Improvement in wall motion after pindolol : a mechanism for the preservation of left ventricular function in coronary artery disease

1. In order to evaluate the mechanism by which beta blockers with intrinsic sympathomimetic activity preserve left ventricular systolic function at rest, 46 patients with coronary artery disease were studied by right and left heart catheterization and left ventriculography. Patients were studied using a double-blind, randomized protocol before and after a single intravenous dose of 3 mg propranolol (N = 22) or 0.5 mg pindolol (N = 24). 2. Mean right atrial pressure increased similarly after both drugs. Mean pulmonary artery pressure, left ventricular end-diastolic pressure, mean aortic pressure, and peripheral vascular resistance did not change significantly after either drug. Cardiac index (before: 3.0 ± 0. 7 (mean± SEM); after: 2.8 ± 0.2 I min·l m·2) and heart rate (before: 78 ± 15; after: 72 ± 12 bpm) decreased only after propranolol administration. 3. Ejection fraction decreased only after propranolol (48 ± 16 to 41 ± 15%). Improvement in segmental wall motion abnormalities was noted (23 of 47 segments) only after pindolol. The total left ventricular wall motion score improved after pindolol and worsened after propranolol (P < 0.05). In patients with impaired left ventricular function, pindolol administration resulted in improved resting ejection fraction. 4. Thus, the acute hemodynamic consequences of pindolol administration differ from those of propranolol owing to the preservation of left ventricular systolic function which seems to be related to the intrinsic sympathomimetic effect of pindolol on areas of reversible wall motion abnormality

Reversão da angina refratária ao uso de nitratos com o emprego de verapamil endovenoso durante cateterismo cardíaco

O presente estudo foi realizado para avaliar os efeitos da administração intravenosa do verapamil (0,15 mg/kg) em 12 pacientes que apresentaram angina durante o cateterismo cardíaco, não havendo alívio da dor 5 minutos após a administração da nitroglicerina sublingual. Após o uso do verapamil, houve desaparecimento da dor anginosa. Os valores das pressões pulmonar, sistólica e diastólica final do ventrículo esquerdo, da freqüência cardíaca e da dP/dt máxima haviam aumentado durante a angina e praticamente permanecido inalterados durante a administração de nitroglicerina. Essas variáveis atingiram valores próximos aos observados em situação basal após o uso do verapamil. Concluímos que o verapamil pode ser uma alternativa no tratamento da angina severa e refratária por reduzir o consumo de oxigênio pelo miocárdio e por suas ações coronariodilatadoras.The present study was conducted to evaluate the effects of intravenous administration of verapamil (0.15 mg/Kg) in 12 patients who presented angina during cardiac catheterization who did not respond after 5 minutes of sublingual nitroglycerin. After the use of verapamil the symptoms of angina disappeared. The values of pulmonary pressure, left ventricular systolic and end diastolic pressure, heart rate and leak dP/dt had increased during angina and had persisted with almost the same values during nitroglycerin administration. These variables returned to values similar to the basal ones after the use of verapamil. We conclude that verapamil may be an alternative in the treatment of serious and refractory angina due to its effects by reducting myocardial oxygen uptake or to its coronary vasodilator effects

Efeito da apnéia inspiratória sobre a circulação geral e sobre o coração

Foram estudados três grupos, o 1.º constituído por 8 pacientes normais (GI), o 2.º por 19 pacientes portadores de insuficiência cardíaca congestiva (G2) e o 3.º, por 28 pacientes portadores de cardiopatia isquêmica sem insuficiência cardíaca (G3), durante cateterismo cardíaco em situação basal e em apnéia inspiratória. Durante a inspiração, a pressão média no átrio direito aumentou de 2,0 ± 0,7 mmHg para 5,0 ± 1,8 mmHg (p 0. 05) in group II; from 3.0 ± 0.4 mmHg to 5.0 ± 1.3 mmHg (p > 0.05) in group III. Mean pulmonary pressure increased from 13.0 ± 1.1 mmHg to 18.0 ± 18 mmHg. (p < 0.05) in group I, did not change in group II and increased in group III from 18,0 ± 3.5 mmHg to 21.2 ± 1.9 mmHg (p < 0.05) in group III. Although left ventricular systolic pressure had a slight decrease in all groups, this decrease proved significant only in patients belonging to group III (p < 0,05). Left-ventricular end-diastolic pressure did not change in any group. The mean aortic pressure decreased from 98.0 ± 3.4 mmHg to 90.0 ± 3.2 mmHg (p < 0.05) in group II and from 114.0 ± 3.6 mmHg to 109.0 ± 3.6 mmHg (p < 0.05) in group III. The heart rate decreased from 80.0 ± 3.2 bpm t o 7 0 . 0 ± 2 . 8 b p m ( p < 0 , 0 1 ) in group I ; from 77.0 ± 3.7 to 70.0 ± 3.2 bpm (p < 0.01) in group II; from 77.0 ± 1,7 bpm to 71.0 ± 1.5 bpm (p < 0,001) in group III. The cardiac output decreased from 6.5 ± 0.3 l/mim to 5.6 ± 0.3 l/ min (p < 0.01) in group I; from 5.8 ± 0.3 1/min to 5.0 ± 0.3 l/ min (p < 0,01) in group II and from 5.7 ± 0.2 l/min to 5.0 ± 0.2 l/min (p < 0.001) in group III. The systolic volume did not change in any group

Efeitos hemodinâmicos e cineangiográficos agudos do propatilnitrato na cardiopatia isquêmica sintomática

Os efeitos hemodinâmicos e cineangiocardiográficos do propatilnitrato sublingual foram estudados em 20 pacientes portadores de cardiopatia isquêmica. As variáveis, obtidas em situação basal e 5 minutos após o uso de 10 mg da droga, foram comparadas entre si, tendo-se observado: 1º) ausência de alterações significativas nas pressões médias de átrio direito e diastólica final de ventrículo esquerdo (VE), no rendimento cardíaco, no volume sistólico e na dP/dt máxima de VE; 2º) aumento significativo da freqüência cardíaca, fração de ejeção e velocidade média de encurtamento circunferência; 3º) redução significativa das pressões médias de artéria pulmonar e aorta e dP/dt máxima de VE, na resistência vascular sistêmica e nos volumes sistólico e diastólico finais do VE; 4º) melhora da motilidade segmentar do VE com normalização da contratilidade em 21 e melhora em 33, de um total de 66 segmentos alterados. Conclui-se que o propatilnitrato melhora o desempenho do coração como bomba, bem como a motilidade segmentar do miocárdio ventricular esquerdo.The hemodynamic and cineangiocardiographic effects of sublingual propatilnitrate were studied in 20 patients with ischemic heart disease. The variables obtained before and 5 minutes after the use of 10 mg of the drug were compared. The results showed: 1º) absence of significant changes in mean right atrial pressure, in left ventricular end diastolic pressure, in cardiac output, in systolic volume and in peak dP/dt; 2º) significant increase in heart rate, in ejection fraction and in mean circunferential fiber shortening velocity; 3º) significant decrease in mean pulmonary and aortic and in maximal dP/dt left ventricular pressures, in systemic vascular resistence and in left ventricular end systolic and enddyastolic volumes; 4º) improvement of left ventricular wall motion with normalization of contractility in 21 and improvement in 33 from a total of 66 altered segments. We conclude that propatilnitrate improves the cardiac performance as a pump as well as the segmental wall motion in patients with ischemic heart disease