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Srivatsa UN, Ebrahimi R, El-Bialy A, Wachsner RY. Electrical Storm: Case Series and Review of Management. J Cardiovasc Pharmacol Ther 2016; 8:237-46. [PMID: 14506549 DOI: 10.1177/107424840300800309] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Electrical storm is defined as a recurrent episode of hemodynamically destabilizing ventricular tachyarrhythmia that usually requires electrical cardioversion or defibrillation. We describe three cases presenting with electrical storm under differing circumstances: (1) a 57-year-old man with ST-elevation myocardial infarction within 1 week of a posterior circulation stroke who developed refractory sustained ventricular tachycardia 10 days after an acute myocardial infarction; (2) a 65-year-old man who developed polymorphic ventncular tachycardia and ventricular fibrillation following dobutamine echocardiography; and (3) a 20-year-old woman who developed intractable ventricular fibrillation following an overdose of a weight-reduction pill. The management of electrical storm is discussed, and evolving literature supporting the routine use of intravenous amiodarone and β-blockers in place of intravenous lidocaine is critically examined.
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Affiliation(s)
- Uma N Srivatsa
- Department of Cardiology, West Los Angeles VA Medical Center and Department of Cardiology, Olive View Medical Center, Sylmar, UCLA School of Medicine, Los Angeles, California 90073, USA
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Alpha-1-adrenergic receptors in heart failure: the adaptive arm of the cardiac response to chronic catecholamine stimulation. J Cardiovasc Pharmacol 2014; 63:291-301. [PMID: 24145181 DOI: 10.1097/fjc.0000000000000032] [Citation(s) in RCA: 56] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Alpha-1-adrenergic receptors (ARs) are G protein-coupled receptors activated by catecholamines. The alpha-1A and alpha-1B subtypes are expressed in mouse and human myocardium, whereas the alpha-1D protein is found only in coronary arteries. There are far fewer alpha-1-ARs than beta-ARs in the nonfailing heart, but their abundance is maintained or increased in the setting of heart failure, which is characterized by pronounced chronic elevation of catecholamines and beta-AR dysfunction. Decades of evidence from gain and loss-of-function studies in isolated cardiac myocytes and numerous animal models demonstrate important adaptive functions for cardiac alpha-1-ARs to include physiological hypertrophy, positive inotropy, ischemic preconditioning, and protection from cell death. Clinical trial data indicate that blocking alpha-1-ARs is associated with incident heart failure in patients with hypertension. Collectively, these findings suggest that alpha-1-AR activation might mitigate the well-recognized toxic effects of beta-ARs in the hyperadrenergic setting of chronic heart failure. Thus, exogenous cardioselective activation of alpha-1-ARs might represent a novel and viable approach to the treatment of heart failure.
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O'Connell TD, Jensen BC, Baker AJ, Simpson PC. Cardiac alpha1-adrenergic receptors: novel aspects of expression, signaling mechanisms, physiologic function, and clinical importance. Pharmacol Rev 2013; 66:308-33. [PMID: 24368739 DOI: 10.1124/pr.112.007203] [Citation(s) in RCA: 133] [Impact Index Per Article: 12.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Adrenergic receptors (AR) are G-protein-coupled receptors (GPCRs) that have a crucial role in cardiac physiology in health and disease. Alpha1-ARs signal through Gαq, and signaling through Gq, for example, by endothelin and angiotensin receptors, is thought to be detrimental to the heart. In contrast, cardiac alpha1-ARs mediate important protective and adaptive functions in the heart, although alpha1-ARs are only a minor fraction of total cardiac ARs. Cardiac alpha1-ARs activate pleiotropic downstream signaling to prevent pathologic remodeling in heart failure. Mechanisms defined in animal and cell models include activation of adaptive hypertrophy, prevention of cardiac myocyte death, augmentation of contractility, and induction of ischemic preconditioning. Surprisingly, at the molecular level, alpha1-ARs localize to and signal at the nucleus in cardiac myocytes, and, unlike most GPCRs, activate "inside-out" signaling to cause cardioprotection. Contrary to past opinion, human cardiac alpha1-AR expression is similar to that in the mouse, where alpha1-AR effects are seen most convincingly in knockout models. Human clinical studies show that alpha1-blockade worsens heart failure in hypertension and does not improve outcomes in heart failure, implying a cardioprotective role for human alpha1-ARs. In summary, these findings identify novel functional and mechanistic aspects of cardiac alpha1-AR function and suggest that activation of cardiac alpha1-AR might be a viable therapeutic strategy in heart failure.
