Lege Artis Medicinae

[Verapamil treatment in hypertrophic cardiomyopathy]

DÉKÁNY Miklós1

JUNE 30, 1992

Lege Artis Medicinae - 1992;2(01 KLSZ)

[The main aims of therapy in hypertrophic cardiomyopathy, in which ways the symptoms of the patients can be decreased and their survival can be made longer, are as follows: to ameliorate the impaired ventricular relaxation during diastole, to decrease or abolish the obstruction to the left ventricular outflow in systole, as well as to prevent or abolish the atrial and ventricular arrhythmias. Verapamil treatment can be advantageous in each of the above respect. The author describes the characteristics and pathophysiology of the disease in order to understand the favourable effects of Verapamil. On the basis of the literature he gives an outline of the experiences attaining with the application of the drug. He makes the reader acquainted with the results of follow-up studies and with his own observations treating 35 patients with verapamil.]


  1. Orvostovábbképző Egyetem II. Belklinika



Further articles in this publication

Lege Artis Medicinae

[The calcium channel blocker verapamil basic properties, pharmacokinetics, interactions, side effects]


[The family of calcium channel blockers is very large and includes its prototype, the monophenylalkylamin drug, verapamil. It is a non-selective vasodilator which exerts a powerful effect equally on myocardium, conducting and nodal tissue of the heart, and both central and peripheral vasculature. Verapamil is almost completely absorbed after oral administration. However, because of extensive first-pass hepatic metabolism, only about 20% of the drug is bioavailable. The elimination phase is slow with a half-time varying from 5 to 7 hours. Orally administered verapamil is extremely well tolerated drug with a very low incidence of gastric intolerance, constipation, vertigo, facial flushing headache and pruritus. During intravenous administration the most common side effects are hypotension and and occasional AV conduction disturbances, or bradycardia. Main contraindications are listed. Coadministration of beta receptor blokers, digitalis and disopyramid should be avoided. ]

Lege Artis Medicinae

[Effects of verapamil on cardiac arrhythmias]


[Verapamil, a „first generation" calcium anta gonist and synthetic papaverine derivate, was initially introduced as a potent peripheral and coronary vasodilator. It was later found to have significant antiarrhythmic activity, the mechanism of which was related to selective inhibition of transmembrane fluxes of the calcium. The electrical activity of the sinus node and of the atrioventricular (AV) node depends primarily on slow inward Ca2+ currents, therefore it is logical to expect that calcium antagonists will be effective here. The main electrophysiologic effects of verapamil include the slowing of conduction and the prolongation of refractoriness in the atrio ventricular node without significantly affecting intraatrial or intraventricular conduction. Thus, verapamil has been effective in the acute termination of reentry tachycardia in volving the atrioventricular node and in slowing the ventricular response during atrial fibrillation or flattern. Since verapamil has little, if any, effect on the electrical activity of the ventricle or the His Purkinje system, it does not provide effective therapy for controlling ventricular tachycardias. This paper focuses on a detailed discussion of the various arrhythmias that respond to calcium antagonist therapy. ]

Lege Artis Medicinae

[Antianginal effects of verapamil]


[Verapamil is the prototype of the calcium antagonists. Administration of the drug produces a beneficial antianginal effect due to de creased preload and afterload through vasodilation without marked reflex tachycardia and also due to a special influence on myocardium (negative inotropy and positive lusitropy) in all forms of ischaemic heart disease. Verapamil is also a strong coronary dilator drug. Verapamil was given in doses of 240–360 mg daily. The investigators concluded that exercise tolerance increased and the number of anginal attacks and nitroglycerin (sublingual) consumption decreased. The rate-pressure product is reduced on verapamil. Its cardio protective effect on myocardial structure is still an object of discussion.]

Lege Artis Medicinae

[Application intravenous verapamil in hypertonic crises]

NAGY Viktor, ISKUM Miklós

[Hypertensive crisis becomes manifest in two clinically well distinguishable forms. Life threatening cases require immediate intervention, while in cases not immediately life threatening, the situation is less critical, but a delay in treatment may lead to serious organ damage. The authors administered 5 mg verapamil intravenously during 3 minutes to 46 patients (mean age 65,7 years, 31 women, and 15 men). The initial blood pressure of 226/125 mmHg decreased to 193/97 mmHg, and the heart rate decreased from 98/min to 81/min three minutes following the injection (p < 0,01 at both parameters). No significant change was observed in either the blood pressure or the heart rate during the subsequent 30 minutes. As a side-effect, flushing was observed in two cases. Based on the literature and their own experiences, the authors recommend intravenous verapamil as the drug of choice for life-threatening hypertensive crises associated with angina pectoris and cerebrovascular circulatory disorder in cases where EKG is available. ]

Lege Artis Medicinae

[Verapamil treatment in hypertension]


[The author describes the mechanisms of action of verapamil, the first calcium antagonist, and also shortly summarizes its indications and ways of administration in hypertension. Its role in antihypertensive combinations and interactions are also conscisely dealt with.]

