Use Of Amyl Nitrite Research Articles

The use of amyl nitrite in the differentiation of Fallot's tetralogy and pulmonary stenosis with intact ventricular septum

The effect of the inhalation of amyl nitrite on the systemic and right ventricular pressures and on the systolic murmur and heart sounds has been studied in pulmonary stenosis with intact ventricular septum and Fallot's tetralogy. In pulmonary or infundibular stenosis with intact ventricular septum the inhalation of amyl nitrite results in a pronounced fall in systemic pressure and a marked rise in right ventricular pressure. The increased right ventricular pressure results in a striking increase in the loudness of the systolic murmur. After cessation of the inhalation, pressures and murmur gradually return to their original state in about 4 minutes. In Fallot's tetralogy the inhalation of amyl nitrite results in a moderate fall in both the systemic and right ventricular systolic pressures, with an increase in right-to-left shunt. The reduced right ventricular pressure results in a diminution in pulmonary flow, which is reflected by a decrease in the intensity and duration of the systolic murmur. As the effect of the vapor wears off, the pressures, murmur, and cyanosis return to the basal level, usually within 3 to 4 minutes. The reasons for these striking differences are discussed fully. The effect was similar whether the case of pulmonary stenosis or Fallot's tetralogy was mild, moderate, or severe. The amyl nitrite test is of value in settling the difficult and important diagnosis of mild (acyanotic) Fallot's tetralogy and moderately severe pulmonary or infundibular stenosis with intact ventricular septum, in cases in which the clinical, electrocardiographic, radiologic, and catheter findings may be identical. The different behavior of the systolic murmur at the bedside and of the pressures during cardiac catheterization readily distinguishes the two conditions.

The significance of and a differential diagnostic test of precordial murmurs in children

<h2>Summary</h2> The value of the subcutaneous injection of epinephrine 1:1,000 as a means of accentuating and differentiating the so-called functional cardiac murmur from the organic is discussed; a five-year clinical follow-up in a group of 32 children previously receiving this test being the basis. A new group of 37 children were given a similar test, using amyl nitrite in 12 for comparative effects. The epinephrine test is found most useful for intensifying the murmurs of the early cases of probable valvular heart disease and also in accentuating the murmurs of the definite organic valvular lesions. The similar use of amyl nitrite as recommended by others is found entirely wanting. Due to the fact that the authors find so large a percentage of children considered as having a functional heart condition, within a period of five years presenting the clinical signs of a recognizable organic cardiac lesion, they strongly urge the physician to be cognizant of the threatening importance of the cardiac murmur, even without the expected concomitant signs and symptoms of organic valvular heart disease.

