Document Detail

Vasoactive parathyroid hormone in the treatment of acute ischemic left ventricular failure and the prevention of cardiogenic shock.
MedLine Citation:
PMID:  4053300     Owner:  NLM     Status:  MEDLINE    
Molecular fragment 1-34 of synthetic bovine parathyroid hormone (bPTH[1-34]) has been found to be a potent coronary vasodilator, a moderate systemic vasodilator, and a positive inotropic agent for the myocardium. On that basis, the hypothesis was tested that "vasoactive" PTH might be effective in the treatment of acute ischemic left ventricular failure (LVF) and the prevention of cardiogenic shock. Dogs whose sympathetic nerve activity was blocked by a combination of reserpine, propranolol, and chlorpromazine were anesthetized and subjected to open-chest occlusion of the left anterior descending coronary artery (LAD) plus sequential ligation of three diagonal branches. In ten untreated animals (control group), acute myocardial ischemia led to LVF and, within 4 hours, to cardiogenic shock (50% or greater reduction in cardiac output; 30% or greater reduction in mean aortic pressure; elevation of left atrial pressure above 20 mm Hg; and significant elevation of arterial blood lactate concentration). At the end of 4 hours, myocardial infarction measured by the incubation of transverse slices of the left ventricle in TTC solution represented 96 +/- 3% of the myocardium "at risk." In ten treated animals (experimental group), PTH(1-34) was administered intravenously, 1 U/kg/min, starting 30 minutes after coronary occlusion. Treatment improved left coronary blood flow from 55 +/- 5 to 120 +/- 11 ml/100 g LV/min, increased cardiac index from 72.5 +/- 7 to 117.5 +/- 12 ml/kg/min, reduced left atrial pressure from 27.5 +/- 2.5 to 15 +/- 2.5 mm Hg (all changes, P less than 0.005), sustained aortic pressure, and prevented the elevation of arterial blood lactate. At the end of 4 hours, myocardial infarction represented 30 +/- 1.2% of the myocardium at risk (difference between the two groups significant, P less than 0.005). Thus, PTH(1-34) exerted a tissue-sparing effect on the myocardium, restored LV function, and prevented the development of shock.
M Feola; H Gonzales; P C Canizaro
Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Circulatory shock     Volume:  17     ISSN:  0092-6213     ISO Abbreviation:  Circ. Shock     Publication Date:  1985  
Date Detail:
Created Date:  1985-12-13     Completed Date:  1985-12-13     Revised Date:  2007-11-15    
Medline Journal Info:
Nlm Unique ID:  0414112     Medline TA:  Circ Shock     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  163-77     Citation Subset:  IM    
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MeSH Terms
Blood Pressure / drug effects
Coronary Circulation / drug effects
Coronary Disease / drug therapy*,  physiopathology
Hemodynamics / drug effects
Lactates / blood
Lactic Acid
Oxygen Consumption / drug effects
Parathyroid Hormone / therapeutic use*
Peptide Fragments / therapeutic use*
Shock, Cardiogenic / physiopathology,  prevention & control*
Vascular Resistance / drug effects
Reg. No./Substance:
0/Lactates; 0/Parathyroid Hormone; 0/Peptide Fragments; 50-21-5/Lactic Acid; 52232-67-4/Teriparatide

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