doi: 10.1093/eurheartj/9.7.826pmid: N/A
Article PDF first page preview Close This content is only available as a PDF. © 1988 The European Society of Cardiology
KISSLING,, G.;BRILLA,, CH.;VOGT,, M.;JACOB,, R.
doi: 10.1093/eurheartj/9.7.800pmid: 3169049
Abstract The vasodilator and inotrapic actions of amrinone were investigated in mine-pigs under pentobarbitone anaesthesia. Left ventriculat volume was determined angiocardiographically under afterloaded and isovolumetric conditions. Furthermore, aortic flow, left ventricular pressure and aortic pressure were measured. In some of the animals, the β-adrenergic receptors were blocked with propranolol prior to the administration of amrinone. Without blockade of the β-receptors, amrinone (2 mg kg −1) caused a significant reduction in mean aortic pressure. Due to less end-diastolic ventricular filling, stroke volume decreased, and thus ejection fraction remained constant. Since heart rate increased under amrinone, cardiac output remained constant. At the same time, the maximum rate of pressure rise increased, despite less end-diastolic ventricular filling. Sfter blockade of the β-adrenergic receptors, aortic pressure, end-diastolic ventricular filling, and stroke volume also decreased with amrinone. In contrast, heart rate remained practically constant, so that cardiac output declined. The maximum rate of pressure rise also declined due to less end-diastolic ventricular filling. It can be concluded from these results that, in situ, the primary action of amrinone occurs on vascular smooth muscle and that a positive inotropic activity with a normal dosage of amrinone is only an indirect outcome of reflex activation of the sympathetic system. Analysis of isovolumetric mechanograms and the ejection phase does not indicate a direct positive inotropic effect of amrinion. In the failing heart, however, beneficial effects can be expected, since the maxima curves follow a flatter course. Thus a reduction in afterload can lead to a significant increase in stoke volume, provided that aortic pressure does not fall below the critical coronary perfusion pressure. Amrinone, inotropic effect, mini-pig, sympathetic reflex, vasodilatatory action. This content is only available as a PDF. © 1988 The European Society of Cardiology
BONGIORNI, M., G.;LEVORATO,, D.;ARLOTTA,, C.;PAPERINI,, L.;CONTINI,, C.
doi: 10.1093/eurheartj/9.7.765pmid: 3139413
Abstract The short- and long-term efficacy of oral encainide was studied in 14 patients with chronic high-frequency ventricular arrhythmias and in 14 patients with chronic frequent episodes of non-sustained ventricular tachycardia (NSVT). Encainide efficacy was assessed during a dose–titration perios and in a 36-month follow-up alos studying the drug effects on routine haematologic data and left ventricular function (LVF). During does–litration, encainide caused a 78.3% decrease in the average hourly frequency of isolated PVC and a 96.1% reduction in NSVT episodes in the two groups pf patients. On follow-up (11 patients in each group) the mean percentage redutions were 95.1% in isolated PVC and 99.7% in NSVT episodes. Encainide did not impair LVF as showed by the comparision of echocardiographic fractional shortening before and after 12 months of treatment. Minor adverse effects of encainide were dose-related visual disturbances in two patients. A major adverse effect was the apperance of sustained VT in one NYHA class IV patient. Oral encainide effectively reduces the frequency of PVC and NSVT, it does not impair left ventricular function and it is associated with infrequent minor side effects. Uncommon, but severe, side effects may appear in patients with marked impairment of left ventricular function. Encainide, ventricular arrhythmias, antiarrhythmic drugs. This content is only available as a PDF. © 1988 The European Society of Cardiology
doi: 10.1093/eurheartj/9.7.825-apmid: N/A
Article PDF first page preview Close This content is only available as a PDF. © 1988 The European Society of Cardiology
DENNISS, A., R.;ROSS, D., L.;CODY, D., V.;RUSSELL, P., A.;YOUNG, A., A.;RICHARDS, D., A.;UTHER, J., B.
doi: 10.1093/eurheartj/9.7.746pmid: 3169044
Abstract Survivors of acute myocardial infarction who had inducible sustained ventricular tachyarrhythmias at programmed stimulation 1–4 weeks after infarction were recruited to a randomized pilot trial of Class 1 antiarrhythmic drugs, in an attempt to determine whether their mortality and risk of spontaneous ventricular tachycardia and fibrillation could be reduced by treatment. Of 136 eligible patients, 96 (71%) joined the trial and 47 were randonized to ‘no treatment’ and 49 were randomized to ‘treatment’ (quinidine, disopyramide or mexiletine given to attain ‘therapeutic’ serum levels). During follow-up, the two groups fared similarly. For the ‘treatment’ and ‘no treatment’ groups, the respective 3-year probabilities of remaining incident-free were:cardiac death, 0.91 vs 0.89; instantaneous death + non-fatal ventricular tachyarrhythmias, 0.87 vs 0.87; cardiac death+non-fatal ventricular tachyarrhythmias, 083 vs 0.85. The highest risk patients with inducible ventricular tachycardia fared similarly in the ‘treatment’ and ’no treatment’ groups. The respective probabilities of remaining incident-free were: cardiac death, 0.89 vs 0.88; instantaneous death+non-fatal ventricular tachyarrhythmias, 0.79 vs 0.84 cardiac death+non-fatal ventricular tachyarrhythmias,0.76 vs 0.77. We conclude that prophylactic Class I antiarrhythmic drug therapy with quinidine, disopyramide or mexiletine given to achieve a ‘therapeutic’ serum level does not appear to alter the prognosis with inducible ventricular tachyarrhythmias after myocardial infarction. Antiarrhythmic drugs, programmed stimulation, ventricular fibrillation, ventricular tachycardia. This content is only available as a PDF. © 1988 The European Society of Cardiology
BOURKE,, S.;CONROY, R., M.;MULCAHY,, R.;ROBINSON,, K.
