Possibilities of ACE inhibitor therapy in acute myocardial ischemia

Ertl, G; Bauer, B; Gaudron, P; Neubauer, S; Schorb, W; Kochsiek, K

Journal article

Possibilities of ACE inhibitor therapy in acute myocardial ischemia

Abstract:: Acute myocardial ischemia results from an increased cardiac workload in presence of a critical coronary stenosis (demand ischemia), coronary occlusion (supply ischemia) or a combination of both. It is complicated by cardiac arrhythmias and deterioration of function of ischemic myocardium and results in an increased load and dilatation of non-ischemic myocardium. Cardiac protection in acute myocardial ischemia can be related to preservation of coronary blood flow, function of ischemic and non-ischemic myocardium or prevention of cardiac arrhythmias. In control animals and humans, ACE-inhibitors have no major effect on coronary blood flow. Myocardial ischemia raises plasma-renin-activity, angiotensin I-conversion by passage through coronary circulation, and plasma-angiotensin-II-concentrations. ACE-inhibitors and angiotensin-II-receptor blockers increase coronary blood flow during myocardial ischemia. Other mechanisms (bradykinin potentiation) may be involved. We found a potentiation of the coronary dilatory effect of the neuropeptide neurotensin (which is probably mediated by prostaglandins) by ACE-inhibitor. ACE-inhibitor may delay infarct development in animal experiments and improve function of ischemic myocardium. The importance of early dilatation of non-ischemic myocardium is unknown and it is unclear whether it may be prevented by an ACE-inhibitor as was shown for late dilatation. Studies on the effect of ACE-inhibitors in exercise-induced angina pectoris are controversial. An antiischemic and coronary dilatory effect has been shown by invasive studies in patients. A preliminary study in unstable angina pectoris was positive. Beneficial hemodynamic and antiarrhythmic effects (as well as excessive hypotension, however) have been shown in patients with acute myocardial infarction.

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APA Style

Ertl, G., Bauer, B., Gaudron, P., Neubauer, S., Schorb, W., & Kochsiek, K. (1991). Possibilities of ACE inhibitor therapy in acute myocardial ischemia. Klinische Wochenschrift, 69 Suppl 24, 10–17; discussion 18.

MLA Style

Ertl, G, et al. “Possibilities of ACE Inhibitor Therapy in Acute Myocardial Ischemia.” Klinische Wochenschrift, 69 Suppl 24, 1991, pp. 10–17; discussion 18.

Chicago Style

Ertl, G, B Bauer, P Gaudron, S Neubauer, W Schorb, and K Kochsiek. 1991. “Possibilities of ACE Inhibitor Therapy in Acute Myocardial Ischemia.” Klinische Wochenschrift 69 Suppl 24: 10–17; discussion 18.
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