Perioperative Calcim Channel Blockade?

[VentdependenT]

We got the ACE for remodelling.

The Statin for clot stabilization/plaque propogation inhibition.

Beta-blocker for longevity.

Spironolactone for cutten down on aldosterone.

What about our friend the calcium channel blocker (L-type specific such as Dilt/Vera)? I haven't read any efficacy trials on them for CAD/MI settings or for perioperative myocardial protection.

It seems like they should work if our goal is to get the HR under control.

I'm just too lazy to sift through the internet to find a study without consulting you all first.

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[VentdependenT]

Bah, I looked anyways.

Seems like non-DHP CCB's are ok for short term rate control (cut down on cardiac events) but actually detrimental in long term mortality/morbidity in the post-MI patient.

 

[Planktonmd]

Bah, I looked anyways.

Seems like non-DHP CCB's are ok for short term rate control (cut down on cardiac events) but actually detrimental in long term mortality/morbidity in the post-MI patient.

Correct.
Calcium channel blockers were a disappointment for long term post MI therapy from a mortality rate point of view. On the other hand they remain valuable in certain situations like Prinzmetal's angina (coronary spasm), and to improve the quality of life in patients with intractable angina not responding to long acting nitrates.

 

[Gator05]

There was a small head to head comparison of betablockers vs ccb for peroperative MI. CCB didn't do diddly.

That said, sometimes a litle dilt goes a long way in rate control for hard to control tachys.