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ARTICLE |

Ineffectiveness of Isoproterenol in Shock Due to Acute Myocardial Infarction FREE

Rolf M. Gunnar, MD; Henry S. Loeb, MD; Raymond J. Pietras, MD; John R. Tobin, Jr., MD
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JAMA. 1967;202(13):1124-1128. doi:10.1001/jama.1967.03130260046007
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Studies of clinical and hemodynamic changes in 13 patients with shock due to acute myocardial infarction were conducted. Both levarterenol (norepinephrine) bitartrate and isoproterenol hydrochloride were infused, and the clinical and hemodynamic effects were compared. Arterial pressure could be increased to nearly normal levels in all patients when levarterenol was infused, and this drug appeared to contribute to recovery in four patients. Adequate arterial pressure was obtained in only one patient during isoproterenol infusion, and clinical deterioration was coincident with the change from levarterenol to isoproterenol infusion in four patients. Increases in cardiac output occurred with both drugs, but was related to clinical improvement only when this increase was associated with an elevation in mean arterial pressure. Maintenance of an adequate arterial perfusion pressure is essential in treating shock due to acute myocardial infarction. In most patients, levarterenol is superior to isoproterenol in achieving this goal.

REFERENCES

Wilson, J.N.:  Rational Approach to Management of Clinical Shock: Utilizing Light-reflection Oximetry and Central Venous Pressure Monitoring , Arch Surg 91:92-120 ( (July) ) 1965;.
Carey, J.S., et al:  Cardiovascular Function in Shock: Responses to Volume Loading and Isoproterenol Infusion , Circulation 35:327-338 ( (Feb) ) 1967;.
Gunnar, R.M.. et al:  Myocardial Infarction With Shock: Hemodynamic Studies and Results of Therapy , Circulation 33: 753-762 ( (May) ) 1966;.
Gunnar. R.M.. et al:  The Physiologic Basis for Treatment of Shock Associated With Myocardial Infarction . Med Clin Amer 51:69-81 ( (Jan) ) 1967;.
Kardos, G.G.:  Isoproterenol in the Treatment of Shock Due to Bacteremia With Gram-negative Pathogens . New Eng J Med 274:868-873 ( (April 21) ) 1966;.
Levin, S., and Painter. M.B.:  The Treatment of Acute Meningococcal Infection in Adults: A Reappraisal , Ann Intern Med 64:1049-1056 ( (May) ) 1966;.
Costantin, L.:  Extracardiac Factors Contributing to Hypotension During Coronary Occlusion , Amer J Cardiol 11:205-217 ( (Feb) ) 1963;.
Gorlin, R., et al:  Effect of Nitroglycerine on the Coronary Circulation in Patients With Coronary Artery Disease or Increased Left Ventricular Work , Circulation 19:705-718 ( (May) ) 1959;.
Ross, J.:  Left Ventricular Contraction and the Therapy of Cardiogenic Shock , Circulation 35:611-613 ( (April) ) 1967;.
Goldfarb, D., et al:  Treatment of Circulatory Failure With a New System for Selective Diastolic Augmentation , Surgery 56: 547-555 ( (Sept) ) 1964;.
Rodriguez. F.L., and Robbins, S.L.:  Postmortem Angiographic Studies on the Coronary Arterial Circulation: Intercoronary Arterial Anastomoses in Adult Human Hearts . Amer Heart J 70:348-364 ( (Sept) ) 1965;.
Jacobey, J.A., et al:  A New Therapeutic Approach to Acute Coronary Occlusion: II. Opening Dormant Coronary Collateral Channels by Counter Pulsation . Amer J Cardiol 11:218-227 ( (Feb) ) 1963;.
Davidson, A.I.G.. and Leighninger, D.S.:  Collateral Flow in the Heart at Different Aortic Perfusion Pressures Using Left Heart Bypass: An Experimental Study , Annals Surg 162:48-52 ( (July) ) 1965;.
Shillingford. J.P.. and Thomas. M.:  Acute Myocardial Infarction, Hypotension and Shock: Their Pathological Physiology and Therapy , Mod Conc Cardiov Dis 36:13-17 ( (March) ) 1967;.
Morse, B.W.; Danzig, R.: and Swan, H.J.C.:  Effect of Isoproterenol in Shock Associated with Acute Myocardial Infarction . Circulation 36 ( (suppl 2) ): 192. 1967;.
Smith, H.J., et al:  Hemodynamic Studies in Cardiogenic Shock: Treatment With Isoproterenol and Metaraminol , Circulation 35:1084-1091 ( (June) ) 1967;.
Dietzman, R.H.. et al:  Relation of Cardiac Work to Survival in Cardiogenic Shock in Dogs . JAMA 199:825-829 ( (March 13) ) 1967;.
Kuhn, L.A., et al:  Effects of Isoproterenol on Hemodynamic Alterations, Myocardial Metabolism and Coronary Flow in Experimental Acute Myocardial Infarction With Shock , abstracted, Amer J Cardiol 19:137 ( (Jan) ) 1967;.

