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European Heart Journal 1982 3(1):23-28;
Copyright © 1982 by the European Society of Cardiology.
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© 1982 by The European Society of Cardiology

The effect of nitroglycerin, beta-blockade with acebutolol and isometric stress on incoordinate left vebtricular function

R. J. C. HALL, J. DORAN, C. PUSEY, D. MCHAFFIE and D. G. GIBSON

Cardiac Department, Brompton Hospital London SW3 6HP, U.K.

Received 6 April 1981; revised 7 July 1981; .

Requests for reprints to: R. J. C. Hall, Ward 14, Royal Victoria Infirmary, Newcastle Upon Tyne NE1 4LP, U.K.

Abstract

In order to investigate mechanisms underlying incoordinate left ventricular wall motion in ischaemic heart disease, simultaneous echo and apexcardiograms were recorded and digitized in 30 patients with ischaemic heart disease. In 20 patients, isometric stress increased blood pressure and significantly reduced peak velocity of circumferential fibre shortening. There was no change in wall motion during isovolumic contraction although mitral valve opening, previously delayed with respect to minimum cavity dimension by 65 ± 30 ms, returned towards normal (35 ± 40 ms, P < 0.01). Sublingual nitroglycerin (1 mg) increased heart rate, and reduced blood pressure and cavity dimensions. Wall motion during isovolumic contraction was unaltered, but incoordinate relaxation was aggravated, with mitral valve opening further delayed (P < 0.05), and 48 ± 30% of total dimension change occurring during the downstroke of the apex-cardiogram compared with a control value of 37 ± 20% (P < 0.01). In 10 patients beta-blockade with intravenous acebutolol (60 mg) slowed heart rate and increased cavity dimensions, but no other effect on wall motion was detected. Sublingual nitroglycerin (1 mg) given immediately after acebutolol caused a further reduction in arterial pressure, but no change in incoordinate wall motion. Cavity dimensions and heart rate returned to pre-acebutolol levels.

We conclude:

(1) Incoordinate wall motion occurring at rest in patients with ischaemic heart disease was not improved by nitroglycerin or beta-blockade, or aggravated by isometric stress, and so is not due to acute ischaemia.

(2) Aggravation of incoordinate relaxation by nitroglycerin was blocked by acebutolol, and so might have been related to changes in heart rate or cavity dimension, but not arterial pressure.

Key Words: Ischaemic incoordinate contraction • nitroglycerin • stress • beta-blockade


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