Reduction of heart rate — Really a new concept in treating angina pectoris?
Myocardial ischemia causing chest pain in patients with angina pectoris is due to an imbalance between coronary blood flow and myocardial metabolic demand. Heart rate is a major determinant of oxygen consumption and metabolic demand, and drugs known to reduce heart rate, such as β-blockers and some calcium blockers have well established effects in patients with angina pectoris. In addition to its importance as a determinant of oxygen consumption, heart rate is also an independent predictor, both of risk of developing acute myocardial infarction as well as a predictor for later complications including death. Increased heart rate can be due to either increased sympathetic activity and/or reduced parasympathetic activity. Psychosocial stress, an important risk factor for development of coronary artery disease, is characterized by an increase in heart rate and systolic blood pressure. β-blockers and calcium blockers are well established in the therapy of ischemic heart disease, and β-blockers are also known to reduce and prevent infarct development and mortality after myocardial infarction. It seems reasonable to believe that new drugs with specific effects on heart rate, without any influence on contractility, could be useful in the therapy of patients with ischemic heart disease, with symptoms of angina pectoris, as well as with supraventricular tachycardia and congestive heart failure.
KeywordsAcute Myocardial Infarction Calcium Channel Blocker Angina Pectoris High Heart Rate Calcium Blocker
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