Antianginal and myocardial metabolic properties of verapamil in coronary artery disease

Ferlinz, Jack; Turbow, Marvin

doi:10.1016/0002-9149(80)90361-6

Cited by 66 publications

(10 citation statements)

References 46 publications

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“…However, our results showing a reduction in myocardial oxygen consumption and maintained myocardial lactate uptake indicate that not only an improved oxygen supply but also reduced myocardial oxygen demand is responsible for the improvement of the supply/ demand ratio. Ferlinz & Turbow(1980) come to similar conclusions in patients with coronary artery disease. Verapamil was given to twelve such patients at rest and during stress with atrial pacing.…”

Section: Discussionsupporting

confidence: 59%

“…The effects of nitroglycerine have been examined in this preparation (Szekeres & Udvary, 1983) and the purpose of the present study is to describe the effects in this model, of two drugs (verapamil and fendiline) that act mainly by inhibiting the transmembrane influx of Ca2 . These calcium antagonists reduce oxidative metabolism in cardiac muscle (Fleckenstein, Doring, Janke & Byoh, 1975) and have been used in the treatment of angina pectoris (Ferlinz & Turbow, 1980;Subramanian, Lahiri, Paramasivan & Raftery, 1980;Carlens, 1981) especially where, in addition, antihypertensive or antiarrhythmic effects are also desired (Kaltenbach, 1977;Pedersen, 1981).…”

Section: Introductionmentioning

confidence: 99%

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Comparison of two calcium antagonists, verapamil and fendiline, in an experimental model of myocardial ischaemia mimicking classical angina on effort

Csik

Szekeres

Udvary

1983

British J Pharmacology

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1 The effects of verapamil (0.15/kg) and fendiline (3 mg/kg) were studied in anaesthetized, thoracotomised dogs with a critical constriction of the left anterior descending coronary artery, paced in excess of the initial rate by 60-70 beats/min. Epicardial ST-segment elevation and changes in lactate uptake were used to assess the severity of myocardial ischaemia. 2 Both drugs prevented the ST-segment elevation and the reduced lactate uptake that resulted from atrial pacing. 3 The anti-ischaemic effect of fendiline is mainly due to its negative chronotropic action, whereas that of verapamil is due in part to bradycardia and in part to the reduced preload and afterload. In addition, both agents increase coronary flow to the ischaemic area and thus improve the myocardial oxygen supply/oxygen requirement ratio.

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Section: Discussionsupporting

confidence: 59%

Section: Introductionmentioning

confidence: 99%

Comparison of two calcium antagonists, verapamil and fendiline, in an experimental model of myocardial ischaemia mimicking classical angina on effort

Csik

Szekeres

Udvary

1983

British J Pharmacology

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“…31. 32 The safety of verapamil in the doses used here remains to be determined in patients with acute left ventricular dysfunction.…”

Section: Recovery Stagementioning

confidence: 99%

“…The hemodynamic effects of verapamil in man have been investigated during catheterization.23-25, [31][32][33][34] Conflicting results have been reported, probably because of the varying laboratory conditions, differing subsets of subjects, methods of administration of verapamil and methods of quantitation. Cardiac output has been reported to decrease,35 increase24, 25 34 or not change,9' 10 and stroke volume has been reported either not to change9 or to increase.24' 25 Left ventricular enddiastolic pressure, pulmonary wedge pressure and left atrial pressure have been reported not to change'10 34 or to increase.9 24 25 3 Left ventricular or aortic dP/dt has been reported to decrease'10 25, 33 or not to change,9 while mean velocity of circumferential fiber shortening has been reported to increase24 and ejection fraction not to change10 or to increase.24 Thus, the reported effects of verapamil on hemodynamic indexes of left ventricular function vary from study to study.…”

Section: Recovery Stagementioning

confidence: 99%

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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“…Hemodynamic studies suggest multiple sites of target action. Verapamil Selective left coronary angiogram (LAO) projection (a) nonfilling of the left anterior descending coronary artery (LAD) due abolishes tachycardia and left ventricular hypercontractility, it lowers arterial pressure and LV afterload and thereby decreases myocardial oxygen demand (Ferlinz and Turbow, 1980;Lewis et al, 1975). The reduction in systemic vascular resistance was observed in acute studies and appeared within minutes of drug administration.…”

Section: Discussionmentioning

confidence: 99%

Intravenous verapamil therapy in imminent myocardial infarction

Hasin

Freiman

Schwarz

et al. 1983

Clinical Cardiology

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Summary:We studied 16 patients with small myocardial infarction who had further episodes of chest pain with ST-segment elevation, a sign of transmural myocardial ischemia and imminent infarction extension. Coronary angiography in 14 showed a critical lesion in 13. Intravenous verapamil abolished chest pain and ST-segment elevation. It caused a fall in right atrial and left ventricular end-diastolic pressures (LVEDP) and cardiac output, reflex systemic vasoconstriction, and a rise in systemic vascular resistance. There was no reflex tachycardia. Volume expansion raised LVEDP and restored a normal cardiac output. Accelerated junctional rhythm with isorhythmic A-V dissociation occurred in 5 patients. Two patients sustained a transmural infarction, 10 underwent coronary artery bypass grafting, and 4 are symptom-free with oral treatment. Intravenous treatment was an effective method of treating acute episodes of transmural myocardial ischemia and preventing their recurrence in patients with critical coronary artery narrowing. Continuous verapamil infusion stabilized the patients' condition and enabled smooth coronary angiography and induction of anesthesia for surgery.

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Antianginal and myocardial metabolic properties of verapamil in coronary artery disease

Cited by 66 publications

References 46 publications

Comparison of two calcium antagonists, verapamil and fendiline, in an experimental model of myocardial ischaemia mimicking classical angina on effort

Comparison of two calcium antagonists, verapamil and fendiline, in an experimental model of myocardial ischaemia mimicking classical angina on effort

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

Intravenous verapamil therapy in imminent myocardial infarction

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