Summary: Berberine, an alkaloid of the protoberberine family, has been shown to have strong positive inotropic and peripheral resistance-lowering effects in dogs with and without heart failure. To determine the acute cardiovascular effects of berberine in humans, 12 patients with refractory congestive heart failure were studied before and during berberine intravenous infusion at rates of 0.02 and 0.2 mg/kg per min for 30 minutes. The lower infusion dose produced no significant circulatory changes, apart from a reduction in heart rate (14%). 14048 -Ribeirrio Preto, SP, Brad sociation properties. These salutary acute effects show that berberine markedly improved cardiac performance in patients with heart failure refractory to conventional medical therapy with digitalis and diuretics. The improvement is probably subsequent to peripheral vasodilatation and to inotropic stimulation. Significant untoward effects appear to be the development of ventricular tachycardia with "torsades de pointes" morphology, detected in 4 patients 1-20 h after the infusion of berberine. This possible association requires further elucidation before the administration of bekrine may be extended to other patients in heart failure.

Normal subjects and cardiac chagasic patients without previous history of congestive failure or actual evidences of cardiac decompensation were exercised on a treadmill or a bicycle ergometer. Patients with less than the expected increase in heart rate during exercise were found to exhibit also an abnormal heart rate response to pharmacologic blockade and acute alterations in systemic vascular resistance. These results are in agreement with previous observations showing neuronal degeneration and autonomic impairment in chronic Chagas’ heart disease.

Fifteen chagasic and 26 non-chagasic patients were evaluated for hemodynamic and cardiovascular responses during induction of anesthesia with etomidate (a hypnotic agent) and Vecuronium (a neuromuscular blocker). Blood for serum testing was collected during anesthesia. Blood pressure, heart rate and rhythm, mean arterial pressure and arterial oxygen saturation were also monitored on six different occasions during anesthesia. When the various stages of anesthesia were compared, significant differences in blood pressure and heart rate were observed. For any of the given stages of anesthesia blood pressure and heart rate did not show significant differences when chagasic were compared to non-chagasic patients. Arterial oxygen saturation remained steady in all cases. We conclude that both drugs are safe for use during the induction of anesthesia in chronic chagasic patients.

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