Hemodynamics, coronary blood flow, and myocardial metabolism in coronary shock; response to l-norepinephrine and isoproterenol

Mueller, Hiltrud S.; Ayres, Stephen M.; Gregory, John J.; Giannelli, Stanley; Grace, William J.

doi:10.1172/jci106408

Cited by 113 publications

(24 citation statements)

References 64 publications

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“…Studies were not performed when these measurements could not be stabilized. Temporal variations of myocardial metabolism in coronary shock were presented previously, demonstrating that a relatively steady state had been achieved and confidence limits had been established, to judge the effect of therapeutic interventions (32). The patients treated with IACP were similar to those previously reported.…”

Section: Experimental Protocolsupporting

confidence: 71%

The effects of intra-aortic counterpulsation on cardiac performance and metabolism in shock associated with acute myocardial infarction

Mueller¹,

Ayres²,

Conklin³

et al. 1971

J. Clin. Invest.

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145

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A B S T R A C T The effect of intra-aortic counterpulsation (IACP, 22-94 hr) on hemodynamics and cardiac energetics was evaluated in 10 patients in shock after acute myocardial infarction. The data clearly indicate that IACP improves myocardial oxygenation, enhances peripheral perfusion, and probably improves myocardial contractility in the severely diseased heart.Before treatment, decreases in cardiac index (mean value, 1.22 liter/min per m'), systolic ejection rate (67 ml/sec), and time-tension index per minute (1280 mm Hg -sec/min) were observed. Systemic vascular resistance varied widely. Low coronary blood flow (68 ml/min per 100 g) was associated with increased myocardial oxygen extraction (79%), low coronary sinus oxygen tension (20 mm Hg), and abnormal myocardial lactate-pyruvate metabolism.During 4-6 hr of IACP, systolic pressure and left ventricular outflow resistance decreased by 18% and 24%, respectively, while cardiac index improved by 38%. Diastolic arterial pressure rose 98%. Increase in coronary blood flow from an average of 68 to 91 ml/100 g per min (P < 0.001) was significantly correlated with rise in mean arterial pressure (r = 0.685). This correlation was best expressed in a third-order curve, which intercepts the point of no flow at a mean aortic pressure of 30 mm Hg. The flow-pressure curve is relatively flat above 65-70 mm Hg, but becomes steeper as mean aortic pressure falls below this point. Myocardial oxygen consumption remained essentially unchanged during early IACP and tended to rise during the later stages.However, the relationship of cardiac work performed to oxygen availability was markedly improved. Myocardial

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Section: Experimental Protocolsupporting

confidence: 71%

The effects of intra-aortic counterpulsation on cardiac performance and metabolism in shock associated with acute myocardial infarction

Mueller¹,

Ayres²,

Conklin³

et al. 1971

J. Clin. Invest.

Self Cite

145

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“…In those 10 animals in which isoproterenol was infused for less than 30 min, final measurements were recorded [15][16][17][18][19][20][21][22][23][24][25][26][27][28][29][30] '3M Co., St. Paul, Minn. min after discontinuation of isoproterenol. Then, the animals were anesthetized with 30 mg/kg pentobarbital sodium, and sacrificed to confirm placement of intramyocardial transducers and to obtain myocardial samples at the same sites for regional blood flow determination.…”

Section: Methodsmentioning

confidence: 99%

Effects of isoproterenol on regional myocardial function, electrogram, and blood flow in conscious dogs with myocardial ischemia.

et al. 1976

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A B S T R A C T The effects of coronary occlusion and of subsequent isoproterenol infusion were examined in conscious dogs. Left ventricular (LV) function was assessed by measurements of LV diameter, pressure, velocity and dP/dt/P, and regional myocardial function was assessed by measurements of segment length (SL) and velocity of SL shortening in normal, border, and ischemic zones. Regional myocardial function was measured from the same sites, along with intramyocardial electrograms and regional myocardial blood flow as determined by radioactive microspheres. Coronary occlusion resulted in graded loss of function from the normal to severely ischemic zones with graded flow reductions and graded increases in ST segment elevation. Isoproterenol improved overall LV function, and function in the normal zone. Isoproterenol also improved function in 19 of 21 border-zone segments and in all moderately ischemic segments, while elevating further the ST segments. These changes were accompanied by increases in myocardial blood flow. In contrast, in severely ischemic segments, isoproterenol resulted in a deterioration of function, in that paradoxical motion occurred in segments previously akinetic during systole, while paradoxical motion was intensified in those segments iii which it was already present. These changes were accompanied by further ST segment elevation but not by concurrent increases in blood flow. In addition, in 2 of 21 border zone segments, myocardial blood flow fell and Dr.

