Comparison of digoxin and dobutamine in patients with severe dilatative cardiomyopathy.

The hemodynamic effects of dobutamine were compared with those of digoxin in seven patients with severe diffuse dilatative cardiomyopathy. Dobutamine (7.5 micrograms per kg of body wt per min) was given intravenously for 30 min and then discontinued until hemodynamics returned towards base line. Digoxin (12.5 micrograms per kg) was then given intravenously and hemodynamics were recorded for 120 min. Thereafter, dobutamine was again given at the previous dose. Dobutamine increased cardiac and stroke volume index and decreased pulmonary occlusive (wedge) pressure and systemic vascular resistance without changing heart-rate or arterial pressure. Digoxin also increased cardiac and stroke volume index and decreased pulmonary wedge pressure and systemic vascular resistance with digoxin without changing arterial pressure. In contrast to dobutamine, heart-rate was decreased with digoxin indicating reduced myocardial oxygen demand. Re-infusion of dobutamine did not have any notable hemodynamic effect, with the exception of an increase in heart-rate-systolic pressure production. These data indicate that the positive inotropic properties of digoxin and dobutamine are not additive. Furthermore, concerning the effect of digoxin on the heart-rate, its use seems preferable to the use of sympathomimetic agents such as dobutamine, in patients with diffuse chronic dilatative myocardiopathy.

[Dehydration in the aged]. / Exsikkose im Alter.

UNLABELLED: The present study seeks to examine the question of the etiology, the diagnostic criteria and therapeutic consequences of exsiccosis in the elderly. The study includes 14 patients (9 males, 5 females) with an average of 76,8 +/- 4,8 years of age, all hospitalized because of dehydration. Following an exact diagnostic procedure a controlled therapy including a discontinuation of treatment was introduced in order to allow an evaluation of the development of dehydration. RESULTS: 1. The diagnosis of senile exsiccosis requires a synthesis of the patient's history, an exact physical examination and laboratory analysis. The central venous pressure (CVP) can be regarded as the most reliable parameter (it was lower than normal in 100% of the patients). There was a strikingly high incidence of increased mean corpuscular volume (MCV)-more than 105 rm3 in 86% of the cases. 2. The mean liquid-deficit of elderly patients with exsiccosis was 4,8 +/- 2,81. 3. The reason for the frequent incidence of exsiccosis in advanced age is to be found in a relative adipsia (the average daily deficit of liquid-intake was 815 +/- 47 ml per patient). Combined with a diminished renal concentration capacity (78,5% of the patients did not reach a specific weight of urine more than 1020 after a concentration test). 4. As a preventive measure, patients with tendency for exsiccosis should receive instructions as to the necessity of daily liquid-intake following exact balancing; furthermore regular weight-controls should be performed.