22:T435,Vasopressin injection (pitressin®) has become widely accepted as a useful aid in roentgen visualization of the gallbladder. Through its ability to increase peristalsis, vasopressin injection results in rapid expulsion of gas from the intestine, thus removing obscuring gas shadows. The drug may cause only transient and minor toxic reactions. Collins and Root¹recognized three contraindications: coronary heart disease, hypertension and hypotension (systolic blood pressure under 100). Kirklin²in reporting on the use of vasopressin injection in 100 cases, noted no serious ill effects although numerous minor reactions were observed, the most frequent being pallor. Recently, Mills and co-workers³directed attention to the possibility of serious myocardial effects of the drug. We observed two cardiac accidents following vasopressin injection during cholecystography. On the basis of generally accepted principles governing its use, no contraindication to the use of the drug was evident in these cases.

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Case

23:T4f0,The mechanisms by which elevated levels of vasopressin (ADH) in man and animals cause serious myocardial dysfunction, evidenced by arrhythmias, reduction in cardiac output and coronary blood flow, are not settled. Experiments were conducted in 16 isolated working left ventricles to examine their metabolic and hemodynamic responses to the infusion of vasopressin and the combination of vasopressin and epinephrine. Contractile performance was evaluated by analysis of positive dP/dt, contractile element velocities, and ventricular work-curves using stroke work/end-diastolic pressure. Relaxation parameters, including negative dP/dt and the early diastolic relaxation time constant, were also studied. Coronary blood flow was reduced 22% or less by vasopressin while cardiac output was maintained at a constant level. Myocardial oxygen consumption, lactate and potassium balances were determined from arterial and coronary sinus concentrations. Vasopressin produced myocardial dysfunction indicated by decrements in contractile and relaxation indices, without evidence of global ischemia. Epinephrine restored the mechanical performance to normal without significant change in coronary blood flow, myocardial oxygen consumption, or lactate and potassium balance.24:T5ca,

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