ISSN:0277-0008    

DOI:10.1002/j.1875-9114.1987.tb04050.x

出版商:Blackwell Publishing Ltd    

年代:1987

数据来源: WILEY

摘要:

Silent myocardial ischemia is reported to account for approximately one‐fifth of all myocardial infarctions and to be very common in patients with a history of angina pectoris. It may also play an important role in sudden cardiac death. Detection of silent ischemia is best accomplished by treadmill testing, electrocardiogram, or Holter monitoring. When detected, it should be treated vigorously in high‐risk patients and all postinfarction patients. Recommendations regarding to the ideal therapy still await the results of controlled clinical testing, although preliminary reports indicate that topical nitrates are effect

ISSN:0277-0008    

DOI:10.1002/j.1875-9114.1987.tb04051.x

出版商:Blackwell Publishing Ltd    

年代:1987

数据来源: WILEY

摘要:

Calcium channel blockers, nitrates, and beta blockers are the primary agents used for the treatment of angina. Calcium has a central role in excitation‐contraction, action potential generation, and ischemic cell death. The three currently available calcium antagonists are nifedipine, verapamil, and diltiazem. Second‐generation agents are in development, and a classification system of calcium channel blockers is used to place the currently available agents and those on the horizon in perspective. Nitrate pharmacology and pharmacodynamics are possibly related to nitrate tolerance; however, this is a matter of some controversy. The beta blockers are all equally effective in the treatment of angina; therefore, drug selection is based on ancillary proper

ISSN:0277-0008    

DOI:10.1002/j.1875-9114.1987.tb04052.x

出版商:Blackwell Publishing Ltd    

年代:1987

数据来源: WILEY

摘要:

The 3 main classes of antianginal drugs are nitrates, beta blockers, and calcium channel blockers. Nitrates have been viewed classically as affecting myocardial demand by reducing intraventricular volume and lowering the filling pressure of the left ventricle. They have been used increasingly to improve oxygen supply in myocardial ischemia by increasing coronary blood flow and actually causing coronary vasodilatation, and by having an effect on endothelial competence. Beta blockers are used to decrease myocardial blood flow by reducing myocardial demand, with reduction of myocardial contractility, afterload, and heart rate. No major improvement of oxygen supply is seen with this class of medication, and in fact, there is some potential for augmenting coronary vasoconstriction. Calcium channel blockers not only reduce myocardial demand by reducing afterload and, in some cases, heart rate, but similar to nitrates, they enhance myocardial oxygen supply.

ISSN:0277-0008    

DOI:10.1002/j.1875-9114.1987.tb04053.x

出版商:Blackwell Publishing Ltd    

年代:1987

数据来源: WILEY

摘要:

Silent myocardial ischemia, an important contributor to myocardial infarction, sudden cardiac death, ischemic arrhythmias, and other aspects of cardiac morbidity and mortality, requires treatment. Two pathophysiologic mechanisms have been proposed to explain transient, acute episodes of myocardial ischemia: an increase in myocardial demand in coronary obstructive disease and a transient dynamic stenosis or increase in tone within the epicardial coronary arteries. Epidemiologic data suggest a high prevalence of asymptomatic myocardial ischemia, and that these episodes are associated with the morbid events of ischemic heart disease. Several choices exist for the treatment of the condition: conservative (risk factor modification), moderate (medical intervention, percutaneous transluminal angioplasty), and aggressive (coronary artery bypass graft). Further research will elucidate the mechanisms by which the dormant atherosclerotic plaque is transformed to a complicated and activated plaque, and by which endothelial dysfunctions contribute to coronary heart disease.

ISSN:0277-0008    

DOI:10.1002/j.1875-9114.1987.tb04054.x

出版商:Blackwell Publishing Ltd    

年代:1987

数据来源: WILEY

ISSN:0277-0008    

DOI:10.1002/j.1875-9114.1987.tb04055.x

出版商:Blackwell Publishing Ltd    

年代:1987

数据来源: WILEY

ISSN:0277-0008    

DOI:10.1002/j.1875-9114.1987.tb04056.x

出版商:Blackwell Publishing Ltd    

年代:1987

数据来源: WILEY