doi: 10.1093/eurheartj/9.7.734pmid: 3169042
Abstract This is a study of the relationship between the site of infarction and both risk factors and in-hospital outcome in 745 consecutive patients admitted with a first myocardial infarction. Patients with anterior infarctions were significantly more likely never to have smoked than patients with inferior infarctions. They had a higher prevalence of hypertension and a higher mean cholesterol level. In hospital prognosis was worse in anterior infarctions, with significantly higher rates of death and complications. Atrioventricular blocks were more common in inferior infarctions. Non-Q-wave infarctions had a lower incidence of complications than Q-wave infarctions. There was no difference in risk factor levels between Q-wave and non-Q-wave infarctions. Anterior and inferior infarctions were of similar size. Non-Q-wave infarctions were significantly smaller. A logistic regression showed a negative relationship between in-hospital mortality and smoking, and a positive one with peak cardiac enzyme levels. Any effect of site of infarction on mortality was eliminated when corrected for these factors. Our data indicate that the adverse prognosis associated with anterior myocardial infarction is related to differences in aetiology rather than to infarction size. Aetiology, coronary disease, myocardial infarction, prognosis, site. This content is only available as a PDF. © 1988 The European Society of Cardiology
, DE MARTINI, M.;NADOR,, F.;BINDA,, A.;ARPESANI,, A.;ODERO,, A.;LOTTO,, A.
doi: 10.1093/eurheartj/9.7.819pmid: 3169050
Abstract We describe a patient with a large intramyocardial hydatid cyst lying in the postero-lateral segment of the left ventricle near the atrioventricular groove level which ruptured into the pericardial sac, resulting in cardiac tamponade. Cross-sectional echocardiographic examination from a modified four-chamber apical view showed the multiloculated cyst and the breach connecting it to the pericardial sac, allowing for the definitive dagnosis and indication for emergency cardiac surgery. The risks of pericardiocentesis and invasive diagnostic procedures could thus be avoided. Cardiac tamponade, cross-sectional echocardiography, hydatid cyst. This content is only available as a PDF. © 1988 The European Society of Cardiology
doi: 10.1093/eurheartj/9.7.715pmid: N/A
Article PDF first page preview Close This content is only available as a PDF. © 1988 The European Society of Cardiology
doi: 10.1093/eurheartj/9.7.825-bpmid: N/A
Article PDF first page preview Close This content is only available as a PDF. © 1988 The European Society of Cardiology
, VAN GILST, W. H.;TIJSSEN, J. G., P.;, VAN ES, G. A.;LUBSEN,, J.
doi: 10.1093/eurheartj/9.7.795pmid: 3169048
Abstract Transient hypokalaemia may occur in acutely ill patients and is associated with an increased incidence of life-threatening arrhythmias. Therefore, we performed a retrospective analysis of the serum potassium values of 538 patients with unstable angina included in the Holland Interuniversity Nifedipine/metoprolol Trial in relation to the use of diuretics. On admission, 113 of these patients used diuretics. Potassium sparing diuretics had been used in 65 Patients (group A) and non-potassium sparing diuretics in 48 patients (group B). From the 425 patients not on diuretics a random sample of 56 (group C) was drawn. Blood samples were taken routinely on admission to the coronary care unit. The serum potassium values found for groups A, B and C were 3.77±0.55, 3.44±0.69 and 4.14±0.48, respectively, and the prevalence of hypokalaemia (<3.6 mmol) 40, 65 and 14% respectively. Rate ratio [95% confidence interval (C1)] for hypokalaemia when compared to groups C was 2.6 (1.2–5.6) group A and 4.9 (2.4–10.1) for group B. The prevalence of hypokalaemia was higher for women than for men (rate ratio, 95% C1: 1.4, 0.9–2.2). Patients already on beta-blocker therapy showed a 10% lower prevalence of hypokalaemia (rate ratio, 95% C1: 0.7, 0.5–1.1). These data were compared with serum potassium values of 104 patients with stable angina, who reported to the outpatient clinic. These patients were also divided into three groups according to the use of diuretics. Only in 15% of the patients using non-potassium sparing diuretics was hypokalaemia observed. These findings indicate that patients with unstable angina have low serum potassium levels and a high prevalence of hypokalaemia on admission to the coronary care unit. Potassium levels are influenced positively by pre-existing beta-blockade and strongly negatively by diuretics, especially non-potassium sparing diuretics. The effect of beta-blockers suggest a transient catecholamine dependent mechanism. Unstable angina pectoris, hypokalaemia, diuretics. This content is only available as a PDF. © 1988 The European Society of Cardiology
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