Acute coronary vasomotor effects of nifedipine and therapeutic correlates in syndrome X

Montorsi, Piero; Cozzi, S.; Loaldi, Alessandro; Fabbiocchi, Franco; Polese, A; Cesare, Nicoletta De; Guazzi, Maurizio D.

doi:10.1016/0002-9149(90)90840-w

Cited by 42 publications

(10 citation statements)

References 19 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…In our present study and in previous studies, [22][23][24][25] calcium antagonists have been preferentially used because they have a vasodilator effect on the microcirculation and some, such as diltiazem and verapamil, decrease myocardial oxygen consumption. Recently, -blockers were reported to be efficacious in relieving symptoms and ST-segment depression.…”

Section: Discussionsupporting

confidence: 62%

Clinical Characteristics and Follow-up in Patients With Microvascular Angina.

Suzuki

Matsubara

Koba

et al. 2002

Circ J

View full text Add to dashboard Cite

Section: Discussionsupporting

confidence: 62%

Clinical Characteristics and Follow-up in Patients With Microvascular Angina.

Suzuki

Matsubara

Koba

et al. 2002

Circ J

View full text Add to dashboard Cite

“…As discussed above, Bugiardini’s study comparing propranolol and verapamil revealed that the beta-blocker had a more favorable effect than the calcium channel blocker [52]. There are few data to support the use of diltiazem in this condition [56], and despite favorable responses such as improvement in exercise-induced ST segment depressions with nifedipine, it has also been shown to worsen clinical symptoms [57]. Similarly, amlodipine has not proven to be effective in controlling chest pain in patients with CSX [50].…”

Section: Therapymentioning

confidence: 99%

Angina in Women without Obstructive Coronary Artery Disease

Banks

Khera³

2010

CCR

View full text Add to dashboard Cite

Angina in the absence of obstructive coronary artery disease, sometimes referred to as cardiac syndrome X (CSX), is a debilitating condition that disproportionately affects women. More than 50% of women evaluated for angina have non-obstructive disease by cardiac catheterization, although the total numbers of women affected by CSX are unknown. Varying clinical definitions and the lack of large scale epidemiologic studies focusing on this illness have resulted in limited knowledge about its risk factors, although there appears to be an association with black race, estrogen deficiency, and insulin resistance. Contrary to prior beliefs about the benign nature of this entity, these women suffer considerable morbidity with costly economic implications that approach the lifetime costs of healthcare utilization for those with obstructive coronary disease. Two prevailing hypotheses have emerged to explain CSX: the ischemic hypothesis detailing abnormal coronary microvascular function and the non-ischemic hypothesis describing altered pain perception and myocardial hypersensitivity. Treatment strategies have focused on both of these pathways with the main goal of improving symptoms. Beta blockers provide the most convincing evidence for benefit, with other antianginals having secondary roles. Other promising pharmacologic therapies include xanthine derivatives, estrogen replacement therapy, ACE inhibitors, and statin medications, among other emerging treatment options. Neurostimulation and lifestyle factors including exercise can also be beneficial in reducing symptoms. However, managing patients with CSX can be frustrating for both patients and physicians, as there is a lack of data regarding an optimal treatment algorithm including few large-scale randomized controlled trials to clarify effective therapies.

show abstract

“…In a randomized double-blind crossover trial in 26 patients, Cannon et al [15] demonstrated that patients receiving calcium channel blockers recorded fewer episodes of angina and consumed fewer nitroglycerin tablets than those receiving placebo. Other investigators obtained similar results [14,16]; however, these results are not consistent in all studies [12,13]. Standard dosage Diltiazem extended-release tablets: 180 to 480 mg/d.…”

Section: Calcium Channel Blockersmentioning

confidence: 88%

“…Furthermore, enrollment criteria and assessment of the effectiveness of therapy varied among studies. Atenolol 100 mg/d + Burgiardini [12] 28 Propranolol 120-160 mg/d + Borghi [13] 24 Propranolol 120-160 mg/d + Romeo [14] 30 Acebutolol 400 mg/d +/-Calcium channel blockers Cannon [15] 17 Verapamil 40-160 mg four times a day + Cannon [15] 9 Nifedipine 10-30 mg four times a day + Borghi [13] 24 Verapamil 320-480 mg/d -Montorsi [16] 18 Nifedipine 10-20 mg four times a day + Burgiardini [12] 28 Verapamil 320 mg/d -Romeo [14] 30 Verapamil 80 mg four times a day + Angiotensin-converting enzyme inhibitors…”

Section: Treatmentmentioning

confidence: 99%

Syndrome X

Suwaidi

Lerman

2000

Curr Treat Options Cardio Med

View full text Add to dashboard Cite

Syndrome X, defined as typical angina with positive exercise test results and normal coronary angiographic findings, represents a multifactorial pathophysiologic state that may range from abnormalities in pain perception to abnormalities in endothelial- and nonendothelial-dependent coronary flow reserve associated with myocardial ischemia. Treatment begins with accurate diagnosis by means of a comprehensive coronary vascular reactivity evaluation. This may lay the groundwork for appropriate treatment. The management of patients with syndrome X is challenging, and it may be necessary to attempt various medications depending on the patient's response. We feel that the first step in the treatment is accurate diagnosis. This is done by performing a functional angiogram (assessment of endothelial-dependent and endothelial-independent coronary flow reserve). In those without evidence of coronary flow reserve abnormalities, reassurance might be curative; however, in those who continue to have symptoms, a trial of imipramine therapy at a dose of 50 mg/d may be attempted, provided other organic disorders (in particular gastrointestinal disorders) are excluded. Those who demonstrate evidence of abnormal coronary vascular reactivity are approached as outlined in Figure 1. Patients are advised to avoid medications that may cause coronary "spasm." We routinely refer our patients to the cardiovascular health clinic for risk factor management and an exercise program. Our first choice of medications usually consists of slow-release calcium channel blockers. We tend to start with a once-a-day regimen, and based on the response, we occasionally change the regimen to twice a day. If the functional angiogram reveals concomitant epicardial disease, then nitrates are added to the medical regimen. Angiotensin-converting enzyme inhibitors are part of the treatment if the patient has hypertension or diabetes or if calcium channel blocker therapy fails. l-Arginine at an initial dosage of 1 g three times daily is added and may be increased to 3 g three times daily if no contraindications are present. Because there are no data regarding the effect of l-arginine, which may affect insulin secretion, in patients with diabetes, we use caution in this patient population. There is no "gold standard" therapy for syndrome X, so each patient may respond differently to the initial medical therapy. Thus, we follow these patients closely to monitor their response to treatment.

show abstract

Acute coronary vasomotor effects of nifedipine and therapeutic correlates in syndrome X

Cited by 42 publications

References 19 publications

Clinical Characteristics and Follow-up in Patients With Microvascular Angina.

Clinical Characteristics and Follow-up in Patients With Microvascular Angina.

Angina in Women without Obstructive Coronary Artery Disease

Syndrome X

Contact Info

Product

Resources

About