The Use of Calcium Entry Blockers in Congestive Heart Failure

  • Robert Zelis
  • Edward Toggart


Patients with severe congestive heart failure operate on a depressed ventricular function curve [28]. They experience symptoms and signs due to: (1) an inadequate cardiac output (especially with exercise) and/or (2) an increase in ventricular filling pressure. Low-output symptoms and signs result from redistribution of an inadequate cardiac output and include fatigue, pallor, and a decreased urinary output. Congestive symptoms and signs result from an increase in pulmonary and systemic venous pressure and fluid accumulation in tissues. The following may occur: shortness of breath from pulmonary congestion (pulmonary edema), edema in dependent portions of the body, hepatic enlargement and tenderness due to congestion, as well as ascites and pleural effusions.


Cardiac Index Systemic Vascular Resistance Negative Inotropic Effect Severe Congestive Heart Failure Left Ventricular Filling Pressure 
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  1. 1.
    Bellocci, F.; Ansalone, G.; Santarelli. P.; Loperfido, F.; Scabbia, E.; Zecchi, P.; Manzoli, U. Oral nifedipine in the long-term management of severe chronic heart failureJ. Cardiovasc. Pharmacol 4: 847 – 855, 1982PubMedCrossRefGoogle Scholar
  2. 2.
    Braunwald, E. Mechanisms of action of calcium-channel-blocking agentsN. Engl. J. Med 26: 1618 – 1627, 1982Google Scholar
  3. 3.
    Brooks, N.; Cattell, M.; Pidgeon, J.; Balcon, R. Unpredictable response to nifedipine in severe cardiac failureBr. Med. J 281: 1324, 1980PubMedCrossRefGoogle Scholar
  4. 4.
    Chatterjee, K.; Parmley, W. W. Vasodilator therapy for chronic heart failureAnnu. Rev. Pharmacol. Toxicol 20: 475 – 512, 1980PubMedCrossRefGoogle Scholar
  5. 5.
    Chew, C. Y. C.; Hecht, H. S.; Collett, J. T.; McAllister, R. G.; Singh, B. N. Influence of severity of ventricular dysfunction on hemodynamic responses to intravenously administered verapamil in ischemic heart diseaseAm. J. Cardiol 47: 917 – 922, 1981PubMedCrossRefGoogle Scholar
  6. 6.
    Cohn, J. N.; Franciosa, J. A. Vasodilator therapy of chronic cardiac failureN. Engl. J. Med 297: 27 – 31, 1977PubMedCrossRefGoogle Scholar
  7. 7.
    Dash, H. Regional wall motion response to diltiazem in coronary artery diseaseCirculation 68:iii–18, 1983Google Scholar
  8. 8.
    Dorsey, J. K.; Ferguson, D. W.; Tracy, J.; Mark, A. L. Effects of calcium blockers on baroreceptor control of vascular resistance in humansClin. Res 31:523A. 1983Google Scholar
  9. 9.
    Epstein, S. E.; Rosing, R. D. Verapamil: Its potential for causing serious complications in patients with hypertrophic cardiomyopathyCirculation 64: 437 – 441, 1981PubMedCrossRefGoogle Scholar
  10. 10.
    Ferlinz, J.; Stavens, C. S. Effects of intracoronary versus intravenous verapamil on exercise performance of patients with coronary artery diseaseClin. Res 31:182A, 1983Google Scholar
  11. 11.
    Ferlinz, J.; Turbow, M. E. Antianginal and myocardial metabolic properties of verapamil in coronary artery diseaseAm. J. Cardiol 46: 1019 – 1026, 1980PubMedCrossRefGoogle Scholar
  12. 12.
    Flaim, S. F.; Weitzel, R. L.; Zelis. R. Mechanism of action of nitroglycerin during exercise in a rat model of heart failure: Improvement of blood flow to the renal, splanchnic, and cutaneous bedsCirc. Res 49: 458 – 468, 1981PubMedGoogle Scholar
  13. 13.
    Flaim, S. F.; Zelis, RCalcium Channel Blockers: Mechanisms of Action and Clinical Applications. Baltimore, Urban & Schwarzenberg, 1982Google Scholar
  14. 14.
    French, W. J.; Adomian, G. E.; Averill, W. K.; Garner, D.; Laks, M. M. Chronic infusion of verapamil produces increased heart weight in conscious dogsClin. Res 31:184A, 1983Google Scholar
