Use of propranolol in heart failure patients: safety, tolerability, and effects on left ventricular function.

INTRODUCTION AND OBJECTIVES: Beta-blockers have been shown to improve prognosis in patients with heart failure (HF). Propranolol, which is a low-cost drug, has not been fully studied in this setting. We sought to determine the safety, tolerability and effects on left ventricular function observed with the use of propranolol in HF patients, in functional class II-IV of the New York Heart Association. POPULATION AND METHODS: Prospective study in which 20 outpatients (10 male, mean age 56 +/- 12 years, ranging from 20 to 70) were included. Mean left ventricular ejection fraction (EF) was 28%. Safety, tolerability and effects on electrocardiographic and echocardiographic variables were analyzed. Patients were evaluated in three steps: a) Step I--optimization on conventional drugs and assessment of baseline parameters; b) Step II--start of propranolol (10-20 mg/day), increasing the dose weekly to achieve a heart rate of 60 bpm, or a maximum daily dose of 120 mg; c) Step III--reappraisal of the parameters analyzed in step I, after 3 months of propranolol treatment. RESULTS: On average, after treatment with propranolol, EF increased by 52% (p = 0.0003), E wave deceleration time was prolonged by 62% (p = 0.001) and effective ventricular filling time increased by 38.5% (p = 0.0005). Two patients developed mild congestion which was controlled by increasing diuretic doses, with no need to interrupt the protocol. Four patients had bradycardia-related symptoms, controlled by reducing digoxin doses. Nine subjects developed hyperkalemia, reversed by interrupting or reducing spironolactone. CONCLUSION: Propranolol was safe and well tolerated, and had beneficial effects on ventricular function in HF patients. Its impact on mortality requires further study.

Effects of propranolol on the QT dispersion in congestive heart failure.

OBJECTIVE: Studies have shown that therapy with beta-blockers reduces mortality in patients with heart failure. However, there are no studies describing the effects of propranolol on the QT dispersion in this population. The objective of this study was to assess the electrophysiological profile, mainly QT dispersion, of patients with heart failure regularly using propranolol. METHODS: Fifteen patients with heart failure and using propranolol were assessed over a period of 12 months. Twelve-lead electrocardiograms (ECG) were recorded prior to the onset of beta-blocker therapy and after 3 months of drug use. RESULTS: A significant reduction in heart rate, in QT dispersion and in QTc dispersion was observed, as was also an increase in the PR interval and in the QT interval, after the use of propranolol in an average dosage of 100 mg/day. CONCLUSION: Reduction in QT dispersion in patients with heart failure using propranolol may explain the reduction in the risk of sudden cardiac death with beta-blocker therapy, in this specific group of patients.

[Hospital outcome and short-term follow-up of elderly patients presenting to the emergency unit with congestive heart failure]. / Evolução intra-hospitalar e seguimento pós-alta de pacientes idosos atendidos com insuficiência cardíaca congestiva na unidade de emergência.

PURPOSE: To evaluate the in-hospital (IH) outcome and the short-term follow-up of predominantly elderly patients presenting to an emergency room (ER) with congestive heart failure (CHF). METHODS: In an 11 month period, 57 patients presenting to the ER with CHF were included. Mean age was 69 +/- 15 years (27 to 94) and 39 (68.4%) were male. CHF diagnosis was based on the Boston criteria. We evaluated IH outcome and prognosis in a mean follow-up of 5.7 +/- 2.7 months (1 to 12). In addition, some mortality predictors and mechanisms of death according on the ACME system were identified. RESULTS: Eight patients (14%) died in the IH period. Modes of death were circulatory failure (CF) in 7, and peri-operative (PO) in one (aortic valve replacement). During follow-up 9 deaths occurred. Five were due to CF, 2 were sudden and 2 were PO (mitral valve replacement and ventriculectomy). Six-months and 1-year survival rates of the patients who were discharged were 82% and 66%, respectively. Sodium lower than 135 mEq/l (p = 0.004) and female gender (p = 0.038) were independent predictors of mortality. CONCLUSION: Elderly patients with CHF admitted to the ER have high in-hospital and short-term follow up mortalities. The majority die from CF due to worsening heart failure.

Evoluçäo intra-hospitalar e seguimento pós-alta de pacientes idosos atendidos com insuficiência cardíaca congestiva na unidade de emergência / Hospital outcome and short-term follow-up of predominatly elderly patients presenting to the emergency department with congestive heart failure

OBJETIVO - Conhecer a evoluçäo intra-hospitalar (IH) e pós-alta (PA) de uma populaçäo predominantemente idosa, com insuficiência cardíaca congestiva (ICC) na unidade de emergência (UE). MÉTODOS - Durante 11 meses, foram selecionados 57 pacientes consecutivos com ICC, atendidos em UE, com idade média de 69ñ15 (27 a 94) anos, sendo 39 (68,4 por cento) homens. O diagnóstico de ICC baseou-se nos critérios de Boston. Avaliou-se a evoluçäo IH e PA num período médio de 5,7ñ2,7 (1 A 12) meses, procurando-se identificar variáveis que se correlacionassem com a mortalidade e o mecanismo de morte, avaliado pelo sistema ACME. RESULTADOS - Oito (14 por cento) pacientes faleceram na fase IH, sendo 7 por falência circulatória (FC), e 1 em pós-operatório (PO). Durante o seguimento ocorreram 9 (18,4 por cento) óbitos, sendo 5 por FC, 2 mortes súbitas e 2 em (troca valvar mitral e ventriculectomia). A sobrevida dos pacientes...

Turbidimetric determination of some sulphur compounds in ethanol from fermentation.

A simple method is described which can be used for the determination of certain sulphur compounds found in industrial ethanol obtained from fermentation of molasses. The method is based on the turbidimetric determination of sulphate after the sample has been treated with dilute hydrogen peroxide solution, by precipitation of the sulphate with barium chloride under appropriate conditions. Several samples of fermentation ethanol have been analysed by this method and the sulphur contents found compared with the total acidity.