Early symptom-relief after valvulotomy in mitral stenosis indicates role of lobeline-sensitive intrapulmonary receptors.
Respiratory sensations of eight patients with mitral stenosis in response to i.v. lobeline and 6-min walk before percutaneous mitral valvulotomy (PMV) were 'being short of breath', pressure in chest, tracheo-bronchial irritation, a desire to cough, persistent dry cough, chest pain and were qualitatively similar amongst 75% (P=0.005) of the patients. A week after PMV lobeline evoked similar sensations but the threshold dose decreased from 32.4+/-3.8 to 24.1+/-3.2 microg/kg (P=0.001) and pulmonary artery wedge pressure (PAwP), signifying reduction in pulmonary congestion, from 23.1+/-1.4 to 14.3+/-3.4 mm Hg (P<0.001). Distance walked in 6 min increased from 217+/-58 to 319+/-51.6m; and mitral valve area from 0.63+/-0.01 to 1.43+/-0.26 cm(2) (P<0.001). A fall in lobeline-sensation threshold dose indicated reduction in pulmonary congestion and stimulus to juxtapulmonary/J (or pulmonary C fibre) receptors which suggests that they had contributed to the respiratory and viscerosomatic symptoms seen before PMV.
Anand
Ashima
A
Exertional Breathlessness Studies Laboratory, Vallabhbhai Patel Chest Institute, Delhi University, Delhi 110007, India. ashima_anand@hotmail.com
Roy
Ambuj
A
Bhargava
Balram
B
Raj
Hans
H
Barde
Pradip B
PB
Vijayan
V K
VK
D000328:Adult; D002404:Catheterization / Q000379:methods*; D005260:Female; D006801:Humans; D008120:Lobeline / Q000494:pharmacology*; D008297:Male; D008946:Mitral Valve Stenosis / Q000503:physiopathology* / Q000601:surgery*; D011669:Pulmonary Wedge Pressure / Q000187:drug effects; D011930:Reaction Time / Q000187:drug effects; D012137:Respiratory System / Q000187:drug effects; D019141:Respiratory System Agents / Q000494:pharmacology*; D011984:Sensory Receptor Cells / Q000187:drug effects*; D012684:Sensory Thresholds / Q000187:drug effects; D016138:Walking; D055815:Young Adult
D019141:Respiratory System Agents; D008120:Lobeline