Physiology and Pathophysiology of the Coronary Circulation and the Role of Nitroglycerin

  • Bertram Pitt
Chapter
Part of the Handbuch der experimentellen Pharmakologie / Handbook of Experimental Pharmacology book series (HEP, volume 40)

Abstract

Under normal circumstances there is a balance between myocardial oxygen supply and demand. A schematic illustration of current concepts of this relationship is shown in Fig. 1. In the presence of a normal coronary circulation any increase in oxygen demands is met by a concomitant increase in oxygen delivery. If, however, oxygen demands should exceed delivery ischemia results. The factors controlling oxygen demand have been recently reviewed [1] and will not be discussed further. Oxygen delivery is dependent upon the extraction of oxygen across the myocardium and coronary blood flow. Since oxygen extraction is near maximal in the myocardium, any major increase in oxygen demands must be met by an increase in coronary blood flow.

Keywords

Coronary Flow Coronary Blood Flow Collateral Vessel Reactive Hyperemia Coronary Circulation 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.
This is a preview of subscription content, log in to check access.

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. 1.
    Sonnenblick, E.H., Skelton, C.L.: Oxygen consumption of the heart: Physiologic principles and clinical implications. Mod. Conc. cardiovasc. Dis. 40, 9 (1971).Google Scholar
  2. 2.
    Pitt, B., Gregg, D.E.: Coronary hemodynamics effects of increasing ventricular rate in the unanesthetized dog. Circulation Res. 22, 753 (1968).PubMedGoogle Scholar
  3. 3.
    Pitt, B., Gregg, D.E.: Effect of exercise at fixed ventricular rate on the coronary hemodynamics in the unanesthetized dog. Circulation 34, 188 (1966) (Abstract).Google Scholar
  4. 4.
    Pitt, B., Gregg, D.E.: Effect of excitement at fived ventricular rate on the coronary hemodynamics in the unanesthetized dog. Physiologist 9, 267 (1966) (Abstract).Google Scholar
  5. 5.
    Pitt, B.: Effect of beta adrenergic receptor blockade on the coronary circulation of the unanesthetized dog. Cardiovascular Beta Adrenergic Responses, edited by Kattus, Ross, and Hall. Los Angeles: UCLA Press 1970.Google Scholar
  6. 6.
    Granata, L., Olsson, R.A., Huvos, A., Gregg, D.E.: Coronary in flow and oxygen useage following sympathetic nerve stimulation in the unanesthetized dog. Circulation Res. 16, 114 (1965).PubMedGoogle Scholar
  7. 7.
    Zuberbuhler, R.C., Bohr, D.F.: Responses of coronary smooth muscle to catecholamines. Circulation Res. 16, 431 (1965).PubMedGoogle Scholar
  8. 8.
    Olsson, R.A., Gregg, D.E.: Myocardial reactive hyperemia in the unanesthetized dog. Amer. J. Physiol. 208, 224 (1965).Google Scholar
  9. 9.
    Rubio, R., Berne, R.M., Katori, M.: Release of adenosine in reactive hyperemia of the dog heart. Amer. J. Physiol. 216, 56 (1969).Google Scholar
  10. 10.
    Talesnik, J., Sunahara, F.A.: Enhancement of metabolic dilatation by aspirin-like substances by suppression of prostaglandin feedback control. Nature (Lond.) New. Biol. 244, 351 (1973).CrossRefGoogle Scholar
  11. 11.
    Pitt, B., Mason, J., Conti, C.R., Colman, R.W.: Observations on the plasma kallikrein system during myocardial ischemia. Trans. Amer. Ass. Physns 82, 98 (1969).Google Scholar
  12. 12.
    Khouri, E. M., et al.: Flow in the major branches of the left cronary artery during experimental coronary insufficiency in the unanesthetized dog. Ciculation Res. 23, 99 (1968).Google Scholar
  13. 13.
    Friesinger, G.C., Conti, C.R., Pitt, B.: Ventricular hemodynamics during spontaneous angina pectoris. Circulation 36, II, 93 (1967).Google Scholar
  14. 14.
