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Tachycardia produced by venous hypertension in man. A study of the Bainbridge reflex
548
AMERICAN
Cohn-Czempin, 5:292 (Sept.),
R. : Cinnabane 1916.
in
HEART
the
Treatment
JOURNAL
of Angina
Pectoris,
Arta
hIed.
Orient.
The favorable effect of Cinnabane, a benzyl-cinnamide, on otosclerosis. as reported by Seelenfreund. suggested the use of this new drug for the treatment of angina pectoris. In view of the vasodilator effect of the benzyl radical and its lipoid-solubility, the drug was expected to have a lasting rather than a transient effect. The results of treatment of seventeen cases of angina pectoris are reported by this author. A course of treatment consisted of ten daily intramuscular injections of a 1 C.C. solution in oil. This treatment could be repeated once or twice after an interval of one week. In fifteen of the seventeen patients cinnabane proved to be a powerful and lasting vasodilator. Pain usually disappeared after the first course. In the presence of hypertension, the blood pressure dropped gradually and remained low for a long time. In seven patients, improvement of electrocardiographic findings w-ere recorded. The improvement consisted in the disappearance of S-T segment depression and return to normal of inverted T waves in Lead IV F. The author concludes that cinnabane, owing to its lasting action as vasodilator, has proved of great value in the treatment of angina pectoris, as well as other forms of heart disease caused by coronary insufficiency. another advantage is that cinnabane therapy can be given periodically, while other vasodilators must be taken continually in order to suppress pain and angina1 attacks. BELLET. Ben-Asher, Cases 25:711
S. : With (Oct.),
On the Toxicity of the Mercurial Suggestions for the Prevention 1946.
Diuretics: of Toxic
Observations Reaction.
Ann.
on Eighteen Int. Med.
The author describes his experiences with 18 patients with congestive heart failure in whom the intravenous administration of a mercurial diuretic was followed by untoward symptoms, such as acute circulatory collapse or an acute cerebral episode manifested by delirium, drowsiness, In 10 of the patients a delayed type of reaction occurred. or mental confusion. Since nine of this number recovered after the administration of salt and water, the author ascribes the delayed reaction to excessive dehydration which resulted from the diuretic effect of the drug, superimposed on the excessive sweating which resulted from high environmental temperatures and humidity. An immediate untoward reaction occurred in eight other patients, but in seven of these, the repetition of such a reaction was prevented either by giving the drug slowly and intermittentI>. or b> preceding the injection with the intravenous administration of sodium thiosulphate. It is also the author’s opinion that the occurrence of either type of reaction increased the seriousness of the prognosis; for this reason he strongly recommends a consideration of all factors which might prevent either form of reaction. WENDFOS. Lequine, J., Segers, tension in Man.
M., and Denolin, A Study of the
11.: Tachycardia Bainbridge Reflex.
Produced Acta
by Venous HyperCardiologica l:l, 1946.
The mechanism of the Bainbridge reflex was studied in man by the following procedures: increasing the venous pressure in a series of eleven normal subjects by the injection of one liter of physiologic serum, warmed to 37” C., into an arm vein in a period of five to ten minutes; (2) altering the venous pressure in a patient who had an arteriovenous fistula of the femoral vessels During both procedures, records were made of the by intermittent compression of the fistula. venous and arterial pressures and of the heart and respiratory rates. The intravenous injections were followed by an increase in venous pressure of 5 to 74 mm. of water. The heart rate was accelerated by 8 to 25 per cent. In four subjects, 1.5 to 2.0 mg. of atropine was administered and during the resultant acceleration of the heart, the infusion was repeated. It was found that although the venous pressure increased as before, there was no appreciable increase of the heart rate. An exercise test after atropinization, on the other hand, (1)
SELECTED
549
ABSTRACTS
increased the heart rate by about 20 per cent. The possibility that an aortic reflex or increased respiratory movements were responsible for the cardiac acceleration during the infusion was excluded by the fact that the blood pressure change was very slight and that no significant change in respiratory rate was noted. In the case of the arteriovenous fistula, closure of the fistula produced an initial increase of 30 mm. in the arterial pressure, but the pressure fell promptlyto its original level in spite of the The venous pressure, on the other hand, decreased to 25 mm. of water fistula remaining closed. below its initial level and this hypotension persisted. The heart rate decreased from 100 to 60 beats per minute and then maintained a constant rate of 75. The association of the slower heart rate and lower venous pressure in the presence of a relatively unchanged arterial pressure was considered further evidence of the existence of the Rainbridge reflex. The administration of 1.5 mg. of atropine completely suppressed the response of the heart to compression of the tistula. Acceleration of the respiratory rate by over 10 per cent occurred during the infusion of serum in eight of the eleven cases. On the other hand, altering the venous pressure by compressing and opening the fistula did not change the respiratory rate. When the venous pressure was elevated by infusion in the four subjects who received atropine, there was no increase in the respirator?, rate. This respiratory reaction as it occurs in man is considered comparable to that described in the dog but is inconstant. The Bainbridge reflex is concluded to be an important but partial element in determining exercise tachycardia. L.&PLACE. Goldfinger,
Am.J.M.Sc.
