Calcium-channel blocking agents and chest pain.

Calcium-channel blocking agents can relieve anginal and chest pain associated with hypermotility of the esophagus. Although calcium-channel antagonists differ in their effects on the esophageal body and the lower esophageal sphincter, reduction of lower esophageal sphincter pressure theoretically could result in gastroesophageal reflux and pain. This pain may be difficult to differentiate from chest pain of cardiac origin. An association between calcium-channel blocking agents and chest pain is speculative at this time. However, the possibility of such an effect should be considered by clinicians in the total management of patients. Future clinical studies are warranted to address the issue of the incidence of such an effect and to define more precisely the potential interrelationship among the calcium-channel antagonists, their efficacy in relieving cardiac pain, and their potential liability in inducing chest pain of noncardiac origin.

Complete heart block during cardiac catheterization in a normal individual.

A 44-year-old white male who developed third-degree heart block during cardiac catheterization is presented. Right heart catheterization precipitated bifascicular block, right bundle branch block with left posterior hemiblock, and resulted in third-degree heart block during the left heart procedure. It is recommended that multiple electrocardiographic lead monitoring be considered during cardiac catheterization in order to recognize more easily high-risk conduction disturbances, ie a bifascicular block pattern with frontal plane axis shifts.