No abstract

1 The haemodynamic effects of ibopamine, an oral dopamine derivative, were studied in eight patients with left ventricular dysfunction using invasive catheterisation techniques. 2 An early rise was seen in the mean right atrial pressure (P < 0.05), the mean capillary wedge pressure (P < 0.01) and the mean pulmonary arterial pressure (P < 0.001) which occurred at 15 min and persisted for 30 min.3 A second, later, positive chronotropic effect was seen as an increase in the heart rate (P < 0.05) at 45 min with an increased cardiac output (P < 0.05) persisting above baseline values at 1 h, but with no change in stroke volume. 4 These results support a biphasic mode of action for ibopamine which may be explained by a time phase difference in a-and P-adrenoceptor stimulatory effects.

Rapid access chest pain clinics are expanding across the country with marked resource implications despite a paucity of data regarding their efficacy. Early assessment of patients in this manner potentially delays review of patients referred via the traditional route. We conducted a prospective observational study of patients referred with chest pain to the Cardiology Outpatient Department over a four-week period in a District General Hospital to compare demographics and outcomes in patients referred to the rapid access with those referred to the general cardiology clinics. There were no significant differences in baseline demographics, exercise test result or clinic outcome. Both populations were low risk. Discussion is needed between primary and secondary care to achieve a consensus as to the purpose of a rapid access system and how best to utilise the service appropriately. Further studies are required to assess the efficacy and health economics of this system.