Cardiac Failure with Reserpine

Abstract

Reserpine (" serpasil ") is a colourless crystalline esteralkaloid derived from the roots of Rauwolfia serpentina, and is useful both as a hypotensive agent and as a sedative in psychiatric practice. During the treatment of out-patients attending hospital we were surprised to discover two cases of cardiac failure occurring apparently in association with the administration of this drug. The two relevant case histories are presented. The results of the investigations suggest that reserpine causes a retention of fluid in the body, a factor which may result in heart failure in susceptible subjects. When next seen she was in cardiac failure with cyanosis of the lips and dyspnoea at rest. On examination marked atherosclerosis was found, the blood pressure being 110/75 with a pulse rate of 92 a minute. The apical impulse lay in the fifth left interspace outside the mid-clavicular line and a loud presystolic triple rhythm could be heard over the lower end of the sternum. In addition there were crepitations at both lung bases. The jugular venous pressure was raised 4 cm. above the sterno-clavicular angle, the liver edge being palpable two fingerbreadths below the right intercostal margin. There was no ascites, although pitting oedema of both ankles was present.Reserpine was withheld. She was advised to rest in bed but refused to do this, remaining fullT ambulant. When she returned again four weeks later no evidence of failure remained, and the presystolic triple rhvthm had disappeared. InvestigationData were collected in order to assess the possibility of fluid retention in patients receiving reserpine.' Nine patients suffering from mild psychiatric disorders were given reserpine in increasing doses for three weeks. The drug was then stopped and the investigations were continued for a further three weeks. As the patients were also having weekly injections of acetylcholine, it was necessary, in addition to using the patients as their own controls, to have a control group of patients receiving acetylcholine alone. Six similar patients on weekly injections of acetylcholine were therefore studied concurrently over five weeks. Both groups of patients were selected at random. Dosage varied from patient to patient, depending upon the side-effects of the drug. The mean dailv dosage in the first, second, and third weeks was, 1.6, 2.5, and 3.3 mg.respectively. The maximum individual daily dosage was 9 mg.Blood was withdrawn at the beginning of the investigation and weekly thereafter, estimations being carried out for haemoglobin, plasma portion of the haematocrit, mean corpuscular haemoglobin concentration, and serum sodium. In addition the patient was weighed at each visit.It is readily acknowledged that tfie assessment of these indirect indices for fluid retention provides no accurate picture of alterations in either extracellular or total body fluid, but it is hoped that the presentation of these results will serve as a stimulus for a more elegant survey of the problem.ResultsThe accompanying charts show the changes in weight (...