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Effects of diltiazem i.v. on exercise induced myocardial ischemia a study of hemodynamics and reproducibility of hemodynamic findings

, : Effects of diltiazem i.v. on exercise induced myocardial ischemia a study of hemodynamics and reproducibility of hemodynamic findings. Zeitschrift fuer Kardiologie 77(1): 36-43

To obtain data about (a) the reproducibility of repeated standardized exercise tests, under blank and placebo conditions and (b) the improvement of ischaemic symptoms and of haemodynamics after intravenous application of dilitiazem (0.3 mg/kg body weight), 20 patients with angina pectoris and angiographically proven coronary heart disease were analysed in a randomized double-blind study. Results: a) A control exercise test 1 h after the first blank test showed no significant changes of the following parameters neither at rest nor during exercise: heart rate, systolic and diastolic blood pressure, double product, pulmonary capillary wedge pressure, cardiac output, peripheral vascular resistance, stroke volume, ST-segment depression, symptoms of angina pectoris, and maximal work tolerance (steady state, supine position). b) After intravenous application of diltiazem, at rest, both systolic blood pressure (-13 mm Hg, p < 0.03); diastolic blood pressure (-10 mm Hg, p < 0.01) and peripheral vascular resistance (-189 dyn .times. s .times. cm-5, p < 0.02) decreased. During exercise testing, diastolic blood pressure (-9 mm Hg, p < p < 0.02), pulmonary capillary wedge pressure (-13 mm Hg, p < 0.01) and peripheral vascular resistance (-152 dyn .times. s .times. cm-5, p < 0.02) were reduced, and angina pectoris was less severe (p < 0.01): in comparison to placebo the onset of anginal symptoms occurred later (24 vs 49 W, p < 0.01). Maximal exercise tolerance and maximal cardiac output were improved, and ST-segment depression was less pronounced. The study shows that haemodynamic data and ischaemic parameters are well reproducible in repeated exercise tests. Intravenous application of diltiazem leads to afterload reduction and significantly improves ischaemic parameters.


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