D.,
and
212:418
Wosika,
(Oct.),
P.
H.:
The
Electrocardiographic
Effects
of
Prostigmine.
1946.
The fact that tachycardia remains a difficult problem therapeutically and often interferes with the proper evaluation of the myocardial status through the interpretation of the electrocardiogram led the authors to study the effects of prostigmine. The study was felt to be especially indicated because of recent reports extolling the effect of this medication in all forms of tachycardia. The electrocardiographic changes were therefore observed in forty-two patients to whom 1 mg. of prostigmine methylsulfate was administered subcutaneously. The cardiac rate was slowed in 86 per cent of the patients studied. The series included patients with both organic and functional conditions. While this slowing may have been as little as IO beats per minute in some instances, yet a similar result could not be obtained by any other method. Besides a decreased rate, other effects were noted, including transient inversion of the P wave, increase in amplitude of the QRS, increase in the amplitude of the T waves, separation of the fused T and P wave in auriculoventricular block, and slowing of the ventricular rate in auricular fibrillation and Most of the effects upon the form of the electrocardiogram were explained upon am-icular flutter. the basis that the rate is slowed by stimulation of the parasympathetics. The P-R interval was uninfluenced except in one case of neurocirculatory asthenia in which it was shortened from 0.18 to 0.16 second and in one case of rheumatic heart disease in which it was lengthened from 0.16 to 0.18 second. The effect of the oral preparation of prostigmine bromide was disappointing when used therapeutically, notable slowing being achieved only with doses which produced intolerable side effects. The procedure recommended in the study of the electrocardiogram is the comparison of the complete electrodardiogram before and twenty minutes after the injection. I~JRANT.
Breytspraak, thrombin
R. W., Time
The and Greenspan, F. S.: in Man. Am.J.M.Sc. 212:476
Effect
of
(Oct.),
1946.
Aminophylline
on
the
Pro-
Aminophylline was administered orally and intravenously, in full dosage, to a small series of young adult, male patients with mild bronchial asthma. The effects of the drug were studied with respect to the changes in the dilute (12.5 per cent) plasma prothrombin time. No significant
AMERICAN
Cohn-Czempin, 5:292 (Sept.),
R. : Cinnabane 1916.
in
HEART
the
Treatment
JOURNAL
of Angina
Pectoris,
Arta
hIed.
Orient.
The favorable effect of Cinnabane, a benzyl-cinnamide, on otosclerosis. as reported by Seelenfreund. suggested the use of this new drug for the treatment of angina pectoris. In view of the vasodilator effect of the benzyl radical and its lipoid-solubility, the drug was expected to have a lasting rather than a transient effect. The results of treatment of seventeen cases of angina pectoris are reported by this author. A course of treatment consisted of ten daily intramuscular injections of a 1 C.C. solution in oil. This treatment could be repeated once or twice after an interval of one week. In fifteen of the seventeen patients cinnabane proved to be a powerful and lasting vasodilator. Pain usually disappeared after the first course. In the presence of hypertension, the blood pressure dropped gradually and remained low for a long time. In seven patients, improvement of electrocardiographic findings w-ere recorded. The improvement consisted in the disappearance of S-T segment depression and return to normal of inverted T waves in Lead IV F. The author concludes that cinnabane, owing to its lasting action as vasodilator, has proved of great value in the treatment of angina pectoris, as well as other forms of heart disease caused by coronary insufficiency. another advantage is that cinnabane therapy can be given periodically, while other vasodilators must be taken continually in order to suppress pain and angina1 attacks. BELLET. Ben-Asher, Cases 25:711
S. : With (Oct.),
On the Toxicity of the Mercurial Suggestions for the Prevention 1946.
Diuretics: of Toxic
Observations Reaction.
Ann.
on Eighteen Int. Med.
The author describes his experiences with 18 patients with congestive heart failure in whom the intravenous administration of a mercurial diuretic was followed by untoward symptoms, such as acute circulatory collapse or an acute cerebral episode manifested by delirium, drowsiness, In 10 of the patients a delayed type of reaction occurred. or mental confusion. Since nine of this number recovered after the administration of salt and water, the author ascribes the delayed reaction to excessive dehydration which resulted from the diuretic effect of the drug, superimposed on the excessive sweating which resulted from high environmental temperatures and humidity. An immediate untoward reaction occurred in eight other patients, but in seven of these, the repetition of such a reaction was prevented either by giving the drug slowly and intermittentI>. or b> preceding the injection with the intravenous administration of sodium thiosulphate. It is also the author’s opinion that the occurrence of either type of reaction increased the seriousness of the prognosis; for this reason he strongly recommends a consideration of all factors which might prevent either form of reaction. WENDFOS. Lequine, J., Segers, tension in Man.
