ABSTRACT
Se ha demostrado efectos cronótropos e inótropos negativos de los ácidos biliares (AB). Sin embargo, se sabe que éstos pueden aumentar la concentración de calcio intracelular, sugiriendo una acción estimulante sobre el corazón. Por esta razón se investigó posibles efectos estimulantes de los AB sobre automatismo y contractilidad cardíaca. En preparaciones sinoatriales con actividad espontánea se estudiaron los efectos de AB sobre la frecuencia sinusal (FS) y en músculos papilares estimulados a frecuencias constantes se analizaron las acciones sobre fuerza contráctil. Los ácidos cólico y taurocólico disminuyeron la FSde forma similar a todas las concentraciones usadas. Se sugiere que el efecto cronótropo negativo es debido, por lo menos en parte, a una disminución de la corriente Isi y a un aumento de la corriente Ik. Sin embargo, no es posible descartar acciones sobre otras corrientes iónicas en especial If. Ambos ácidos tuvieron efecto inótropo positivo que puede deberse a inhibición de la ATPasa sodio-potasio, aunque no es posible descartar la existencia de otros mecanismos. En resumen, lo AB tienen efectos sobre el automatismo del nódulo sinusal y la contractilidad miocárdica que permite considerarlos como agentes digitalis-like
Subject(s)
Animals , Rats , Bile Acids and Salts/pharmacokinetics , Myocardial Contraction , Electrophysiology , Digitalis , Heart Rate , Rats, Sprague-Dawley/physiologyABSTRACT
The benefits of digoxin in patients with atrial fibrillation may be reduced due to its limited effect on atrioventricular conduction. The aim of this work was to compare digoxin and etanolol on functional class, resting and exercise heart rate and exercise capacity in patients with atrial fibrillation. Thirteen subjects with this condition, normal echocardiographic left ventricular function and size, a resting heart rate less than 80 beats/min and with no contraindication for beta blocker or digoxin use, were studied. Patients were randomly assigned to receive initially digoxin 0.25 mg. o.d. or atenolol 100 mg o.d. in a double blind fashion. The doses were sdjusted to obtain a heart rate between 60 and 80 beats-min at the end of the first week of treatment. After 2 weeks of treatment, outcomes were assessed, patients were left without treatment for one week and crossed over to the other drug after that. Resting heart rates achieved with digoxin and atenolol were similar (67ñ11 and 65ñ23 beats/min respectively). However, maximal exercise heart rates and maximal exercise time were higher during digoxin treatment (166ñ23 vs 135ñ27 beats/min and 9.95ñ1.68 vs 8.5ñ2 min respectively). NYHA functional class deteriorated in 3 patients receiving atenolol. We conclude that atenolol achieves a better control of heart rate during exercise but also reduces maximal exercise capacity