A Study on Pathogenesis and Treatment of Angina Pectoris

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We performed treadmill exercise test repeatedly and examined the effects of various drugs on the exercise-induced attack in 126 patients with angina pectoris with one vessel disease. The attacks could not be induced or could not be reproducibly induced by maximal treadmill exercise at the same hour of the different days within a week period in 64 (50.8 %) of the patients. In the 62 patients whose attacks were reproducibly induced by the exercise, propranolol 80 mg given orally did not suppress the attacks in 52 (83.9 %) of the patients. Diltiazem 90 mg and nifedipine 20 mg given orally suppressed the attacks completely in 48 (77.4 %) of the 62 patients and in 42 (73.7 %) of the 57 patients respectively. Coronary arteriography showed that dynamic obstruction of the artery supplying the area of myocardium represented by ST segment deviation appeared during the attacks and disappeared with subsidence of the attacks in all but 1 of the 62 patients in whom coronary arteriography was done during the attack. We conclude that angina pectoris is usually cause not by increased myocardial oxygen demand but by dynamic coronary obstruction or by combination of both in most patients with on vessel disease and that calcium antagonists such as diltiazem and nifedipine are very useful for the treatment of angina pectoris in patients with one vessel disease.