ABSTRACT
Plasma catecholamine (adrenaline, noradrenaline and dopamine) concentrations have been measured in 48 patients within 6 hours of the onset of symptoms of an acute myocardial infarction. The concentrations of all three catecholamines were elevated, and there were positive correlations between plasma noradrenaline concentrations and the severity of infarct as assessed by the coronary prognostic index and serum LDH levels. Plasma glucose, free fatty acid, lactate and cortisol levels were elevated while insulin levels were reduced. The site of infarction did not influence the pattern of hormonal and metabolic responses although heart rate was significantly lower in the inferior than in the anterior infarct group. Seven patients went into ventricular fibrillation shortly (less than 1.8 h) after blood sampling. Plasma catecholamine concentrations were markedly elevated in these patients with levels similar to those previously reported after cardiac arrest.
Subject(s)
Catecholamines/blood , Myocardial Infarction/blood , Adult , Aged , Blood Glucose/analysis , Dopamine/blood , Epinephrine/blood , Female , Humans , Hydrocortisone/blood , Insulin/blood , Lactates/blood , Male , Middle Aged , Myocardial Infarction/pathology , Myocardium/pathology , Norepinephrine/blood , Time FactorsABSTRACT
Plasma catecholamine concentrations in cardiac arrest (ventricular fibrillation and asystole) are significantly higher than after myocardial infarction. The levels reached are well above those normally required to stimulate cardiac activity. Possible reasons for the failure of the myocardium to respond to the catecholamines are discussed and the rationale for giving more catecholamines is questioned.
Subject(s)
Catecholamines/blood , Heart Arrest/blood , Myocardial Infarction/blood , Adult , Aged , Blood Glucose , Dopamine/blood , Epinephrine/blood , Fatty Acids, Nonesterified/blood , Female , Humans , Hydrocortisone/blood , Insulin/blood , Lactates/blood , Male , Middle Aged , Norepinephrine/bloodABSTRACT
A prospective controlled trial involving over 1000 patients did not reveal any difference between four drugs commonly used in accident and emergency departments for the relief of mild to moderate pain. There were no significant variations in therapeutic effect, side-effects or patient compliance. When considering the supply of analgesics which may be no more potent than those available without prescription from retail chemists, cost and safety are more important than analgesic effect. By restricting the choice of analgesics available, the accident and emergency department should be able to increase awareness among its staff of the actions and side-effects of a small number of prescribed drugs and to contain costs.
