Antianginal Drugs: Pathophysiological, Haemodynamic, Methodological, Pharmacological, Biochemical and Clinical Basis for Their Use in Human Therapeutics.
Authors: Robert Charlier
Journal: Annals of Internal Medicine (1972)

Coronary Atherosclerosis: General Considerations.- Epidemiology of Coronary Atherosclerosis.- Clinical Manifestations of Coronary Atherosclerosis.- General Therapeutic Measures in Angina Pectoris.- Physical Training in Angina Pectoris.- Treatment of Determining Factors of Atherosclerosis - of Formed Anatomical Lesions: Surgery.- - of Predisposing Factors.- a) Hypercholesterolaemia and Hypertriglyceridaemia.- b) High Blood Pressure.- c) Metabolic Diseases.- d) Tobacco.- - of the Anginal Syndrome.- I. Pathophysiology of Angina Pectoris.- 1. Pathophysiology of the Anginal Attack.- Imbalance Between Myocardial Oxygen Consumption and Coronary Blood Flow.- Lactate Production.- Myocardial Electrolyte Balance.- Robinson's Index.- 2. Cardiac Dynamics during the Anginal Attack.- 3. Part Played by Hypersympathicotony in the Anginal Attack.- 4. Trends in Pharmacological Research for the Development of Antianginal Medications.- 4.1. Coronary Vaso-Dilation.- 4.2. Reduction in Cardiac Work.- 4.3. Inhibition of Monoamineoxydase.- 4.4. Blockade of Hypersympathicotony.- 4.5. Blockade of the Adrenergic ?-Receptors.- 4.6. Overall Inhibition of Hypersympathicotony.- 4.7. Dilatation of the Coronary Conductance Vessels.- 4.8. Improvement of Functional Coronary Microcirculation.- 4.9. Development of a Collateral Coronary Circulation.- 4.10. Potentiation of the Endogenous Mediators of the Coronary Autoregulation.- 4.11. Prophylaxis of Myocardial Necrosis.- 4.12. Inhibition of Platelet Aggregation or Adhesiveness.- II. Haemodynamic Basis for Coronary Pharmacology.- General Considerations.- Blood Pressure.- Myocardial Oxygen Consumption.- Cardiac Work.- Cardiac Output.- Heart Rate.- Regulation of Coronary Circulation.- Hypoxaemia.- Vasomotor Metabolites.- CO2.- Lactic Acid.- pH.- Histamine.- Potassium.- Adenosine.- Sympathine.- Bradykinine.- Hyperemine.- III. Pharmacological Methodology for Testing Antianginal Drugs.- Coronary Blood Flow.- Isolated Heart.- Heart in situ.- 1. Measurement of Coronary Outflow.- 1.1. Morawitz Technique.- 1.2. Heart-Lung Preparation.- 1.3. Rodbard Technique.- 1.4. Busch Technique.- 1.5. Catheterization of the Coronary Sinus without Thoracotomy.- 2. Measurement of Coronary Inflow.- 2.1. Techniques with Extra-Arterial Cannulation.- 2.1.1. Melville Technique.- 2.1.2. Schofield Technique.- 2.2. Techniques with Intra-Arterial Cannulation.- 2.2.1. Gregg Technique.- 2.2.2. Pieper Technique.- 2.2.3. Berne Technique.- 2.3. Techniques without Arterial Cannulation.- 2.3.1. Direct Methods.- 2.3.1.1. The Thermostromuhr.- 2.3.1.2. The Calorimetric Method.- 2.3.1.3. Method Using the Electromagnetic Flow Transducer.- 2.3.1.4. Method Using the Ultrasonic Flowmeter.- 2.3.2. Indirect Methods.- 2.3.2.1. The Nitrous Oxide Technique.- 2.3.2.2. Methods Based on the Employment of Radioactive Substances.- 2.3.2.2.1. Non-diffusible Substances.- 2.3.2.2.2. Diffusible Substances.- 2.3.2.2.3. Diffusible Inert Gases.- 3. Nutritional Myocardial Micro-Circulation.- 4. Collateral Coronary Circulation.- 4.1. Acute Experiment.- 4.1.1. Linder Technique.- 4.1.2. Rees Technique.- 4.1.3. McGregor Technique.- 4.2. Chronic Experiment.- 4.2.1. Meesmann Technique.- 4.2.2. Schmidt Technique.- 4.2.3. Schaper Technique.- 5. Experimental Chronic Coronary Insufficiency.- Measuring Cardiac Output.- Measuring Cardiac Work.- Measuring Myocardial Oxygen Consumption.