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Affiliation(s)
- Timothy D O'Connell
- VA Medical Center (111-C-8), 4150 Clement St., San Francisco, CA 94121. ; or Dr. Timothy D. O'Connell, E-mail:
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Kenis S, D'hooghe M, Verniest G, Reybroeck M, Dang Thi TA, Pham The C, Thi Pham T, Törnroos KW, Van Tuyen N, De Kimpe N. Nucleophile-Directed Selective Transformation ofcis-1-Tosyl-2-tosyloxymethyl-3-(trifluoromethyl)aziridine into Aziridines, Azetidines, and Benzo-Fused Dithianes, Oxathianes, Dioxanes, and (Thio)morpholines. Chemistry 2013; 19:5966-71. [DOI: 10.1002/chem.201204485] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2012] [Indexed: 11/06/2022]
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Vandekerckhove S, De Moor S, Segers D, de Kock C, Smith PJ, Chibale K, De Kimpe N, D'hooghe M. Synthesis and antiplasmodial evaluation of aziridine–(iso)quinoline hybrids and their ring-opening products. MEDCHEMCOMM 2013. [DOI: 10.1039/c3md20377h] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
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Kaler A, Meena VS, Singh M, Pujala B, Chakraborti AK, Banerjee UC. Lipase-mediated kinetic resolution of (RS)-1-bromo-3-[4-(2-methoxy-ethyl)-phenoxy]-propan-2-ol to (R)-1-bromo-3-(4-(2-methoxyethyl) phenoxy) propan-2-yl acetate. Tetrahedron Lett 2011. [DOI: 10.1016/j.tetlet.2011.08.031] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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Zhang JY, Liu HM, Wang XJ, Wang P, Zheng JX. Application of kinetic resolution using HCS as chiral auxiliary: Novel synthesis of β-blockers (S)-betaxolol and (S)-metoprolol. Chirality 2009; 21:745-50. [DOI: 10.1002/chir.20674] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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Zhang JY, Liu HM, Xu HW, Shan LH. Non-enzymatic kinetic resolution of β-amino alcohols using C-12 higher carbon sugar as a chiral auxiliary. ACTA ACUST UNITED AC 2008. [DOI: 10.1016/j.tetasy.2008.01.039] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Abstract
Drug treatment of chronic heart failure is undergoing continuous modifications according to the data of new trials. Treatment has to be adjusted to current guidelines. The state of the art of medical treatment of chronic heart failure is addressed in this report.
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Affiliation(s)
- M Böhm
- Universitätsklinikum des Saarlandes, Klinik für Innere Medizin III, Homburg/Saar.
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Muthukrishnan M, Garud DR, Joshi R, Joshi R. Concise synthesis of β-blockers (S)-metoprolol and (S)-betaxolol using hydrolytic kinetic resolution. Tetrahedron 2007. [DOI: 10.1016/j.tet.2006.12.016] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Abstract
Although beta-adrenergic blocking agents are not always considered anti-arrhythmic drugs, the results of several recent trials have suggested an anti-arrhythmic mechanism for at least part of their mortality benefit in the treatment of chronic congestive heart failure. We review background experimental and clinical evidence for the anti-arrhythmic actions of beta-blockers and then review the results of published beta-blocker heart failure trials. A majority of trials showed improvement in overall survival as well as reduction in sudden death and ventricular arrhythmias with beta-blocker treatment. Although different effects were seen with different specific agents, these trials overall support a clinically significant anti-arrhythmic effect of several beta-blockers.
