Effect of Priscol on the Pulmonary Circulation in Cor Pulmonale

Abstract

Pulmonary hypertension in chronic pulmonary disease is due mainly to the impairment of the pulmonary vascular bed. It is still doubtful, however, whether neuro-humoral factors also participate in the genesis of this hypertension. Because of the difficulties of the methods that have to be used in the study of this problem, little is known about the autonomous regulation of the lesser circulation in man. Lately there have been some attempts to extend our knowledge in this field by pharmacological investigations of the lesser circulation.Most of the authors have dealt with pulmonary hypertension in congenital or acquired heart disease. Several substances have been employed as e.g. TEAB (Davies et al., 1954;Scott et al., 1955), hexamethonium (Gilmore et al., 1952;Judson et al., 1954;Wade et al., 1956) Rudolph et al., 1958).The genesis of hypertension in congenital and acquired heart disease, however, differs from that of hypertension in cor pulmonale. Little attention has been paid to pulmonary hypertension in cor pulmonale so that the number of studies concerned with the pharmacology of this problem is small. The only substances to be used in sufficiently large groups of subjects with cor pulmonale have been TEAB (Fowler et al., 1950) and hexamethonium (Malamos et al., 1957; Sancetta, 1955).However, results are difficult to assess since the doses of these substances used lowered systemic blood pressure. An attempt was therefore made to affect pulmonary hypertension in cor pulmonale pharmacologically by employing a substance that would lower pulmonary arterial blood pressure without substantially affecting systemic blood pressure. Since it was found (Widimsky et al., 1959) that priscol fulfils these requirements, the effect of this drug upon patients with cor pulmonale has been investigated in greater detail.Methods. Fifteen patients with pulmonary disease, 11 of these with pulmonary hypertension at rest, within an age range of 21-68 years were investigated by catheterization of the pulmonary circulation. One day before catheterization the following premedication was applied: phenobarbital 0-06 g. natr. bromati 0-6 g., chinidini sulphur 0-2 g., and on the day of catheterization phenobarbital 0 03 g., natrii bromati 0 3 g., and chinidini sulphur 0-1 g. were administered. Catheterization was performed in the usual manner, always in the morning.

Effect of Reserpine on the Lesser Circulation in Chronic Pulmonary Diseases

“…Pressure changes in the lesser circulation were similar to those recorded in our previous work on priscol (Widimsky et al, 1960), but the duration of the hypotensive effect of reserpine was longer. In contrast with the action of priscol, the extent of changes after reserpine did not depend on the initial values.…”

Cardiac Failure in Cor Pulmonale Due to Pulmonary Tuberculosis

“…In all patients with decompensated cor pulmonale there was a com mon element of an extensive bilateral fibrocirrholic process, the important factor here being the bilaterality. Unilateral disease rarely leads to congestive failure, and we have observed that total unilateral pneumonectomy does not lead to a rise in resting pulmonary artery pressure (see also nor to hyper tension during muscular exercise, as long as the remaining pul monary parenchyma was healthy (38).…”

Pulmonary vascular resistance in children with congenital heart disease.

“…Pulmonary vascular disease is inferred from the presence of an irreversibly raised resistance, reversibility being assessed by the response of the vascular bed to oxygen or to other vasodilator agents such as tolazoline. 2 Use of the direct Fick principle to measure pulmonary blood flow, on which the assessment of reversibility depends, requires sampling of pulmonary arterial and pulmonary venous blood as well as measurements of metabolic gas exchange. Elegant techniques have been developed for the determination of oxygen consumption in air,3 but simple, rapid, and accurate estimation of gas exchange while the patient breathes 100% oxygen has proved more difficult to achieve.…”