ANTI-ANGINAL MEANS — the connections having property to warn or remove attacks of angina pectoris (angina pectoris).
On the mechanism of therapeutic action of Ampere-second. divide into two groups. Carry the substances increasing inflow of blood to a myocardium to the first — amyle nitrite (see), nitroglycerine (see), aerinite (see), papaverine (see), Euphyllinum (see), Prenylaminum (see. Diphryl ), karbokhromen (see), Dipiridamolum (curantyl), veraiamit (Isoptinum), Chloracizinum (see), validol (see), etc.; to the second — the connections reducing power expenditure of heart — propranolol (see), etc. This division is conditional since a number of substances of the first group (hloratsizpn, verapamil, nitrates) has also property to reduce the need of heart for oxygen.
Almost all Ampere-second., increasing blood supply of a myocardium (except validol and nitrates), cause this effect thanks to myotropic vasodilating action. Validol eliminates a spasm of coronal vessels reflex, exciting receptors of a mucous oral cavity. Nitroglycerine and other nitrates along with myotropic have also neurotropic spasmolytic effect on coronary vessels, blocking the reflex narrowing influences on them by impact on the vasculomotor centers.
The mechanism of therapeutic effect of nitrates at angina pectoris is not found out. Despite a high therapeutic effectiveness of nitroglycerine, its vasodilating action it is expressed much more weakly, than at others a crown of rorasshiryayushchy means (a papaverine, Dipiridamolum, Prenylaminum). This discrepancy can be explained probably with the fact that nitroglycerine expands vessels of heart only at their spasm. Elimination of the neurogenic tone supporting this spasm leads to normalization of a coronal blood-groove. The therapeutic effect of nitroglycerine at angina pectoris can be explained with also bystry lowering of arterial pressure at a way of administration of drug simple, available to the patient that leads to reduction of power expenditure of heart in the moment of rupture.
Coronarodilator means thanks to strengthening of a blood-groove increase delivery to heart of oxygen. Some of them (an Euphyllinum, a papaverine) at the same time increase also the need of a myocardium for oxygen. In this regard there is an opinion that these substances cause «malignant» vasodilatation of heart and at coronary insufficiency can strengthen air hunger of a myocardium only. However at special studying of an Euphyllinum and papaverine in clinic and in an experiment their efficiency at coronary insufficiency is proved. Obviously, the therapeutic effect at these means is shown by hl. obr. when coronary vessels keep ability to extend in response to increase in energy demands of a myocardium.
Increase in blood supply of the site of ischemia of a myocardium with the help koronarorasshpryayushchpkh means can be provided with improvement of collateral circulation owing to expansion of already existing anastomosis between coronal arteries or by stimulation of development of collaterals in a myocardium (by means of a papaverine, Chloracizinum, a dipirndamol).
Reduction of need of heart for oxygen can be reached by decrease in its loading. In this regard began to apply the substances suppressing function of a thyroid gland as hormones thyroxine and triiodothyronine increase the frequency and force of reductions of heart and increase absorption by a myocardium of oxygen. However purpose of such substances at a coronary disease is inexpedient since the lowered function of a thyroid gland can promote development of atherosclerosis — the process which is the cornerstone of a pathogeny of a coronary disease. An important stage in treatment of a coronary disease was use of β-adrenoblockers.......... Reducing influence of sympathetic nerves on heart, they reduce the frequency and force of reductions of a myocardium, reduce cordial emission and thus reduce power expenditure. Efficiency of propranolol and other β-adrenoblockers at a coronary disease is established as a result of many researches. Owing to decrease in absorption by heart of oxygen under the influence of propranolol also the coronary blood stream since rate of volume flow of coronal blood circulation corresponds to tnergetichesky requirement of a myocardium decreases.
Reduction of need of heart for oxygen can be reached also by increase in efficiency of processes of energy balance in a myocardium. Chloracizinum has such effect, e.g. This drug activates oxidizing phosphorylation therefore absorption by heart of oxygen decreases at not changed education level of makroergichesky phosphoric connections. A result of such changes is increase in efficiency of action of the heart under the influence of Chloracizinum: despite reduction of expenses of oxygen and substrates of oxidation, arterial pressure, cordial emission and a cardiac rhythm at use of this substance do not decrease.
Bibliography: Gatsura V. V. Pharmacological regulation of collateral coronary circulation, M., 1969, bibliogr.; Kaverina N. V. Pharmacology of coronary circulation, M., 1963, bibliogr.; Gregg D. E. Coronary circulation in health and disease, Philadelphia, 1950, bibliogr.; Parratt J. R. Some aspects of the pharmacology of prospective antianginal drugs, Acta cardiol. (Brux.), Suppl. 13, p. 191, 1969, bibliogr.; Russek H. I. Are the xanthines effective in angina pectoris? Amer. J. med. Sci., v. 239, p. 187, 1960, bibliogr.