digitoxin and Aortic-Valve-Insufficiency

Topics: Adolescent; Adult; Aged; Angiocardiography; Aortic Valve Insufficiency; Cardiomegaly; Child; Child, Preschool; Diet, Sodium-Restricted; Digitalis; Diuretics; Endocarditis, Subacute Bacterial; Heart Failure; Heart Septal Defects, Ventricular; Hemodynamics; Humans; Infant; Infant, Newborn; Middle Aged; Phytotherapy; Plants, Medicinal; Plants, Toxic; Pulmonary Circulation; Pulmonary Valve Stenosis

The haemodynamic effects of N, N-bis(phenyl-carbamoylmethyl) dimethylammonium chloride (QX-572) in man were studied. A controlled study was performed to rule out a possible influence of the catheterization procedure as such on the results. Ten patients with mild to moderate aortic regurgitation were studied: based on clinical data the patients were divided into 2 groups of 5. Randomly it was decided that one group should constitute a control group receiving saline while the second group received QX-572 , MG/KG BODY WEIGHT. In both groups the administration was performed as a slow intravenous infusion during 30 minutes. Heart rate, pressures in brachial artery and right atrium, cardiac output, stroke volume, and systemic vascular resistance were determined before, during, and up to 30 minutes after completion of placebo or QX-572. These variable remained stable in the control group while QX-572 produced an increase in heart rate most pronounced at the end of the infusion period. A transient decrease in systolic and mean brachial artery pressure during the infusion, and during the same period a decrease in right atrial pressure. Cardiac output and systemic vascular resistance were unchanged by QX-572 but they were not measured during the infusion when the changes in pressures were most pronounced. QX-572 was thought to act as a peripheral vasodilator during the infusion. Left ventricular contractility was studied by means of pressure curves obtained from a catheter tip manometer placed in the left ventricle. The first derivative of the isovolumic left ventricular pressure at the highest level (45mmHg) common to all patients was used (dp/dt-45). No significant difference could be observed when comparing mean changes of dp/dt-45 for the two groups. In the control group there was a slight but significant increase in dp/dt-45 during the time of observation. In the QX-572 group the results varied between individuals. Two of the patients differed from all other patients in the control and QX-572 groups showing a decrease in dp/dt-45 which, when most pronounced at the end of the infusion period, was -31 and -28 per cent of the preinfusion levels, respectively. This decrease probably reflects reduction of contractility. It was concluded that QX-572 in a dose of 8 mg/kg body weight did not have any major haemodynamic drawbacks.

Topics: Adult; Anti-Arrhythmia Agents; Aortic Valve Insufficiency; Arrhythmias, Cardiac; Blood Pressure; Brachial Artery; Carbamates; Cardiac Output; Clinical Trials as Topic; Digitoxin; Digoxin; Female; Heart Atria; Heart Rate; Heart Ventricles; Hemodynamics; Humans; Infusions, Parenteral; Male; Middle Aged; Placebos; Quaternary Ammonium Compounds; Vascular Resistance

Topics: Aortic Valve Insufficiency; Digitalis; History, 17th Century; History, 18th Century; Humans; Literature, Modern; Phytotherapy; Plant Preparations; Plants, Medicinal; Syphilis, Cardiovascular

Although electrocardiographic left ventricular hypertrophy is a recognized marker of disease severity in patients with chronic aortic regurgitation, the quantitative relations of repolarization abnormalities and QRS voltage to measurements of cardiac structure and function have not been established. The presence or absence of the "strain" pattern of repolarization and QRS voltage was compared with echocardiographic and radionuclide cineangiographic findings in 95 adults with sever, pure, chronic aortic regurgitation and no evidence of coronary artery disease. In contrast to 54 patients with normal repolarization, 41 patients with an abnormal repolarization pattern had greater left ventricular end-diastolic and end-systolic dimensions (7.2 +/- 1.1 versus 6.6 +/- 0.8 cm, p less than 0.002 and 5.2 +/- 1.2 versus 4.4 +/- 0.7, p less than 0.001, respectively), greater left ventricular mass (431 +/- 138 versus 303 +/- 89 g, p less than 0.001), higher end-systolic stress (128 +/- 46 versus 95 +/- 27 dynes-cm2 X 10(3), p less than 0.001), lower fractional shortening (28 +/- 8 versus 34 +/- 5%, p less than 0.001) and lower exercise ejection fraction (39 +/- 11 versus 51 +/- 8%, p less than 0.001). Multiple logistic regression analysis revealed that left ventricular mass and end-systolic stress were independently related to the presence of repolarization abnormalities (p less than 0.005). Among the 73 asymptomatic patients, those with normal repolarization had significantly lower prevalences of fractional shortening less than 25% (1 of 45 versus 5 of 27, p less than 0.05), left ventricular systolic dimension greater than 5.5 cm (1 of 45 versus 8 of 27, p less than 0.05).(ABSTRACT TRUNCATED AT 250 WORDS)

Topics: Adolescent; Adult; Aged; Aortic Valve Insufficiency; Digitalis; Electrocardiography; Female; Humans; Male; Middle Aged; Plants, Medicinal; Plants, Toxic; Prognosis; Rest

Topics: Adult; Aortic Valve Insufficiency; Atrial Fibrillation; Bicarbonates; Blood Proteins; Body Composition; Body Water; Body Weight; Bromine; Cardiac Complexes, Premature; Chlorides; Creatinine; Digitalis; Diuretics; Female; Heart Diseases; Heart Failure; Humans; Male; Middle Aged; Mitral Valve Insufficiency; Phytotherapy; Plants, Medicinal; Plants, Toxic; Potassium; Potassium Chloride; Potassium Isotopes; Sodium; Sodium Isotopes; Spironolactone; Tachycardia

Topics: Adult; Aged; Aortic Valve Insufficiency; Arrhythmia, Sinus; Atrial Fibrillation; Cardiac Volume; Digitalis; Electric Countershock; Electrocardiography; Female; Humans; Hypertension; Male; Middle Aged; Mitral Valve Stenosis; Myocardial Infarction; Plants, Medicinal; Plants, Toxic

Topics: Adult; Aged; Aortic Valve Insufficiency; Aortic Valve Stenosis; Arrhythmia, Sinus; Atrial Fibrillation; Cardiac Volume; Digitalis; Electric Countershock; Electrocardiography; Female; Heart Atria; Humans; Male; Methods; Middle Aged; Mitral Valve Insufficiency; Mitral Valve Stenosis; Plants, Medicinal; Plants, Toxic

Topics: Aged; Aortic Valve Insufficiency; Digitoxin; Digoxin; Ethacrynic Acid; Female; Furosemide; Heart Failure; Humans; Male; Middle Aged; Mitral Valve Insufficiency; Oxygen Inhalation Therapy; Pulmonary Heart Disease; Spironolactone

Topics: Animals; Aortic Valve Insufficiency; Aortic Valve Stenosis; Body Weight; Columbidae; Coronary Disease; Digitoxin; Heart Failure; Heart Rate; Heart Septal Defects, Atrial; Humans; Hypertension; Hyperthyroidism; Mitral Valve Stenosis; Pericarditis, Constrictive; Pulmonary Heart Disease