Pharmacotherapy of myocardial ischemia.

The cornerstones of pharmacotherapy for myocardial ischemia are the nitrites and the beta-adrenergic blocking agents. These drugs not only inhibit cardiac mechanical activity (and therefore energy requirements) in a variety of ways but also redistribute available blood flow to the potentially ischemic segments of cardiac muscle. The least effective dose of nitroglycerin and the most tolerated (or blocking) dose of propranolol provide the optimum in management. There is increasing evidence that certain orally administered nitrates at larger than usual dosage can further increase the tolerance to effort. Amelioration of hypertension or congestive failure may play a significant role in selected patients.