ABSTRACT
The acute hemodynamic effects of combining administration of digoxin (DIG)(0.01 mg/kg intravenously) with molsidomine (MLS)(4 mg sublingually) were compared with those of DIG and MLS considered alone in 12 patients with congestive heart failure following acute myocardial infarction. The patients were classified into two subgroups, A (cardiac index [CI] less than or equal to 2.2 L/min/m2 and B (CI greater than 2.2 L/min/m2), to verify differences between the responses to the three drug regimens. MLS significantly reduced systolic blood pressure from 121.2 +/- 12.3 (mean +/- SD) to 111.7 +/- 10.9 mm Hg (p less than 0.01) after 60 min, mean right atrial pressure (RAP) from 6.2 +/- 3.6 to 2.4 +/- 2.1 mm Hg (p less than 0.0001), mean pulmonary arterial pressure (PAP), left ventricular filling pressure (LVFP) from 20.6 +/- 2.1 to 12.2 +/- 2.8 mm Hg (p less than 0.0001), and pulmonary vascular resistance (PVR). Left ventricular stroke work index (LVSWI) significantly increased after 60 min. DIG induced a significant reduction in heart rate, RAP, PAP, and LVFP from 20.1 +/- 2 to 14.3 +/- 2.7 mm Hg (p less than 0.0001) after 90 min. Stroke volume index (SVI) increased from 24.7 +/- 4.2 to 27.7 +/- 3.1 ml/beat/m2 (p less than 0.001) and LVSWI from 25.9 +/- 7.2 to 31.9 +/- 5.4 g X m/m2 (p less than 0.0001). The combination of DIG and MLS produced a reduction in RAP, PAP, and LVFP greater than that achieved with either agent alone, with a further shift of the ventricular function curve to the left, thereby leading to an improvement in cardiac performance.(ABSTRACT TRUNCATED AT 250 WORDS)
Subject(s)
Digoxin/therapeutic use , Heart Failure/drug therapy , Hemodynamics/drug effects , Oxadiazoles/therapeutic use , Sydnones/therapeutic use , Vasodilator Agents/therapeutic use , Aged , Drug Therapy, Combination , Female , Heart Failure/etiology , Humans , Male , Middle Aged , Molsidomine , Myocardial Infarction/complicationsSubject(s)
Digoxin/therapeutic use , Heart Failure/drug therapy , Hemodynamics/drug effects , Nifedipine/therapeutic use , Pyridines/therapeutic use , Aged , Blood Pressure/drug effects , Cardiac Output/drug effects , Digoxin/pharmacology , Drug Therapy, Combination , Female , Humans , Male , Middle Aged , Mitral Valve Insufficiency/drug therapy , Nifedipine/pharmacology , Stroke Volume/drug effects , Vascular Resistance/drug effectsSubject(s)
Isosorbide Dinitrate/administration & dosage , Myocardial Infarction/drug therapy , Acute Disease , Aged , Electrocardiography , Female , Heart/drug effects , Hemodynamics/drug effects , Humans , Isosorbide Dinitrate/pharmacology , Male , Middle Aged , Myocardial Infarction/complications , Myocardium/pathology , Necrosis , VectorcardiographyABSTRACT
A case of myotonic dystrophy accompanied by alveolar hypoventilation and hypersomnia is presented. Radiological studies and EMG examination of the intercostal muscles demonstrated that the respiratory muscles were affected by the disease, while polygraphic recordings showed that the alveolar hypoventilation and pulmonary hypertension worsened during sleep. The hypersomnia preceded the appearance of clinical signs of the muscular disease by many years and persisted even after treatment when the blood gas analysis values were greatly improved. During both diurnal and nocturnal sleep, the patient frequently fell asleep directly into a REM stage. The possibility is discussed that, concomitant with the respiratory musculature involvement, there is an alteration in the central nervous system in myotonic dystrophy which is at least partially responsible for both the alveolar hypoventilation and the hypersomnia.