  15. 15.
    Gillmer, D. J.; Kark, P. Pulmonary oedema precipitated by nifedipineBr. Med. J 280: 1420, 1980PubMedCrossRefGoogle Scholar
  16. 16.
    Hossack, K. F.; Bruce, R. A.; Ritterman, J. B.; Kusumi, F.; Trimble, S. Divergent effects of diltiazem in patients with exertional anginaAm. J. Cardiol 49: 538 – 546, 1982PubMedCrossRefGoogle Scholar
  17. 17.
    Kaltenbach, M.; Hopf, R.; Kober, G.; Bussman, W. D.; Keller. M.; Petersen, Y. Treatment of hypertrophic obstructive cardiomyopathy with verapamilBr. Heart J 42: 35 – 42, 1979PubMedCrossRefGoogle Scholar
  18. 18.
    Kinoshita, M.; Kusakawa, R.; Shimono, Y.; Motomura, M.; Tomoroga, G.; Hoshino, T. Effect of diltiazem hydrochloride on sodium diuresis and renal function in chronic congestive heart failureArzneim. Forsch 29: 676 – 681, 1979Google Scholar
  19. 19.
    Klugmann, S.; Salvi, A.; Camerini, F. Haemodynamic effects of nifedipine in heart failureBr. Heart J 43: 440 – 446, 1980PubMedCrossRefGoogle Scholar
  20. 20.
    Low, R. I.; Takeda, P.; Lee, G.; Mason, D. T.; A wan, N. A.; DeMaria, A. N. Effects of diltiazem-induced calcium blockade upon exercise capacity in effort angina due to chronic coronary artery diseaseAm. Heart J 101: 713 – 718, 1981PubMedCrossRefGoogle Scholar
  21. 21.
    Ludbrook, P. A.; Tiefenbrunn, A. J.; Sobel, B. E. Influence of nifedipine on left ventricular systolic and diastolic function. Relationships to manifestations of ischemia and congestive failureAm. J. Med 71: 683 – 692, 1981PubMedCrossRefGoogle Scholar
  22. 22.
    Matsumoto, S.; Ito, T.; Sada, T.; Takahashi, M.; Su, K.-M.; Ueda, A.; Okabe, F.; Sato, M.; Sekine, I.; Ito, Y. Hemodynamic effects of nifedipine in congestive heart failureAm. J. Cardiol 46: 476 – 479, 1980PubMedCrossRefGoogle Scholar
  23. 23.
    Polese, A.; Fiorentini, C.; Olivari, M. T.; Guazzi, M. D. Clinical use of a calcium antagonistic agent (nifedipine) in acute pulmonary edemaAm. J. Med 66: 825 – 830, 1979PubMedCrossRefGoogle Scholar
  24. 24.
    Rosing, D. R.; Kent, K. M.; Borer, J. S.; Seides, S. F.; Maron, B. K.; Epstein, S. E. Verapamil therapy: anew approach to the pharmacologic treatment of hypertrophic cardiomyopathy (parts I and II)Circulation 60: 1201 – 1213, 1979PubMedGoogle Scholar
  25. 25.
    Vlietstra, R. E.; Farias, M. A. C.; Frye, R. L.; Smith, H. C.; Ritman, E. L. Effect of verapamil on left ventricular function: A randomized, placebo-controlled studyAm. J. Cardiol 51: 1213 – 1217, 1983PubMedCrossRefGoogle Scholar
  26. 26.
    Zelis, R.; Flaim, S. F. Alterations in vasomotor tone in congestive heart failureProg. Cardiovasc. Dis 24: 437 – 459, 1982PubMedCrossRefGoogle Scholar
  27. 27.
    Zelis, R.; Flaim, S. F. Calcium blocking drugs for angina pectorisAnnu. Rev. Med 33: 465 – 478, 1982PubMedCrossRefGoogle Scholar
  28. 28.
    Zelis, R.; Flaim, S. F.; Liedtke, A. J.; Nellis, S. H. Cardiocirculatory dynamics in the normal and failing heartAnnu. Rev. Physiol 43: 455 – 476, 1981PubMedCrossRefGoogle Scholar
  29. 29.
    Zelis, R.; Starke, K.; Brunner, H. Abnormal vascular sympathetic nerve function in heart failureClin. Res 31:464A, 1983Google Scholar
  30. 30.
    Zelis, R.; Wichmann, T.; Starke, K. Inhibition of vascular noradrenaline release by diltiazemCirculation 66: 11139, 1982Google Scholar

Copyright information

© Plenum Press, New York 1985

Authors and Affiliations

  • Robert Zelis
    • 1
  • Edward Toggart
    • 1
  1. 1.Cardiology Division, The Milton S. Hershey Medical CenterThe Pennsylvania State UniversityHersheyUSA

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