By Robert Charlier

If the varied healing acquisitions of the prior few years have enriched very various fields of human pathology, it does appear that coronary pathology has been given very precise cognizance, as witness the wide range of antianginal medicinal drugs put on the disposal of the clinical career. there are lots of causes for this scenario, one among them most likely being that the medica tions successively proposed don't totally fulfill the practitioner and one other that the full variety of contributors struggling with the clinicaI manifestations of heart affliction deals, through its dimension, an enormous revenue strength for the pharma ceuticaI undefined. This box of purposes opens up such clients that it has inspired a prolific volume of pageant among numerous study laborato ries, and it really is no exaggeration to claim that each significant company has its individuaI anti anginaI drug in its healing cataIogue. yet another issue has aIso contributed drastically to this proliferation of medi cinal arrangements meant for the remedy of angina pectoris: this can be the fast boost in our knowIedge of the physiopathoIogy of angina, which in flip has produced originaI recommendations of pharmacological and biochemical study. accordingly, there have emerged new elements whose motion mechanisms have claimed to be most suitable to the cardiovascular problems answerable for cardiac ache.

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Extra resources for Antianginal Drugs: Pathophysiological, Haemodynamic, Methodological, Pharmacological, Biochemical and Clinical Basis for Their Use in Human Therapeutics

Example text

The degree of isehoomia, the number of diseased vessels and the reserve eapaeity of nondiseased myocardium are a few of the many faetors whieh determine the overall response of the heart to stress. As pointed out by CRoss [68e] the riddle that remains to be answered is how are depressed eontraetility and angina related now that it is known they are associated. From simultaneous metabolle and hoomodynamie studies earried out in angiographieally proven eoronary heart disease cases in whom atrial pacing resulted in angina, WIENER eonsiders that the acute myoeardial isehoomia thus indueed, and depieted by abnormaI laetate and pyruvate metabolism, is not direetly responsible for angina; it is rather asudden impairment of ventrieular eomplianee whieh is thought to eonstitute the mechanieal basis for the anginal syndrome [338e].

1416] and [179 e]). Cireles: normal group. Squares: angina group. angina group. In the three groups: 1: during control period. 2: during atrial pacing. 3: during immediate post-pacing period. 4: during exercise. LVSWI accompanying the increase in haart rate during pacing is associated with a reduction in LVEDP according with the Starling relationship. b) The group without angina reaets in the same way as the normal group. e) The patients in the angina group, in spite of a similar decrease in LVSWI during pacing, show no change in L VEDP and thus change from a normal to an abnormal ventricular function curve when ischaemia develops.

8 Sinee aeeurate measurement of the small ehanges whieh oeeur in the eoronary sinus blood should allow a more objeetive assessment of the presenee and severity of isehaemia than ean be made by other existing methods, an improvement on the eonventional enzymatie method for laetate determinations has been reeently proposed, the reeovery of laetate being virtually 100%, and linear over a range of prepared laetate standards [207 e]. 26 Pathophysiology of Angina Pectoris Although the eardiae pain brought on by the intravenous injection of isoprenaline more frequently leads to laetate produetion than does physieal effort [73, 346, 817], PARKER et al.

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