M., and Denolin, A Study of the
11.: Tachycardia Bainbridge Reflex.
Produced Acta
by Venous HyperCardiologica l:l, 1946.
The mechanism of the Bainbridge reflex was studied in man by the following procedures: increasing the venous pressure in a series of eleven normal subjects by the injection of one liter of physiologic serum, warmed to 37” C., into an arm vein in a period of five to ten minutes; (2) altering the venous pressure in a patient who had an arteriovenous fistula of the femoral vessels During both procedures, records were made of the by intermittent compression of the fistula. venous and arterial pressures and of the heart and respiratory rates. The intravenous injections were followed by an increase in venous pressure of 5 to 74 mm. of water. The heart rate was accelerated by 8 to 25 per cent. In four subjects, 1.5 to 2.0 mg. of atropine was administered and during the resultant acceleration of the heart, the infusion was repeated. It was found that although the venous pressure increased as before, there was no appreciable increase of the heart rate. An exercise test after atropinization, on the other hand, (1)
SELECTED
549
ABSTRACTS
increased the heart rate by about 20 per cent. The possibility that an aortic reflex or increased respiratory movements were responsible for the cardiac acceleration during the infusion was excluded by the fact that the blood pressure change was very slight and that no significant change in respiratory rate was noted. In the case of the arteriovenous fistula, closure of the fistula produced an initial increase of 30 mm. in the arterial pressure, but the pressure fell promptlyto its original level in spite of the The venous pressure, on the other hand, decreased to 25 mm. of water fistula remaining closed. below its initial level and this hypotension persisted. The heart rate decreased from 100 to 60 beats per minute and then maintained a constant rate of 75. The association of the slower heart rate and lower venous pressure in the presence of a relatively unchanged arterial pressure was considered further evidence of the existence of the Rainbridge reflex. The administration of 1.5 mg. of atropine completely suppressed the response of the heart to compression of the tistula. Acceleration of the respiratory rate by over 10 per cent occurred during the infusion of serum in eight of the eleven cases. On the other hand, altering the venous pressure by compressing and opening the fistula did not change the respiratory rate. When the venous pressure was elevated by infusion in the four subjects who received atropine, there was no increase in the respirator?, rate. This respiratory reaction as it occurs in man is considered comparable to that described in the dog but is inconstant. The Bainbridge reflex is concluded to be an important but partial element in determining exercise tachycardia. L.&PLACE. Goldfinger,
Am.J.M.Sc.
D.,
and
212:418
Wosika,
(Oct.),
P.
H.:
The
Electrocardiographic
Effects
of
Prostigmine.
1946.
The fact that tachycardia remains a difficult problem therapeutically and often interferes with the proper evaluation of the myocardial status through the interpretation of the electrocardiogram led the authors to study the effects of prostigmine. The study was felt to be especially indicated because of recent reports extolling the effect of this medication in all forms of tachycardia. The electrocardiographic changes were therefore observed in forty-two patients to whom 1 mg. of prostigmine methylsulfate was administered subcutaneously. The cardiac rate was slowed in 86 per cent of the patients studied. The series included patients with both organic and functional conditions. While this slowing may have been as little as IO beats per minute in some instances, yet a similar result could not be obtained by any other method. Besides a decreased rate, other effects were noted, including transient inversion of the P wave, increase in amplitude of the QRS, increase in the amplitude of the T waves, separation of the fused T and P wave in auriculoventricular block, and slowing of the ventricular rate in auricular fibrillation and Most of the effects upon the form of the electrocardiogram were explained upon am-icular flutter. the basis that the rate is slowed by stimulation of the parasympathetics. The P-R interval was uninfluenced except in one case of neurocirculatory asthenia in which it was shortened from 0.18 to 0.16 second and in one case of rheumatic heart disease in which it was lengthened from 0.16 to 0.18 second. The effect of the oral preparation of prostigmine bromide was disappointing when used therapeutically, notable slowing being achieved only with doses which produced intolerable side effects. The procedure recommended in the study of the electrocardiogram is the comparison of the complete electrodardiogram before and twenty minutes after the injection. I~JRANT.
Breytspraak, thrombin
R. W., Time
The and Greenspan, F. S.: in Man. Am.J.M.Sc. 212:476
Effect
of
(Oct.),
1946.
Aminophylline
on
the
Pro-
Aminophylline was administered orally and intravenously, in full dosage, to a small series of young adult, male patients with mild bronchial asthma. The effects of the drug were studied with respect to the changes in the dilute (12.5 per cent) plasma prothrombin time. No significant