Related Experiment Videos
[Early digitalisation of patients with arterial hypertension (author's transl)]
Insights
Beta-methyl-digoxin improved myocardial function in patients with arterial hypertension and early left-ventricular impairment, but only when coronary heart disease was absent. The drug did not benefit patients with existing coronary artery disease.
Area of Science:
- Cardiology
- Pharmacology
Context:
- Arterial hypertension and early left-ventricular dysfunction present complex cardiovascular challenges.
- Assessing the impact of digitalis glycosides on myocardial function is crucial for treatment strategies.
- Coronary heart disease can significantly influence the response to cardiac medications.
Purpose:
- To investigate the haemodynamic effects of beta-methyl-digoxin in patients with arterial hypertension and impaired left-ventricular function.
- To determine if the presence of coronary heart disease alters the response to acute digitalisation.
Summary:
- Haemodynamic tests were conducted on 41 patients with arterial hypertension and early left-ventricular dysfunction, before and after a single dose of beta-methyl-digoxin.
- Patients were divided into two groups: those with coronary heart disease (Group I) and those without (Group II).
- Beta-methyl-digoxin did not alter cardiac output in either group but significantly reduced elevated pulmonary wedge pressure and right atrial pressure during exercise in Group II (without coronary heart disease).
Impact:
- Acute digitalisation with beta-methyl-digoxin demonstrates efficacy in improving abnormal myocardial function primarily in the absence of concurrent coronary heart disease.
- These findings suggest that the presence of coronary artery disease may mitigate the beneficial effects of beta-methyl-digoxin on ventricular function.
- This research informs clinical decisions regarding the use of digitalis in hypertensive patients with varying degrees of cardiac compromise.
Abstract:
Haemodynamic tests were performed at rest and during exercise in 41 patients with arterial hypertension and early impairment of left-ventricular function, before and after administration of a single dose of 0.6 mg beta-methyl-digoxin. After clinical, ECG and coronary-angiographic studies, the patients were assigned to two groups. Group I: 17 patients with transmural infarcts in the chronic stage or with angina. Cardiac output was within normal limits at rest and on exercise and was not significantly altered by administration of beta-methyl-digoxin. There was no significant fall during exercise of the abnormally elevated pulmonary "wedge" pressure or of other pressures in the lesser circulation after digitalis. Group II: 24 patients without signs of coronary heart disease. They, too, had a normal cardiac output at rest and on exercise, not significantly changed by digitalisation with beta-methyl-digoxin. But pulmonary "wedge" pressure and right-atrial mean pressure were significantly reduced during exercise. Before beta-methyl-digoxin the mean "wedge" pressure rose on exercise to an average of 27.3 +/- 5.4 mm Hg, but after beta-methyl-digoxin to only 21.7 +/- 5.1 mm Hg (P less than 0.001). The mean right atrial pressure changed similar. These results indicate that acute digitalisation at the stated dosage in general has an effect on abnormal myocardial function only if there is no additional coronary heart disease.