    Dwyer, E. M.: Left ventricular pressure volume alterations and regional disorders of contraction during myocardial ischemia induced by atrial pacing. Circulation 42, 111 (1970).Google Scholar
  15. 15.
    McLawrin, L.P., Rolett, E.L., Grossman, W.: Impaired left ventricular relaxation during pacing-induced ischemia. Amer. J. Cardiol. 32, 751 (1973).CrossRefGoogle Scholar
  16. 16.
    Scharf, S., Bromberger-Barnea, B., Permutt, S.: Distribution of coronary venous flow. J. appl. Physiol. 30, 657 (1971).PubMedGoogle Scholar
  17. 17.
    Becker, L., Pitt, B.: Regional myocardial blood flow, ischemia, and anti-anginal drugs. Ann. Clin. Res. 3, 353 (1971).PubMedGoogle Scholar
  18. 18.
    Masseri, A., Pescola, A., Contini, C., L’Abbata, A.: Regional alterations of myocardial perfusion in angina pectoris. Circulation 38, IV, 65 (1973 (Abstract).Google Scholar
  19. 19.
    Scheuer, J.L.: Coronary insufficiency and relations between hemodynamic electrical and biochemical parameters. Circulation Res. 18, 178 (1966).Google Scholar
  20. 20.
    Armour, J.A., Randall, W.C.: A cardio-cardiac reflex in dog. Fed. Proc. 32, 331 (1973).Google Scholar
  21. 21.
    Shaw, J., Pitt, B.: Peripheral mechanisms involved in a cardiocardiac reflex. Fed. Proc. 32, 331 (1973).Google Scholar
  22. 22.
    Unpublished observations: Shaw, J., Armour, J. A., Randall, W. C., and Pitt, B. Google Scholar
  23. 23.
    Flaherty, J.T., Khuri, S.F., O’Riordan, J.B., Pitt, B., Gott, V.L.: Quantitation of myocardial ischemia by intramyocardial carbon dioxide oxygen electrograms. Fed. Proc. 33, 335 (1974).Google Scholar
  24. 24.
    Bishop, E.L., Weisfeldt, M.L., Ross, R. S.: Effects of pH and PCO2 on performance of hypo-perfused myocardium. Fed. Proc. 33, 890 (1974).Google Scholar
  25. 25.
    Ganz, W., Marcus, H.S.: Fairlure of intra coronary nitroglycerin to alleviate pacing induced angina. Circulation 48, 880 (1972).Google Scholar
  26. 26.
    Fortuin, N.J., Chatham, F., Pitt, B.: Noninvasive evaluation of effects of nitroglycerin on determinants of myocardial oxygen consumption. Clin. Res.Google Scholar
  27. 27.
    Becker, L., Fortuin, N. J., Pitt, B.: Effect of ischemia and anti-anginal drugs on the distribution of microspheres in the canine left ventricle. Circulation Res. 28, 263 (1971).PubMedGoogle Scholar
  28. 28.
    Goldstein, R.E., Stinson, E.B., Scherer, J.L., Seningen, R.P., Grehl, T.M., Epstein, S. E.: Intraoperative coronary collateral function in patients with coronary occlusive disease. Circulation 49, 298 (1974).PubMedGoogle Scholar
  29. 29.
    Gold, H.K., Leinbach, E.C., Sanders, G.A.: Use of sublingual nitroglycerin in congestive heart failure following myocardial infarction. Circulation 46, 839 (1972).PubMedGoogle Scholar
  30. 30.
    Flaherty, Reid, P., Kelly, D.T., Taylor, D., Weisfeldt, M., Pitt, B.: Intravenous nitroglycerin in acute myocardial infarction. Circulation 48, 4.104 (1973) (Abstract).Google Scholar
  31. 31.
    Franciosa, J.A., Guiha, N.H., Limas, C. J., Rodriguera, E., Cohn, J.N.: Improved left ventricular function during nitroprusside infusion in acute myocardial infarction. Lancet 1972I, 650.CrossRefGoogle Scholar
  32. 32.
    Chatterjee, K., Parmley, W.W., Swan, H.J.C., Berman, G., Forester, J., Marcus, H.S.: Beneficial effects of vasodilator agents in severe mitral regurgitation due to dysfunction of subvalvular apparatus. Circulation 48, 684 (1973).PubMedGoogle Scholar
  33. 33.
    Epstein, S.E., Goldstein, R.E., Redwood, D.R., Kent, K.M., Smith, E.R.: The early phase of acute myocardial infarction: Pharmacologic aspects of therapy. Ann. intern. Med. 78, 918 (1973).Google Scholar

Copyright information

© Springer-Verlag Berlin · Heidelberg 1975

Authors and Affiliations

  • Bertram Pitt

There are no affiliations available

Personalised recommendations