[The effects of Cardiodoron on cardio-respiratory coordination--a literature review]. / Wirkung von Cardiodoron(R) auf die kardiorespiratorische Koordination - ein Literaturüberblick.

BACKGROUND: In healthy subjects self-regulation of the organism establishes the order of rhythmical functions. This self-regulation is altered in patients suffering from idiopathic orthostatic syndrome resulting from disturbances of functional aspects only. Thus the cardio-respiratory coordination, which may serve as the representative of the order of rhythmical functions, is modified. OBJECTIVE: In the case of idiopathic orthostatic syndrome the anthroposophic medicine offers the medicament Cardiodoron(r). Does it stimulate self-regulation in order to normalise the cardio-respiratory coordination? MATERIAL AND METHODS: This claim is analysed by a systematic review of the literature. Only those publications were considered where the cardio-respiratory coordination was analysed in studies with patients or healthy subjects. RESULTS: The methods of the studies with patients and healthy subjects vary strongly. Nevertheless, a normalisation of the cardio-respiratory coordination could be found in studies with patients suffering from idiopathic orthostatic syndrome as well as in studies with healthy subjects. CONCLUSION: The studies show that the use of the medicament results in a normalisation of the cardiorespiratory coordination. By stimulating the self-regulation the medicament leads to an improvement of the order of rhythmical functions in the human organism.

Bimodal dose-dependent effect on autonomic, cardiac control after oral administration of Atropa belladonna.

This single-blind placebo-controlled study was designed to investigate the dose-dependent vagolytic and vagotonic effects after a single oral administration of Atropa belladonna tincture (ABT, 0.1 mg/ml alkaloid concentration, atropine/scopolamine = 20:1). In eight healthy young subjects, heart rate and noninvasive arterial finger blood pressure were recorded simultaneously over 4 h after oral application of four different doses of ABT (day 1: 2 ml, day 2: placebo, day 3: 5 ml, day 4: 1 ml). On each day, 14 20-min sequences under controlled experimental conditions were performed. Among others, mean RR interval (RR), high-frequency spectral power of heart rate variability (HF), and noninvasive baroreflex sensitivity (BRS) were calculated during metronome breathing in supine position. These parameters were robust markers of vagal activity. One hour after 5ml ABT, RR, HF and BRS decreased clearly in six of eight subjects. This effect was interpreted as vagolytic response. After 1 and 2 ml ABT, and after placebo, RR and HF increased markedly. The increase after ABT was much higher than the increase solely due to adaptation after placebo administration, and it could be clearly identified as an augmentation of vagal cardiac activity caused by low-dose ABT. In conclusion, low doses of orally administered ABT can be effectively used to stimulate parasympathetic activity in man. The mode of vagal activation changes between 2 and 5 ml ABT from vagotonic to vagolytic. ABT has no or very little effect on blood pressure control.

Evaluation of modulations in heart rate variability caused by a composition of herbal extracts.

The purpose of this prospective, placebo-controlled, randomized double-blind study was the examination of changes of the basic vegetative rhythms due to Cardiodoron, a composition of extracts of blossoms from Primula officinalis and Onopordon acanthium and from the herbs of Hyoscyamus niger. In its clinical use it is known as a modulating medicine in the treatment of functional disturbances of the cardiovascular system. With use of Holter monitoring, 24-h ECG recordings were obtained from 100 healthy subjects of whom 50 took the composition and 50 a placebo. Heart rate variability was evaluated from the 24-h ECGs by means of a power spectral analysis based on the Fast Fourier Transformation (FFT). Regulative influences on the rhythmic system due to the medicine were found. After four weeks of medication half of the verum group showed a tendency to an increased variability in the low and high frequency range at night (LFn: 0.04-0.15 Hz, HFn: 0.15-0.4 Hz) in contrast to the placebo group. The mean heart rate at night (HRn) showed a tendency towards a normalization in the verum group: in subjects with a low HRn the heart rate was increased and in subjects with a high HRn the heart rate was decreased. This effect could not be observed in the placebo group. After two further weeks without any medication this difference between verum and placebo was abolished.

Circadian aspects of apparent correlation dimension in human heart rate dynamics.

The purpose of this study was to examine changes in complexity of cardiac dynamics over 24 h. With use of Holter monitoring, 27 24-h electrocardiogram recordings were obtained from 15 healthy subjects. For each recording, the apparent dimension (DA) was calculated for consecutive sections of 500 heartbeats. These were used to determine nighttime and daytime dimension (D(An) and D(Ad), respectively) as well as the difference between D(An) and D(Ad) (delta DA). Mean 24-h DA, D(An), and D(Ad) were 5.9 +/- 0.3, 6.3 +/- 0.5, and 5.6 +/- 0.6, respectively. D(An) was significantly higher than D(Ad) (P < 0.001), with a mean delta DA of 0.6 +/- 0.7. Furthermore, 67% of delta DA values were significantly different from zero at the 0.05 level. The results show that dimension analysis may be applied to heart rate dynamics to reveal circadian differences of heart rate complexity. We suggest that the decreased complexity during daytime may result from the synchronization of physiological functions. The increase in complexity at night would then correspond to an uncoupling of these functions during the regenerative period.

Quality of life and circadian variation of heart rate and heart rate variability in short-term survivors and nonsurvivors after acute myocardial infarction.

The purpose of this study was the simultaneous examination of the quality of life and changes in heart rate (HR) variables of patients immediately following acute myocardial infarction (AMI). Quality of life, estimated on a rating scale assessing the patients' well-being, as well as the circadian rhythm of their HR and HR variability, were determined within the first 3 days and at approximately 3 weeks after admission and the results were related to survival. The quality of life within the first 3 days post AMI was low in both the surviving (n = 42) and the nonsurviving (n = 5) patients but only the scores of the survivors increased significantly over the following three weeks. The HR of the survivors, initially lower than that of the nonsurvivors, decreased significantly at 3 weeks and a normal circadian pattern had developed. The HR variability of the survivors within the first 3 days was significantly higher than that of the nonsurvivors and had developed a clear circadian pattern after 3 weeks. It is concluded that in patients with AMI such diverse clinical aspects as quality of life and circadian patterns of HR and HR variability can be assessed meaningfully immediately post AMI and may find common expression in changes in sympathovagal balance.

[Which digitalis therapy is still justified today? (author's transl)]. / Welche Digitalis-Behandlung ist gegenwärtig noch vertretbar?

Recent intoxication studies during digitalis therapy have shown that digoxin and digitoxin produce different pharmakokinetic results. The main difference is in the elimination pathways of the two substances. Whereas digoxin is almost exclusively excreted by the kidneys, digitoxin may be excreted both by the kidneys and by the intestine via the bile. New dosage guidelines have resulted from these studies. The problems of adjustment by means of instrumental parameters are presented and the need for individual dosage on the least effective dose principle is discussed.