The Reaction to Nitrites in the Anginal Syndrome and Arterial Hypertension

Article1 October 1931The Reaction to Nitrites in the Anginal Syndrome and Arterial HypertensionALEX M. BURGESS, M.D., F.A.C.P.ALEX M. BURGESS, M.D., F.A.C.P.Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-5-4-441 SectionsAboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail ExcerptSince the introduction of the use of amyl nitrite by Sir Lauder Brunton in 1867 nothing has been found to excel the nitrites for the relief of the pain in angina pectoris. Although the pharmacology of the members of this group has been exhaustively studied the question as to the mode of their action in anginal pain has never been definitely settled. This is due partly to the fact that the cause of the pain has not been thoroughly understood. Furthermore, because of their known action on the walls of the peripheral arterioles resulting in a lowering of blood pressure,...References1 STEIGLITZ EJ: Arterial hypertension: evaluation of the prognosis, Arch. Int. Med., 1930, xlvi, 227. CrossrefGoogle Scholar2 WALLACERINGER : The lowering of blood pressure by the nitrite group, Jr. Am. Med. Assoc., 1909, liii, 1629. CrossrefGoogle Scholar3 STEIGLITZ EJ: Loc. cit. Google Scholar4 LEAKELOEVENHARTMUEHLBERGER CDAS: Dilation of cerebral vessels as a factor in headache, Jr. Am. Med. Assoc., 1927, lxxxviii, 1076. CrossrefGoogle Scholar5 RAPHAELSTANTON TJM: Action of certain drugs on brain circulation in man. Arch. Neurol. and Psych., 1919, ii, 389. CrossrefGoogle Scholar6 MACHT DI: Action of nitrites on the isolated surviving pulmonary artery, Jr. Am. Med. Assoc., 1914, lxii, 525. Google Scholar7 VOEGTLINMACHT CDI: Jr. Pharm. and Exper. Therap., 1913, v, 77. Google Scholar8 SCHLOSS K: Deutsch. Arch. f. klin. Med., 1913, cxi, 310. Google Scholar9 LOEB O: Arch. f. exp. Path. u. Pharm., 1903, li, 64. CrossrefGoogle Scholar10 SMITH FM: The action of the nitrites on the coronary circulation, Arch. Int. Med., 1921, xxviii, 836. CrossrefGoogle Scholar11 KEEFERRESNIK CSWH: Angina pectoris: a syndrome caused by anoxemia of the myocardium, Arch. Int. Med., 1928, xli, 769. CrossrefGoogle Scholar12 MAY H: Die "Arbeits-reaktion" des Blutdruckes bei Gesunden und Kreislaufkranken und ihr Zusammenhang mit der Angina Pectoris, Med. Klin., 1928, xxiv, 1704. Google Scholar13 AYMAN D: Normal blood pressure in essential hypertension. Jr. Am. Med. Assoc., 1930, xciv, 1214. CrossrefGoogle Scholar14 BROOKS H: Concerning certain phases of angina pectoris, Internat. Clinics, 1928, iv, 12-32. Google Scholar This content is PDF only. To continue reading please click on the PDF icon. Author, Article, and Disclosure InformationAffiliations: Providence, R. I.*Presented at the Baltimore Meeting of the American College of Physicians, March 24, 1931. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetails Metrics Cited byThe effect of aspirin on the hemodynamic response to nitroglycerinCirculatory changes during the pain of angina pectorisCirculatory changes associated with spontaneous angina pectorisRelationship between Arterial Pressure and Exertional Angina Pectoris in Hypertensive PatientsInositol and Mannitol Hexanitrates in Hypertension ManagementTHE DRUG TREATMENT OF HYPERPIESIAThe relation of the systolic blood pressure and heart rate to attacks of angina pectoris precipitated by effortObservations on arterial blood pressure during attacks of angina pectorisDie Klinik der Coronarerkrankungen 1 October 1931Volume 5, Issue 4Page: 441-462KeywordsAnginaArteriolesBlood pressureHypertensionPharmacology ePublished: 1 December 2008 Issue Published: 1 October 1931 PDF downloadLoading ...

Effect of lead salts and of the nitrites upon the movements of the intestines

Riegel (1875) and J. Pal (Die Gefässkrisen, 1906) suggested the use of amylnitrite for the control of pain in lead colic and in the gastric crises of tabes dorsalis, believing that the fall of blood pressure sufficed to bring about diminution in these symptoms. The present series of experiments was undertaken in order to determine whether the nitrites might not act by causing relaxation of a spastic condition of the intestinal walls. The experiments were carried out on rabbits whose intestinal movements were observed through a large window in the abdominal wall, which was closed from the outside air by inserting a crystallizing dish 10 cm. in diameter. The sides of the crystallizing dish were coated with thick beeswax and the window was held in place by fixing the abdominal walls around it with a purse string suture. The animals were lightly anæsthetized with ether. Injection of 5 mg. lead acetate per kg. immediately caused the onset of intense peristaltic movements which seemed to be due to stimulation of the preganglionic synapse, since they were abolished by injection of nicotin or by painting nicotin upon the intestine, but were not affected by extirpation of the spinal cord and section of the vagi. As was suspected from the clinical results reported by Riegal and Pal, this peristalsis could be inhibited by inhalation of amylnitrite, by placing two drops of nitroglycerin upon the tongue or by the injection of 80-100 mg. per kg. sodium nitrite. The effects of the two former drugs were most marked, though the effects of the latter were more prolonged. Atropin, either locally or intravenously, also inhibited the peristalsis, as had been shown by Harnack. The same effects were also obtained with the nitrites and with atropin when increased peristalsis was brought on by the local effect of heat, secured by placing warm water in the crystallizing dish window.