Vacheron A
Arch Mal Coeur Vaiss. 1983 Feb;76 Spec No:71-5.
In the face of the recent introduction of beta-blockers and calcium inhibitors, the author examines the role of Amiodarone, Perhexiline and Molsidomine in the treatment of angina pectoris. Amiodarone, introduced in 1967, remains a very useful anti-anginal drug. The beta and alpha-sympathetic inhibition it produces, makes it effective in effort and resting angina. It is particularly useful in anginal patients with arrhythmias as it has a potent anti-arrhythmic effect at all levels. It can be used in patients with bronchial asthma, in elderly patients and in cardiac failure. However, it may give risk to hypo or hyperthyroidism and so, should not be used in patients with a history or thyroid disorders. Perhexiline has been used in France since 1973 and is a second-line drug to be used in cases of intolerance or contraindications to other anti-anginal drugs. It is effective but may cause severe, undesirable hepatic and neurological complications. These side effects are however rare at low doses. Molsidomine, a more recent molecule, has an action similar to that of the nitrate derivatives: it mainly reduces left ventricular preload. It has a slower onset of action than the classical nitrate derivatives but its duration of action seems to be longer; Molsidomine and betablockade can be a useful therapeutic association.
面对近期β受体阻滞剂和钙拮抗剂的问世，作者探讨了胺碘酮、哌克昔林和莫西赛利在心绞痛治疗中的作用。1967年引入的胺碘酮仍然是一种非常有用的抗心绞痛药物。它产生的β和α交感神经抑制作用使其对劳力性和静息性心绞痛均有效。对于伴有心律失常的心绞痛患者尤为有用，因为它在各个层面都有强大的抗心律失常作用。它可用于支气管哮喘患者、老年患者和心力衰竭患者。然而，它可能导致甲状腺功能减退或亢进，因此，有甲状腺疾病史的患者不应使用。哌克昔林自1973年起在法国使用，是在对其他抗心绞痛药物不耐受或有禁忌证的情况下使用的二线药物。它有效，但可能引起严重的、不良的肝脏和神经并发症。不过，这些副作用在低剂量时很少见。莫西赛利是一种较新的药物，其作用与硝酸盐衍生物相似：主要降低左心室前负荷。它的起效比经典硝酸盐衍生物慢，但其作用持续时间似乎更长；莫西赛利与β受体阻滞剂联合使用可能是一种有效的治疗组合。
