Reduction of stress/catecholamine-induced cardiac necrosis by beta 1-selective blockade.
114 haemodynamically stable patients with acute head injury were randomised, double-blind, to either placebo or atenolol given intravenously (10 mg every 6 h) for 3 days then orally (100 mg daily) for a further 4 days. Both groups were equally stressed as shown by raised arterial noradrenaline levels. In patients receiving placebo, but not in those receiving atenolol, there was a significant (p less than 0.01) positive correlation between arterial noradrenaline and levels of the myocardial isoenzyme of creatine kinase (CKMB). 30% of the placebo group compared with 7.4% of the atenolol group (p less than 0.05) showed CKMB levels greater than 3% of total creatine kinase (compatible with myocardial damage). CKMB levels greater than 6% of total creatine kinase (compatible with acute myocardial infarction) were present in 16.7% of patients receiving placebo but in no patients receiving atenolol (p = 0.053). Atenolol appeared to reduce significantly the likelihood of supraventricular tachycardia and ST-segment and T-wave changes and prevented cardiac necrosis seen at necropsy.
D000293:Adolescent; D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use*; D000328:Adult; D000368:Aged; D001262:Atenolol / Q000627:therapeutic use; D002648:Child; D002986:Clinical Trials as Topic; D006259:Craniocerebral Trauma / Q000097:blood / Q000150:complications; D003402:Creatine Kinase / Q000097:blood; D004311:Double-Blind Method; D004562:Electrocardiography; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007527:Isoenzymes; D008297:Male; D008875:Middle Aged; D009206:Myocardium / Q000473:pathology*; D009336:Necrosis; D009638:Norepinephrine / Q000097:blood*; D010865:Pilot Projects; D011897:Random Allocation; D013312:Stress, Physiological / Q000150:complications*; D013617:Tachycardia, Supraventricular / Q000517:prevention & control
D000319:Adrenergic beta-Antagonists; D007527:Isoenzymes; D001262:Atenolol; D003402:Creatine Kinase; D009638:Norepinephrine