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Affiliation(s)
- Daejoon Anh
- Section of Cardiac Electrophysiology, Henry Ford Heart and Vascular Institute, Detroit, MI 48202, USA
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Haqqani HM, Kalman JM. Recently diagnosed nonischemic dilated cardiomyopathy: When should we implant the defibrillator? Heart Rhythm 2006; 3:404-5. [PMID: 16567285 DOI: 10.1016/j.hrthm.2006.02.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2006] [Indexed: 11/17/2022]
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A new approach towards 2-amino-1-aryloxy-3-methoxypropanes from 1-arylmethyl-2-(bromomethyl)aziridines. Tetrahedron 2006. [DOI: 10.1016/j.tet.2005.12.006] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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D'hooghe M, Rottiers M, Kerkaert I, De Kimpe N. Ring opening of 2-(bromomethyl)-1-sulfonylaziridines towards 1,3-heteroatom substituted 2-aminopropane derivatives. Tetrahedron 2005. [DOI: 10.1016/j.tet.2005.06.036] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Rickli H, Steiner S, Müller K, Hess OM. Betablockers in heart failure: Carvedilol Safety Assessment (CASA 2-trial). Eur J Heart Fail 2005; 6:761-8. [PMID: 15542414 DOI: 10.1016/j.ejheart.2003.11.025] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2002] [Revised: 07/18/2003] [Accepted: 11/12/2003] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Betablockers are a cornerstone in the treatment of patients with chronic heart failure (CHF). The purpose of the present study was to assess safety and tolerability of carvedilol in CHF-patients. METHODS 66 general practitioners, who were supervised by a local cardiologist, enrolled 151 CHF-patients. All patients were on standard therapy with ACE-inhibitors and diuretics. Carvedilol treatment was started with 3.125 mg twice daily and slowly uptitrated in 2-week intervals to 2x25 mg per day. Mean follow-up was 12 weeks. RESULTS 145 of the 151 patients (96%) finished the study according to protocol, six patients were lost to follow-up (4%). 59 patients (41%) experienced minor and nine (6%) serious adverse events. 68 were under maximal therapy with 50 mg daily, 33 received 25 mg, and 15 12.5 mg. Overall tolerability was good and NYHA-class fell significantly from 2.2 to 1.8 (P<0.001). Mean heart rate decreased from 78 to 69 bpm (P<0.001), mean systolic blood pressure from 137 to 132 mmHg (P<0.001) and mean diastolic blood pressure from 80 to 76 mmHg (P<0.001). Quality of life significantly improved under carvedilol with a reduction in the Minnesota living with heart failure score from 1.28 to 0.88 (P<0.001). CONCLUSIONS Carvedilol is well tolerated in CHF-patients treated by general practitioners. Serious adverse events and hospitalisations are rare. Thus, carvedilol is a safe drug in the treatment of CHF-patients and can be easily initiated and managed by the general practitioner.
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Affiliation(s)
- Hans Rickli
- Division of Cardiology, St. Gallen, Switzerland
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Jayasankar V, Bish LT, Pirolli TJ, Berry MF, Burdick J, Woo YJ. Local myocardial overexpression of growth hormone attenuates postinfarction remodeling and preserves cardiac function. Ann Thorac Surg 2004; 77:2122-9; discussion 2129. [PMID: 15172279 DOI: 10.1016/j.athoracsur.2003.12.043] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/10/2003] [Indexed: 11/25/2022]
Abstract
BACKGROUND Ventricular remodeling with chamber dilation and wall thinning is seen in postinfarction heart failure. Growth hormone induces myocardial hypertrophy when oversecreted. We hypothesized that localized myocardial hypertrophy induced by gene transfer of growth hormone could inhibit remodeling and preserve cardiac function after myocardial infarction. METHODS Rats underwent direct intramyocardial injection of adenovirus encoding either human growth hormone (n = 9) or empty null vector as control (n = 9) 3 weeks after ligation of the left anterior descending coronary artery. Analysis of the following was performed 3 weeks after delivery: hemodynamics, ventricular geometry, cardiomyocyte fiber size, and serum growth hormone levels. RESULTS The growth hormone group had significantly better systolic cardiac function as measured by maximum left ventricular pressure (73.6 +/- 6.9 mm Hg versus control 63.7 +/- 7.8 mm Hg, p < 0.05) and maximum dP/dt (2845 +/- 453 mm Hg/s versus 1949 +/- 605 mm Hg/s, p < 0.005), and diastolic function as measured by minimum dP/dt (-2520 +/- 402 mm Hg/s versus -1500 +/- 774 mm Hg/s, p < 0.01). Ventricular geometry was preserved in the growth hormone group (ventricular diameter 12.2 +/- 0.7 mm versus control 13.1 +/- 0.4 mm, p < 0.05; borderzone wall thickness 2.0 +/- 0.2 mm versus 1.5 +/- 0.1 mm, p < 0.001), and was associated with cardiomyocyte hypertrophy (6.09 +/- 0.63 microm versus 4.66 +/- 0.55 microm, p < 0.005). Local myocardial expression of growth hormone was confirmed, whereas serum levels were undetectable after 3 weeks. CONCLUSIONS Local myocardial overexpression of growth hormone after myocardial infarction resulted in cardiomyocyte hypertrophy, attenuated ventricular remodeling, and improved systolic and diastolic cardiac function. The induction of localized myocardial hypertrophy presents a novel therapeutic approach for the treatment of ischemic heart failure.