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[The use of verapamil in paediatric cardiology]


[Experience with verapamil, a calcium antagonist drug, in three disorders of paediatric cardiology has been described. The differences concerning the clinical features and drug effect between children, adolescents and adults are underlined. Most of the attention has been paid to paroxysmal supraventricular tachycardia since verapamil is very effective in this dangerous type of attack. The author's own experience based on one county's material confirms its decisive role. The use of verapamil in hypertrophic cardiomyopathy and arterial hypertension is also discussed. In addition, suggestions are made for the use of verapamil in perinatology. ]

Clinical Neuroscience

Evaluation of the effectiveness of transforaminal epidural steroid injection in far lateral lumbar disc herniations

EVRAN Sevket, KATAR Salim

Far lateral lumbar disc herniations (FLDH) consist approximately 0.7-12% of all lumbar disc herniations. Compared to the more common central and paramedian lumbar disc herniations, they cause more severe and persistent radicular pain due to direct compression of the nerve root and dorsal root ganglion. In patients who do not respond to conservative treatments such as medical treatment and physical therapy, and have not developed neurological deficits, it is difficult to decide on surgical treatment because of the nerve root damage and spinal instability risk due to disruption of facet joint integrity. In this study, we aimed to evaluate the effect of transforaminal epidural steroid injection (TFESI) on the improvement of both pain control and functional capacity in patients with FLDH. A total of 37 patients who had radicular pain caused by far lateral disc herniation which is visible in their lumbar magnetic resonance imaging (MRI) scan, had no neurological deficit and did not respond to conservative treatment, were included the study. TFESI was applied to patients by preganglionic approach. Pre-treatment Visual Analogue Scale (VAS) and Oswestry Disability Index (ODI) scores of the patients were compared with the 3rd week, 3rd month and 6th month scores after the procedure. The mean initial VAS score was 8.63 ± 0.55, while it was 3.84 ± 1.66, 5.09 ± 0.85, 4.56 ± 1.66 at the 3rd week, 3rd month and 6th month controls, respectively. This decrease in the VAS score was found statistically significant (p = 0.001). ODI score with baseline mean value of 52.38 ± 6.84 was found to be 18.56 ± 4.95 at the 3rd week, 37.41 ± 14.1 at the 3rd month and 34.88 ± 14.33 at the 6th month. This downtrend of pa­tient’s ODI scores was found statistically significant (p = 0.001). This study has demonstrated that TFESI is an effective method for gaining increased functional capacity and pain control in the treatment of patients who are not suitable for surgical treatment with radicular complaints due to far lateral lumbar disc hernia.

Clinical Neuroscience

Comparison of direct costs of percutaneous full-endoscopic interlaminar lumbar discectomy and microdiscectomy: Results from Turkey

ÜNSAL Ünlü Ülkün, ŞENTÜRK Salim

Microdiscectomy (MD) is a stan­dard technique for the surgical treatment of lumbar disc herniation (LDH). Uniportal percutaneous full-endoscopic in­terlaminar lumbar discectomy (PELD) is another surgical op­tion that has become popular owing to reports of shorter hos­pitalization and earlier functional recovery. There are very few articles analyzing the total costs of these two techniques. The purpose of this study was to compare total hospital costs among microdiscectomy (MD) and uniportal percutaneous full-endoscopic interlaminar lumbar discectomy (PELD). Forty patients aged between 22-70 years who underwent PELD or MD with different anesthesia techniques were divided into four groups: (i) PELD-local anesthesia (PELD-Local) (n=10), (ii) PELD-general anesthesia (PELD-General) (n=10), (iii) MD-spinal anesthesia (MD-Spinal) (n=10), (iv) MD-general anesthesia (MD-General) (n=10). Health care costs were defined as the sum of direct costs. Data were then analyzed based on anesthetic modality to produce a direct cost evaluation. Direct costs were compared statistically between MD and PELD groups. The sum of total costs was $1,249.50 in the PELD-Local group, $1,741.50 in the PELD-General group, $2,015.60 in the MD-Spinal group, and $2,348.70 in the MD-General group. The sum of total costs was higher in the MD-Spinal and MD-General groups than in the PELD-Local and PELD-General groups. The costs of surgical operation, surgical equipment, anesthesia (anesthetist’s costs), hospital stay, anesthetic drugs and materials, laboratory wor­kup, nur­sing care, and postoperative me­dication diffe­red significantly among the two main groups (PELD-MD) (p<0.01). This study demonstrated that PELD is less costly than MD.

Lege Artis Medicinae

[Diagnosis and treatment of microvascular coronary heart disease. Specialities of conditions in Hungary]


[Invasive investigations show that in two-thirds of patients the myocardial ischaemia persists without obstructive coronary disease and any other heart conditions (INOCA). The underlying cause may be microvascular dysfunction (CMD) with consecutive microvascular coronary disease (MVD) and microvascular or epicardial vasospastic angina (MVA). The modern practice of clinical cardiology while using the developed non-invasive cardiac imaging permits exact measuring of the coronary flow with its characteristic indices. All of these improve the diagnosing of CMD-induced myocardial ischemia and provide opportunity to determine primary MVD cases. Since the recognition and treatment of MVD is significantly underrep­resented in the Hungarian medical care, the primary stable microvascular angina (MVA) is described in detail below with its modern invasive and non-invasive differential diagnosis and treatment, concerning especially its frequency provoked by high blood pressure and female coronary heart diseases. There are highlighted all recommended diagnostic procedures available under domestic conditions.]