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  • Title: Improved myocardial oxygen utilization by diltiazem in patients.
    Author: Kern MJ, Walsh RA, Barr WK, Porter CB, O'Rourke RA.
    Journal: Am Heart J; 1985 Nov; 110(5):986-90. PubMed ID: 4061275.
    Abstract:
    Calcium entry blocking drugs produce different effects on systemic and coronary hemodynamics and myocardial oxygen extraction. To examine the effects on myocardial oxygen extraction, intravenous diltiazem (100 micrograms/kg bolus with a continuous 10 micrograms/kg/min infusion) was administered to 11 patients at rest and during controlled heart rates (100 +/- 5 and 120 +/- 5 bpm). At rest, diltiazem decreased mean arterial pressure from 109 +/- 13 to 99 +/- 14 mm Hg (p less than 0.01), increased heart rate from 64 + 12 to 74 +/- 14 bpm (p less than 0.01), and decreased coronary sinus resistance (1.02 +/- .41 to 0.87 +/- .40 U, p less than 0.05). Myocardial oxygen extraction was significantly reduced since coronary sinus oxygen content increased (6.0 +/- 0.9 to 7.8 +/- 1.2 ml/dl, p less than 0.01) and the arterial-coronary sinus oxygen difference decreased (12.0 +/- 1.7 to 10.6 +/- 1.6 ml/dl, p less than 0.01). Similar changes occurred with heart rate held constant. There were no significant changes in absolute coronary sinus blood flow, calculated myocardial oxygen consumption, or left ventricular dP/dt. Diltiazem decreases mean arterial pressure while reducing both myocardial oxygen extraction and coronary arterial resistance, suggesting that a principal mechanism of a beneficial effect upon the coronary circulation appears to be an improvement in myocardial oxygen extraction relative to myocardial oxygen demand.
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