Useofan ultra short-acting f-blocker inpatients withacutemyocardial ischemia

Esmolol is a new ultra short-acting (half-life [t1/2] beta 9 min) beta 1-adrenergic-receptor antagonist reported to have no intrinsic sympathomimetic activity. The safety and efficacy of esmolol in lowering the ventricular rate and rate-pressure product in patients with acute myocardial infarction (n = 5), postmyocardial infarction angina (n = 10), or acute unstable angina (n = 4), and without cardiogenic shock were studied. After a 30 min observation period, esmolol was titrated to a maximum dose of 300 micrograms/kg/min and infused for up to 420 min. The ventricular rate fell from 92 +/- 11 (mean +/- SD) to 77 +/- 13 beats/min (p less than .01) and the systolic arterial pressure decreased from 120 +/- 13 to 97 +/- 11 mm Hg (p less than .01) during the initial 30 min titration period. There was no significant change during the maintenance phase, and both the ventricular rate and arterial pressure returned rapidly toward baseline values within 30 min of termination of the infusion. The cardiac index fell from 2.8 +/- 0.6 to 2.2 +/- 0.6 liters/min/m2 (p less than .01) during the same period, and also returned to the baseline level 30 min after termination of the infusion. There was no significant change in the pulmonary capillary wedge pressure, respiratory rate, or PR interval. Five patients required termination of infusion because of hypotension and all recovered uneventfully within 30 min of stopping the esmolol. One patient required a brief infusion of dopamine to restore hemodynamic stability.(ABSTRACT TRUNCATED AT 250 WORDS)

[1]  H. Gold,et al.  Propranolol-induced reduction of signs of ischemic injury during acute myocardial infarction. , 1976, The American journal of cardiology.

[2]  W. Delius,et al.  [Treatment of acute myocardial infarction with metoprolol (author's transl)]. , 1978, Deutsche medizinische Wochenschrift.

[3]  R. Sung,et al.  Safety and efficacy of esmolol (ASL-8052: an ultrashort-acting beta-adrenergic blocking agent) for control of ventricular rate in supraventricular tachycardias. , 1984, Journal of the American College of Cardiology.

[4]  R. Jennings,et al.  Reduction by Propranolol of Myocardial Necrosis following Temporary Coronary Artery Occlusion in Dogs , 1973, Circulation research.

[5]  E. Braunwald,et al.  Enhancement of salvage of reperfused myocardium by early beta-adrenergic blockade (timolol). , 1984, Journal of the American College of Cardiology.

[6]  E. Braunwald,et al.  First ultra-short-acting beta-adrenergic blocking agent: its effect on size and segmental wall dynamics of reperfused myocardial infarcts in dogs. , 1983, The American journal of cardiology.

[7]  R. Gorlin,et al.  The intermediate coronary syndrome: clinical, angiographic and therapeutic aspects. , 1973, The New England journal of medicine.

[8]  R. Vollmer,et al.  Cardiovascular pharmacology of ASL-8052, an ultra-short acting β blocker , 1983 .

[9]  Timolol-induced reduction in mortality and reinfarction in patients surviving acute myocardial infarction. , 1981, The New England journal of medicine.

[10]  E. Amsterdam,et al.  Hemodynamic effects of propranolol in acute myocardial infarction , 1973 .

[11]  E. Braunwald,et al.  Thrombolytic therapy. A new strategy for the treatment of acute myocardial infarction (1). , 1984, The New England journal of medicine.

[12]  A. Yacobi,et al.  Esmolol: a pharmacokinetic profile of a new cardioselective beta-blocking agent. , 1983, Journal of pharmaceutical sciences.

[13]  K. Swedberg,et al.  Effect of metoprolol on indirect signs of the size and severity of acute myocardial infarction. , 1983, The American journal of cardiology.

[14]  K. Swedberg,et al.  [Effect on mortality of metoprolol in acute myocardial infarction. A randomized double-blind trial (author's transl)]. , 1982, MMW, Munchener medizinische Wochenschrift.

[15]  E. Braunwald,et al.  Thrombolytic therapy. A new strategy for the treatment of acute myocardial infarction (2). , 1984, The New England journal of medicine.

