The Polarizing Treatment of Acute Myocardial Infarction

Sodi‐Pallares, Demetrio; Bisteni, A; Medrano, Gustavo A.; Testelli, Mario R.; Micheli, Alfredo de

doi:10.1378/chest.43.4.424

Cited by 115 publications

(19 citation statements)

References 6 publications

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“…A similar ineffectiveness has been observed when egress of myocardial potassium was induced by acetyl strophanthidin (10), so that the state of K+ transport in cardiac muscle may qualitatively modify the hormones' action on ion uptake. In the instance of ischemia, there is a qualitative restoration of the normal response of the cation to insulin during the production of hyperglycemia, associated with antiarrhythmic effects in agreement with an earlier report (27).…”

Section: Discussionsupporting

confidence: 91%

Ventricular Arrhythmias and K+ Transfer during Myocardial Ischemia and Intervention with Procaine Amide, Insulin, or Glucose Solution*

Regan¹,

Harman²,

Lehan³

et al. 1967

J. Clin. Invest.

118

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Abstract. To assess the relation of ventricular arrhythmias to myocardial Ki movement during ischemia, we placed an electrode catheter in the left anterior descending coronary artery for thrombus production in intact anesthetized dogs. 85Kr injections distal to the thrombus permitted serial coronary blood flow measurements. Animals of Group I with a moderate flow reduction exhibited no arrhythmia or myocardial egress of K+. In Group II, marked flow reduction was accompanied by an injury potential and loss of K+ from the ischemic site, before and during ventricular tachycardia.Therapeutic interventions were performed in animals having the same degree of ischemia as Group II. Systemic procaine amide in Group III interrupted the tachycardia and egress of K+, despite persistent ischemia. Group IV did not respond to intracoronary insulin with K+ uptake, as did normal dogs, and progressed to fibrillation. During the production of hyperglycemia in Group V, myocardial loss of Ki ceased with maintenance of sinus rhythm.Hemodynamic factors did not appear to have a major role in the genesis of the arrhythmia.Since intracoronary infusion of Ki in normal dogs similarly altered repolarization and produced fibrillation, it would appear that during ischemia egress of Ki before development of the arrhythmia indicates a major role of the ion in pathogenesis. This view is supported by the myocardial loss of K+ and arrhythmia induced in normal dogs by strophanthidin and by the fact that pharmacologic regulation of K+ loss is associated with correction of the arrhythmia, despite persistence of low blood flow.

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Section: Discussionsupporting

confidence: 91%

Ventricular Arrhythmias and K+ Transfer during Myocardial Ischemia and Intervention with Procaine Amide, Insulin, or Glucose Solution*

Regan¹,

Harman²,

Lehan³

et al. 1967

J. Clin. Invest.

118

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“…Thus, it would appear that the hemodynamic response to the glucose infusate was not dependent on enhanced osmolality of extracellular fluid. 2 Hemodvnamic response to ischemia. In the untreated animals the LV end-diastolic pressuire rose, the svstolic ejection phase parameters including stroke volume, ejection fraction and mean rate of fiber shortening declined over 4 h of ischemia.…”

Section: Resultsmentioning

confidence: 99%

“…The ideal intervention would enhance ventricular ftunction without evoking arrhvthmias or extending the area of ischemia. Glucose-insulin-potassium (GIK)1 appears to at least partially fulfill these criteria (2). The incidence of ventricular arrhythmias and fibrillation is reduced in the early period after the onset of experimental ischemia in intact animals with proximal occlusion of the left anterior descending artery (3,4).…”

Section: Introductionmentioning

confidence: 99%

Sustained effect of glucose-insulin-potassium on myocardial performance during regional ischemia. Role of free fatty acid and osmolality.

