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Betablockers and Calcium Antagonists: Mode of Action in Angina pectoris

  • P. R. Lichtlen
  • H. J. Engel
  • I. Amende
Conference paper

Summary

The different effects of betablockers and calciumantagonists on LV hemodynamics and coronary blood flow (CBF) are discussed based on studies performed with atenolol, propranolol and nifedipine. LV hemodynamics were recorded in coronary patients at rest, measuring LV volumes and pressures simoultaneously during angiography with the use of Millar tip manometers. CBF was assessed at rest and during atrial pacing up to ischemia (ST depression ± angina) without and with the drug using the precordial xenon clearance technique (gamma camera, CDC 1700 computer). Basic differences were present both for hemodynamics as for coronary dynamics: under betablockade LV contractility, cardiac output and ejection fraction decreased, enddiastolic volume increased and the pressure-volume relation was shifted upwards and flattened, indicating both an increase in diastolic wall stress and a decrease in passive elastic stiffness. During atrial pacing CBF decreased both in the normal as well as in the ischemic (poststenotic) zone, when compared to control, a result of the decrease in MVO2 due to the reduced contractility. After Nifedipine LV function improved slightly, contractility and cardiac output increasing, and peripheral resistance decreasing; enddiastolic volume and pressure remained unchanged. After the drug, CBF during pacing showed a further (not sign.) increase in the ischemic zone and remained unchanged in the normal area, inspite of a sign, decrease in MVO2 i.e. in the rate pressure product. Hence, calcium antagonists improve stable angina, i.e. ischemia due to increased O2 demand (exercise, pacing) by increasing O2 supply in the ischemic zone and decreasing demand through afterload reduction, whereas betablockers decrease both O2 demand and supply, the latter by autoregulatory changes of CBF.

Today, the treatment of angina pectoris is based on nitrates, betablockers and most recently, on calcium antagonists, three different therapeutic principles with different indications. Their mode of action varies both with regard to their influence on myocardial oxygen consumption as well as on coronary blood flow. The following presentation, which concentrates mainly on the difference between betablockers and so-called calcium antagonists, describes the hemodynamic effects and the action on the coronary circulation of both groups of drugs in patients with coronary artery disease.

Keywords

Calcium Antagonist Myocardial Blood Flow Coronary Blood Flow Atrial Pace Regional Myocardial Blood Flow 
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.

