heart failure, primary prevention with aspirin, and risk factor modification. JAMA 260: 2259–2263

    Article  PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Kardiologische Universitätsklinik, Garnisongasse 13, A-1090, Wien, Österreich

    Dr. T. Stefenelli & H. Weber

Authors
  1. Dr. T. Stefenelli
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. H. Weber
    View author publications

    You can also search for this author in PubMed Google Scholar

Editor information

Editors and Affiliations

  1. I. Medizinische Klinik, Technischen Universität München Klinikum rechts der Isar, Ismaninger Straße 22, 8000, München 80, Germany

    Georg Schmidt

Rights and permissions

Reprints and permissions

Copyright information

© 1991 Dr. Dietrich Steinkopff Verlag, GmbH Co. KG, Darmstadt

About this paper

Cite this paper

Stefenelli, T., Weber, H. (1991). Betablocker: Wer soll behandelt werden?. In: Schmidt, G. (eds) Medikamentöse Behandlung des Postinfarktpatienten nach CAST. Steinkopff. https://doi.org/10.1007/978-3-642-85414-9_10

Download citation

  • DOI: https://doi.org/10.1007/978-3-642-85414-9_10

  • Publisher Name: Steinkopff

  • Print ISBN: 978-3-642-85415-6

  • Online ISBN: 978-3-642-85414-9

  • eBook Packages: Springer Book Archive

Publish with us

Policies and ethics

Search

Navigation