ABSTRACT
Although digitalis glycosides were introduced for the treatment of cardiac disorders almost 200 years ago, controversy persists regarding the relative role of these inotropic agents, particularly in patients with coronary artery disease in sinus rhythm. With the advent of more potent diuretics and the demonstrated benefit of vasodilators in left ventricular unloading, the relative worth of digitalis in patients with coronary artery disease and myocardial infarction is being re-examined.
Subject(s)
Coronary Disease/drug therapy , Digitalis , Plants, Medicinal , Plants, Toxic , Angina Pectoris/drug therapy , Arrhythmias, Cardiac/etiology , Clinical Trials as Topic , Coronary Disease/metabolism , Coronary Vessels/drug effects , Heart Failure/drug therapy , Humans , Myocardial Infarction/drug therapy , Oxygen Consumption/drug effects , Substance Withdrawal Syndrome , Vascular Resistance/drug effectsABSTRACT
Of 77 patients hospitalized for unstable angina pectoris and failure of oral, dermal, or intravenous nitrates and/or beta blockade, 81 percent with negligible or single-vessel disease and 55 percent with two- or three-vessel disease showed response (p less than 0.05) to nifedipine therapy. Patients with either S-T elevation or no change during pain responded better (31 of 45) than those with any S-T depression (16 of 32; p less than 0.05). Patients with negligible or single-vessel disease had a higher prevalence of S-T elevation (13 of 16) than patients with two- or three-vessel disease (15 of 31; p = 0.004). S-T motion did not predict response in patients with two- or three-vessel disease, but did predict response in patients with negligible or single-vessel disease. On follow-up study at 9 +/- 8 (range one to 33) months, 39 of 42 who had shown response were free from pain. Three died from infarction without unstable angina. (range one to 33) months, 39 of 42 who had shown response were free from pain. Three died from infarction without unstable angina. Five who showed response had elective bypass surgery. The addition of nifedipine abolished or reduced pain episodes by more than 50 percent in 61 percent of patients with refractory unstable angina pectoris. Patients with negligible or single-vessel disease with S-T elevation benefit most. In patients with two- or three-vessel disease, the type of S-T motion did not predict response. Follow-up of all those with response indicated sustained amelioration by nifedipine therapy. Failure of nifedipine therapy should not be accepted until a dose of 120 mg per day has been achieved, or until intolerable side effects appear.