A Critical Appraisal of the Role of Calcium Antagonists in the Management of Patients with Ischemic Heart Disease

Chirac was probably the first investigator to describe the consequences of coronary artery ligation when, almost 300 years ago, he reported that hearts stop beating soon after coronary artery occlusion [1]. Chirac was describing the consequences of experimentally induced coronary insufficiency in dogs, but naturally occurring occlusions occur in man with equally undesirable consequences. The occlusions can occur for a variety of reason, such as coronary artery spasm, thrombosis, and atheroma. Inadequate perfusion can be triggered by other events, including a sustained increase in heart rate without an accompanying increase in coronary blood flow. Such a condition is encountered when the coronary vasculature is either stenosed, maximally dilated, or atheromatous. Severe systemic hypotension — such as that which occurs during shock or excessive vasodilator therapy — can also promote underperfusion.