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Affiliation(s)
- Vasant Jayasankar
- Department of Surgery, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania, USA
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Melgar-Fernández R, Demare P, Hong E, Rosas MA, Escalante J, Muñoz-Muñiz O, Juaristi E, Regla I. Synthesis and cardiovascular activity of metoprolol analogues. Bioorg Med Chem Lett 2004; 14:191-4. [PMID: 14684326 DOI: 10.1016/j.bmcl.2003.09.070] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
The synthesis of four novel analogues of metoprolol, a well-known beta1-blocker used to reduce arterial blood pressure, is described. The preparation of (2S,2'S)-7, (2R,2'S)-7, (2R,2'R)-8, and (2S,2'R)-8 was based on the reaction of racemic 2-[4-(2'-methoxyethyl)-phenoxymethyl]-oxirane (4) with (R)- or (S)-2-amino-1-butanol. Salient characteristics of analogues 7 and 8 relative to metoprolol are the incorporation of an additional stereogenic center, as well as a methyl group and a hydroxyl function on the nitrogen-containing chain. These novel derivatives present significant hypotensive and bradycardiac activity, although no blocking action toward beta1 and beta2 adrenergic receptor.
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Affiliation(s)
- Roberto Melgar-Fernández
- Facultad de Estudios Superiores-Zaragoza, Universidad Nacional Autónoma de México, 09230 Mexico, D.F., México
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Yao A, Kohmoto O, Oyama T, Sugishita Y, Shimizu T, Harada K, Matsui H, Komuro I, Nagai R, Matsuo H, Serizawa T, Maruyama T, Takahashi T. Characteristic effects of alpha1-beta1,2-adrenergic blocking agent, carvedilol, on [Ca2+]i in ventricular myocytes compared with those of timolol and atenolol. Circ J 2003; 67:83-90. [PMID: 12520158 DOI: 10.1253/circj.67.83] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Beta-adrenergic stimulation and the resultant Ca(2+) load both seem to be associated with progression of heart failure as well as hypertrophy. Because the alpha(1)-, beta(1,2)-blocker, carvedilol, has been shown to be outstandingly beneficial in the treatment of heart failure, its direct effects on intracellular calcium ion concentration ([Ca(2+)](i)), including antagonism to isoproterenol, in ventricular myocytes were investigated and then compared with a selective beta(1)-blocker, atenolol, and a non-selective beta(1,2)-blocker, timolol. At 1-300 nmol/L, carvedilol decreased the amplitude of [Ca(2+)] (i) by approximately 20% independently of its concentration, which was a similar effect to timolol. All the beta-blockers at 10 nmol/L decreased the amount of cAMP, but atenolol had the least effect. Carvedilol in the micromol/L order further diminished the amplitude of [Ca(2+)](i) transients, and at 10 micromol/L increased the voltage threshold for pacing myocytes. These effects were not observed with timolol or atenolol. L-type Ca2+ currents (I(Ca)) were decreased by carvedilol in the micromol/L order in a concentration dependent manner. As for the beta-antagonizing effect, the concentrations of carvedilol, timolol, and atenolol needed to prevent the effect of isoproterenol by 50% (IC(50)) were 1.32, 2.01, and 612 nmol/L, respectively. Furthermore, the antagonizing effect of carvedilol was dramatically sustained even after removal of the drug from the perfusate. Carvedilol exerts negative effects on [Ca(2+)](i), including inhibition of the intrinsic beta-activity, reduction of I(Ca) in the micromol/L order, and an increase in the threshold for pacing at > or =10 micromol/L. Data on the IC(50) for the isoproterenol effect suggest that carvedilol could effectively inhibit the [Ca(2+)](i) load induced by catecholamines under clinical conditions.