Ahmed¹,

Lee²,

Oldewurtel³

et al. 1978

J. Clin. Invest.

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A B S T R A C T To evaluate the influence of glucose infusate administered with insulin and potassium on left ventricular function during 4 h of ischemia, as well as mechanism of action, four groups of intact anesthetized dogs were studied. Acute crease of plasma FFA in contrast to controls which manifested a significant rise. To examine the postulate that the decrease in FFA was important to therapeutic action, a third group was infused wvith Intralipid (Cutter Laboratories, Inc., Berkeley, Calif.) and heparin, simultaneously with the glucose infusate, to effect an elevation of plasma FFA durinig ischenmia. Changes in myocardial function and electrolyte composition, as well as precordial electrocardiograimi mapping, were similar to that of animals receiving glucose alone. Because serum osmolalitv wvas increased approximately 40 mosmol during the glucose infusion, the potential role of' hyperosmolalitv was assessed by infusion of 20% mannitol during acute ischemia in a fourth group. After a transient small increase, there was a moderate decline in ftunction by 4 h, suggesting that the response to glucose is not dependent upon extracellular osmolality. Thus, it is concluded that dutring the initial hours after the onset of myocardial ischemia the gltucose infusate improves ventricular performance without evidence of arrhythmia induction or intensification of isclemiiic injury. Evoltution of irreversible necrosis appears to be delayed rather than prevented uinder the circumilstances of this study.

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“…12 The preceding decade witnessed the introduction of polarizing solutions for the prevention of ventricular arrhythmias and other electrophysiological sequellae of acute myocardial ischemia. 3 " 8 It was reasoned that glucose, insulin, and potassium (GIK) would restore intracellular potassium, extruded by the ischemic lesion from myocardial cells into the extracellular compartment. 9 Since potassium is a key ion in membrane polarization, it was assumed that the electrophysiological effects of GIK were mediated by changes in potassium metabolism.…”

Section: Influence Of Glucose Insulin and Potassium On Vulnerabilitmentioning

confidence: 99%

Influence of glucose, insulin, and potassium on vulnerability to ventricular fibrillation in the canine heart.

Obeid¹,

Verrier²,

Lown³

1978

Circulation Research

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SUMMARY We studied the influence of glucose (G), insulin (I) and potassium (K + ) on vulnerability to ventricular fibrillation (VF) of the nonischemic canine myocardium. Vulnerability was assessed by determining VF and repetitive extrasystole (RE) thresholds with a single stimulus applied to the right ventricular endocardium during the vulnerable period. Electrical testing of the heart was performed before and after 1 and 2 hours of infusing G (10 mg/kg per min) and I (0.025 U/kg per min) with and without K + . Infusion of glucose, insulin, and potassium (GIK) in 11 dogs significantly increased both VF (22%) and RE (33%) thresholds within the 1st hour and only the VF threshold (64%) in the 2nd hour. No significant changes in serum K + concentration occurred. Spontaneous termination of VF was observed in six dogs during GIK infusion. Glucose and insulin infusion increased both VF and RE thresholds within the 1st (17% and 19%) and 2nd hours (43% and 43%). This occurred despite substantial reductions in serum K + concentration. Lowering serum K + by hemodialysis in six dogs decreased both VF and RE thresholds within the 1st (33% and 32%) and 2nd hours (35% and 14%). Restoration of the serum K + concentration by KC1 infusion while maintaining dialysis returned the thresholds to control values. In six dogs, insulin infusion during low K + dialysis increased the VF and RE thresholds despite a further reduction in serum K + concentration. We concluded that insulin exerts a protective effect against vulnerability to VF in the normal canine heart. This salutary action is most marked when the drug's hypokalemic effect is prevented by concomitant K + infusion.

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The Polarizing Treatment of Acute Myocardial Infarction

Cited by 115 publications

References 6 publications

Ventricular Arrhythmias and K+ Transfer during Myocardial Ischemia and Intervention with Procaine Amide, Insulin, or Glucose Solution*

Ventricular Arrhythmias and K+ Transfer during Myocardial Ischemia and Intervention with Procaine Amide, Insulin, or Glucose Solution*

Sustained effect of glucose-insulin-potassium on myocardial performance during regional ischemia. Role of free fatty acid and osmolality.

Influence of glucose, insulin, and potassium on vulnerability to ventricular fibrillation in the canine heart.

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