Clinical characteristics of patients with increased urinary excretion of adrenaline in mild to moderate heart failure.

BACKGROUND: We have previously demonstrated that adrenaline (AD) is released into the circulation during acute myocardial infarction and is associated with a more severe clinical course. The role of elevated AD levels in congestive heart failure is not known. HYPOTHESIS: The study aimed to determine whether increased daily AD excretion is associated with more severe clinical symptoms and a more complicated clinical course in patients with exacerbation of congestive heart failure (CHF). METHODS: Urinary excretion of AD, noradrenaline, magnesium (Mg), and potassium (K), serum levels of aldosterone, K, and Mg, as well as the incidence of arrhythmias (24-h Holter) were assessed in 49 patients with CHF New York Heart Association (NYHA) class II-III. The patients were allocated to two groups, with normal (Group 1) and increased (Group 2) excretion of AD. RESULTS: Groups 1 and 2 did not differ in respect of age, etiology of CHF, or the medication used. Also, left ventricular ejection fraction was similar in the two groups. However, left ventricular end-diastolic dimension was greater in Group 2 (61+/-9 vs. 55+/-11 mm, p<0.05), as was the proportion of patients in NYHA class III (74 vs. 40%). Group 2 was also characterized by increased urinary excretion of Mg (60+/-24 vs. 43+/-16 mg/24 h, p < 0.007) and the presence of more complex and numerous ventricular arrhythmias (74 vs. 37% and 68 vs. 33% of patients, respectively). CONCLUSIONS: Urinary excretion of AD is increased only in a subgroup of patients with CHF. These patients are characterized by a more advanced NYHA class, increased end-diastolic left ventricular diameter, and increased urinary excretion of magnesium. It is likely that all these factors contribute to the presence of more complex and numerous ventricular arrhythmias in this subgroup of patients.

[Myocardial infarction pain duration in relation to alterations in homeostasis characteristics of cardiac injury]. / Czas trwania bólu zawalowego a zaburzenia homeostazy i cechy uszkodzenia miesnia sercowego.

Relationship between duration of myocardial infarction pain (MIP) and homeostatic disturbances as well as degree of myocardial injury was investigated. Thirty patients admitted to the Coronary Care Unit during the pain due to progressive myocardial infarction were studied. Patients were divided into two groups according to the duration of pain. First one consisted of subject with pain lasting up to four hours, second group included those whose pain exceeded 4 hours. Following parameters were measured: 24 hours urine catecholamines excretion, serum triiodothyronine and creatinine phosphokinase activity estimated every 6 hours during consecutive two days. We concluded that patients with longer MIP displayed lager thyro-adrenergic and myocardial injury.