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 147,016 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

1. Twenty-three hypertensive patients were treated by sotalol, a pure beta-adrenergic receptor blocking agent. The drug produced a significant decrease of blood pressure in nineteen patients. 2. On average, cardiac index decreased but not significantly; heart rate decreased and stroke index increased significantly. Total peripheral resistance varied in both directions. 3. Sotalol determined a fall in plasma renin concentration (only significant in the high-renin group), a fall in plasma angiotensin II concentration and in urinary excretion rate of aldosterone accompanied by a rise in plasma potassium concentration. 4. The fall of blood pressure was not correlated with the decreases of renin and angiotensin II concentrations or excretion rate of aldosterone. However, in the placebo period plasma angiotensin II concentration was significantly correlated with total peripheral resistance; during sotalol treatment the variations of these two parameters seemed also to be correlated. 5. There was a poor correlation between decreases of cardiac output and of blood pressure; it was impossible to foresee the magnitude of the lowering of the blood pressure from the initial cardiac index. 6. The association of a diuretic with sotalol enhanced the hypotensive effect of the beta-receptor blocking drug, without significant increase of plasma renin and angiotensin II concentrations.
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PMID:Effect of sotalol on haemodynamics and renin-angiotensin-aldosterone system in hypertensive patients. 93 70

This study was designed to investigate the haemodynamic effects of d-sotalol at plasma concentrations producing class III antiarrhythmic effects. d-Sotalol 1, 4 and 10 mg/kg intravenously was given after beta-blockade (propranolol 0.25 mg/kg intravenously) to seven pentobarbital anaesthetized dogs. Left ventricular (LV) systolic and end-diastolic pressures, LV dP/dtmax, mean aortic pressure, stroke volume, cardiac output and total peripheral resistance were not significantly changed by d-sotalol. There was a linear correlation between the dose of d-sotalol infused and the plasma concentration of d-sotalol obtained. Heart rate decreased and QT-time increased with increasing plasma concentrations of d-sotalol, whereas the QRS-width did not change. There was a linear correlation between the decrease in heart rate and the increase in QT-time, and between the plasma concentration of d-sotalol and increase in QT-time. In conclusion, the study indicates that after beta-blockade, d-sotalol has no cardiodepressive effects at concentrations that prolong repolarization.
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PMID:Plasma concentrations and haemodynamic effects of d-sotalol after beta-blockade in dogs. 198 98

Sotalol is a nonselective, water-soluble beta-adrenoceptor antagonist with no membrane-stabilizing activity or intrinsic sympathomimetic activity. Sotalol is, essentially, completely absorbed and is not metabolized. Consequently, bioavailability is close to 100%. Age and food have slight but unimportant effects on bioavailability. Cmax of sotalol is 2 to 3 hours with a t1/2 between 7 and 15 hours. Excretion of sotalol is primarily through the kidneys, with no metabolism by liver and no first-pass effect. Therefore, sotalol plasma levels and half-life are directly related to creatinine clearance and glomerular filtration rate. Appropriate dose adjustments must be made for patients with impaired renal function or increased renal blood flow, as in pregnancy. The beta-adrenoceptor antagonistic effects of sotalol are directly related to plasma levels, which, in turn, are directly related to dose. However, the beta-adrenoceptor antagonism t1/2 is longer than the sotalol plasma t1/2. As a consequence of its ability to prolong the action potential duration, sotalol also increases cardiac contractility in isolated ventricular, but not atrial, preparations by 20 to 40%. This positive inotropic effect is not blocked by beta or alpha blockade or reserpine pretreatment and seems to be related to sotalol's effects on cardiac ionic currents. Like the effects of sotalol on action potential duration, the positive inotropic effects are inversely proportional to rate. The hemodynamics of sotalol indicate a relative lack of direct cardiac depressant activity in both animals and humans. The typical hemodynamic effects of sotalol in normotensive humans, even with depressed myocardial function, are a reduction in heart rate with little or no change in blood pressure, a reduction in cardiac output with no change in stroke volume, and little or no change in pulmonary wedge pressure and left ventricular end-diastolic pressure or volume, and little or no change in ejection fraction either at rest or during exercise.
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PMID:Pharmacology, pharmacodynamics and pharmacokinetics of sotalol. 240 31

