Comparison of verapamil versus propranolol therapy in syndrome X

2011 ACCF/AHA Focused Update Incorporated Into the ACC/AHA 2007 Guidelines for the Management of Patients With Unstable Angina/Non–ST-Elevation Myocardial Infarction

“…928,929 Beneficial effects with nitrates are seen in approximately one half of patients. 930 The use of alphaadrenergic blockers would appear to be a rational therapy, but the results of small trials are inconsistent.…”

“…If the patient continues to have episodes of chest pain, a calcium channel blocker or beta blocker can be started. 929 Finally, 50 mg of imipramine daily has been successful in reducing the frequency of chest pain episodes. 932 Cognitive behavioral therapy can be beneficial.…”

Ischemia and No Obstructive Coronary Artery Disease (INOCA): What Is the Risk?

“…The current ACC/AHA guidelines for patients with stable CAD echoes the ACC/AHA recommendations for patients with unstable angina/non–ST‐segment–elevation MI for subgroups of patients with no obstructive CAD, which was defined as CSX 22, 78. While there have been studies evaluating therapy in patients with CSX,79, 80, 81, 82 these studies are limited in their characterization of coronary vasomotor function. Indeed, this emerging INOCA patient population remains underdiagnosed and undertreated, likely perseverating this observed therapeutic equipoise.…”

Coronary Microvascular Dysfunction in CAD: Consequences and Potential Therapeutic Applications

“…In contrast, Lanza et al (1999) demonstrated that calcium channel blockers did not decrease the number of episodes of chest pain (Gaetano Antonio Lanza et al, 1999). In addition, a 7-day treatment with verapamil made no difference in the frequency of episodes of ST-segment depression, measured by continuous ECG monitoring over 2 days (Bugiardini et al, 1989).…”

“…One randomized, double-blinded prospective trial found that beta blockers, but not calcium channel blockers or nitrates, significantly reduced chest pain episodes in patients diagnosed with cardiac "syndrome X" (Gaetano Antonio Lanza, Colonna, Pasceri, & Maseri, 1999). Similarly, in 16 patients with transient myocardial ischemia and normal coronary angiography randomized to treatment with propanolol, verapamil or placebo, those patients receiving propanolol had significantly fewer episodes of ischemic chest pain when compared to placebo (Bugiardini, Borghi, Biagetti, & Puddu, 1989).…”