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Affiliation(s)
- Atsushi Yao
- Department of Cardiovascular Medicine, Graduate School of Medicine, University of Tokyo, Japan.
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Tatewaki T, Inagaki M, Kawada T, Shishido T, Yanagiya Y, Takaki H, Sato T, Sugimachi M, Sunagawa K. Biphasic Response of Action Potential Duration to Sudden Sympathetic Stimulation in Anesthetized Cats. Circ J 2003; 67:876-80. [PMID: 14578623 DOI: 10.1253/circj.67.876] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Although certain roles of the sympathetic nervous system have been suggested as possible mechanisms of life-threatening arrhythmias and sudden cardiac death, the dynamic electrophysiological response to sympathetic activation remains unclear. The aim of this study was to investigate the dynamic response of action potential duration (APD) to sudden sympathetic stimulation (SYM) using monophasic action potential (MAP) recording. In 10 anesthetized cats, MAPs were continuously recorded from the right ventricular endocardium under constant pacing. The dynamic response of the APD to SYM (3 Hz) were examined before and after the administration of propranolol (0.5 mg/kg i.v.) (n=5) or phentolamine (1.0 mg/kg i.v.) (n=5). In response to SYM, the APD was transiently prolonged by 5.5+/-3.2 ms at 7.0+/-1.3 s, and monotonically shortened toward a steady-state level (-14.5+/-6.9 ms). Propranolol almost abolished both the transient prolongation (6.6+/-4.5 to 0.2+/-0.4 ms, p<0.05) and the steady-state shortening (-13.7+/-3.6 to -1.1+/-2.4 ms, p<0.005), whereas phentolamine did not have a significant effect on the response of APD to SYM. These findings might partly account for the propensity of ventricular arrhythmias to occur immediately after sudden sympathetic activation.
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Affiliation(s)
- Teiji Tatewaki
- Department of Cardiovascular Dynamics, National Cardiovascular Center Research Institute, Suita, Japan
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Abstract
PURPOSE To present an evidence-based review of the systemic adverse effects of beta-adrenergic blockers and recommend safety guidelines for use of ophthalmic beta-adrenergic blockers. DESIGN Literature review of published articles in peer-reviewed journals and medical texts. METHODS Pre-MEDLINE and MEDLINE search of relevant English language articles from 1966 to the present. Cardiovascular, pulmonary, endocrine/metabolic, central nervous system, sexual, exercise, and neuromuscular effects of systemic or ophthalmic beta-adrenergic blockers were reviewed. RESULTS Systemic beta-adrenergic antagonists unequivocally reduce mortality in patients with mild, moderate, and even severe congestive heart failure. Development of symptomatic bradycardia on systemic or ophthalmic beta-adrenergic blockers alone likely indicates underlying cardiac conduction disturbances. Beta 2-adrenergic blockade, regardless of route of administration, may exacerbate or trigger bronchospasm in patients with asthma or pulmonary disease associated with hyper-reactive airways. This review identifies no scientific studies supporting the development of worsening claudication, depression, hypoglycemic unawareness, or prolonged hypoglycemia in non-insulin-dependent diabetes, sexual dysfunction, or impaired neuromuscular transmission with systemic or ophthalmic beta-adrenergic blockers. CONCLUSIONS Many commonly presumed adverse beta-adrenergic blocker effects observed via systemic or ocular administration are not supported by published randomized clinical trials. Wide acceptance of such traditionally purported side effects has been largely due to propagation of isolated case reports and short series as well as personal communication felt to reflect expert opinion. Many more patients may be eligible to use these drugs. Obtaining a careful medical history and checking pulse rate and rhythm in the office should identify the vast majority of patients with potential cardiopulmonary contraindications.
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Affiliation(s)
- Paul J Lama
- Department of Ophthalmology and Visual Science, The University of Medicine and Dentistry of New Jersey (UMDNJ), New Jersey Medical School, Newark, New Jersey, USA.
