Cardiac ambulance services.
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Biomedical subjects
Publications and source records attributed to A A Adgey.
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Mexiletine administered either intravenously or orally was found to be an effective antiarrhythmic agent. Unfortunately, important adverse effects occurred in approximately half of the patients. Adverse effects which appeared during oral therapy were dose related. Mexiletine controlled lignocaine-resistant ventricular dysrhythmias in more than half of the patients treated. Ventricular tachycardia and ventricular fibrillation occurred at plasma concentrations which were not significantly different from those associated with severe side-effects, suggesting that when mexiletine is used to control these major dysrhythmias the incidence of important side effects will be high.
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Most deaths from ischaemic heart disease are sudden, occur outside hospital, and result from ventricular fibrillation. But defibrillators have only limited availability because of their size and weight. A miniature defibrillator has been developed. A singe low-energy shock succeeded in removing ventricular fibrillation in 73 out of 82 episodes, and a further shock was successful in seven more episodes. Primary ventricular fibrillation probably always responds to low-energy electrical shocks, which challenges the conventional view that correction of ventricular fibrillation requires high-energy direct-current shock. Thus even smaller and lighter defibrillators are possible. Furthermore low-energy shocks cause less myocardial damage.
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Of 74 patients seen within 30 minutes of the onset of acute myocardial infarction 68 (92%) had signs of autonomic imbalance. Excessive vagal activity was evident in 41 (55%) and there was sympathetic overactivity in 27 (36%). The high incidence of sudden death in the acute phase of a coronary attack probably results from the electrical imbalance caused by autonomic disturbance. This disturbance must therefore be taken into account in any prophylactic regimen against the lethal early ventricular dysrhythmias.
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