ABSTRACT
Enoximone is a selective inhibitor of phospho-diesterase- III enzyme [PDE-III] and possesses positive inotropic and vasodilatory effects
Methods: a total of 36 patients undergoing elective coronary by pass grafting [CABG] was done from March 2004 to December 2005 at National Heart Institute. Prospectively collected data concerning parameters of coagulation were analysed to determine the influence effect of enoxirnone of hemostasis. 18 patients receiving enoximone in the following ways were compare to a control group [18 patients]. Parameters of coagulation were studied following a single bolus dose injection [0.5 mg/kg] and during a continuous infusion after bolus dose at dose [5 and 10 [micro]g/kg/min]. This parameters we studied before operation, at end of operation and 6hi after operation
Results : no difference between study and control groups was found for the parameters of coagulation during the investigation period
Conclusion : enoximone can be judged to be safe in respect to its effects on coagulation, even at relatively high doses
ABSTRACT
Cardiogenic shock is the severest clinical expression of left ventricular failure due to extensive damage of the myocardium [at least 40% of LV mass is affected] in more than 80% of AM patients in whom it occurs and the remainder have a mechanical defect such as VSD or papillary muscle rupture or predominant RV infarction. The challenge for the clinician is to promptly and thoroughly identify the patients at risk for developing cardiogenic shock; and so, preventive measures may be implemented in an attempt to avert the development of cardiogenic shock. This study was performed to develop clinical and biochemical criteria to predict the occurrence of cardiogenic shock in AMI patients who were treated with thrombolytic therapy [streptokinase] within 24 hours from the onset of chest pain. Sixty [60] patients with AMI who were treated by thrombolytic therapy [streptokinase] were included in this study. All patients were subjected to; complete history taking and full clinical examination; resting 12 leads surface ECG; laboratory investigations [serum level of total CPK and CK-MB measured daily for at least 48 h., random blood sugar, fasting lipid profile, serum level of sodium and potassium, serum level of urea and creatinine, acute phase reactants as [erythrocyte sedimentation rate [ESR], total leucocytic count, C-reactive protein [CRP]]]; and echocardiography. The sixty patients were divided into 2 groups; Group A, which included 30 patients with AMI who were treated by thrombolytic therapy and developed cardiogenic shock and Group B, which included 30 patients with AMI who were treated by thrombolytic therapy and did not develop cardiogenic shock. A statistical comparison was held between group A and group B. Which revealed that the mean age in group A was 63 +/- 6.51 year, while; in group B was 45 +/- 5.04 year which is highly significant between the two groups [P<0.01 [HS]]. Also; This study revealed that patients who were female gender; obese; diabetic; had previous history of AMI; extensive anterior MI and anterior MI; past history of hypertension; family history of IHD; heart rate [>124]; Killip classes [II or III]; systolic blood pressure < 100 mmHg; ejection fraction of the left ventricle < 42% and C-reactive protein level >35 mg/L in the first few hours on presentation are predictors of development of shock after thrombolytic therapy. In this study; patients presented with extensive anterior MI were associated with a greater reduction in left ventricular ejection fraction [LVEF] and more reduction in SBP and presented to emergency room [ER] by Killip class II and III and were diabetic more than patients presented with other types of MI locations and they had worse prognosis [cardiogenic shock]. It is possible to estimate with accuracy the risk of shock. A simple criteria that can predict the risk of cardiogenic shock after thrombolytic therapy for AMI patients who did not present with shock based primarily on the older age of the patient [above 63 year] and findings easily derived from the physical examination upon presentation such as female sex, diabetic, prior MI, anterior MI or extensive anterior MI, systolic blood pressure < 100 mmHg, heart rate >124 beat/min., Killip class [II and III] and left ventricle ejection fraction < 42% and the laboratory data such as serum level of C-reactive protein >35mg/L