TREATMENT AFTER ACUTE MYOCARDIAL INFARCTION

Propranolol shows great potential for preventing sudden cardiac death Following an acute myocardial infarction, 32 patients having frequent ventricular arrhythmias were intially given 20mg oral propranolol qid. The dosage was increased by 80mg daily every 4-7 days until 50 % suppression of premature ventricular complexes was achieved, until the dosage reached 480mg or until side effects made it necessary to stop treatment. The average propranolol dose was 160mg daily. During treatment the average maximal heart rate decreased from 153 beats/ min to 117 beats/ min. Systolic BP also fell significantly. There was a lower incidence of multifocal premature ventricular complexes, paired complexes, bigeminy and ventricular tachycardia during propranolol treatment compared to control periods before and after treatment. Eight patients reported fatigue, dizziness or gastrointestinal problems during the study but 6 of them tolerated long term treatment. Six patients responded poorly to treatment, 3 developed mild cardiomegaly and I patient could tolerate only 80mg of propranolol daily because of diarrhea. All 32 patients were alive 6 months after myocardial infarction. Koppes. G.M . et al. : American Journal of Cardiology 46: 322 (Aug 1980)

Albuterol may help in cases with cardiogenic shock and pump failure Acute myocardial infarction in 31 patients was complicated by cardiogenic shock which was resistant to furosemide (frusemide, 80-500mg). The patients were given a continuous infusion of albuterol (salbutamoI), 13j.lg/ min. Hemodynamic measurements in 9 patients showed an· average cardiac ind~x increase from 1.25L1min/m2 to 1.76L1min/m2• The average stroke index rose 28 %

. and the heart rate increased by an average of 13 %. The systemic vascular resistance fell from 26.2 units to 21.9 units. The only complication was the development of supraventricular tachycardia in I patient. Eight of the 31 patients survived to leave hospital. Although the survival rate is disappointing, the results suggest that 'salbutamol is a valid alternative drug in the management of pump failure and cardiogenic shock complicating acute mvocardial infarction'. Dawson. J.R. et al.: British Heart Journal 43 : 523 (May 1980)

12 INPHARMA 20 Sep 1980 0156-2703/80/0920-0012 $00.50/0 @ADIS Press