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Affiliation(s)
- David J Callans
- Department of Medicine, University of Pennsylvania School of Medicine, Philadelphia, USA.
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Singh BN. Antiarrhythmic drugs in cardiac arrest resuscitation: intravenous amiodarone or intravenous lidocaine? J Cardiovasc Pharmacol Ther 2002; 7:61-4. [PMID: 12075393 DOI: 10.1177/107424840200700201] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Victal OA, Teerlink JR, Gaxiola E, Wallace AW, Najar S, Camacho DH, Gutierrez A, Herrera G, Zuniga G, Mercado-Rios F, Ratcliffe MB. Left ventricular volume reduction by radiofrequency heating of chronic myocardial infarction in patients with congestive heart failure. Circulation 2002; 105:1317-22. [PMID: 11901042 DOI: 10.1161/hc1102.105566] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Myocardial infarct expansion and left ventricular (LV) remodeling are integral components in the evolution of chronic heart failure and predict morbidity and mortality. Radiofrequency (RF) heating and patch placement of chronic LV aneurysms caused a sustained reduction in LV infarct area and volume in an ovine infarct model. This study evaluated the effect of RF heating and epicardial patch as an adjunct to coronary artery bypass graft on LV volumes in patients with prior myocardial infarction, evidence of akinetic/dyskinetic scar, and LV ejection fraction < or =40%. METHODS AND RESULTS Ten patients (3 female; mean age, 64+/-11 years) scheduled for coronary artery bypass graft were enrolled (Canadian Cardiovascular Society angina class 2.1+/-1.1; New York Heart Association class 3.1+/-0.5). Intraoperative digital photography demonstrated an acute 39% reduction in infarct area (n=5; P=0.01), and transesophageal ECGs demonstrated a 16% acute reduction in LV end-diastolic volumes (n=9; P=0.002) after RF treatment. There were no intraoperative or procedure-related postoperative complications, and during an average follow-up of >180 days, there have been no safety issues. All patients had complete relief of their angina and improvement in exercise tolerance. Serial transthoracic ECGs over the 6 months of follow-up after RF treatment demonstrated persistent reductions in LV end-diastolic volume (29%; P<0.0001) and LV end-systolic volume (37%; P<0.0001) with improved ejection fraction (P<0.02). CONCLUSIONS RF heating and patch placement in these 10 patients resulted in acute reduction in infarct area and ventricular volumes that were maintained 180 days after procedure. This technique may reduce the incidence of congestive heart failure and mortality in these patients and warrants investigation in larger clinical trials.
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Camm AJ, Yap YG. Clinical trials of antiarrhythmic drugs in postmyocardial infarction and congestive heart failure patients. J Cardiovasc Pharmacol Ther 2001; 6:99-106. [PMID: 11452341 DOI: 10.1177/107424840100600110] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- A J Camm
- St. George's Hospital, London, United Kingdom
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Hameedi A, Chadow HL. The promise of selective aldosterone receptor antagonists for the treatment of hypertension and congestive heart failure. Curr Hypertens Rep 2000; 2:378-83. [PMID: 10981173 DOI: 10.1007/s11906-000-0041-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
Inappropriate elevations in plasma aldosterone levels have multiple actions that play an important role in the pathophysiology of hypertension and heart failure. Patients with hypertensive cardiovascular disease are at increased risk for coronary artery disease, myocardial infarction, congestive heart failure, and sudden cardiac death. Despite long-term treatment with an angiotensin converting enzyme inhibitor or an angiotensin II receptor blocker, aldosterone levels usually remain high in these patients. The effectiveness of low-dose spironolactone raises the possibility that a nonselective aldosterone antagonist can block the deleterious effects of aldosterone on the cardiovascular system. However, side effects limit the use of this drug in many patients. The advent of selective aldosterone antagonists, which have a lower affinity for androgen and progesterone receptors, should minimize these side effects, leading to better compliance.
