Clinical evaluation of glucagon by continuous infusion in the treatment of low cardiac output states

Ark, Condon R. Vander; Reynolds, Ernest W.

doi:10.1016/0002-8703(70)90253-x

Cited by 59 publications

(14 citation statements)

References 8 publications

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“…Similarly, in man glucagon has been reported as effective in increasing cardiac output when the myocardium is severely depressed by beta-blockade. 2 We know of only one previously reported case in which glucagon was used effectively to treat myocardial depression after self-poisoning with beta-blocking agents.5 Our patient showed the effect of glucagon in the presence of overwhelming betablockade unresponsive to intravenous catecholamines.…”

Section: Commentmentioning

confidence: 61%

Carbenoxolone-induced hypokalaemia simulating Guillain-Barre syndrome.

Royston¹,

Prout²

1976

BMJ

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Section: Commentmentioning

confidence: 61%

Carbenoxolone-induced hypokalaemia simulating Guillain-Barre syndrome.

Royston¹,

Prout²

1976

BMJ

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“…While the use of glucagon in low cardiac output syndromes of acute onset is encouraging, its use in chronic congestive heart failure has met with variable success. 59,89,91,108,125,131 The previously discussed data of Gold and associates 38 may provide a more fundamental explanation for the disappointing results in treating chronic heart failure with glucagon.…”

Section: Resultsmentioning

confidence: 94%

Glucagon: Present status in cardiovascular disease

Kones

Phillips

1971

Clin Pharma and Therapeutics

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The actions of pancreatic glucagon, a known hyperglycemic, hypoaminoacidemic, and lipolytic agent, have received recent attention because of a variety of effects mediated by increases in cyclic AMP concentrations. Studies in the dog demonstrated the positive inotropic and chronotropic actions of glucagon, unaltered by reserpine, insulin, or propranolol. Enhanced contractility was additive with that of the digitalis preparations but did not produce undesirable arrhythmias. The ability of glucagon to increase contractility was attenuated with longer duration of experimental congestive heart failure, thus implying greater effectiveness in acute pathology. In man, variables dependent upon contractility are correspondingly enhanced with the use of glucagon. Current evidence suggests glucagon is a secondary coronary vasodilator and lowers renal vascular resistance as well. improvement have been noted as a result of continuous glucagon therapy in patients with early congestive heart failure, cardiogenic shock, myocardial infarction, and in low output syndromes following open heart surgery. Glucagon appears to activate adenyl cyclase to increase cycliC AMP levels, which in tum enlarges the intracellular calcium pool. Thus, according to current excitation-contraction theories, an increase in contractility results.Extracardiac and metabolic effects

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“…A significant percentage of arrhythmias, primarily ventricular, were controlled by each of these agents as was the underlying heart failure. 3 …”

Section: Discussionmentioning

confidence: 99%

Newer Inotropic Agents in the Management of Arrhythmias Associated With Cardiac Failure

Coodley

1972

Angiology

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While a number of anti-arrhythmic drugs are currently available for the control of both atrial and ventricular arrhythmias, these drugs all have the relative disadvantage of a negative inotropic characteristic. Other than digitalis, there are no anti-arrhythmic drugs in current use that possess the inotropic effect that may be required in patients who have arrhythmias with associated heart failure.We have been interested in the use of three newer agents possessing this characteristic, i.e. phentolamine, glucagon and bretylium tosylate. These drugs have been studied in a series of patients with varying types of arrhythmias associated with congestive heart failure and the efhcacy of these agents will be listed in subsequent paragraphs. METHOD OF STUDYEleven patients with arrhythmias and heart failure were given glucagon in a dose of 3 mg., intravenously, at 20 minute intervals for three doses and then placed on an infusion of 10 mg./hour for periods of four to eight hours. Thirteen patients with similar type arrhythmias and heart failure were given phentolamine in a dose of .3 mg./minute, intravenously, for periods of 15 to 60 minutes. Fifteen patients with arrhythmias and heart failure were given bretylium tosylate in a dose of 5 mg./kg. in a single intravenous dose and then 5 mg./kg., intramuscularly, at six hour intervals for four doses.The varying arrhythmias studied are shown in Table 1. Characteristics of the patient population are shown in Table 2. Patients were all followed by frequent electrocardiographic studies, clinical assessment of failure, central venous pressure monitoring in some cases, determination of changes in urinary output and frequent determinations of blood pressure. Table 3 illustrates the efhcacy of these differing agents on the control of the arrhythmias studied. RESULTS OF STUDYIt can readily be seen that the majority of arrhythmias showed improvement with each of the agents tested with premature ventricular contractions respondat CARLETON UNIV on July 3, 2015 ang.sagepub.com Downloaded from

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Clinical evaluation of glucagon by continuous infusion in the treatment of low cardiac output states

Cited by 59 publications

References 8 publications

Carbenoxolone-induced hypokalaemia simulating Guillain-Barre syndrome.

Carbenoxolone-induced hypokalaemia simulating Guillain-Barre syndrome.

Glucagon: Present status in cardiovascular disease

Newer Inotropic Agents in the Management of Arrhythmias Associated With Cardiac Failure

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