Angina pectoris Prinzmetal

TREATMENT Coronary Artery Spasm and Variant Angina Pectoris (Prinzmetal ... 

DHPs are potent arterial vasodilators. They act on resistance vessels and therefore reduce peripheral vascular resistance, lower arterial blood pressure, and antagonize vasospasms in coronary or peripheral arteries. By reducing afterload, DHPs also reduce cardiac oxygen demand. Together with their vascular spasmolytic effect, this explains most of the beneficial actions of DHPs in angina pectoris. Most DHPs are only licensed for the therapy of hypertension, some of them also for the treatment of angina pectoris and vasospastic (Prinzmetal) angina. 

Do not give dihydroergotamine to patients with ischemic heart disease (angina pectoris, history of Ml, documented silent ischemia) or to patients who have clinical symptoms or findings consistent with coronary artery vasospasm, including Prinzmetal variant angina. 

Verapamil (Isoptin, Covera), in addition to its use as an antiarrhythmic agent, has been employed extensively in the management of variant (Prinzmetal s) angina and effort-induced angina pectoris (see Chapters 17 and 19). It selectively inhibits the voltage-gated calcium channel that is vital for action potential genesis in slow-response myocytes, such as those found in the sinoatrial and A-V nodes. 

Contraindications Basilar or hemiplegic migraine, coronary artery disease, ischemic heart disease (including angina pectoris, history of Ml, silent ischemia, and Prinzmetal s angina), uncontrolled hypertension, use within 24 hours of ergotamine-contain-ing preparations or another serotonin receptor agonist, use within 14 days of MAOls... 

Organic nitrates (and nitrites) are simple nitric and nitrous acid esters of alcohols. They differ in their volatility for example, isosorbide dinitrate is solid at room temperature, nitroglycerin is only moderately volatile, whereas amyl nitrate is extremely volatile. These compounds cause a rapid reduction in myocardial oxygen demand followed by rapid relief of symptoms. They are effective in stable and unstable angina, as well as Prinzmetal s or variant angina pectoris. 

Verapamil (80 mg p.o. q. 6 to 8 hours) is indicated in the management of Prinzmetal s or variant angina or unstable or chronic, stable angina pectoris verapamil (0.075 to 0.15 mg/kg rv pnsh over a 2-minnte period) is indicated in the treatment of supraventricnlar tachyarrhythmias verapamil (240 to 480 mg p.o. daily) is indicated in the prevention of recurrent paroxysmal supraventricular tachycardia verapamil (240 to 320 mg p.o. daily) is indicated in the control of the ventricular rate in digitalized patients with chronic atrial flatter and/or fibrillation and verapamil (80 mg p.o. t.i.d.) is indicated in the management of hypertension. 

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