PMCCPMCCPMCC

Search tips
Search criteria 

Advanced

 
Logo of jcinvestThe Journal of Clinical Investigation
 
J Clin Invest. 1974 September; 54(3): 563–575.
PMCID: PMC301589

Effects of Catecholamines, Exercise, and Nitroglycerin on the Normal and Ischemic Myocardium in Conscious Dogs

Abstract

The effects of isoproterenol, norepinephrine, dobutamine, exercise, and nitroglycerin on left ventricular diameter, pressure, velocity of shortening, dP/dt, dP/dt/P, arterial pressure, left circumflex coronary blood flow, and coronary vascular resistance were examined in healthy conscious dogs with normal coronary perfusion and in the same animals after moderate global ischemia had been induced by partial occlusion of the left main coronary artery. In the normal nonischemic heart, all interventions improved left ventricular performance, as evidenced by increases in dP/dt/P and velocity at the same or lower left ventricular end-diastolic diameter. Interventions, which in the normal heart caused large increases in heart rate and myocardial contractility, e.g. isoproterenol and exercise, or which decreased coronary perfusion pressure, e.g. nitroglycerin or isoproterenol, elicited paradoxical responses in moderate global ischemia, i.e., left ventricular enddiastolic diameter and pressure rose, and dP/dt/P and velocity fell substantially. On the other hand, norepinephrine, which increased coronary perfusion pressure along with myocardial contractility but did not increase heart rate, improved left ventricular function. Dobutamine, which did not alter heart rate or arterial pressure substantially while improving myocardial contractility, produced an intermediate response between that of norepinephrine and isoproterenol in the presence of moderate global myocardial ischemia. Thus, interventions that increase myocardial O2 requirements, by increasing heart rate and myocardial contractility without augmenting coronary perfusion pressure, can produce a paradoxical depression of ventricular function in the presence of global myocardial ischemia.

Full text

Full text is available as a scanned copy of the original print version. Get a printable copy (PDF file) of the complete article (2.4M), or click on a page image below to browse page by page. Links to PubMed are also available for Selected References.

Images in this article

Click on the image to see a larger version.

