Prazosin in chronic congestive heart failure due to ischemic heart disease.

Oral prazosin hydrochloride (2-20 mg/day) was administered to 38 patients with chronic congestive heart failure due to ischemic heart disease for 6-18 months. Half (19) of the patients were hypertensive and half (19) nonhypertensive. All were receiving furosemide (80 mg/day, orally) and 19 were receiving digoxin (0.25-0.5 mg/day, orally) in addition to prazosin. Clinical radiological, mechanocardiographic, echocardiographic, and biochemical observations were made initially, at peak response, and at the end of 6 months. Prazosin improved left ventricular function indexes at rest, relieved symptoms and signs of congestion, and remained effective for 6-18 months with little or no increase in dose. There was no reflex tachycardia, tension-time indexes fell in all patients, angina was relieved in 8 patients who complained of it, and dyskinesia of left ventricular wall was corrected in 8 of 13 patients. The New York Heart Association functional class improved in all patients, but to a greater extent in hypertensive patients and in those not receiving concomitant digoxin. Mild, transient side effects occurred in 6 patients.

Effect of Abana on ventricular function in ischemic heart disease.

Mechanocardiography has been in use to evaluate ventricular function and the cardiac effect of drugs. Twenty-five patients with ischemic heart disease (IHD) and 25 patients with IHD and mild hypertension (HTN) were enrolled in a double-blind, placebo controlled study of Abana. Half the patients in each group received Abana--a formulation based on Ayurvedic principles--and the other half received a placebo in a randomized manner. The effect of Abana was evaluated by means of LV apex cardiogram (ACG), phonocardiogram and carotid pulse tracing and ECG (mechanocardiography) before and at the end of 8 weeks of treatment. As compared to placebo, Abana significantly reduced the frequency and severity of anginal episodes, as judged by clinical improvement and nitrate consumption. Significant improvement in ventricular function was observed as reflected by a decrease in ACG A amplitude and A wave duration, along with a significant increase in LV ejection fraction and VCF. The decrease in double and triple products reflected decreased MVO2. A significant fall in diastolic blood pressure was noted in patients with mild hypertension. Abana seems to reduce preload and afterload and improve diastolic function and pump function, which may be responsible for the beneficial effects of Abana in ischemic heart disease.

Prazosin in hypertension with heart failure.

Prazosin, in daily doses of 6--16 mg, was used along with furosemide and polythiazide in 11 hypertensive heart failure patients. Average supine and standing blood pressures were reduced from 180/108 and 171/106 to 130/84 and 135/86, respectively. Average heart rate decreased from 83 to 73 supine and from 84 to 75 standing. Changes in the indices of cardiac function--indlucing the ejection fraction, ejection time, and apical indices--each indicated improvement of left ventricular function. Thus prazosin along with diuretic agents may be particularly useful in the treatment simultaneously of heart failure and of elevated blood pressure with few side effects.

Ejection phase indexes by invasive and noninvasive methods: an apexcardiographic, echocardiographic and ventriculographic correlative study.

A new noninvasive method of measuring ejection fraction and the mean velocity of circumferential fiber shortening from the apexcardiogram and carotid pulse tracing is described and compared with the echocardiographic and angiographic measurement of these values in 35 patients with coronary artery disease. The correlations of the apexcardiographic derived values with the angiographic measurements were excellent (r = 0.89 and 0.96, respectively, P less than 0.001) even though asynergy was present in 14 of the 35 patients. Only 6 percent of the derived ejection fractions and none of the mean velocity measurements were discordant with the angiographic data. In contrast, correlations of the echocardiographic measurements of the ejection phase indexes with the same angiographic data were poorer (r = 0.75 and 0.66, respectively, for ejection fraction and mean velocity, P less than 0.01). Twenty-eight percent of echocardiographic ejection fraction measurements and 20 percent of the echocardiographic mean velocity measurements were discordant with the angiographic data. It is concluded that the apexcardiogram is a dependable bedside test for estimating left ventricular function and is superior to the echocardiogram for measuring ejection phase indexes.

Clinical manifestations of papillary muscle dysfunction in Ehlers Danlos Syndrome.

A total of 14 cases of papillary muscle dysfunction have been observed in Ehlers Danlos syndrome. Five patients had clinically identifiable syndrome of prolapsing mitral leaflets. This form of rare interesting cardiovascular abnormality in Ehlers Danlos syndrome is discussed. The relevant literature is reviewed.