New concepts in ischemic heart disease

Abstract

Over the past several years a number of new concepts have greatly increased our knowledge about the pathophysiology and therapy of ischemic heart disease. These concepts include (1) reperfusion following acute myocardial infarction, (2) balloon angioplasty of coronary lesions, (3) secondary prevention of coronary events, (4) the role of coronary tone in producing ischemia, and (5) prevention of atherosclerosis. The use of calcium entry blockers has emphasized the potential importance of spasm or increased tone in the genesis of myocardial ischemia. In standard exercise-induced angina, however, the primary mechanism whereby calcium entry blockers relieve angina appears to be related to a reduction in myocardial oxygen demand rather than to an increase in coronary flow. The calcium entry blockers have also been shown experimentally to retard the development of atherosclerosis in animals fed high-lipid diets. This emphasizes the potential role of calcium in the atherosclerotic process and the potential role of calcium blockers in preventing this sequence.