Determination of alinidine in human plasma by high-performance liquid chromatography.

Influence of digoxin on sinus node function after pharmacologic autonomic blockade.

The effect of iv digoxin on normal sinus node function was studied after pharmacologic autonomic blockade (AB) in ten patients. Sinus cycle length (SCL), sinus node recovery time (SNRT) and sinoatrial conduction time (SACT) were determined before and after AB with propranolol (0.2 mg/kg body weight) and atropine sulfate (0.04 mg/kg body weight) iv, and 15 min, 30 min, and 45 min after 1 mg iv digoxin. AB resulted in a significant decrease (P less than 0.01) in SCL (916 +/- 158 to 716 +/- 120 ms), in SNRT (1,229 +/- 221 to 871 +/- 190 ms), and in SACT (79 +/- 34 to 44 +/- 10 ms). Fifteen minutes after iv digoxin there was no significant change observed in SCL (716 +/- 120 to 708 +/- 92 ms), …

Separation of left atrium from right pulmonary artery: a new echocardiographic sign of pericardial effusion.

We report a new echocardiographic sign of pericardial effusion in patients with pericardial effusion examined by the suprasternal approach. In normal individuals the right pulmonary artery is closely connected with the superior wall of the left atrium. A separation of these structures is only to be noticed during atrial contraction. In 12 of 17 patients with a pericardial effusion observed a separation of the left atrium from the right pulmonary artery ranging from 3 to 20 mm throughout the cardial cycle. We suggest that this echo-free zone represents fluid in the transverse pericardial sinus which is located between the two structures. In five patients with a small pericardial effusion (le…

Estimation of pulmonary arterial pressure by measuring the size of the right pulmonary artery in the suprasternal echocardiogram.

We studied 175 patients within 24 hr before cardiac catheterization with suprasternal echocardiography to evaluate whether pulmonary arterial hypertension can be derived by measuring the size of the right pulmonary artery. Group I consisted of 103 patients without pulmonary arterial hypertension (enddiastolic less than or equal to 12 mm Hg; mean pressure less than 20 mm Hg) and group II consisted of 72 patients with pulmonary arterial hypertension. The right pulmonary artery could be imaged in 91.2% of the patients studied. The size of the right pulmonary artery at the end of diastole in group I measured 17.9 +/- 0.2 mm (mean +/- SEM) and correlated best to the body surface area in this gro…

Anticoagulant Activity of the Enantiomers of Acenocoumarol in Man

For the mono-coumarin derivatives warfarin and phen-procoumon it was shown that in man and rats the S(−) enantiomer is several times more potent as anticoagulant than the R(+) enantiomer. These stereoselective differences in the anticoagulant potency reflect differences in the affinity for the receptor site rather than differences in the pharmacokinetics.

PLASMA CONCENTRATION-EFFECT RELATIONSHIP OF THE ANTIARRHYTHMIC AGENT LORCAINIDE

Lorcainide; II. Plasma concentration-effect relationship

Effect of intravenous flecainide on atrial vulnerability in man.

Sixteen patients were investigated by means of programmed atrial stimulation at two different driving rates: 100 and 120/min. All patients had an increased atrial vulnerability at both driving rates. After intravenous flecainide application (1 mg/kg body weight as a bolus followed by the same amount given by infusion over a period of 20 min) the increased vulnerability was abolished in 11 and 9 patients respectively. In the remaining patients the rate of induced atrial tachyarrhythmia decreased. These findings correlate with a significant prolongation of the effective refractory period of the right atrium and a significant shortening of the relative refractory period of the right atrium. It…

Haemodynamic effects of a single intravenous dose of lorcainide in patients with heart disease

The cardiovascular effects of a single i.v. dose (2 mg/kg over 5 min) of lorcainide were studied in 14 patients with heart disease. In the haemodynamic part of the study (6 patients), the aortic and pulmonary systolic, diastolic and mean pressures, left ventricular systolic and end-diastolic pressures, cardiac output and the rate of rise of left ventricular pressure were measured before and for 30 min after administration of the drug. Lorcainide produced a slight and short-lasting decrease in the aortic and pulmonary systolic pressures, and all other pressure values remained unchanged. The cardiac output and systemic vascular resistance were not altered by lorcainide. It consistently depres…

Wall motion characteristic of the right pulmonary artery in the suprasternal echocardiogram

This study describes the motion pattern of the right pulmonary artery (RPA) as it can be assessed from the suprasternal echocardiogram. The motion characteristic of the RPA is dependent on hemodynamic factors within the lumen of the RPA and those within the left atrium and the aortic arch. During atrial contraction the superior wall of the left atrium separates from the inferior wall of the RPA (IWRPA) and produces an "a" dip in the wall motion of the IWRPA. During isovolumic contraction the RPA is shifted upward (IC point). The incisura in the pulmonary artery pressure curve reflecting pulmonic valve closure can be seen by a sudden decrease in the diameter of the RPA (PC point). In conditi…

DISOPYRAMIDE-INDUCED INTRAHEPATIC CHOLESTASIS

Prognostic significance of repetitive ventricular response in chronic coronary artery disease.

