THE EFFECTS OF PHENTOLAMINE AND NITROGLYCERIN ON RIGHT-SIDED HEMODYNAMICS IN CARDIAC PATIENTS CAN BE EXPLAINED BY A SHIFT OF THE SYSTEMIC VENOUS RETURN CURVE AND RIGHT-VENTRICULAR OUTPUT CURVE

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The present study investigated the effects of phentolamine (PH) and nitroglycerin (NG) on the hemodynamics of the right heart in patients with cardiac disease. The patients were divided into a well-functioning left heart group (W group, n=15) and a poorly-functioning left heart group (P group, n=15). Right cardiac hemodynamic parameters and plasma noradrenaline (NA) and adrenaline (A) concentrations were measured before and after administering PH (0.1 mg/kg, i.v.) or NG (0.6 my, sublingual). In a parallel animal study we obtained a systemic venous return curve by measuring mean circulatory pyressure (MOP), mean right atrial pressure (<RAP>^^^- ) and cardiac output, before and after administering PH (0.1 mg/kg, i.v.) or NG (12.5 μg/kg, i.v.) to anesthetized open-chest dogs (n=14). We used MOP data (W group: 7.5 mmHg, P group: 10 mmHg) obtained in a separate series of human studies in our laboratory. We constructed the venous return curve by connecting the MOP point on abscissa with the cardiac index (CI)-<RAP>^^^- plot obtained in the clinical study. We also constructed the right ventricular output curve by connecting the point of -2 mmHg on the abscissa with the CI-<RAP>^^^- plot. We obtained the following results: (1) PH shifted the CI-<RAP>^^^- plot to the left and upwards, while NG shifted the CI-<RAP>^^^- plot to the left almost horizontally on the CI-<RAP>^^^- plane, where CI was plotted on ordinate and <RAP>^^^- on abscissa. The length (|<CHP>^^^ →|, C=control point, PH=point after PH) of the shift of CI-<RAP>^^^- plot due to PH was greater in the P group than in W group, while there was no difference in the length (|<CNG>^^^→|, C=control point, NG=point after NG) of the shift of CI-RAP plot due to NG between P and W groups. (2) Both PH and NG significantly elevated plasma NA and A concentrations in both the W and P groups. In the P group, PH increased the plasma NA concentration significantly more than did NG, but both drugs increased plasma A concentration to a similar extent. (3) Both PH and NG significantly decreased the mean pulmonary arterial pressure with NG doing so significantly more than PH. (4) In anesthetized open-chest dogs, PH 100 μg/kg i.v. rotated the venous return curve clockwise and shifted it to the left, while NG 12.5 μg/kg i.v. shifted the venous return curve parallel to the left. We interpreted the changes in the CI-RAP plot caused by PH and NG in human studies on the basis of venous return curve changes obtained in the dog experiments. It is suggested that the PH-induced increase in cardiac output is due to (a) stimulation of β-adrenoceptors in the systemic capacitance vessels (a decrease in resistance to venous return) by PH-induced increase in plasma NA level and (b) an improvement in pumping function of the right heart by the stimulation of cardiac β-adrenoceptors by a PH-induced increase in plasma NA level.
社団法人日本循環器学会の論文
1992-08-20

THE EFFECTS OF PHENTOLAMINE AND NITROGLYCERIN ON RIGHT-SIDED HEMODYNAMICS IN CARDIAC PATIENTS CAN BE EXPLAINED BY A SHIFT OF THE SYSTEMIC VENOUS RETURN CURVE AND RIGHT-VENTRICULAR OUTPUT CURVE

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