- IV. Clinical Methods for Assessment of the Therapeutic Value of Antianginal Medications.- Diagnosis of Angina Pectoris.- Clinical Assessment of Antianginal Drugs.- 1. Objective Methods.- 1.1. Russek Method.- 1.2. Levy Method.- 1.3. Riseman Method.- 1.4. Solvay Method.- 1.5. Rookmaker Method.- 1.6. Frick Method.- 2. Subjective Methods.- Greiner Method.- 3. Conclusions on Methods of Clinical Assessment.- V. Pharmacological and Clinical Features of Antianginal Drugs.- Nitrites.- 1. Nitroglycerin.- - Effect on Coronary Flow in Dogs.- - Effect on Coronary Flow in Humans.- - Haemodynamic Effects in Humans.- - Haemodynamic Effects in the Case of the Angina Patient Suffering an Attack.- - Mechanisms of the Antianginal Effect.- - Therapeutic Effect of Nitroglycerin.- - Special Galenic Preparations.- 2. Triethanolamine Trinitrate.- 3. Erythrityl Tetranitrate.- 4. Pentaerythritol Tetranitrate.- 5. Mannitol Hexanitrate.- 6. Amyl Nitrite.- 7. Octyl Nitrite.- 8. Sodium Nitrite.- 9. Isosorbide Dinitrate.- 10. Nilatil.- 11. Etrynit.- 12. Propanediol Dinitrates.- Papaverine.- Xanthines.- 1. Aminophylline.- 2. Choline Theophyllinate.- 3. Various Theophylline Derivatives.- Khellin.- Carduben.- Diacromone.- Phenyl-chromone.- Recordil.- Monoamineoxydase Inhibitors (Maoi).- Irrigor.- Segontin.- Amplivix.- Isoptin.- Persantine.- Intensaine.- Ustimon.- Ildamen.- Clinium.- ?-Adrenergic Blocking Drugs.- 1. Inderal.- - Primary Cardiac Effect.- - Effect on Coronary Flow.- - Effect on Cardiac Output.- - Antianginal Effect.- - Mechanisms of the Antianginal Effect.- - Effect on the Cardiac function.- - Recommendations for the Treatment of Angina Pectoris.- - Ineffectiveness of Inderal in Acute Myocardial Infarction.- - The Use of Inderal in Cardiac Arrhythmia.- 2. Trasicor.- Clinical Application.- 3. Aptin.- 4. Eraldin.- 5. ICI 45763 or Ko 592 (doberol).- 6. Visken (LB 46).- 7. Ro 3-3528.- 8. INPEA.- 9. Sotalol (M.J. 1999).- 10. Recetan.- 11. PhQA 33.- 12. AH 3474.- 13. D 477 A.- 14. USVC 6524.- 15. S-D/1601.- 16. Bunolol.- Cordarone.- 1. Pharmacological Properties.- 1.1. Intrinsic Effects.- 1.2. Antiadrenergic Effects.- 1.2.1. a-antiadrenergic Effects.- 1.2.2. ?-antiadrenergic Effects.- 1.3. Action Mechanisms and Therapeutic Deductions.- 1.3.1. Intrinsic Effects.- 1.3.2. Antiadrenergic Effects.- 1.4. Anti-Arrhythmic Properties.- 2. Therapeutic Properties.- 2.1. Antianginal Effects in Open Tests.- 2.2. Antianginal Effects in Double-Blind Tests.- 2.3. Effects on the Symptomatology of the Cardiac Overload Tests.- 2.3.1. Hypoxia Test.- 2.3.2. Ergometric Bicycle Test.- 2.3.3. Master Type Effort Test.- 2.4. Effects on Pathological Electrocardiogram in Coronary Angina.- 2.5. Anti-Arrhythmic Effects.- 2.6. Clinical Tolerance and Side Effects.- Miscellaneous.- Section no. 1.- Adenylocrat.- Aminocetone.- Anginin.- Baralgin.- Baxacor.- Eucilat.- Griseofulvine.- Mederel.- Opticardon.- Pexid.- Piridoxilate.- Polarising Solutions.- Sandolanid.- Surheme.- Terodiline.- Tromcardin.- Vastarel.- Vialibran.- Section no. 2.- Morphine.- Barbiturates.- Ethyl Alcohol.- Valium.- Phenothiazines.- Chlorpromazine.- Mepazine.- Chloracizine.- Diphenylhydantoin.- Cinchona Alcaloids.- Daucarine.- Vitamin E.- Hexoestrol.- Adenosine and Related Substances.- Thyroxine.- Section no. 3.- Phenoxy-Isopropyl-Norsuprifen.- Phenyl-Isobutyl-Norsuprifen.- Cyclospasmol.- Vasculat.- Reserpine.- Padutin.- Recosen.- Cortunon.- Heparin.- Dicoumarol.- Ilidar.- Priscol.- Hydergine.- Ronicol.- Poly-Methoxyphenol Derivatives.- Triparanol.- Varia.- Carotid Sinus Nerve Stimulation.- Prospects of future research.- Table of Side Effects in Man.- References.- Author Index.