Catecholamineに関する研究,特に心不全について(第3報) : 心不全症例に各種自律神経作用物質を負荷した際の尿中active catecholsの反応態度とその意義について

抄録

Much has been discussed on the significance of catecholamine in disease conditions. But its relation to the autonomic nervous system in the area of cardioangiology is extremely important, from the observation of sympathicotonic aspect of the nervous system in reference to cardiac failure. Studies on these relationship serve to contribute to further clarification of the pathophysiology of cardiac failure. Previously, the author had studied 239 cases of cardiac failure complicated from the acquired valvular diseases and hypertensives. Determination of the urinary catecholamine in 24 hour urine were made and obtained the following results. 1) In grade II-IV of cardiac failures, urinary excretion of adrenaline and noradrenaline was found to be increased above the normal. 2) Adrenaline and noradrenaline have in-creased in an order of I, II, III of cardiac failure grade and up to 111 grade which was the highest. On the contrary in grade IV, slight decrease was shown but still higher than the normal level. This urinary excretion pattern of catecholamine in cardiac failure has well been recognized in each case. 3) Increase of adrenaline showed with relatively steadly pace, while noradrenaline excretion ranged rather widely. 4) Degree of increase in adrenaline and noradrenaline was due to severity of the disease rather than primary disease which complicated the failing heart. 5) The excretion ratio of adrenaline/aoradrenaline increased in degree with the progress of cardiac failure I, II, III, but in grade IV the value was below the normal. 6) The stage ofsympathico-adrenal activity as indicated by the increased urinary cate-cholamine in cardiac failure is presumably result of the regulatory mechanism. Hence, it is assumed that increased urinary catecholamine in cardiac failure may be advantageous for cardiac failure to improve, as previously re-ported. (The Journal of Japanese Society of Internal Medicine 53 : 413, 1964). Present studies were made (1) to make clear the pathophysiological significance of the sympathico-adrenal activity in cardiac failure by rapid digitalization on the patients suffering from acquired valvular heart diseases and of hypertension, and by observing the urinary excretion of active catechols referring to the clinical features with its relation to time before during and after rapid digitalization treatment. (2) To observe urinary excretion of active catechols with pilocarpine administration and upon response of the sympathetic nerve center in the failing heart. (3) To pursue the effect of decreased syrnpathico-adrenal activity on the cardiac failure, and by estimating active urinary catechols upon the administration of reserpine.