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Nitrate III pp 210-219 | Cite as

Systemische Nitroglycerin-Wirkungen auf die Durchblutung des ischämischen Myokards bei koronarer Herzkrankheit

  • D. T. Mason
  • R. C. Klein
  • N. A. Awan
Conference paper

Zusammenfassung

Die antianginösen Wirkungen der Nitrate bei Patienten mit ischämischer Herzerkrankung bestehen bekanntlich darin, daß diese Substanzen das Gleichgewicht zwischen dem kardialen Sauerstoffbedarf und der eingeschränkten ventrikulären Perfusion verbessern, indem sie die erkrankten Koronargefäße direkt erweitern [15, 23, 27] und/oder den myokardialen Energiebedarf durch Reduzierung der äußeren Arbeit herabsetzen [20-22,28]. Die konventionelle und vordergründige Auffassung ist, daß diese therapeutische Wirkung der Nitrate hinsichtlich der Bela-stungs-Angina-pectoris vorwiegend auf einer systemischen Venendilatation beruht [8, 21, 22, 28, 29], die ein peripheres Blutpooling und eine Verminderung der Herzgröße bewirkt (Preload-Senkung), wodurch die systolische Wandspannung (After-load) und der Sauerstoffverbrauch des ischämischen linken Ventrikels zurückgehen [19]. Es ist jedoch nicht ausgeschlossen, daß diese Substanzen auch die behinderte segmentale Durchblutung erhöhen, indem sie auch erkrankte Gefäße diktieren und/oder die Durchblutung über das Kollateralsystem verbessern. In diesem Zusammenhang wurde bei Patienten mit angiographisch nachgewiesenen fixierten Koronarstenosen ohne Gefäßspasmus der Einfluß von systemisch angewandtem Nitroglycerin auf die regionale koronare Kreislaufdynamik durch die objektive Messung des antegraden Blutstroms durch intakte Bypass-Brücken aus V.-saphe-na-Segmenten direkt erhoben.

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Copyright information

© Springer-Verlag Berlin Heidelberg 1982

Authors and Affiliations

  • D. T. Mason
  • R. C. Klein
  • N. A. Awan

There are no affiliations available

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