Orginal Publication Date
MCV/Q, Medical College of Virginia Quarterly
In conclusion I would like to stress that these observations do not constitute direct evidence of the mechanism whereby the nitrates relieve angina pectoris. It is probable that they are capable of causing some reduction of myocardial oxygen consumption. However, there is increasing indirect evidence which suggests that the site of action of these drugs is principally on the large coronary arteries. Their administration may thus relieve coronary spasm, if this ever causes angina, and more importantly will increase collateral flow into ischemic areas of myocardium when collateral channels have become enlarged. Drugs such as dipyridamole which seem to act on the small vessels, which are the site of autoregulation, are unlikely to have this effect. Indeed, if the autoregulatory mechanism is necessary to direct a limited blood flow to the most ischemic areas of myocardium, such drugs may theoretically be harmful.
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