Beta-adrenergic blocking agents may have negative inotropic effects that are particularly worrisome in patients with depressed cardiac function. Their membrane-stabilizing properties may be a contributing factor. Sotalol is currently thought not to cause significant myocardial depression. Intravenous sotalol administration has minimal effects on resting stroke volume, although heart rate and consequently cardiac output are significantly decreased. Systolic blood pressure decreases, with a minimal change in diastolic or mean pressure. Hemodynamic effects are usually seen within 15 to 20 minutes of administration. Hemodynamic indexes are maintained even in patients with mildly depressed ejection fractions (mean ejection fraction of 43 +/- 15%) after oral sotalol administration. Although heart rate decreases, cardiac index is unchanged because of a significant increase in stroke volume index. The latter results from an increase in preload (secondary to bradycardia) and a decrease in afterload. Sotalol is well tolerated, although occasionally it may cause worsening heart failure. This is seen in patients with markedly depressed left ventricular function and inadequate cardiac reserve characterized by an inability to increase stroke volume and cardiac output with exercise. Long-term (1-year) patient follow-up reveals no significant hemodynamic deterioration from initial values obtained after oral administration.
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PMID:Hemodynamic effects of intravenous and oral sotalol. 240 32

There are few placebo controlled studies in acute myocardial infarction concerning the haemodynamic effects of beta blockade. In a controlled, double-blind randomized study, the haemodynamic effects of sotalol were evaluated in 20 patients with acute myocardial infarction within 24 hours of the onset. Sotalol was administered to 10 patients over 12 hours by a continuous infusion including three different infusion rates. A serum level around 1.4 microgram ml-1 was achieved after one hour of infusion. The placebo patients were given saline infusion. The patients were monitored invasively using a thermodilution catheter in the pulmonary artery. In the sotalol group, there was a significant reduction in heart rate, systolic blood pressure, cardiac output and stroke volume compared to placebo. A slight increase in the mean pressures of right atrium, pulmonary artery systolic and diastolic pressures was also seen. The infusion was well tolerated and no adverse reaction was seen.
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PMID:Haemodynamic effects of intravenous sotalol in acute myocardial infarction. 353 17

Sotalol is a beta-adrenergic blocking drug with the additional property of lengthening the cardiac action potential. These electrophysiologic properties render the drug attractive for use in the prevention of postoperative supraventricular arrhythmias (SVA), and previous studies have suggested that it was indeed effective. The hemodynamic response to sotalol and its safety early after coronary artery bypass graft (CABG) surgery were therefore studied. Forty-two patients undergoing CABG were randomly assigned either to receive sotalol to prevent postoperative SVA (25 patients) or to serve as controls (17 patients). Sotalol was started 6 hours after surgery if patients had a cardiac index > 2.8 L/min/m2 with a pulmonary capillary wedge pressure < 15 mmHg, and if they had no contraindications to the use of beta-blockers. The drug was given as a loading infusion of 1 mg/kg over 2 hours, followed by a maintenance infusion of 0.15 mg/kg/h for 24 hours. Three hours later, patients received the first oral dose of 80 mg to be repeated every 8 or 12 hours. Adverse effects necessitating discontinuation of the drug (bradycardia < 50 beats/min, systolic blood pressure < 90 mmHg, or cardiac index < 2.2 L/min/m2) occurred in six patients (24%) and were mainly related to the loading infusion. The hemodynamic data for patients who completed the study were characterized by a significant fall of the cardiac index caused by a lower heart rate without significant change of the stroke volume index. The incidence of supraventricular arrhythmias was not significantly different in the two groups (3/19 in the sotalol group, 5/17 in the control group).(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Hemodynamic effects and safety of sotalol in the prevention of supraventricular arrhythmias after coronary artery bypass surgery. 794

We explored the central hemodynamic responses to oral sotalol during dose titration in patients with ventricular arrhythmias who underwent programmed ventricular stimulation. Twelve patients were included in the study, 9 with a history of sustained ventricular tachyarrhythmias (6 postmyocardial infarction and 3 with cardiomyopathy) and 3 with a history of nonsustained ventricular tachycardia postmyocardial infarction. Left ventricular ejection fractions were < 45% in 10 patients, and < 35% in 5; the mean ejection fraction was 37% (range 20-51%). Sotalol prevented the induction of ventricular tachycardia in each of 3 patients with nonsustained ventricular tachycardia and in 6 of 9 with sustained ventricular tachycardia at baseline study. At peak action (2 hours) after sotalol loading (mean dose, 167 mg orally twice daily), the hemodynamic effects included bradycardia, decreased cardiac index, increased left ventricular filling pressure and systemic vascular resistance, and no change in stroke volume or stroke work index. One patient was not continued on sotalol, owing to an excessive increase in the pulmonary capillary wedge pressure, despite the lack of symptomatic heart failure. Congestive heart failure in association with marked bradycardia developed in another patient, who had suppression of inducible ventricular tachycardia after sotalol loading; this patient was managed with a reduction in the dose of sotalol and a regimen of digoxin and furosemide, and has been well compensated and without a recurrence of sustained ventricular tachycardia for more than 4 years. Ventricular tachycardia has been controlled with sotalol, without hemodynamic deterioration, in 6 of these patients.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Effect of oral sotalol on systemic hemodynamics and programmed electrical stimulation in patients with ventricular arrhythmias and structural heart disease. 834 25