A prospective study was conducted in 267 patients with angiographically defined coronary artery disease without documented ventricular tachycardia to determine the prognostic significance of repetitive ventricular response (RVR) after programmed electrical stimulation (PES). The patients were classified inducible if RVR with 3 or more echo beats (RVR greater than or equal to 3) could be induced. 89 patients without previous myocardial infarction (MI), 61 survivors of MI occurring between 6 weeks and 3 months before and 117 patients who had survived longer than 3 months after MI were studied. A standardized stimulation protocol with single (S1S2) and double (S1S2S3) extrastimuli during ventr…

Combined medical and mechanical recanalization in acute myocardial infarction

A technique of combined medical and mechanical recanalization was employed in 96 patients with acute transmural myocardial infarction. The mean time between onset of symptoms and admission to hospital was 170 +/- 65 min (X +/- SD). After 10 +/- 16 min, 250,000 U streptokinase was administered intravenously for 20 min. Intracoronary thrombolysis was commenced within 38 +/- 14 min. First coronary angiograms demonstrated reperfusion, an open vessel in 25/96 patients (26%). In 15/71 patients (21%) reperfusion occurred during thrombolysis therapy, before mechanical recanalization could be performed. Recanalization was achieved mechanically in 37/71 patients (52%) with occluded coronary vessels. …

Coronary artery bypass grafting in adult coronary artery disease due to suspected Kawasaki disease in childhood

Development of coronary artery aneurysms is one typical complication of Kawasaki disease and can cause coronary artery disease even in early childhood. Information about course and outcome in adults is rare. Here, we present a 49-year-old man with serious three-vessel coronary artery disease and giant coronary artery aneurysms following suspected Kawasaki disease.

Vulnerability of the right ventricle to cathodal, anodal, and bipolar stimulation at double diastolic threshold strength

The repetitive ventricular response (RVR) to three stimulation techniques (bipolar, cathodal and anodal) was investigated in 35 patients. 26 patients suffered from coronary heart disease and 9 patients from dilative cardiomyopathy. The stimulation study was performed at a ventricular driving rate of 120/min with one and two premature ventricular extrastimuli. We used rectangular impulses of 1.8 ms duration at duable diastolic threshold strength. RVR was scored as follows: 0: no RVR, 1: one nonstimulated RVR, 2: two nonstimulated RVR, 3: three nonstimulated RVR, 4: four to ten nonstimulated RVR, 5: more than ten nonstimulated RVR lasting less than 2 minutes, 6: sustained ventricular tachycar…

Echocardiography in assessing acute pulmonary hypertension due to pulmonary embolism.

Eighteen patients with acute pulmonary embolism were studied with right heart catheterization and M mode echocardiography. No patient had evidence of preexisting cardiopulmonary disease; pulmonary embolism was documented with pulmonary angiography. The mean pulmonary arterial pressure correlated with the angiographic severity index of embolic obstruction (r = 0.61, p 2 , p 2 ) and in 5 patients with acute pulmonary embolism and a mean normal pulmonary arterial pressure (10.9 ± 0.4 mm/m 2 ). For all measurements the index size of the right pulmonary artery correlated with the mean pulmonary arterial pressure (r = 0.84, p

SATURABLE PRESYSTEMIC ELIMINATION OF THE ANTIARRHYTHMIC DRUG LORCAINIDE

Kardiovaskuläre Effekte von Lorcainid, einer neuen antiarrhythmischen Substanz

Wir untersuchten die kardiovaskularen Effekte eines neuen und sehr wirksamen Antiarrhythmicums vom Lokalanasthetika-Typ. Folgende Parameter wurden wahrend einer diagnostischen Herzkatheteruntersuchung gemessen: Aortendruck, Pul- monalarteriendruck, Herzminutenvolumen, linksventrikularer Druck und dp/dt max. Nach i.v. Gabe von Lorcainid (2 mg/kg) kam es zu einer zeit- und dosisabhangigen Verminderung aller Kontraktilitatsindizes: dp/dt max. wurde maximal um 18.75% gegenuber der Ausgangslage reduziert. Alle Veranderungen waren bis zur 15. min nach Infusionsende maximal und zeigten innerhalb von 30 min eindeutige Ruckbildungstendenz. Der systolische Aortendruck, der linksventrikulare Druck, da…

Experience in the long term use of new antiarrhythmic drugs.

Meinertz et a1. (1984) investigated the long term efficacy and tolerability of flecainide in patients with ventricular arrhythmias. 15 patients were studied, 8 women and 7 men, aged 19 to 74 (mean 58.7) years, with more than 30 ventricular premature complexes (VPCs) per hour, and ventricular arrhythmias of Lown grade IVA or IVB. 11 had coronary artery disease and 2 had idiopathic dilated cardiomyopathy. Patients were excluded on the basis of sustained ventricular tachycardia (VT) [defined as ~ 3 consecutive beats at a rate of> 100 beats/min]; myocardial infarction within the last 6 months; unstable angina; severe congestive heart failure; or conduction abnormalities. Previously unsuccessful…

Autonome Blockade: Bedeutung in der elektrophysiologischen Diagnostik des kranken Sinusknotens

Die normale Sinusknotenfunktion ist von einer komplexen und ausgewogenen Interaktion zwischen intrinsischen elektrophysiologischen Eigenschaften des Sinusknotens und der sinuatrialen Leitung einerseits sowie von extrinsischen Faktoren andererseits abhangig [1]. Unter letzteren spielt das autonome Nervensystem die wichtigste Rolle. Vagale Stimulation oder Acetylcholin fuhren zu einer Senkung der Herzfrequenz und zu einer Verlangsamung der sinuatrialen Leitungszeit. Im Gegensatz dazu steigert Sympathikusstimulation oder Katecholamingabe die Herzfrequenz und verkurzt die sinuatriale Leitungszeit [2].

Lorcainide. I. Saturable presystemic elimination.