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Digoxin or verapamil or metoprolol for heart rate control in patients with mitral stenosis--a randomised cross-over
R C Ahuja1, N Sinha, R K Saran
1Department of Medicine, King George's Medical College, Lucknow, India.
Insights
Metoprolol and verapamil effectively improved symptoms in patients with mitral stenosis and normal sinus rhythm or atrial fibrillation. Drug efficacy correlated with heart rate control during rest and exercise.
Area of Science:
- Cardiology
- Pharmacology
Background:
- Isolated mitral stenosis can cause symptoms impacting quality of life.
- Heart rate control is crucial for managing symptoms in mitral stenosis patients.
Purpose of the Study:
- To evaluate the efficacy of digoxin, metoprolol, and verapamil in improving symptoms of isolated mitral stenosis.
- To determine the optimal drug choice for heart rate control in patients with normal sinus rhythm or atrial fibrillation.
Main Methods:
- Open randomized cross-over study involving 20 patients (10 with normal sinus rhythm, 10 with atrial fibrillation).
- Drugs evaluated: digoxin, metoprolol, and verapamil.
- Efficacy assessed via visual analog scale (subjective) and treadmill exercise test (objective).
Main Results:
- In sinus rhythm, metoprolol showed 90% subjective improvement, followed by verapamil (40%). Objective improvement (work done) was highest with metoprolol.
- In atrial fibrillation, verapamil yielded 80% subjective improvement, followed by metoprolol (40%). Objective improvement was highest with verapamil.
- Drug efficacy was linked to their ability to control heart rates at rest and during exercise.
Conclusions:
- Metoprolol and verapamil are effective in improving symptoms in patients with isolated mitral stenosis.
- The choice of drug for heart rate control should consider the patient's heart rhythm and the drug's effect on exercise capacity.
Abstract:
The effect and choice of a drug to control heart rate for symptomatic improvement in patients with isolated mitral stenosis with normal sinus rhythm (n = 10) or atrial fibrillation (n = 10) were studied. Digoxin (0.25-0.5 mg daily), metoprolol (50-100 mg twice a day) and verapamil (40-80 mg three times a day) were evaluated for this purpose. An open randomised cross-over design was followed. The efficacy of a drug was evaluated by: (1) subjective improvement on a visual analog scale, and (2) objective improvement on repeated multi-stage symptom-limited treadmill exercise. In patients with sinus rhythm greater than or equal to 50% subjective improvement was seen in 90%, 40% and nil with metoprolol, verapamil and digoxin, respectively. The total work done by these patients was 1008 +/- 541 kpm (control), 2869 +/- 1418 kpm on metoprolol, 2369 +/- 884 kpm on verapamil and 1654 +/- 918 kpm on digoxin. In patients with atrial fibrillation greater than or equal to 50% subjective improvement was seen in 80%, 40% and 30% with verapamil, metoprolol and digoxin, respectively. The total work done by these patients was 555 +/- 232 kpm (control), 1379 +/- 553 kpm on verapamil, 1251 +/- 575 kpm on metoprolol and 716 +/- 340 kpm on digoxin. The degree of improvement on a drug appeared to be a function of its ability to control resting and exercise heart rates in two different rhythms in these patients.(ABSTRACT TRUNCATED AT 250 WORDS)