Advertisement

Idiopathic hypertrophic subaortic stenosis

Intraventricular gradient reduction associated with oral guanethidine therapy
      This paper is only available as a PDF. To read, Please Download here.

      Abstract

      Clinical and hemodynamic data prior to and during oral guanethidine therapy in two patients with idiopathic hypertrophic subaortic stenosis are presented. In both patients the systolic intraventricular pressure gradient both at rest and during exercise was reduced following continued guanethidine administration. Concomitantly, computed values for left ventricular effective outflow tract area were significantly larger during the guanethidine studies than during the control studies. The symptomatic patient (Case 1) experienced increased work tolerance and diminished dyspnea on exertion. Guanethidine did not prevent the increased intraventricular gradient and reduction of the aortic pulse pressure which occur during isoproterenol infusion or in the contraction following a premature ventricular beat. It is suggested that chronic guanethidine administration, by reducing the systolic obstruction, may be a useful pharmacologic agent in this disorder.
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to The American Journal of Medicine
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Morrow A.G.
        • Lambrew C.T.
        • Braunwald E.
        Idiopathic hypertrophic stenosis: II. Operative treatment and the results of pre- and postoperative hemodynamic evaluations.
        Circulation. 1964; 30: 120
        • Beachfeld N.
        • Gorlin R.
        Subaortic stenosis: a revised concept of the disease.
        Medicine. 1959; 38: 415
        • Brock R.
        • Dobel A.R.C.
        • Scott H.J.
        Hypertrophic subaortic stenosis. Evolution of a surgical technique.
        J. Thoracic & Cardiovasc. Surg. 1964; 47 (Discussion): 26
        • Braunwald E.
        • Ebert P.A.
        Hemodynamic alterations in idiopathic hypertrophic subaortic stenosis induced by sympathomimetic drugs.
        Am. J. Cardiol. 1962; 10: 489
        • Krasnow N.
        • Rolett E.J.
        • Yurchak P.M.
        • Hood W.B.
        • Gorlin R.
        Isoproterenol and cardiovascular performance.
        Am. J. Med. 1964; 37: 514
        • Whalen R.E.
        • Cohen A.J.
        • Sumner R.G.
        • McIntosh H.D.
        Demonstration of the dynamic nature of idiopathic hypertrophic subaortic stenosis.
        Am. J. Cardiol. 1963; 11: 8
        • Krasnow N.
        • Rolett E.
        • Hood W.B.
        • Yurchak P.M.
        • Gorein R.
        Reversible obstruction of the ventricular outflow tract.
        Am. J. Cardiol. 1963; 11: 1
        • Wigle E.D.
        • David P.R.
        • Labrosse C.J.
        • McMeekan J.
        Muscular subaortic stenosis: the interrelation of wall tension, outflow tract, “distending pressure” and orifice radius.
        Am. J. Cardiol. 1965; 15: 761
        • Klein M.D.
        • Lane F.J.
        • Gorlin R.
        Effect of left ventricular size and shape upon the hemodynamics of subaortic stenosis.
        Am. J. Cardiol. 1965; 15: 773
        • Chamberlain D.A.
        • Howard J.
        Guanethidine and methyl dopa: a hemodynamic study.
        Brit. Heart J. 1964; 26: 528
        • Graettinger J.S.
        • Muenster J.J.
        • Checchia C.S.
        • Grissom R.L.
        • Campbell J.A.
        A correlation of clinical and hemodynamic studies in patients with hypothyroidism.
        J. Clin. Invest. 1958; 37: 502
        • Gorlin R.
        • Gorlin S.G.
        Hydraulic formula for calculation of the area of the stenotic mitral valve, other cardiac valves, and central circulatory shunts.
        Am. Heart J. 1951; 41: 1
        • Bowyer A.F.
        • Carleton R.A.
        • Graettinger J.S.
        Augmentation of gradient by tachycardia in subaortic stenosis.
        Clin. Res. 1966; 14: 240
        • Maxwell R.A.
        • Plummer A.J.
        • Schneider F.
        • Povlaski H.
        • Daniel A.I.
        Pharmacology of (2- [octahydro-1-azocinyl]-ethyl)-guanethidine sulfate (SU 5864).
        J. Pharmacol. & Exper. Therap. 1960; 128: 22
        • Cass R.
        • Kuntzman R.
        • Brodie B.B.
        Norepinephrine depletion as a possible mechanism of action of guanethidine (SU 5864), a new hypotensive agent.
        in: 3rd ed. Proc. Soc. Exper. Biol. & Med.106. 1961: 259
        • Harrison D.C.
        • Chidsey C.S.
        • Goldman R.
        • Braunwald E.
        Relationships between the release and tissue depletion of norepinephrine from the heart by guanethidine and reserpine.
        Circulation Res. 1963; 12: 256
        • Krayer O.
        • Alper M.H.
        • Paasonen M.K.
        Action of guanethidine and reserpine upon the isolated mammalian heart.
        J. Pharmacol. & Exper. Therap. 1962; 133: 164
        • McCubbin J.W.
        • Kancko Y.
        • Page J.H.
        Peripheral cardiovascular action of guanethidine in dogs.
        J. Pharmacol. & Exper. Therap. 1961; 131: 346
        • Cohn J.N.
        • Tiptok T.E.
        • Freis E.D.
        Hemodynamic effects of guanethidine in man.
        Circulation Res. 1962; 12: 298
        • Kahler R.L.
        • Gaffney T.E.
        • Braunwald E.
        The effects of autonomic nervous system inhibition on the circulatory response to muscular exercise.
        J. Clin. Invest. 1962; 41: 1981
        • Richardson D.W.
        • Wyss E.M.
        • Magee J.W.
        • Covell G.C.
        Circulatory effects of guanethidine. Clinical, renal, and cardiac responses to treatment with a novel antihypertensive drug.
        Circulation. 1960; 22: 184
        • Goldstein S.
        • Killip III, T.
        Catecholamine depletion in thyrotoxicosis. Effect of guanethidine on cardiovascular dynamics.
        Circulation. 1965; 31: 219
        • Gaffney T.E.
        • Braunwald E.
        Importance of the adrenergic nervous system in the support of circulatory function in patients with congestive heart failure.
        Am. J. Med. 1963; 34: 320
        • Rosenblum R.
        • Green R.
        Hyperkinetic heart syndrome—hypertrophic subvalvular muscular hypertrophy—one entity.
        Clin. Res. 1964; 7 (Abstract.): 192
        • Goodwin J.F.
        Cardiac function in primary myocardial disorders—Part I.
        Brit. M. J. 1964; 1: 1527