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References

  1. 1.
    Amende I, Simon R, Hood WP, Lichtlen PR (1979) The effects of the beta-blocker atenolol and nitroglycerin on left ventricular function and geometry in man. Circulation 60: 836PubMedGoogle Scholar
  2. 2.
    Amende I, Simon R, Lichtlen PR (1980) Early effects of nifedipine on left ventricular diastolic function in man. Circulation 62: 111–259Google Scholar
  3. 3.
    Antman E, Muller J, Goldberg S et al. (1980) Nifedipine therapy for coronary-artery spasm: experience in 127 patients. N Engl J Med 302: 1269PubMedCrossRefGoogle Scholar
  4. 4.
    Engel H-J, Lichtlen PR (1980) Effect of nifedipine on regional myocardial blood flow of coronary patients at rest and during rapid atrial pacing. In: Puech P, Krebs R (eds) 4th International Adalat Symposium: new Therapy of Ischemic Heart Disease. Excerpta Medica, Amsterdam, p 55Google Scholar
  5. 5.
    Engel H-J, Hundeshagen H, Lichtlen PR (1980) Prevention of pacing-induced ischemia by propranolol - changes of regional myocardial blood flow and coronary sinus O2- content. Circulation 62: 111 - 296Google Scholar
  6. 6.
    Engel H-J, Wolf R, Hundeshagen H, Lichtlen PR (1980) Different effects of nitroglycerin and nifedipine on regional myocardial blood flow during pacing induced angina pectoris. Eur Heart J 1 [Suppl B]: 53PubMedGoogle Scholar
  7. 7.
    Freudenberg H, Lichtlen PR (1981) Das normale Wandsegment bei Koronarstenosen. Z f Kardiol (in press)Google Scholar
  8. 8.
    Gaasch WH, Cole JS, Quinones MA, Alexander JK (1975) Dynamic determinants of left ventricular diastolic pressure-volume relations in man. Circulation 51: 317PubMedGoogle Scholar
  9. 9.
    Hood WP, Amende I, Simon R, Lichtlen PR (1980) The effects of intracoronary nitroglycerin on left ventricular systolic and diastolic function in man. Circulation 61: 1098PubMedGoogle Scholar
  10. 10.
    Kaltenbach M, Schulz W, Kober G (1979) Effects of nifedipine after intravenous and intracoronary administration. Am J Cardiol 44: 832PubMedCrossRefGoogle Scholar
  11. 11.
    Leutenegger F, Rafflenbeul W, Gahl K, Walpurger G, Engel H-H, Lichtlen P (1980) Quantitative Koronarangiographie: Dilatation von Koronarstenosen nach Nifedipin. Schweiz Med Wochenschr 110: 1703Google Scholar
  12. 12.
    Lichtlen PR (1975) Coronary and left ventricular dynamics under nifedipine in comparison to nitrates, beta-blocking agents and dipyridamole. In: Lochner W, Braasch W, Kroneberg G (eds) 2nd International Adalat Symposium: New Therapy of Ischemic Heart Disease. Springer, Berlin Heidelberg New York, p212Google Scholar
  13. 13.
    Lichtlen PR, Engel H-J (1979) Assessment of regional myocardial blood flow using the inert gas washout technique. Cardiovasc Radiol 2: 203PubMedCrossRefGoogle Scholar
  14. 14.
    Lichtlen PR, Engel H-J (in press) Relation between myocardial blood flow and degree of coronary obstruction under increased oxygen demand induced by rapid atrial pacing. In: Detection of ischemic myocardium with exercise. Symposium of the European Society of Cardiology, Düsseldorf, Springer-Verlag Berlin Heidelberg New YorkGoogle Scholar
  15. 15.
    Lichtlen PR, Engel H-J, Amende I, Rafflenbeul W, Simon R (1976) Mechanisms of various antianginal drugs. Relationship between regional flow behaviour and contractility. In: Jatene AD, Lichtlen PR (eds) 3rd International Adalat Symposium. Excerpta Medica, Amsterdam, p 14Google Scholar
  16. 16.
    Lichtlen PR, Amende I, Simon R, Hundeshagen H (1977) Left ventricular function and regional myocardial blood flow after atenolol in normals and patients with coronary artery disease. Postgrad Med J 53 [Suppl]: 85PubMedGoogle Scholar
  17. 17.
    Lichtlen PR, Engel H-J, Hundeshagen H (1977) Regional myocardial blood flow in normal and poststenotic areas after nitroglycerin, betablockade (atenolol), coronary dilatation (dipyridamole) and calcium antagonism (nifedipine). Herz 2: 81Google Scholar
  18. 18.
    Lichtlen PR, Engel H-J, Hundeshagen H (1978) Clinical application and results of the assessment of coronary blood flow by the regional precordial xenon residue detection technique. Nucl Med 17: 161Google Scholar
  19. 19.
    Lichtlen PR, Engel H-J, Amende I, Hundeshagen H (1978) Effect of beta blockade on regional myocardial blood flow in coronary heart disease. In: Gross F (ed) Modulation of sympathetic tone in the treatment of cardiovascular diseases. Huber, Bern, p 134Google Scholar
  20. 20.
    Mirsky I, Cohn PF, Levine JA, Gorlin R, Herman MY, Kreulen ThH, Sonnenblick EH (1974) Assessment of left ventricular stiffness in primary myocardial disease and coronary artery disease. Circulation 50: 128PubMedGoogle Scholar
  21. 21.
    Schroeder JS, Russell RO, Resnekov L, Wölk M, Hutter AM, Rosati RA, Conti CR et al. (1978) Unstable angina pectoris-national randomized study of surgical vs. medical therapy: results in Prinzmetal type angina. Am J Cardiol 41: 397CrossRefGoogle Scholar
  22. 22.
    Simon R, Amende I, Lichtlen PR (1979) Das linksventrikuläre Angiogramm. In: Lichtlen PR (ed) Koronarangiographie. Straube, Erlangen, p249Google Scholar

Copyright information

© Springer-Verlag, Berlin, Heidelberg 1981

Authors and Affiliations

  • P. R. Lichtlen
  • H. J. Engel
  • I. Amende

There are no affiliations available

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