Comparative effects of three calcium antagonists (nifedipine, verapamil and diltiazem) on hemodynamics in recent myocardial infarction

Sakai, M.; Ueda, K.; Nakahara, K.; Tsuchimochi, H.; Mutsushita, S.; Kuramoto, K.; Murakami, M.

Kokyu to Junkan. Respiration and Circulation 33(2): 159-164


ISSN/ISBN: 0452-3458
PMID: 4001593
Accession: 039617174

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Hemodynamic effects of diltiazem and verapamil were compared with those of nifedipine in 11 patients with recent myocardial infarction by crossover method. Right heart catheterization and echocardiography were performed in 5 patients (group A) with an oral dose of 10 mg of nifedipine followed by an i.v. injection of 10 mg of diltiazem, and in 6 patients (group B) with nifedipine followed by an i.v. injection of 10 mg of verapamil. After the administration of nifedipine, systemic vascular resistance (SVR) decreased by 13.4% and cardiac output (CO) increased by 11.0% without the change of heart rate (HR). Ejection fraction (EF), which was measured by echocardiography, tended to increase. This vasodilator effect (.DELTA.SVR) was proportional to SVR in control state and accompanied with an increase of CO. Vasodilator effect of 3 Ca antagonists was not significantly different (.DELTA.SVR:verapamil -10.0 .+-. 2.9%, nifedipine -13.4 .+-. 3.0%, diltiazem -20.0 .+-. 6.4%). But EF tended to decrease with verapamil and diltiazem, and HR was unchanged following the administration of both drugs. Verapamil and diltiazem increased pulmonary artery pressure and suppressed atrioventricular (AV) nodal conduction with a prolongation of P-R interval, but nifedipine did not show these changes. Among these 3 Ca antagonists nifedipine can be used as a vasodilator with the least untoward effects on AV conduction and cardiac contractility in patients with recent myocardial infarction.