ergoline and Heart-Failure

Hyperthyroidism is an important inducing factor in patients with atrial fibrillation, and may trigger heart failure. Thyrotropin (thyroid stimulating hormone, TSH)-secreting pituitary tumors are rare causes of hyperthyroidism. Here, we report a 66-year-old man with a pituitary TSH-secreting tumor who presented with hyperthyroidism and congestive heart failure. Endonasal trans-sphenoidal pituitary adenomectomy was performed. After the operation, the symptoms of hyperthyroidism and congestive heart failure were relieved, associated with normalization of thyroid function tests. Unfortunately, hand tremor and progressively elevated free T4 and TSH concentrations recurred 5 months after surgery. A dopaminergic agonist, cabergoline was administered and euthyroidism was restored for at least 11 months.

Topics: Aged; Cabergoline; Dopamine Agonists; Ergolines; Follow-Up Studies; Heart Failure; Humans; Male; Pituitary Neoplasms; Thyrotropin

A potential risk of heart failure was recently observed in randomized trials of the dopamine agonist pramipexole. The extent of the risk with this and other dopamine agonists is unknown.. We used the UK General Practice Research Database (GPRD) to identify all users of anti-parkinsonian drugs, 40-89 years of age, between 1997 and 2009. All incident heart failure cases were identified and classified as probable or possible on the basis of their treatment and mortality. Using a nested case-control approach, each case was matched with up to 10 controls selected among the cohort members. Incidence rate ratios (RR) of heart failure associated with the current use of dopamine agonists were estimated using conditional logistic regression, adjusted for covariates.. The cohort included 26,814 users of anti-parkinsonian drugs, with 783 newly diagnosed with heart failure during follow-up (rate 8.7 per 1000 per year). The incidence rate of heart failure was increased with the current use of any dopamine agonist (RR = 1.58, 95% CI = 1.26-1.96), and particularly so for pramipexole (RR = 1.86, 95%CI = 1.21-2.85) and cabergoline (RR = 2.07, 95%CI = 1.39-3.07), compared with no use. The increase was not significant with ropinirole (RR = 1.23, 95%CI = 0.85-1.97) or pergolide (RR = 1.42, 95%CI = 0.95-2.12). Pramipexole was not associated with a significantly increased rate when compared with all other dopamine agonists collectively (RR = 1.28, 95%CI = 0.82-2.00).. The use of dopamine agonists, especially pramipexole and cabergoline, is associated with an increased risk of heart failure.

Topics: Adult; Aged; Aged, 80 and over; Antiparkinson Agents; Benzothiazoles; Cabergoline; Case-Control Studies; Databases, Factual; Dopamine Agonists; Ergolines; Female; Heart Failure; Humans; Incidence; Logistic Models; Male; Middle Aged; Pramipexole; Risk; United Kingdom

Cabergoline, an ergot-derived dopamine receptor agonist, is used widely in the treatment of Parkinson's disease (PD) and hyperprolactinemia, but may cause heart valve fibrosis, retraction, and clinically significant regurgitation in PD patients. While cabergoline has been used at much lower doses in patients with hyperprolactinemia, controversy persists as to whether it may cause heart valve disease in this situation. Cabergoline is also used in acromegaly at doses similar to those used in hyperprolactinemia. The case is reported of a female patient with acromegaly who had been taking low-dose (0.5 mg/day) cabergoline for one year, and presented with signs and symptoms of right-sided heart failure. Echocardiography revealed a thickened and retracted tricuspid valve associated with severe tricuspid regurgitation and enlargement of the right-heart chambers. The morphology of the tricuspid valve was typical for cabergoline-related valvulopathy. Cabergoline may not be totally safe even at lower doses, and close echocardiographic monitoring is recommended in patients receiving cabergoline treatment, regardless of the dose level employed.

