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Cardiac Effects of a Cocktail

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Cardiac Effects of a Cocktail Cardiac Effects of a Cocktail Lawrence Gould, MD; Mohammad Zahir, MD; Anthony DeMartino, MD; and Robert F. Gomprecht, MD The hemodynamic effects of a cocktail in cardiac disease have not been key to drink in less than ten minutes. previously studied, to our knowledge. Ten patients with cardiac disease Thirty minutes after the ingestion of and four normals underwent cardiac catheterization. Hemodynamic the whiskey, the pressures and car¬ diac were measured. measurements were obtained prior to and 30 minutes after oral ingestion output Left ventricular function was as¬ of 2 oz of Canadian With alcohol, all of the with cardiac whiskey. patients sessed to the de¬ disease demonstrated a fall in the cardiac index and stroke index. Alcohol according following terminations: produced in the normals an increase in these measurements. The cardiac rate, systemic blood pressure, and pulmonary artery pressure were LVSW = LVS LVd x SI X 1.36 x 1.050 - essentially unchanged in both groups. Small amounts of alcohol can 100 (1) cardiac function in with cardiac disease. impair patients LVSP = LVSW/SEP (2) MSER = SI/SEP (3) Alcohol is consumed in varying and 8 of the 12 subjects rarely took an TTIb = LVsxSEP (4) L\ amounts a alcoholic beverage. However four of by large segment TTIm = LVBXSEPxHR * *» of the population. It has even the patients admitted to excessive al¬ (5) been cohol prescribed by many physicians consumption. LVW = for their patients because of a pre¬ Procedures. -Catheterization of the CIX^^XBA (6) sumed cardiac stimulant effect. left ventricle was performed by retro¬ PR = BA„x 1,332 the a number arterial In last few years of grade catheterization CO (7) groups have investigated the cardiac through a brachial arteriotomy. A effects of alcohol in man. However, Cournand needle was placed into the Where LVSW signifies left ventricular most of these studies have been lim¬ opposite brachial artery. A No. 7 stroke work (g-m/beat/sq m of body sur¬ face stroke index (ml/beat/sq m ited to right ventricular catheter- Goodale-Lubin catheter was placed in area); SI, of body surface area); LV, mean left ven¬ izations1-5 so that left ventricular the pulmonary artery. Cardiac output tricular systolic pressure (mm Hg); LV„, function could not be ana¬ was determined in the precisely duplicate by left ventricular end-diastolic pressure (mm In the amount of eth- Fick and the results did lyzed. addition, technique, Hg); LVSP, mean left ventricular stroke anol administered over a short not differ more than 7%. period by Oxygen power (g-m/beat/sq m body surface of time was so excessive that it bore consumption was determined by mea¬ area/systolic sec); SET, mean systolic ejec¬ no relationship to the drinking habits suring ventilation with a spirometer, tion time (sec); MSER, mean systolic ejec¬ of most individuals.1-4" and analyzing the expired gas with a tion rate (ml/beat/sq m/systolic sec); TTI„, Micro-Scholander apparatus. Two to¬ tension time index per beat (mm Hg tension time index For editorial comment see page 1822. nometers were used for the gas collec¬ sec/beat), TTIm, per tions, and the results of the analysis minute (mm Hg/sec/min); HR, heart rate (beats/min); LVW, left ventricular work Thus, the cardiac effects of a cock¬ of the two gas samples had to agree (kg-m/min/sq m body surface area); BAm, tail in with cardiac disease 0.04%. Mixed venous blood was ob¬ patients by mean brachial tained from the artery pressure (mm Hg); are unknown. The following study pulmonary artery PR, systemic peripheral resistance (dynes- an¬ and arterial blood from the brachial was designed and performed to sec-cm '); CO, cardiac output (ml/sec); 1.36, swer this unresolved question. artery. Arterial and mixed venous conversion factor from mm Hg to cm HO; oxygen contents were determined by 1.050, whole blood specific gravity. Materials and Methods the method of Van Slyke and Neill. The statistical significance of the Selection ofPatients.