- Email: [email protected]
On the standardization of digitalis by the cat unit method
478
THE
AMERICAN
HEART
JOURNAL
effects.” In consequence, it favors a steeper gradient, and a larger systolic discharge. The latter occurs in the phase of ejection and as a result of the increased At no stage of digitalis action is systolic discharge the ventricles decreased as long as the rate of the effects are produced only by cardiac acceleration. Sidel, Nathan, Fibrillation.
and Dorwart, Bost. Med.
and
Frederick Murg.
G.: Jour.,
a higher pressure maximum, spite of a further reduction in velocity of ejection. recluccd or the diastolic size of heart is kept constant. Such
Quinidine 1927, cxcvi,
Sulphate 216.
in
Anricular
This report on the treatment of auricular fibrillation with quinidine is presented primarily to demonstrate the desirability of giving larger doses #of the drug than are usually administered. The series consists of 20 unselected cases of aurieular fibrillation admitted to the medical scrvicc of the Boston City Hospital. It includes one patient with ventricular fibrillation and a boy ten years old showing auricular fibrillation. P’ractically all of the patients were admitted because ,of varying degrees of heart failure as described in the case reports. The ages range from 10 to 53. All were chronic established fibrillators. Rheumatic heart disease in 7 and artcriosclerotic myocarditis in 13 were the underlying conditions. The dosage was increased gradually, if regular rhythm did not result. It is significant that of the 13 cases that reverted to normal rhythm 7 required a daily dosage of 75 grains and more hefmore regularity occurred. Regular rhythm under quinidinc therapy resulted in 100 of the patients with a cardiac history of two years or less. All of the cases except one had recent heart failure. All except one became compensated with digitalis, etc., before quinidine was started. The highest single dosage was 45 grains. The highest daily dosage was 200 grains. The hi.ghest total dosage pro,ducing regular rhythm was 920 grains. The highest total dosage over a period of two months was 33Sl grains. It is emphasized very strongly that large doses of quinidinc are not being advocated. This report simply shows that large divided doses of quinidine can be given after small doses have been tried and found unsuccessful. If larger amounts are to be given in the gradually increased dosage used in this series, the patient sh,ould be h,ospitalized so that his condition may be followed carefully. McFarlane, Cat Unit
A., and Method.
Masson, Jour.
G. A.: Eharmacol.
On
the Standardization and Eaper. Thcrap.,
of Digitalis 1927, xxx,
by 293.
the
The authors have attempted to determine the reason for the varying results in the Hatcher-Brody method of assay of digitalis which occur in Edinburgh as compared with other places. As the result of this study they feel that there are probably two groups of cats The relatively high results belong to a small and apparently disbeing dealt with. tinct gr.oup of animals with a grcatcr resistance to the drug. The presence of this small group of cats may cause pronounced variations in the estimatiou of the strength of digitalis powder, as only a small number of animals have been used for each assay.
THE
AMERICAN
HEART
JOURNAL
effects.” In consequence, it favors a steeper gradient, and a larger systolic discharge. The latter occurs in the phase of ejection and as a result of the increased At no stage of digitalis action is systolic discharge the ventricles decreased as long as the rate of the effects are produced only by cardiac acceleration. Sidel, Nathan, Fibrillation.
and Dorwart, Bost. Med.
and
Frederick Murg.
G.: Jour.,
a higher pressure maximum, spite of a further reduction in velocity of ejection. recluccd or the diastolic size of heart is kept constant. Such
Quinidine 1927, cxcvi,
Sulphate 216.
in
Anricular
This report on the treatment of auricular fibrillation with quinidine is presented primarily to demonstrate the desirability of giving larger doses #of the drug than are usually administered. The series consists of 20 unselected cases of aurieular fibrillation admitted to the medical scrvicc of the Boston City Hospital. It includes one patient with ventricular fibrillation and a boy ten years old showing auricular fibrillation. P’ractically all of the patients were admitted because ,of varying degrees of heart failure as described in the case reports. The ages range from 10 to 53. All were chronic established fibrillators. Rheumatic heart disease in 7 and artcriosclerotic myocarditis in 13 were the underlying conditions. The dosage was increased gradually, if regular rhythm did not result. It is significant that of the 13 cases that reverted to normal rhythm 7 required a daily dosage of 75 grains and more hefmore regularity occurred. Regular rhythm under quinidinc therapy resulted in 100 of the patients with a cardiac history of two years or less. All of the cases except one had recent heart failure. All except one became compensated with digitalis, etc., before quinidine was started. The highest single dosage was 45 grains. The highest daily dosage was 200 grains. The hi.ghest total dosage pro,ducing regular rhythm was 920 grains. The highest total dosage over a period of two months was 33Sl grains. It is emphasized very strongly that large doses of quinidinc are not being advocated. This report simply shows that large divided doses of quinidine can be given after small doses have been tried and found unsuccessful. If larger amounts are to be given in the gradually increased dosage used in this series, the patient sh,ould be h,ospitalized so that his condition may be followed carefully. McFarlane, Cat Unit
A., and Method.
Masson, Jour.
G. A.: Eharmacol.
On
the Standardization and Eaper. Thcrap.,
of Digitalis 1927, xxx,
by 293.
the
The authors have attempted to determine the reason for the varying results in the Hatcher-Brody method of assay of digitalis which occur in Edinburgh as compared with other places. As the result of this study they feel that there are probably two groups of cats The relatively high results belong to a small and apparently disbeing dealt with. tinct gr.oup of animals with a grcatcr resistance to the drug. The presence of this small group of cats may cause pronounced variations in the estimatiou of the strength of digitalis powder, as only a small number of animals have been used for each assay.