Advances in Nitrate Therapy by Dr. Adam Schneeweiss, Dr. Marija Weiss (auth.)

By Dr. Adam Schneeweiss, Dr. Marija Weiss (auth.)

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In order to characterize regional myocardial perfusion and glucose metabolism in unstable angina and the effect ofISDN on these parameters Araujo et al [75] studied 22 patients with angiographically proven coronary artery disease and severe unstable angina, using positron-emission tomography. Myocardial glucose utilization was found to be increased in these patients, even in the absence of acute myocardial necrosis, clinical signs of acute ischemia or detectable perfusion abnormalities. Intravenous administration of ISDN reduced myocardial oxygen utilization, suggesting a beneficial effect on myocardial metabolism.

It should be remembered, however, that the only beta-blockers which fail to decrease mortality after acute myocardial infarction are those with sympathomimetic activity (alprenolol, oxprenolol). This has been attributed to inadequate decrease of heart rate by these agents. The main determinant of efficacy of betablockers in secondary prevention appears to be a reduction in heart rate. This suggests that acceleration of heart rate by nitrates might prevent expression of their anti-ischemic effect.

It was concluded that 44 Silent Ischemia both IS-5-MN and nifedipine reduce ischemic episodes by about 65%. A much longer study, evaluating the effect of trans dermal nitroglycerin on silent ischemia by eight periods of Holter monitoring in each patient, is now being performed by my group. The most important question to be answered is whether the beneficial effect of transdermal nitroglycerin in silent ischemia is maintained throughout chronic therapy. 9. Acute Myocardial Infarction In previous chapters it has been shown that nitrates are used to treat various preinfarction ischemic conditions as well as postinfarction complications, such as acute heart failure, mechanical complication and postinfarction angina.

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