Pathophysiology of Coronary and Myocardial Function in Angina Pectoris: Important Aspects for Drug Treatment

Abstract

Knowledge of ischaemia and its consequences in man has been considerably expanded during the last two decades. This was made possibly mainly through the development of new techniques such as coronary and left ventricular angiography(2), and by various methods of assessing regional coronary blood flow(3) and perfusion(4) in man, especially those employing isotopes and computer-assisted devices to study regional wall motion(5). All these techniques allow analysis of both the anatomy and the function of the coronary system and the left ventricle in detail which was never achieved before. These advances, however, also revealed the great complexity of the physiologic and pathophysiologic factors influencing the human coronary circulation in new dimensions. At the same time, treatment of ischaemia entered a new phase; two new invasive methods, bypass surgery(6) and coronary angioplasty(7) were successfully introduced, as well as new classes of antianginal drugs such as beta-blocking agents(8,9) and, in the last decade, the calcium antagonists(10,11) The following review discusses some of the most important and more recent aspects of the normal and abnormal coronary circulation in man, especially those events which play an important role in today's preventive drug treatment of ischaemia.