Previous reports of the follow-up of patients with atrial fibrillation have been confusing because of the variety of clinical presentations, heterogeneity of underlying pathology, and the initiation of follow-up at various stages of the patient's disease. The Canadian Registry of Atrial Fibrillation (CARAF) is a non-interventional, follow-up study of patients enrolled at the time of their initial diagnosis with atrial fibrillation at seven Canadian centres. At baseline, a comprehensive database recorded clinical, laboratory, and echocardiographic variables. No specific intervention was initiated and care was left to the attending physicians. Follow-up was performed at 3 months, 1 year, then annually. Echocardiograms were repeated every 2 years. Recurrence of atrial fibrillation, medical intervention, stroke, death, and other significant events have been specifically recorded. To date, 967 patients have been enrolled. Seven hundred and sixty-seven patients have been followed for 1 year, 468 for 2 years, and 217 for 3 years. Several studies have been undertaken on these patients. One study compared the variables of patients who were symptomatic with those who were asymptomatic. This study demonstrated that symptoms were more likely to occur if the patient were younger, had high blood pressure and high ventricular response during atrial fibrillation, and were female. These all achieve statistical significance and a formula was developed to predict the probability of symptoms in different subgroups of patients. Antiarrhythmic drug use was evaluated. Sotalol and propafenone were the most commonly used drugs and their use increased when atrial fibrillation was recurrent. Many patients initially received no antiarrhythmic drugs. Trends suggest that therapy is more aggressive with recurrence of the arrhythmia. The prevalence of thyroid abnormalities was investigated utilizing sensitive TSH measurements. This showed that overt hyperthyroidism is rare (1%) but laboratory abnormalities and history of thyroid dysfunction occurred more frequently, in 19% of patients. Another study evaluated antithrombotic therapy. Factors known to increase stroke risk, including congestive heart failure, previous stroke, and large left atrium all increased the use of anticoagulants. Anticoagulants were used more frequently in patients over the age of 65 and in patients with recurrent or chronic atrial fibrillation. There was concern that hypertension, shown to be a high predictor of stroke, did not result in a significant use of warfarin. Aspirin use was common in patients not placed on anticoagulants. Further studies are being undertaken with the ultimate goal to utilize baseline data to predict clinical outcomes.
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PMID:Follow-up of atrial fibrillation: The initial experience of the Canadian Registry of Atrial Fibrillation. 880 39

The portal heart of the New Zealand hagfish (Eptatretus cirrhatus) was perfused in situ. Stroke volume, cardiac output and power output increased in response to increased preload, in accordance with Starling's law of the heart. A positive chronotropic effect was found when the input pressure increased from 0.05 to 0.1 kPa. Increased afterload decreased stroke volume and cardiac output. Power output peaked at an output pressure of 0.22 kPa, after which it decreased. There was no change in heart rate in response to increased afterload. In unanaesthetized resting animals, the pressure in the supraintestinal vein, which supplies the portal heart, ranged from 0.025 to 0.07 kPa (mean 0.040&plusmn;0.005 kPa). The beta-adrenoceptor antagonist sotalol did not affect the response to different input and output pressures. Sotalol produced a significant decrease in heart rate and abolished the pressure-sensitive increase in heart rate. Bolus injections of adrenaline produced a transient increase in portal heart rate. The negative chronotropic response to sotalol and the response to adrenaline indicate the presence of an endogenous beta-adrenergic tonus on the portal heart.
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PMID:Effects of preload and afterload on the performance of the in situ perfused portal heart of the New Zealand hagfish Eptatretus cirrhatus 931 28

The effects of preload and afterload on the performance of the systemic heart of the hagfish Myxine glutinosa were investigated before and during sotalol treatment using an in situ perfusion technique. Elevation of input pressure (preload) increased flow by means of increased stroke volume and heart rate in accordance with Starling's law of the heart, while increased output pressure (afterload) decreased flow mainly because of decreased stroke volume. Treatment with the beta-adrenoceptor antagonist sotalol did not change the quality of the responses to increased preload or afterload, although power output decreased by 40 % and flow rate was reduced by 35 % mainly due to a decrease in heart rate. Isolated preparations of the systemic heart and the portal heart provided information on the chronotropic effects of different agonists and antagonists. Both the systemic heart and the portal heart were insensitive to adrenergic and cholinergic agonists, adrenocorticotropic hormone and the cholinoceptor antagonist atropine. Sotalol treatment lowered the rate of spontaneous contractions by 30 % in the systemic heart preparation and by 21 % in the portal heart preparation. This study has given further evidence for the existence of a tonic beta-adrenoceptor stimulation of the hagfish systemic heart and portal heart, and demonstrated the importance of that stimulation in maintaining systemic heart performance.
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PMID:Control of the systemic heart and the portal heart of Myxine glutinosa 931 26


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