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and Demand

Oxygen Supply

Oxygen Demand

Coronary blood flow Aortic diastolic pressure Endocardial-epicardial flow Coronary collateral blood flow

Wall tension Ventricular volume Radius or heart size Systolic pressure

(afterload) Diastolic pressure

(preload) Heart rate Contractility

Coronary blood flow Aortic diastolic pressure Endocardial-epicardial flow Coronary collateral blood flow

Large coronary artery diameter

Wall tension Ventricular volume Radius or heart size Systolic pressure

(afterload) Diastolic pressure

(preload) Heart rate Contractility ischemic areas has been documented in experimental animals following nifedipine (Adalat, Procardia), diltiazem (Cardizem),verapamil (Calan), amlodipine (Norvasc), nitroglycerin (Nitrostat, Tridil, Nitro-Dur), or propranolol (Inderal) administration. Increases in collateral flow to ischemic areas also have been observed in experimental animals and humans after treatment with certain calcium entry blockers and organic nitrates.

When coronary vasospasm occurs, the balance between oxygen supply and demand can be restored by relieving the spasm, thereby restoring normal coronary blood flow. Acute vasospasm has been successfully aborted through the use of nitroglycerin. In contrast, calcium entry blockers and long-acting nitrates have proved effective in the chronic therapy of coronary vasospasm.

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