Serial M-mode echocardiography in evaluation of the cardiovascular effects of tiapamil and their relationship to plasma levels in patients with coronary heart disease

Tiapamil was effectively used in 32 surgical patients in the treatment of intra-and postoperative cardiac arrhythmias such as atrial fibrillation, supraventricular paroxysmal tachycardia and extrasystoles and in ventricular ectopic beats. In 28 patients aged between 38 and 82 years, bolus doses of 0.3-1.5 mg/kg were used. Before administration, hypoxaemia, hypercarbia, metabolic acidosis and electrolyte imbalances were excluded. Small doses of 0.3-0.5 mg/kg were only effective in patients with tachycardic atrial fibrillation. In most other arrhythmias the effective dose was between 1 and 1.5 mg/kg. In 4 surgical patients aged between 56 and 82 years, the continuous infusion of 12-25 mg/h (in 2 patients preceded by a bolus injection of 1 mg/kg) was effective in abolishing arrhythmias. In 18 healthy subjects, systolic time intervals were measured continuously and noninvasively before, during and for 9 min after 1 mg/kg tiapamil or 0.13 mg/kg verapamil, given intravenously according to a randomization schedule. Heart rate increased and systolic blood pressure decreased slightly but significantly. A significant improvement in myocardial function, with a decrease in PEP and PEP/LVET ratio, was found after both calcium antagonists. The effect of tiapamil on myocardial function lasted significantly longer than that of verapamil.

Section: Discussionsupporting

confidence: 58%

Effect of Tiapamil on Perioperative Cardiac Arrhythmias and Myocardial Function

List¹,

Metzler²

1982

“…Stauch et al [15], by using radionuclide ventriculography, after acute oral administration, observed no varia tions in enddiastolic volume, a reduction in ejection fractions at rest and an increase in ejection fractions during exercise. During chronic treatment, echocardiography is a use ful tool for assessing the drug influence on the left ventricular function, and the technique has been used for evaluating calcium antago nist drugs [ 16,17], During chronic treatment with gallopamil, Scrutinio et al [3] and Fisman et al [ 18] found no variations in ejection fractions and ventricular volumes in patients with a normal left ventricular function; the same result was obtained by Tartagni et al [19] using nuclear ventriculography. In our patients, though statistically significant, only a minimal variation in the enddiastolic diam eter was evident.…”

Section: Discussionsupporting

confidence: 55%

Gallopamil in Chronic Stable Angina: Antianginal Effect and Mechanism of Action

Zanolla¹,

Carbonieri²,

Rossi³

et al. 1992

A double-blind, placebo-controlled, cross-over trial of oral gallopamil was performed in 10 patients with stable angina. Gallopamil significantly increased mean exercise time and 1-mm ST time. The rate-pressure product was increased at 1 -mm ST time, but unmodified at the highest comparable work load and at peak exercise. The ST segment depression was significantly reduced both at the highest comparable work load and at peak exercise. Gallopamil proves safe and effective; the mechanism of its anti-ischemic effect seems to be due both to an increase in myocardial oxygen supply and to a reduction in myocardial oxygen demand.

“…In contrast, in 8 coronary patients. Lindvall et al [11] noted a decrease in systolic blood pressure only, on the 4th day of oral administration of 250 mg tiapamil three times a day. These authors found no change in either diastolic pressure or in heart rate.…”

Section: Discussionmentioning

confidence: 99%

Acute Hemodynamic Effects of Intravenous Tiapamil in Patients with Coronary Artery Disease

Bopp¹,

Mérier²,

Scheidegger³

et al. 1982

The acute hemodynamic effects of intravenous tiapamil were studied during heart catheterization in 19 patients with coronary artery disease (age range 41-66 years, mean 52.4 years). 10 subjects received an initial intravenous loading dose of 1 mg/kg followed by intravenous infusion of 50 µg/kg/min for 15 min. The other 9 patients received an initial intravenous dose of 1.5 mg/kg which was followed by an intravenous infusion of 75 µg/kg/min for 15 min.Tiapamil had little effect on heart rate, intracardiac pressures and left ventricular dp/dt_max. The ejection fraction increased, but not significantly. The most striking findings were an increase in cardiac output and a decrease in systemic vascular resistance. The overall results are consistent with the drug’s propensity to produce peripheral vasodilatation which outweighs its intrinsic negative inotropic property due to calcium antagonism in myocardial tissues.