Cardiotonic Therapeutic for the Acute Myocardial Infarction

Quintiliano H. de Mesquita, M.D.

Based on the Myogenic Theory as the origin of myocardial infarction we came also to a new therapeutic concept which differs from that hold by the orthodox cardiology and involves the controversial participation of the cardiotonic.

 Going from the unstable angina over to the behavior of 1290 patients usually considered as having an acute myocardial infarction from the clinical, electrocardiographical and enzymatic point of view face to intravenous G or K strophanthin or digitalis provided daily for 6 days remarkable aspects were observed as regards its immediate effect on the ECG and in the clinical and enzymatic picture without greater complications.

 The behavior of the acute patients treated with cardiotonics was effectively altered and this constitutes a new experience truly different owing to the obvious behavioral transformation making us call this situation as clinical infarctioning picture, a condition which may lead to infarction but which may also be interrupted and even avoided.

 The upkeep of these cases with an oral cardiotonic - digitalis or proscilaridine - in association with a coronary dilator has revealed itself calm and stable. Owing to the myocardial effects set forth through the enzymatic peaks, we can thus identify as an avoided infarction in 20% of cases with no or slight registry of enzymatic peaks lower than two times the normal higher parameter, interrupted in 47% with peaks lower than three times the normal parameter, and as an declared infarction all those which excel this index (33%).

 The study of these results brings the belief that the cardiotonic acts as a protector of the myocardium in the infarctioning clinical condition where there is predominance of the regional myocardial failure instead of the highly divulged post-thrombotic myocardial necrosis. The cardiotonic used routinely in the infarctioning picture seems to have a protective action on the myocardium which may be seen specially through the following prompt effects:

a) optimal receptivity by the infarctioning myocardium even in presence of alarming initial electrocardiographic patterns.

b) marked decrease of the period of pain.

c) regressive features and easy electrocardiographic reversibility, even of the Q and QS deflections.

d) low incidence of arrythmias.

e) usual incidence of partial and total atrioventricular block.

f)  low incidence of heart failure.

g) low incidence of cardiogenic shock (2%).

h) lowering of the peaks of graded enzymatic reactions and fast return to normalcy < 3xN in 67% of the cases as arrested infarction and > 3xN in 33% of the cases as declared myocardial infarction.

 i) low mortality rate (12.2%).

After 1972 when we started the use of cardiotonics for the acute myocardial infarction we established an early and sure deambulation for our patients, which was revolutionary at that time.

The deambulation for patients with the infarctioning picture as arrested or avoided takes place in the 5 th day and in the declared infarction it takes place in the 10 th day. The discharge of patients from hospital is realized one day after.

The mortality rate related with the early deambulation was 0.4 % in the 1290 fore mentioned patients.