Topics: Acromegaly; Cabergoline; Diuretics; Echocardiography, Doppler, Color; Ergolines; Female; Furosemide; Heart Failure; Hormone Antagonists; Humans; Middle Aged; Severity of Illness Index; Treatment Outcome; Tricuspid Valve Insufficiency

We experienced 2 patients of valvular heart disease in Parkinson's patients taking cabergoline. Patient 1 was a 79-year-old woman who began taking 4 mg cabergoline daily after being diagnosed with Parkinson's disease (PD) in June 2003. She presented with dyspnea in November 2005. The patient had cardiomegaly, pulmonary congestion, and pleural effusion, and an echocardiogram showed valvular heart disease in the form of aortic regurgitation (AR) (grade I), tricuspid regurgitation (TR) (grade I), and mitral regurgitation (MR) (grade III). Cabergoline was thought to have caused these phenomena, so it was replaced with pramipexole, and after administration of diuretics and angiotensin-converting enzyme inhibitors (ACEIs) the patient's symptoms gradually disappeared. MR, AR and TR also disappeared 3 months later. Patient 2 was a 74-year-old woman who presented with sluggish movement in April 2001 and subsequently developed Parkinson's. While being administered 700 mg levodopa (Menesit) and 4 mg cabergoline, the patient presented with shortness of breath in April 2005. An echocardiogram showed valvular heart disease in the form of MR (grade I) and TR (grade I). Heart function improved with the administration of diuretics. However, heart function again worsened in November 2005, and the patient presented with edema of the lungs and lower limbs. An echocardiogram in January 2006 showed worsening MR (grade III) and TR (grade II), and the patient also had pulmonary hypertension. ACEIs were administered along with diuretics and cabergoline was replaced with pramipexole, but the patient also developed malignant syndrome and disseminated intravascular coagulation (DIC) and later died. Patient 2 is the first case in Japan of death due to heart failure caused by the side effects of cabergoline. Caution is usually needed when treating a Parkinson's patient for valvular heart disease due to a dopamine agonist, and periodic checks for heart murmurs and echocardiography are crucial. When signs of heart failure develop during treatment with an ergot preparation of dopamine agonist, it is essential to immediately either stop the administration of the ergot preparation or change to a non-ergot preparation of dopamine agonist.

Topics: Aged; Antiparkinson Agents; Cabergoline; Ergolines; Fatal Outcome; Female; Heart Failure; Heart Valve Diseases; Humans; Parkinson Disease

The acute haemodynamic effects of an alpha-blocking vasodilator, nicergoline, observed during cardiac catheterisation were studied in 9 babies and 1 infant (mean age 11 months) with severe cardiac failure due to a large left-to-right interventricular shunt. Nicergoline was administered intravenously at a dose of 0.05 mg/kg/mn to 0.2 mg/kg/mn to lower mean systemic blood pressure by at least 10 mmHg. No significant changes in heart rate or in right and left atrial pressures were observed. On the other hand, mean systemic and pulmonary arterial pressures fell by 16% (p less than 0.001) and 13% (p less than 0.01) respectively. The ratio of pulmonary and systemic flow (Qp/Qs) decreased in 8 patients by an average of 21% (p less than 0.002). This fall was accompanied by a parallel reduction in oxygen concentrations of pulmonary arterial blood (16%) compared with mixed venous blood. However, the Qp/Qs ratio increased in the other 2 patients by over 50%. In the group of 8 patients in which the left-to-right shunt decreased, the ratio of pulmonary to systemic resistance (Rp/Rs) increased by 33% (p less than 0.002) whilst this value fell by 36% in the 2 patients in whom the volume of the shunt increased. There were no discriminatory parameters between the two groups with regards to age, pulmonary artery pressures, the volume of the shunt (Qp/Qs) or level of pulmonary resistances (Rp/Rs) to explain the variability of the therapeutic response on the left-to-right shunt.(ABSTRACT TRUNCATED AT 250 WORDS)

Topics: Cardiac Catheterization; Child, Preschool; Ergolines; Heart Failure; Heart Septal Defects; Hemodynamics; Humans; Infant; Nicergoline

Topics: Adult; Aged; Ergolines; Female; Heart Failure; Hemodynamics; Humans; Nicergoline