Verapamil in angina pectoris.

Abstract

1 New knowledge of the pathophysiology of coronary disease has helped determine the therapy for angina pectoris. Calcium antagonists have the advantage of being direct coronary vasodilators as well as decreasing overall demand by systemic vasodilatation. 2 Verapamil has the same anti-anginal effect during exercise as 0-adrenoceptor blockers but has the advantage of increasing rather than decreasing the cardiac output and so fatigue both at rest and exercise commonly seen with P-adrenoceptor blockers is not found with verapamil. The longterm incidence of side-effects with verapamil are few and it can be used as a single anti-anginal therapy in a three times daily dosage. Left ventricular function where normal and near-normal is not depressed. Tolerance to therapy has not been recorded. The anti-anginal effects have been shown to remain effective over at least a 5 year period. Verapamil should be considered as initial therapy for patients with stable angina pectoris.The pathophysiology of coronary disease can be depicted as a triad with atherosclerosis, vasospasm and thrombosis interacting to obstruct the coronary vessels. Angina occurs when the oxygen supply, impaired by the partially obstructed coronary vessels, is exceeded by oxygen demand of the heart.The anatomy of atherosclerotic segments of coronary arteries is also important. Traditionally the artery was thought to be concentrically narrowed with gradual progressive obliteration of the lumen. Much attention has been recently focused on the eccentric lesion. This is thought to be associated with vasospasm. An atherosclerosis plaque opposite the normal arterial wall may produce selective vasospasm at that site (i.e. more pronounced than that occurring in the rest of the artery) (Figure 1). The eccentric type of atherosclerosis is often ulcerative and this type of lesion progresses producing unstable angina or infarction. The specific morphology of atherosclerosis now appears to have clinical relevance (Greg Brown et al., 1984).Meyer Friedman writing on the pathology of atherosclerosis stated 'The die is cast when plaque rupture occurs, only the time of the catastrophe remains to be determined.' Atherosclerotic plaque rupture can activate all the mechanisms which promote either vasospasm or thrombosis through platelet activation, prostanoids and neurogenic amines, so that both the coagulation cascade and the factors that produce vasospasm may operate together to further narrowing or occlusion of that artery (Figure 2

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“… 41 Verapamil (VER), as a calcium channel blocker, can be used for the prevention and relief of angina pectoris. 42 , 43 Also, it has been extensively studied as a positive control drug in myocardial ischemia experiments 44 , 45 and has shown significant anti-ischemic effects. 46 , 47 Therefore, VER was used as a positive control drug in this research.…”