[16]  A. Yacobi,et al.  Kinetics of esmolol, an ultra‐short‐acting beta blocker, and of its major metabolite , 1983, Clinical pharmacology and therapeutics.

[17]  J. Herlitz,et al.  Limitation of infarct size by beta blockers and its potential role for prognosis. , 1983, Circulation.

[18]  F. Waagstein,et al.  Double-blind study of the effect of cardioselective beta-blockade on chest pain in acute myocardial infarction. , 2009, Acta medica Scandinavica. Supplementum.

[19]  R. Lyons.  Reduction of infarct size with the early use of timolol in acute myocardial infarction. , 1984, The New England journal of medicine.

[20]  W. Frishman,et al.  β-Adrenoceptor Antagonists: New Drugs and New Indications , 1981 .

[21]  S. Taylor,et al.  Intravenous beta-blockade in coronary heart disease: is cardioselectivity or intrinsic sympathomimetic activity hemodynamically useful? , 1982, The New England journal of medicine.

[22]  A. Yacobi,et al.  Esmolol: a pharmacokinetic profile of a new cardioselective beta-blocking agent. , 1983, Journal of pharmaceutical sciences.

[23]  J L Ritchie,et al.  Western Washington randomized trial of intracoronary streptokinase in acute myocardial infarction. , 1983, The New England journal of medicine.

[24]  R. Vollmer,et al.  Cardiovascular pharmacology of ASL-8052, an ultra-short acting beta blocker. , 1983, European journal of pharmacology.

[25]  R. Lee,et al.  Pharmacology of ASL‐8052, a Novel β-Adrenergic Receptor Antagonist with an Ultrashort Duration of Action , 1983, Journal of cardiovascular pharmacology.

[26]  W. G. Anderson,et al.  Ultra-short acting beta-blockers: a proposal for the treatment of the critically ill patient. , 1982, Life sciences.

[27]  J. Covell,et al.  Increased Myocardial Oxygen Consumption and Contractile State Associated with Increased Heart Rate in Dogs , 1969, Circulation research.

[28]  R. P. Ahlquist.  Present state of alpha and beta adrenergic drugs III. Beta blocking agents. , 1977, American heart journal.

[29]  W. Frishman,et al.  beta-Adrenoceptor antagonists: new drugs and new indications. , 1981, The New England journal of medicine.

[30]  K. Pennert,et al.  Göteborg Metoprolol Trial: tolerance. , 1984, The American journal of cardiology.

[31]  S. Ayres,et al.  Propranolol in the Treatment of Acute Myocardial Infarction: Effect on Myocardial Oxygenation and Hemodynamics , 1974, Circulation.

[32]  Friedman Lm.  How do the various beta blockers compare in type, frequency and severity of their adverse effects? , 1983 .

[33]  R. Gorlin,et al.  Propranolol and angina pectoris. , 1966, The American journal of cardiology.

[34]  W. Frishman,et al.  Clinical pharmacology of the new beta-adrenergic blocking drugs. Part 3. Comparative clinical experience and new therapeutic applications. , 1979, American heart journal.

[35]  E. Sivertssen,et al.  Haemodynamic effects of propranolol (Inderal) in acute myocardial infarction. , 1967, British medical journal.

[36]  K. Swedberg,et al.  Hemodynamic effects of the cardioselective beta-blocking agent metoprolol in acute myocardial infarction. A 24-hour catheterization study. , 1978, Acta medica Scandinavica.

[37]  E. Sonnenblick,et al.  Clinical pharmacology of the new beta-adrenergic blocking drugs. Part 4. Adverse effects. Choosing a beta-adrenoreceptor blocker. , 1979, American heart journal.

[38]  D. Shand,et al.  Clinical Pharmacology of Propranolol , 1975, Circulation.

[39]  E. Braunwald,et al.  Role of beta-adrenergic blockade in the therapy of patients with myocardial infarction. , 1983, The American journal of medicine.

[40]  G. Ferrier,et al.  Contribution of Variable Entrance and Exit Block in Protected Foci to Arrhythmogenesis in Isolated Ventricular Tissues , 1983, Circulation.