Revista Colombiana de Cardiología
versão impressa ISSN 0120-5633
MELGAREJO R, Enrique. Heart rate and its intervention in ischemic heart disease: A new approach and alternative. Rev. Colom. Cardiol. [online]. 2009, vol.16, n.4, pp. 159-169. ISSN 0120-5633.
We have known for many years that in the different zoological scales the heart rate is a determinant of life expectancy in years. It seems that something similar occurs in the human species. In a recent study (BEAUTIFUL), performed in patients with heart failure and coronary heart disease, patients with heart rate higher or equal to 70 beats per minute had a significant benefit in coronary events, hospitalization for cardiac infarct and coronary revascularization, by reducing it with a new drug that acts exclusively in the sinus node If current, without any hemodynamic associated component (this is, no inotropic negative effect). Ischemic heart disease has been seen as an imbalance between oxygen supply and demand in the myocardium. Therefore, medications that decrease its consumption (betablockers and some calcium antagonists) have become the mainstay for the management of this process, due to its negative inotropic effect. Nevertheless, betablocker effect has an extra cost that is the vasoconstrictor effect, mediated by the alfa effect that is liberated when blocking the beta receptors. For that reason, betablockers with vasodilator effect-carvediol, nebivolol- do not have this disadvantage. Recently, a new therapeutic class that may help in coronary patients management emerged, by selectively decreasing the heart rate and prolonging diastolic filling time, improving myocardial perfusion especially in the most vulnerable zone: the subendocardium. The first specific heart rate-lowering agent is ivabradine. A review of the heart rate role on the cardiovascular system, the If current, ischemic heart disease physiology, and ivabradine benefits when exclusively decreasing the heart rate with its additional impact on the vascular wall and more specifically in the atheroesclerotic plaque hemodynamics, is made.
Palavras-chave : cardiac ischemia; heart rate; ivabradine; coronary disease.