Therapeutic implications of slow-channel blockade in cardiocirculatory disorders.

Ellrodt, Gray; Chew, Christopher; Singh, Bramah N.

doi:10.1161/01.cir.62.4.669

Cited by 228 publications

(52 citation statements)

References 33 publications

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“…1 Mean end-diastolic and end-systolic left ventricular nuclide volume equivalents were increased by 34% and 60% of their respective baseline values in group LA ( fig. 2) and by 28% and 34% respectively in group LB ( fig.…”

Section: Immediate Effects Of Verapamil On LV Functionmentioning

confidence: 92%

The acute hemodynamic effects of intravenous verapamil in coronary artery disease. Assessment by equilibrium-gated radionuclide ventriculography.

Klein¹,

R²,

Oren³

et al. 1983

Circulation

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SUMMARY The acute hemodynamic effects of an i.v. bolus of verapamil, 0.1 mg/kg or 0.06-0.075 mg/kg, were examined by serial radionuclide studies in 46 patients with coronary artery disease. In 20 patients with ejection fractions (EFs) > 35% (group 1A), verapamil, 0.1 mg/kg given over 1-1'/2 minutes, had a biphasic effect: first, a transient decrease in EF accompanied by increased left ventricular (LV) volumes and cardiac output equivalents; then, an overshoot of EF to values above control, accompanied by a decrease in peripheral vascular resistance and a drastic decrease in LV volumes, while cardiac output equivalent remained slightly elevated. In eight patients with EFs < 35% (group 1B), only the first effect on EF was noted. In 10 patients with EFs > 35% (group 2), verapamil, 0.0640.075 mg/kg, exerted qualitatively similar but milder effects on hemodynamic function. Finally, verapamil, 0.1 mg/kg given more slowly, over 2-21/2 minutes, produced no significant changes in EF or LV volumes in another eight patients (group 3). The acute effects of verapamil are thus both time-related and dose-dependent. They are also related to the baseline functional reserve of the left ventricle. This study documents that verapamil exerts a depressant effect on LV function. However, the transient nature of this depression and the quick recovery to normal or above-normal values indicate that verapamil, in the doses used in this study, is safe to use intravenously in patients with coronary artery disease.

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Section: Immediate Effects Of Verapamil On LV Functionmentioning

confidence: 92%

The acute hemodynamic effects of intravenous verapamil in coronary artery disease. Assessment by equilibrium-gated radionuclide ventriculography.

Klein¹,

R²,

Oren³

et al. 1983

Circulation

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“…The variable tissue responses to changes in CaZ+ flux have been well discussed (Ellrodt et al, 1980;Stone et a f . , 1980).…”

Section: Discussionmentioning

confidence: 98%

Combination therapy with diltiazem and propranolol: Precipitation of congestive heart failure

Strauss¹,

Egan²,

McIntyre³

et al. 1985

Clinical Cardiology

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Summary:Although congestive heart failure has been reported with the combination of a beta blocker and either verapamil or nifedipine, it has not previously been reported for combination therapy that includes diltiazem. The following case documents the occurrence of clinical congestive failure in a patient with baseline left ventricular dysfunction and severe angina pectoris. Although the patients had tolerated propranolol therapy for years without difficulty, and high-dose diltiazem monotherapy with an excellent clinical response, the combination of diltiazem and propranolol resulted in the development of congestive heart failure. Thus, although generally well tolerated, given the suitable scenario of reduced left ventricular function, the combination of diltiazem and a beta blocker may adversely affect left ventricular performance.

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“…It is well known that most cases of acute myocardial ischaemia are complicated by ventricular arrhythmias arising mainly as a result of ischaemia-induced electrical instability. In contrast with the other calcium antagonists, such as diltiazem or verapamil, nifedipine appears to have no direct antiarrhythmic effect (Ellrodt et al, 1980;Ribeiro et al, 1981). Coker & Parratt (1985) and Sheehan & Epstein (1982) have found no protection against reperfusion ventricular fibrillation after nifedipine treatment in anaesthetized open chest dogs.…”

Section: Introductionmentioning

confidence: 94%

Nifedipine effects in severe myocardial ischaemia in the dog due to left anterior descending coronary occlusion with left circumflex coronary artery constriction

Szekeres

Udvary

Végh

1987

British J Pharmacology

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1 The effects of nifedipine were studied in a model of local myocardial ischaemia, comprising anaesthetized thoracotomized dogs in which a critical constriction of the left circumflex coronary artery (LCX) was combined with sudden occlusion of the left anterior descending coronary artery (LAD). Since more than one coronary artery is involved in ischaemic heart disease, the model seems to reflect the clinical situation very closely. 2 In this model, infusion of 1 jig kg-' min-' nifedipine increased myocardial blood flow within the stenosed area served by the LCX as well as in the myocardial region supplied by the LAD, mainly in the subepicardium. Accordingly, the drug reduced ischaemic ST-segment elevation only in the epicardium. 3 It is suggested that nifedipine directed flow to the sub-epicardium of the ischaemic area by improving the collateral circulation. This redistribution of flow resulted in a decrease in the endo/ epicardial flow ratio. 4 Nifedipine did not change the inhomogeneity of electrical activation indicating that it has no effect on the ischaemia-induced conduction delay. At the same time nifedipine was not able to reduce either the number ofextrasystoles appearing in the early postocclusion and reperfusion phase or the incidence of ventricular fibrillation occuring mainly during reperfusion.

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Therapeutic implications of slow-channel blockade in cardiocirculatory disorders.

Cited by 228 publications

References 33 publications

The acute hemodynamic effects of intravenous verapamil in coronary artery disease. Assessment by equilibrium-gated radionuclide ventriculography.

The acute hemodynamic effects of intravenous verapamil in coronary artery disease. Assessment by equilibrium-gated radionuclide ventriculography.

Combination therapy with diltiazem and propranolol: Precipitation of congestive heart failure

Nifedipine effects in severe myocardial ischaemia in the dog due to left anterior descending coronary occlusion with left circumflex coronary artery constriction

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