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“…15 Ten of 11 patients treated with isoproterenol alone, l-norepinephrine alone, or with both agents died during their initial hospitalization. Three of these patients lived longer than 3 days, and the survival time of the entire group who died in the hospital ranged from none to 10 days.…”

Section: Methodsmentioning

confidence: 99%

“…4 11-16 Previous studies from our laboratory demonstrated striking differences in cardiac performance and metabolism among the various types of shock and suggested that pharmacologic therapy should be based on metabolic abnormalities of the myocardium. 15 This study was undertaken to determine whether either isoproterenol or l-norepinephrine could improve myocardial metabolism and performance in coronary shock. Selection of any existing pharmacologic agent may well involve a compromise since improvement of cardiac function is achieved at the expense of increased cardiac work.…”

mentioning

confidence: 99%

Effect of Isoproterenol, l -Norepinephrine, and Intraaortic Counterpulsation on Hemodynamics and Myocardial Metabolism in Shock following Acute Myocardial Infarction

et al. 1972

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SUMMARYThe effects of isoproterenol, l-norepinephrine, and intraaortic counterpulsation on hemodynamics and myocardial metabolism were evaluated in shock due to acute myocardial infarction. Before treatment, the cardiac index was markedly reduced, averaging 1.35 liters/min/m2. Mean aortic pressures ranged from 40 to 65 mm Hg.Decreases in coronary blood flow (mean, 68 ml/100 g/min) and in myocardial oxygen consumption (mean, 8.11 ml/100 g/min) were associated with abnormally high myocardial oxygen extractions (mean, 78%) and with lactate production (mean, 9%). Isoproterenol increased cardiac index 63% and heart rate 26%. Coronary blood flow rose an average of 12 ml/100 g/min in the face of decreased diastolic aortic pressure.Rate of myocardial lactate production increased. 1-Norepinephrine increased mean aortic pressure and coronary blood flow an average of 21 mm Hg and 27 ml/ 100 g/min. Mean myocardial oxygen consumption rose 2.24 ml/ 100 g/min. While myocardial lactate production shifted to extraction (mean, 12%), myocardial oxygen extraction remained abnolmally high (mean, 73%). Cardiac index did not change. Intraaortic counterpulsation increased mean aortic pressure and coronary blood flow an average of 15 mm Hg and 23 ml/100 g/min. Myocardial oxygen consumption remained essentially unchanged. Both myocardial lactate and oxygen extraction improved toward normal values (15 and 61%). Cardiac index increased an average of 0.45 liters/min/m2. Hemodynamics and myocardial metabolism then were markedly abnormal in shock due to acute myocardial infarction. Isoproterenol improved cardiac performance but myocardial oxygenation deteriorated. Therefore isoproterenol does not seem to be helpful in coronary shock. 1-Norepinephiine improved myocardial perfusion and oxygenation, but did not change cardiac output. It appears to be the vasoactive agent of choice in the initial treatment of coronary shock. Intraaortic counterpulsation changed myocardial metabolism toward normal and improved systemic perfusion. Mortality remained unchanged however during the three different therapeutic interventions emphasizing the importance of early recognition of the shock state and of further aggressive diagnostic and therapeutic management.

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Hemodynamics, coronary blood flow, and myocardial metabolism in coronary shock; response to l-norepinephrine and isoproterenol

Abstract: A B S T R A C T Hemodynamics and myocardial metabo

Cited by 113 publications

References 64 publications

The effects of intra-aortic counterpulsation on cardiac performance and metabolism in shock associated with acute myocardial infarction

The effects of intra-aortic counterpulsation on cardiac performance and metabolism in shock associated with acute myocardial infarction

Effects of isoproterenol on regional myocardial function, electrogram, and blood flow in conscious dogs with myocardial ischemia.

Effect of Isoproterenol, l -Norepinephrine, and Intraaortic Counterpulsation on Hemodynamics and Myocardial Metabolism in Shock following Acute Myocardial Infarction

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