Shock accompanying myocardial infarction: Treatment with pressor amines

Hellerstein, Herman K.; Brofman, Bernard L.; Caskey, Walter H.

doi:10.1016/0002-8703(52)90262-7

Cited by 58 publications

(8 citation statements)

References 25 publications

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“…Basilar rales did not diminish M ith Neo-Synephrine therapy and, in fact, became more prominent. When the blood pressure became unobtainable, intravenous infusion of l-norepinephrine, 4 mg. per liter of 5 per cent glucose solution, was begun with an immediate response of blood pressure to 100/70 and an increase in intensity of heart tones. Eight hours later, auricular fibrillation developed.…”

Section: Resultsmentioning

confidence: 99%

Heart Force Effects of Sympathomimetic Amines as a Basis for Their Use in Shock Accompanying Myocardial Infarction

1953

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The treatment of 14 patients in severe shock accompanying myocardial infarction with l -norepinephrine (Levophed) in some cases and phenylephrine (Neo-Synephrine) in others demonstrated a significantly higher recovery rate with l -norepinephrine. Twelve of the patients were in congestive heart failure. Using strain-gage technics in fully conscious, trained dogs, l -norepinephrine was shown to produce substantial increments in heart contractile force in addition to its recognized pressor effects. Approximately equipressor doses of Neo-Synephrine under the same conditions had little effect on contractile force. These pronounced differences in heart force effects are presented as a basis for the difference in clinical results.

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Section: Resultsmentioning

confidence: 99%

Heart Force Effects of Sympathomimetic Amines as a Basis for Their Use in Shock Accompanying Myocardial Infarction

1953

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“…Because the ability to monitor bedside he modynamics was limited to blood pressure measured by arm cuff, the prevailing view in the early 1950's was that elevation of blood pressure with vasoconstrictors was the pri mary goal in the management of cardiogenic shock [4], However, advances in basic knowledge of autonomic pharmacology led to the clinical use of drugs that operated via specific receptors on the heart and blood ves sels. Among these were the alpha-adrenergic agonists, including methoxamine, a powerful vasopressor.…”

Section: The Early Periodmentioning

confidence: 99%

Management of Shock in Acute Myocardial Infarction: Changing Concepts; Past, Present and Future

Wd¹,

Am²

1987

Cardiology

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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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Shock accompanying myocardial infarction: Treatment with pressor amines

Cited by 58 publications

References 25 publications

Heart Force Effects of Sympathomimetic Amines as a Basis for Their Use in Shock Accompanying Myocardial Infarction

Heart Force Effects of Sympathomimetic Amines as a Basis for Their Use in Shock Accompanying Myocardial Infarction

Management of Shock in Acute Myocardial Infarction: Changing Concepts; Past, Present and Future

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

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