Abstract
The action of 3 of the most commonly used inotropic agents was studied in the human transplanted heart. Digoxin increased the first derivative of the right or left ventricular pressure curve ( dp dt ) in 2 patients. The cardiac output was increased in a patient with latent heart failure but remained unchanged in another with normal cardiac function. Digoxin did not appear to produce atrioventricular (A-V) nodal blockade in 2 patients with atrial flutter or fibrillation. Isoproterenol effected a marked rise in cardiac index and stroke index as well as in right ventricular dp dt in a patient who was in the terminal phase of rejection. Glucagon produced a marked increase in cardiac output and index, stroke index and left ventricular dp dt in a patient who was already digitalized. From these actions it is concluded that digoxin produces a positive inotropic effect in patients with cardiac transplants, without affecting the A-V nodal refractory period. Isoproterenol and glucagon both exert a positive chronotropic and inotropic effect. All 3 drugs exert a direct action on the transplanted denervated heart, in accord with previous observations on experimental animals.
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