—A group of 14 The blood samples were analyzed in differences (P values) in the normal hospitalized patients, 11 men and two different machines, and the re¬ and abnormal group prior to alcohol three women, underwent right and sults did not differ by more than 0.2 ingestion as well as the differences in left ventricular catheterizations, pri¬ vol/100 ml. the normal and abnormal group 30 marily as an aid to their clinical man¬ Left ventricular, pulmonary ar¬ minutes after the ingestion of alcohol agement. The conditions of the pa¬ terial, and systemic arterial pres¬ were calculated with the Student t- tients are listed in Table 1. A history sures, and cardiac output were mea¬ test. of alcohol consumption was obtained sured in the resting state. All Results pressures were obtained using the From the Department of Medicine, Mis- mid thoracic level as the reference Complete data on all 14 patients ericordia-Fordham Hospital Affiliation, Bronx, point. are in Table 1. In NY. presented addition, The were then 2 oz values before and after alco¬ Reprint requests to 600 E 233rd St, Bronx, NY subjects given average 10466 (Dr. Gould). of chilled 86.8-proof Canadian whis- hol ingestion in the normal and ab- Downloaded From: http://jama.amarc.silverchair.com/ by a American Medical Association User on 04/10/2014 Table 1.—Complete Hemodynamic Patient RA, RV PA LV BA Rate SET SET No. Experimental Sex and Mean S/D S/D S/D S/D (Beats/ (Sec/ (Rate Condition State Age (yr) (mm Hg) (mm Hg) (mm Hg) Mean (mm Hg) (mm Hg) Mean Minute) Beat) Corrected) Control M 36 20/3 20/11 14 107/8 107/60 76 86 0.26 0.41 Normal Alcohol 19/10 13 110/8 110/65 80 84 .265 .40 2 Control 25/0 25/12 16 115/7 117/72 87 77 .28 .41 Normal Alcohol 24/10 15 115/7 118/68 84 84 .28 .42 3 Control M 21 16/0 15/0 115/6 120/70 87 68 .26 .36 Normal Alcohol 12/6 110/6 120/70 87 73 .32 .44 4 Control F 24 16/1 16/8 10 115/72 86 79 .30 .43 Normal Alcohol 15/7 9 110/70 84 79 .30 .43 5 Viral Control F 37 13/0 13/8 10 117/62 80 100 .27 .44 pericarditis Alcohol 12/7 9 107/68 81 100 .26 .43 Pericarditis and chronic Control M 32 24/0 24/9 14 105/4 110/63 79 71 .30 .42 alcoholic Alcohol 20/8 12 112/5 128/80 96 75 .28 .41 Constrictive Control M 65 26/8 27/14 18 100/10 100/60 73 56 .28 .38 pericarditis Alcohol 18/12 14 98/11 98/58 72 64 .28 .38 8 Mitral Control F 52 35/5 35/16 23 135/10 135/60 85 68 .33 .45 stenosis Alcohol 27/12 17 130/10 137/58 85 54 .33 .42 9 Mitral Control M 53 82/7 82/30 47 90/18 100/67 78 100 .22 .39 insufficiency Alcohol 95/30 52 88/20 95/60 72 99 .22 .39 10 Hyperkinetic Control M 26 25/3 23/11 15 120/3 120/70 87 77 .31 .44 heart syndrome Alcohol 27/12 17 128/7 128/78 95 83 .30 .44 11 Mitral stenosis, aortic insufficiency, Control M 41 1 40/1 40/18 25 107/2 118/70 86 88 .24 .39 chronic alcoholic Alcohol 35/18 24 118/5 130/80 96 96 .24 .40 12 i Primary myo- cardial disease Control M 45 1 37/2 37/20 25 100/19 104/63 77 100 .23 .40 and chronic alcoholic Alcohol 43/23 29 94/20 100/60 73 100 .24 .41 13 Primary myo- cardial disease Control M 58 12 60/12 60/30 40 125/16 125/85 99 120 .20 .40 and chronic alcoholic Alcohol 60/28 39 130/18 130/80 96 104 .20 .37 14 Coronary heart Control M 56 6 25/5 25/13 16 130/9 138/78 98 67 .28 .39 disease Alcohol 30/17 21 130/13 142/80 100 71 0.27 0.39 *RA signifies right atrial pressure; S/D, systolic/diastolic; RV, right ventricular pressure; PA, pulmonary artery pressure; BA, brachial artery pressure; SET, systolic ejection time; LVSW, left ventricular stroke work; LVSP, left ventricular stroke power; MSER, mean systolic ejection rate; TTIb, tension time index per beat; TTIm, tension time index per minute; and LVW, left ventricular work. normal groups are listed in Table 2. (P<.001). Similarly, the cardiac in¬ Comment There was no statistical difference dex rose in the normal group and fell in any of the hemodynamic measure¬ in the abnormal group (P<.02). The The present study demonstrated ments prior to the ingestion of alcohol varying response of the cardiac index that alcohol administration produced in the normal and abnormal group. in the two groups was due primarily a decrease in the cardiac index and Comparison of the two groups after to a narrowing of the arteriovenous stroke index in all of the patients the ingestion of alcohol revealed no oxygen difference in the normal with cardiac disease. The arterial significant differences in the brachial group and a widening of this value in pressure was essentially unchanged, artery mean pressure, pulmonary ar¬ the abnormal group (P<.05). and therefore the peripheral resist¬ tery mean pressure, and left ventricu¬ The significant increase in the left ance rose in the abnormal group. This lar and diastolic pressure.
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