Chest pain antagonists

Nitroglycerin will be effective for on-going chest pain relief. Ca channel antagonists and long-acting Nitrates can be used when jS-blockers are contraindicated. These drugs may be also used for the initial therapy, additional to -blockers or when jS-blockers treatment failed. However, for the effectiveness of vasodilatation itself is relatively weaker evidence. 

Beta-adrenoceptor antagonists can cause non-anginal chest pain because of esophagitis (218), due to adherence of the tablet mass, resulting in esophageal spasm, inflammatory change, and even perforation. 

Most reports have attributed chest pain to vasospasm (29). Certainly, the ischemic-hke pains and electrocardiographic findings, lack of changes in creatine kinase, and frequent responses to nitrates and at times to calcium antagonists in the setting of anatomically normal coronary angiography, plus reversible contractihty defects suggest... 

However, in one case, both oral nitrates and calcium antagonists failed to prevent chest pain associated with 5-fluorouracil (45). 

Adverse effects with dipyridamole thallium testing are minimal, the main adverse effects being chest pain (with or without ischemic changes on the ECG), headache, dizziness, and nausea. Adverse effects are related to the increased adenosine activity and can be ameliorated by xanthine compounds because they are direct competitive antagonists of adenosine. Caffeine products must be avoided for about 24 hours prior to the test. Adenosine is associated with a higher incidence of adverse effects (80% versus 50%), but these are very transient, and some studies have shown that patients prefer it over dipyridamole. Both agents are relatively contraindicated in patients with a history of bronchospasm. 

In the event of prolonged chest pain and ischemic ECG changes unrelieved by nitrate therapy or calcium channel antagonists, one may assume total occlusion of a coronary vessel, and steps should be taken to restore blood flow with either PCI or CABG. 

Drug adulteration Adulteration of heroin with clenbuterol is frequently reported [112 ]. In 13 confirmed cases of exposure to clenbuterol in this way, clenbuterol was identified in the blood and or urine of 12 [113 ]. Symptoms included nausea, chest pain, palpitation, dyspnea, and tremor. The physical findings included significant tachycardia and hypotension, and there was laboratory evidence of hyperglycemia, hypokalemia, and increased lactate concentrations six patients had biochemical evidence of myocardial injury. Ten were given beta-adrenoceptor antagonists without adverse effects. 

Coronary artery disease Treatment with nitrates and calcium antagonists, which decrease the LES pressure detection bias with chest pain evaluation... 

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