Calcium channel antagonists block the inward movement of calcium by binding to the L-type calcium channels in the heart

and in smooth muscle of the peripheral vasculature. CCB’s dilate coronary arteries and peripheral arterioles, but not veins. They also decrease cardiac contractility (negative inotropic effect) ,automaticity at the SA node and conduction at the AV node. Dilation of the coronary arteries increases myocardial oxygen supply.

Dihydropiridines have minimal effect on cardiac conduction or heart rate, while they have potent actions as arteriolar vasodilators. This class of drugs can cause reflex tachycardia when peripheral vasodilation is marked. On the other hand, verapamil and diltiazem slow AV conduction and decrease SA node automaticity, they also decrease heart rate. Diltiazem is used in the treatment of variant angina because of its coronary antispasmodic properties.

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