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Wilson, J.N.:  Rational Approach to Management of Clinical Shock: Utilizing Light-reflection Oximetry and Central Venous Pressure Monitoring , Arch Surg 91:92-120 ( (July) ) 1965;.
Carey, J.S., et al:  Cardiovascular Function in Shock: Responses to Volume Loading and Isoproterenol Infusion , Circulation 35:327-338 ( (Feb) ) 1967;.
Gunnar, R.M.. et al:  Myocardial Infarction With Shock: Hemodynamic Studies and Results of Therapy , Circulation 33: 753-762 ( (May) ) 1966;.
Gunnar. R.M.. et al:  The Physiologic Basis for Treatment of Shock Associated With Myocardial Infarction . Med Clin Amer 51:69-81 ( (Jan) ) 1967;.
Kardos, G.G.:  Isoproterenol in the Treatment of Shock Due to Bacteremia With Gram-negative Pathogens . New Eng J Med 274:868-873 ( (April 21) ) 1966;.
Levin, S., and Painter. M.B.:  The Treatment of Acute Meningococcal Infection in Adults: A Reappraisal , Ann Intern Med 64:1049-1056 ( (May) ) 1966;.
Costantin, L.:  Extracardiac Factors Contributing to Hypotension During Coronary Occlusion , Amer J Cardiol 11:205-217 ( (Feb) ) 1963;.
Gorlin, R., et al:  Effect of Nitroglycerine on the Coronary Circulation in Patients With Coronary Artery Disease or Increased Left Ventricular Work , Circulation 19:705-718 ( (May) ) 1959;.
Ross, J.:  Left Ventricular Contraction and the Therapy of Cardiogenic Shock , Circulation 35:611-613 ( (April) ) 1967;.
Goldfarb, D., et al:  Treatment of Circulatory Failure With a New System for Selective Diastolic Augmentation , Surgery 56: 547-555 ( (Sept) ) 1964;.
Rodriguez. F.L., and Robbins, S.L.:  Postmortem Angiographic Studies on the Coronary Arterial Circulation: Intercoronary Arterial Anastomoses in Adult Human Hearts . Amer Heart J 70:348-364 ( (Sept) ) 1965;.
Jacobey, J.A., et al:  A New Therapeutic Approach to Acute Coronary Occlusion: II. Opening Dormant Coronary Collateral Channels by Counter Pulsation . Amer J Cardiol 11:218-227 ( (Feb) ) 1963;.
Davidson, A.I.G.. and Leighninger, D.S.:  Collateral Flow in the Heart at Different Aortic Perfusion Pressures Using Left Heart Bypass: An Experimental Study , Annals Surg 162:48-52 ( (July) ) 1965;.
Shillingford. J.P.. and Thomas. M.:  Acute Myocardial Infarction, Hypotension and Shock: Their Pathological Physiology and Therapy , Mod Conc Cardiov Dis 36:13-17 ( (March) ) 1967;.
Morse, B.W.; Danzig, R.: and Swan, H.J.C.:  Effect of Isoproterenol in Shock Associated with Acute Myocardial Infarction . Circulation 36 ( (suppl 2) ): 192. 1967;.
Smith, H.J., et al:  Hemodynamic Studies in Cardiogenic Shock: Treatment With Isoproterenol and Metaraminol , Circulation 35:1084-1091 ( (June) ) 1967;.
Dietzman, R.H.. et al:  Relation of Cardiac Work to Survival in Cardiogenic Shock in Dogs . JAMA 199:825-829 ( (March 13) ) 1967;.
Kuhn, L.A., et al:  Effects of Isoproterenol on Hemodynamic Alterations, Myocardial Metabolism and Coronary Flow in Experimental Acute Myocardial Infarction With Shock , abstracted, Amer J Cardiol 19:137 ( (Jan) ) 1967;.
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