Noninvasive studies have shown the efficacy of combined digitalis and propranolol treatment of angina pectoris. To validate these data further, a hemodynamic study of 12 patients who were taking propranolol for angina pectoris was done to determine the effects of acute digitalization in cases without cardiomegaly or clinical congestive heart failure. Patients on an average of 300 mg oral propranolol daily were studied at cardiac catheterization before and 45 minutes after administration of 0.5 mg intravenous ouabain.Baseline left ventricular end-diastolic pressure, cardiac index, and left ventriculogram were compared with these indices after ouabain. Surprisingly, all patients had elevated left ventricular end-diastolic pressure, varying from 13 to 33 mm Hg (average 21.5 mm Hg), which fell 22.7% (P <.001) to 16.6 mm Hg after ouabain. Mean end-systolic volume fell 12.2% (P <.02) and ejection fraction rose 6.7% (P <.025). The cardiac index, left ventricular end-diastolic volume, heart rate, stroke volume, and mean aortic pressure did not change significantly.We conclude that ouabain shifts the patient's hemodynamics from its position on the Starling function curve directly leftward. The demonstration of a reduction in preload from a consistently elevated level suggests the value of using propranolol and digitalis in combination in patients with angina, even in the absence of congestive failure or cardiomegaly.
|Original language||English (US)|
|Number of pages||7|
|Journal||Journal of Cardiac Rehabilitation|
|State||Published - 1982|
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