Selected References

These references are in PubMed. This may not be the complete list of references from this article.
  • WEISSLER AM, LEONARD JJ, WARREN JV. The hemodynamic effects of isoproterenol in man, with observations on the role of the central blood volume. J Lab Clin Med. 1959 Jun;53(6):921–925. [PubMed]
  • DODGE HT, LORD JD, SANDLER H. Cardiovascular effects of isoproterenol in normal subjects and subjects with congestive heart failure. Am Heart J. 1960 Jul;60:94–105. [PubMed]
  • KRASNOW N, ROLETT EL, YURCHAK PM, HOOD WB, Jr, GORLIN R. ISOPROTERENOL AND CARDIOVASCULAR PERFORMANCE. Am J Med. 1964 Oct;37:514–525. [PubMed]
  • Vatner SF, Franklin D, Higgins CB, Patrick T, Braunwald E. Left ventricular response to severe exertion in untethered dogs. J Clin Invest. 1972 Dec;51(12):3052–3060. [PMC free article] [PubMed]
  • Vatner SF, Higgins CB, Milland RW, Franklin D. Direct and reflex effects of nitroglycerin on coronary and left ventricular dynamics in conscious dogs. J Clin Invest. 1972 Nov;51(11):2872–2882. [PMC free article] [PubMed]
  • Maroko PR, Libby P, Braunwald E. Effect of pharmacologic agents on the function of the ischemic heart. Am J Cardiol. 1973 Dec;32(7):930–936. [PubMed]
  • Elliott WC, Gorlin R. Isoproterenol in treatment of heart disease. Hemodynamic effects in circulatory failure. JAMA. 1966 Aug 1;197(5):315–320. [PubMed]
  • COHEN LS, ELLIOTT WC, ROLETT EL, GORLIN R. HEMODYNAMIC STUDIES DURING ANGINA PECTORIS. Circulation. 1965 Mar;31:409–416. [PubMed]
  • Gunnar RM, Loeb HS, Pietras RJ, Tobin JR., Jr Ineffectiveness of isoproterenol in shock due to acute myocardial infarction. JAMA. 1967 Dec 25;202(13):1124–1128. [PubMed]
  • Herman MV, Elliott WC, Gorlin R. An electrocardiographic, anatomic, and metabolic study of zonal myocardial ischemia in coronary heart disease. Circulation. 1967 May;35(5):834–846. [PubMed]
  • Cohn PF, Gorlin R. Abnormalities of left ventricular function associated with the anginal state. Circulation. 1972 Dec;46(6):1065–1078. [PubMed]
  • Mueller H, Ayres SM, Gregory JJ, Giannelli S, Jr, Grace WJ. Hemodynamics, coronary blood flow, and myocardial metabolism in coronary shock; response of 1-norepinephrine and isoproterenol. J Clin Invest. 1970 Oct;49(10):1885–1902. [PMC free article] [PubMed]
  • Maroko PR, Kjekshus JK, Sobel BE, Watanabe T, Covell JW, Ross J, Jr, Braunwald E. Factors influencing infarct size following experimental coronary artery occlusions. Circulation. 1971 Jan;43(1):67–82. [PubMed]
  • Maroko PR, Libby P, Covell JW, Sobel BE, Ross J, Jr, Braunwald E. Precordial S-T segment elevation mapping: an atraumatic method for assessing alterations in the extent of myocardial ischemic injury. The effects of pharmacologic and hemodynamic interventions. Am J Cardiol. 1972 Feb;29(2):223–230. [PubMed]
  • Franklin DE, Watson NW, Pierson KE, Van Citters RL. Technique for radio telemetry of blood-flow velocity from unrestrained animals. Am J Med Electron. 1966;5(1):24–28. [PubMed]
  • Vatner SF, Franklin D, VanCitters RL. Simultaneous comparison and calibration of the Doppler and electromagnetic flowmeters. J Appl Physiol. 1970 Dec;29(6):907–910. [PubMed]
  • Suga H, Sagawa K. Assessment of absolute volume from diameter of the intact canine left ventricular cavity. J Appl Physiol. 1974 Apr;36(4):496–499. [PubMed]
  • GLICK G, SONNENBLICK EH, BRAUNWALD E. MYOCARDIAL FORCE-VELOCITY RELATIONS STUDIED IN INTACT UNANESTHETIZED MAN. J Clin Invest. 1965 Jun;44:978–988. [PMC free article] [PubMed]
  • Mason DT, Braunwald E, Covell JW, Sonnenblick EH, Ross J., Jr Assessment of cardiac contractility. The relation between the rate of pressure rise and ventricular pressure during isovolumic systole. Circulation. 1971 Jul;44(1):47–58. [PubMed]
  • Corday E, Lillehei RC. Pressor agents in cardiogenic shock. Am J Cardiol. 1969 Jun;23(6):900–910. [PubMed]
  • Smith HJ, Oriol A, Morch J, McGregor M. Hemodynamic studies in cardiogenic shock. Treatment with isoproterenol and metaraminol. Circulation. 1967 Jun;35(6):1084–1091. [PubMed]
  • Braunwald E. Control of myocardial oxygen consumption: physiologic and clinical considerations. Am J Cardiol. 1971 Apr;27(4):416–432. [PubMed]
  • Forman R, Kirk ES, Downey JM, Sonnenblick EH. Nitroglycerin and heterogeneity of myocardial blood flow. Reduced subendocardial blood flow and ventricular contractile force. J Clin Invest. 1973 Apr;52(4):905–911. [PMC free article] [PubMed]
  • BERNE RM, HOFFMAN WK, Jr, KAGAN A, LEVY MN. Response of the normal and denervated kidney to L'epinephrine and L'nor-epinephrine. Am J Physiol. 1952 Dec;171(3):564–571. [PubMed]

Articles from The Journal of Clinical Investigation are provided here courtesy of American Society for Clinical Investigation