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Einfluß von Spirolactone auf die myokardiale Kaliumbilanz unter Strophanthin beim Menschen

Influence of spirolactone on the myocardial potassium balance following strophanthin in man

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Summary

In order to examine the question, whether improved digitalis tolerance by Spirolactone may be partially a result of antagonism on myocardial potassium balance, 6 patients without clinical signs of heart failure were given 400 mg, 3 were given 200 or 300 mg Spirolactone orally daily and 6 patients received placebo during a 5 to 7 days period. During cardiac catheterization hemodynamics and serum potassium concentrations were determined repeatedly prior to and following intravenous administration of 0,375 to 0,625 mg Strophanthin. Injection of Strophanthin resulted in a significant drop in left ventricular enddiastolic pressure and a rise indp/dt max. In the control group a significant increase in arterial and coronary sinus potassium concentration was observed. Myocardial potassium balance was definitely negative from the third to the eighth minute. Values in the group receiving Spirolactone did not differ significantly from the placebo group. It is suggested that therapeutic doses of Strophanthin result in a loss of potassium from the myocardium by inhibition of the Na+, K+ membrane ATPase not influenced by pretreatment with Spirolactone.

Zusammenfassung

Zur Prüfung der Frage, ob eine Verbesserung der Digitalistoleranz unter Spirolactone durch eine gegensinnige Beeinflussung der myokardialen Kaliumbilanz mitbedingt wird, erhitelen 6 klinisch nicht kardial dekompensierte Patienten 5–7 Tage hindurch täglich 400 mg, 3 Patienten 200 bzw. 300 mg Spirolactone oral und 6 Patienten Placebo. Im Rahmen eines diagnostischen Herzkatheterismus wurden hämodynamische Messungen und multiple Serumkaliumbestimmungen vor und nach Gabe von 0,375–0,625 mg Strophanthin intravenös durchgeführt. Nach Strophanthin kam es zu einem signifikanten Abfall des enddiastolischen Drucks und zu einem Anstieg desdp/dt max im linken Ventrikel. In der Kontrollgruppe war ein signifikanter Anstieg der Kaliumspiegel im arteriellen und Koronarsinusblut zu beobachten, es bestand eine negative myokardiale Kaliumbilanz von der 3. bis zur 8. min nach Strophanthin. Die entsprechenden Werte nach Spirolactonevorbehandlung unterschieden sich von jenen der Kontrollgruppe nicht signifikant. Es wird geschlossen, daß nicht toxische Dosen von Strophanthin beim Menschen durch Hemmung der Natrium-Kalium-Membran ATPase zu einem myokardialen Kaliumverlust führen, der durch orale Vorbehandlung mit Spirolactone nicht sicher verändert wird.

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  1. I. Medizinische Universitätsklinik Wien, Austria

    J. Slany & H. Mösslacher

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  1. J. Slany
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Slany, J., Mösslacher, H. Einfluß von Spirolactone auf die myokardiale Kaliumbilanz unter Strophanthin beim Menschen. Klin Wochenschr 54, 671–676 (1976). https://doi.org/10.1007/BF01469147

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