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Affiliation(s)
- A Hameedi
- Division of Cardiology, The Brookdale University Hospital and Medical Center, 1 Brookdale Plaza, Brooklyn, NY 11212-3198, USA
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Ratcliffe MB, Wallace AW, Teerlink JR, Hong J, Salahieh A, Sung SH, Keung EC, Lee RJ. Radio frequency heating of chronic ovine infarct leads to sustained infarct area and ventricular volume reduction. J Thorac Cardiovasc Surg 2000; 119:1194-204. [PMID: 10838539 DOI: 10.1067/mtc.2000.105826] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJECTIVE Myocardial infarct expansion and subsequent left ventricular remodeling are associated with increased incidence of congestive failure and mortality. Collagen is known to denature and contract when heated above 65 degrees C. We therefore tested the hypothesis that radio frequency heating of myocardial infarct tissue with application of a restraining patch causes a sustained reduction in myocardial infarct area and left ventricular volume. METHODS Thirteen male Dorset sheep underwent surgical coronary artery ligation. At least 14 weeks later, animals were randomized to either radio frequency infarct heating (95 degrees C) with application of a restraining patch or a sham operation. Before treatment, after treatment, and 10 weeks later, left ventricular volume was measured with transdiaphragmatic echocardiography and myocardial infarct area was measured with an array of sonomicrometry crystals. RESULTS Radio frequency infarct heating causes an acute decrease of 34% (-215 +/- 82 mm(2); P =.0002) in infarct area at end-diastole that is maintained at 10 weeks (-144 +/- 79 mm(2); P =.0002). Radio frequency infarct heating causes a downward trend in end-diastolic left ventricular volume measured by echocardiography of 20% (-15.7 +/- 6.3 mL; P = no significant difference) and end-systolic left ventricular volume of 32% (-17.1 +/- 9.8 mL; P =.09), which are significantly decreased at 10 weeks (-13.6 +/- 22.3 mL; P =.007 and -15.3 +/- 21.9 mL; P =.008, respectively). Radio frequency infarct heating causes an acute improvement in systolic function (P <.001), a sustained increase in left ventricular ejection fraction (+0.11%; P =.06), and preserved stroke volume. CONCLUSION Radio frequency heating of chronic left ventricular myocardial infarct causes a sustained reduction in infarct area and left ventricular volume. This technique may beneficially reverse infarct expansion and left ventricular remodeling after myocardial infarction.
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Affiliation(s)
- M B Ratcliffe
- Division of Cardiothoracic Surgery, Department of Surgery, San Francisco, USA.
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Singh BN. Initial antiarrhythmic drug therapy during resuscitation from sudden cardiac death: a time for a fundamental change in strategy? J Cardiovasc Pharmacol Ther 2000; 5:3-9. [PMID: 10687668 DOI: 10.1177/107424840000500101] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Ogunyankin KO, Singh BN. Mortality reduction by antiadrenergic modulation of arrhythmogenic substrate: significance of combining beta blockers and amiodarone. Am J Cardiol 1999; 84:76R-82R. [PMID: 10568664 DOI: 10.1016/s0002-9149(99)00706-7] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Over the last 3 decades, there have been numerous experimental and clinical studies that utilized beta blockers for acute as well as chronic myocardial syndromes, especially in the setting of myocardial infarction in which the focus has been on mortality reduction. The results of these studies demonstrated the benefits of these agents at all stages of coronary artery disease. Although these data have always indicated that beta blockade per se is an antiarrhythmic as well as an antifibrillatory mechanism, the recognition of this phenomenon has been slow in finding universal appreciation. More recent studies have evaluated the additive role of beta blockers to newer therapies. A number of investigations have now established that this class of drugs does exert antifibrillatory action in preventing the occurrence of ventricular tachycardia (VT) and ventricular fibrillation (VF), thereby reducing sudden arrhythmic death and prolonging survival. It is of interest that 2 of the leading antiarrhythmic drugs, amiodarone and sotalol, also have antiadrenergic properties. This article reviews the expanding role of beta-blocking drugs in the control and prevention of life-threatening ventricular tachyarrhythmias with a particular focus on the evidence for synergistic benefits when they are combined with other interventions, especially amiodarone.
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Affiliation(s)
- K O Ogunyankin
- Division of Cardiology, Bassett Healthcare, Cooperstown, New York 13326, USA
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Affiliation(s)
- B N Singh
- Division of Cardiology, Veterans Administration Medical Center of West Los Angeles and University of California at Los Angeles, 90073, USA
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