Restoration of sinus rhythm in experimental and clinical ventricular arrhythmias by methoxamine hydrochloride

Brill, I. C.; Krueger, James D.; McCawley, Elton L.

doi:10.1016/0002-9149(59)90215-2

Cited by 13 publications

(2 citation statements)

References 11 publications

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“…Evidence has been strengthened in support of single supraventricular focus by case reports of paroxysmal bidirectional ventricular tachycardia that were abruptly abolished by carotid sinus stimulation (Hellman and Lind, 1956;Schwartz and de Sola Pool, 1950;Brill, Krueger, and McCawley, 1959) and Valsalva manceuvre (Velasquez and Kelser, 1957). They concluded that the focus was of supraventricular origin because vagal stimulation had no effect on ventricular ectopic foci.…”

Section: Discussionmentioning

confidence: 99%

Experimental Bidirectional Ventricular Tachycardia in the Dog

Mehta¹,

Sharma²

1964

Heart

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Bidirectional ventricular tachycardia is an uncommon cardiac arrhythmia and reports of only 50 cases have hitherto been published. Levy and Lewis (1911) were the first to notice this arrhythmia during their experimental work on cats, while Schwensen (1922) (1) With diastolic intervals equal to those of regular rhythm but with the QRS complexes always alternating in direction.(2) With alternation of longer and shorter diastolic intervals as well as that of QRS configurations. In this variety the interval between the complexes that resemble each other is usually equal, and between those that do not resemble each other it is unequal.(3) With the length of the diastole as well as the shape of the ventricular complexes varying irregularly.Its genesis is a subject of considerable uncertainty, as many as seven theories having been postulated to explain its mechanism. No experimental work on this matter, or on the manner of production of the arrhythmia has been found in earlier publications on this subject. MATERIAL AND METHODS Ventricular ectopic arrhythmiaswere produced by adrenaline hydrocarbon in 200 mongrel dogs, according, to the method described by Riker et al. (1955). In our experiments it consisted in anesthetizing mongrel dogs with pentobarbital 30 mg./kg. intravenously, artificial respiration being instituted by a tracheal injection of 0 1 ml./kg. of petroleum ether followed by intravenous injection of 30 ,ag./kg. of adrenaline. The arrhythmias were usually ventricular in origin.Electrocardiographic tracings of 30 experiments out of 200 showed bidirectional ventricular tachycardia and they were selected for the purpose of this study. Of these 30 animals, 20 were male and 10 were female. Their weights ranged from 4 to 16 kg. with an average of 7 kg. All the tracings were recorded on a Grass ink-writing oscillograph machine and were analysed in detail particularly from the point of view of explaining the mechanism of this arrhythmia. RESULTSThe ventricular arrhythmias comprised irregular ventricular ectopic activity, ventricular tachycardia, ventricular fibrillation, and ventricular premature beats. In 30 experiments (1 5%y) the electrocardiogram showed bidirectional ventricular tachycardia. The detailed analysis of the representative patterns of this arrhythmia, observed during the course of this study, are described below.

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Section: Discussionmentioning

confidence: 99%

Experimental Bidirectional Ventricular Tachycardia in the Dog

Mehta¹,

Sharma²

1964

Heart

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“…None of the patients we have described were hypotensive nor was there evidence of reduced cardiac output between the episodes of ventricular arrhythmia. Brill, Krueger, and McCawley (1959) noted that methoxamine, whose action is mediated via alpha receptors, would suppress ventricular ectopics in normotensive patients by raising their systemic blood pressure to hypertensive levels. Similarly, Kravetz, Kagan, and Frement (1962) described the use of metaraminol to terminate ventricular tachycardia in a normotensive patient whose pressure rose to 194/120 mm.…”

Section: Discussionmentioning

confidence: 99%

Use of isoprenaline as an antiarrhythmic agent after valve replacement surgery.

Gunning¹,

Shanahan²,

Windsor³

1969

Heart

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The sympathomimetic drugs are generally considered to increase cardiac automaticity, thus predisposing to ventricular ectopic beats, ventricular tachycardia, and ventricular fibrillation (Foster, 1966;Hellerstein, Brofman, and Caskey, 1952). This paper describes the use of isoprenaline, a sympathomimetic drug, as an antiarrhythmic agent in three patients. These patients were having recurrent ventricular tachycardia and ventricular fibrillation in the early post-operative period after cardiac valve replacement. CASE REPORTS Case 1. A married woman, aged 53 years, had become increasingly breathless over 10 years. This was accompanied by lethargy and recurrent bronchitis and orthopnoea. The clinical signs of mitral stenosis, aortic stenosis and incompetence, and tricuspid incompetence were present. Chest x-ray showed biventricular and left atrial enlargement, increased pulmonary vascular markings, and septal lymphatic lines. Electrocardiogram showed atrial fibrillation and left ventricular hypertrophy. Cardiac catheterization and cine-angiography confirmed the clinical diagnosis. Both the mitral and aortic valves were calcified.Aortic replacement with a No. 8 Starr-Edwards prosthesis, mitral commissurotomy, and tricuspid valve annuloplasty were performed. Two hours after operation carried out on January 26, 1967, the electrocardiogram showed atrial fibrillation with ventricular bigeminy (Fig. A). Serum potassium was 2-0 mEq/litre, and 50 mEq potassium were given by infusion in the following 3 hours. After this ventricular bigeminy ceased. Serum potassium 5 hours after operation was 3-3 mEq/ litre. Four hours later ventricular bigeminy again developed and was followed by short episodes of ventricular tachycardia and fibrillation which reverted spontaneously (Fig. B). Procainamide 500 mg. intravenously, and 40 mEq/litre potassium by intravenous infusion were given. An hour later ventricular fibrilla-83 tion occurred and in the subsequent 90 minutes, 50 defibrillations were performed. Procainamide 500 mg. was repeated and lignocaine 40 mg. was given at 10-minute intervals for 5 doses without effect. Between episodes of ventricular fibrillation, the cerebral state was lucid and the systemic blood pressure was 115/70 mm. Hg. An hour later an isoprenaline infusion, 1 mg. in 500 ml. 5% dextrose in water, was begun. Almost immediately the episodes of ventricular arrhythmia ceased. Blood pressure remained at 120/80 mm. Hg. Two hours later episodes of ventricular tachycardia recurred followed by ventricular fibrillation requiring electric countershock When the rate of the isoprenaline infusion was increased, the arrhythmias ceased (Fig. C). Between 17 hours and 21 hours after the operation 100 defibrillations were necessary. During this period, isoprenaline infusion, 2 mg. in 500 ml., was continued. Other treatment included an infusion of lignocaine 300 mg., digoxin 0 5 mg. intravenously, procainamide 500 mg. intramuscularly six-hourly, and potassium 10 mEq/litre/hour intravenously. Subsequent serum potassium estimations were...

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Antiarrhythmic Compounds

Szekeres

Papp

1968

Progress in Drug Research / Fortschritte Der Arzneimittelforschung / Progrès Des Recherches Pharmaceutiques

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Restoration of sinus rhythm in experimental and clinical ventricular arrhythmias by methoxamine hydrochloride

Cited by 13 publications

References 11 publications

Experimental Bidirectional Ventricular Tachycardia in the Dog

Experimental Bidirectional Ventricular Tachycardia in the Dog

Use of isoprenaline as an antiarrhythmic agent after valve replacement surgery.

Antiarrhythmic Compounds

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