心肌耗氧量=收缩压×心率×左心室射血时间 心肌氧需食 冠状动脉供血↓ 血供、氧供失平衡 心肌暂肘缺血缺氧 decrease myocardial Increase oxygen oxygen requirement d elver
血供、氧供失平衡 心肌暂时缺血缺氧 decrease myocardial oxygen requirement increase oxygen delivery 心肌耗氧量=收缩压×心率×左心室射血时间 心肌氧需 冠状动脉供血
Strategies for angina treatment Decrease the oxygen demand and/or increase the delivery Dilating arteries, especially coronary arteries, including relieving spasm and opening collateral circulation Dilating veins Cardiac inhibition: decrease HR, contractility, tensility of myocardium Antiatherosclerosis and prevention of thrombosis
Decrease the oxygen demand and/or increase the delivery BY Strategies for angina treatment - Dilating arteries, especially coronary arteries, including relieving spasm and opening collateral circulation - Dilating veins - Antiatherosclerosis and prevention of thrombosis - Cardiac inhibition: decrease HR, contractility, tensility of myocardium 12
Antianginal drugs Organic nitrates β- receptor blockers Calcium channel blockers Other drugs(ACEIs, nicorandil 可地尔, molsidomine吗多明
Antianginal drugs ◼ Organic nitrates ◼ -receptor blockers ◼ Calcium channel blockers ◼ Other drugs (ACEIs, nicorandil尼 可地尔, molsidomine吗多明)
硝酸酯类药物的百年发展历程 19·德国柏林举行硝酸酯-120年大会 1987 Palmer等发现此类药物是通过释放NO来 介导药理学作用 1978·第个5SMN" elantan@ long上市 1947·第一个SDN在瑞典上市 1879 伦敦的 William murrel第一个用NTG在临床治 疗心绞痛( Lancet jan128,1879) 1867·瑞典的化学家和实业家 Alfred nobel建立自己的化工厂 ·爱丁堡的 LAnder brunton报告亚硝酸异戊酯的抗心绞 痛作用Lancet July?271867) 1846 ·意大利的化学家 Ascanio sobrero首先合成NTG
硝酸酯类药物的百年发展历程
Organic nitrates(硝酸酯类) Nitroglycerin(NTG,硝酸甘油) Isosorbide dinitrate(硝酸异山梨酯,消心痛) Isosorbide mononitrate(ISMN,单硝酸异山梨酯) Actions Dilate vessels: Dilate veins and arteries, decrease pre/after-load and cardiac oxygen demand Dilate coronary arteries, epicardial vessels and open collateral circulation redistribute blood to ischemic area Decrease LVFP increase blood to subendocardial area Protect myocardial cells against ischemic injury Anticoagulation of platelets
Nitroglycerin（NTG, 硝酸甘油） Isosorbide dinitrate（硝酸异山梨酯，消心痛） Isosorbide mononitrates（ISMN, 单硝酸异山梨酯） Actions ➢ Dilate vessels: - Dilate veins and arteries, decrease pre/after-load and cardiac oxygen demand - Dilate coronary arteries, epicardial vessels and open collateral circulation, redistribute blood to ischemic area - Decrease LVFP, increase blood to subendocardial area ➢ Protect myocardial cells against ischemic injury ➢ Anticoagulation of platelets Organic nitrates （硝酸酯类）