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Myocardial Infarction Prevention by Digitalis: A Successful Experience of 28 Years, 1972-2000
Dr Mesquita and colleagues from Brazil presented in 2002 their experience using cardiac glycosides in patients with stable coronary artery disease - digoxin, digitoxin, acetyldigoxin, beta-methyldigoxin, lanatoside-C or proscilaridin-A, plus coronary dilators - to prevent unstable angina, acute myocardial infarction, congestive heart failure and sudden death (1). According Dr. Mesquita's paper the use of cardiac glycosides by his group is based on the Myogenic Theory of Myocardial Infarction, developed in 1972. The Myogenic Theory demands the cardiotonics as anti-infarction drugs (2, 3). In fact, the use of cardiotonics in stable coronary artery disease, with or w/out previous infarction, presented by Dr Mesquita and col. show very low rates in mortality and morbidity. They retrospectively analyzed data from a period of 28 years (1972-2000) (1). The patients were divided in two groups:
The first group included 994 patients w/out prior infarction, presenting in 28 years the following morbidity and mortality: - Myocardial infarction: 14 cases (1.4%) - Heart failure mortality: 32 cases (3.2%) - Sudden Death: 71 cases (7.2%) - Stroke mortality: 13 cases (1.3%) - Cancer mortality: 14 cases (1.4%) - Total Mortality: 142 cases (14.2%) - (0.5% per year) - Mean Age at Death: 76 years
The second group included 156 patients with prior infarction, presenting in 28 years the following morbidity and mortality: - Re-infarction: 8 cases (5.1%) - Heart failure mortality: 17 cases (10.8%) - Sudden Death: 31 cases (20.5%) - Stroke mortality: 7 cases (4.4%) - Cancer mortality: 3 cases (1.9%) - Total Mortality: 64 cases (41.0%) - (1.45% per year) - Mean Age at Death: 72 years
Dr Mesquita tells in another paper, published in 2002, about the effects of cardiotonic plus coronary dilators in stable coronary artery disease, informing it complements the benefic and protective effects of collateral coronary circulation in front of severe coronary obstructions having as objective the correction of the regional contractile deficiency state of ischemic myocardium and the preservation of myocardial inotropism, as prevention of unstable angina cardiac insufficiency and severe arrhythmias that lead to sudden death (4). Dr. Mesquita also wrote an article that was published at this website, about his experience using digitalis in clinical practice during 60 years disclosing his therapeutic conduct (5).
Cardiotonics
Digoxin: 0.125 - 0.25 mg/day Coronary dilators Verapamil: 120 - 240 mg/day Prenilamine: 120 - 180 mg/day Nifedipine: 20 - 30 mg/day Fendiline: 100 - 150 mg/day Diltiazem: 90 - 180 mg/day
References 1. Cardiotônico: insuperável na preservação da estabilidade miocárdica como preventivo das síndromes coronárias agudas e responsável pela prolongada sobrevida, Quintiliano H de Mesquita, Cláudio A S Baptista, Ars Cvrandi, maio de 2002;35:3 (full text) 2. Book Myogenic Theory of Myocardial Infarction, by Quintiliano H. de Mesquita (summary in English) 3. Why Myogenic Theory not Thrombogenic Theory, Arq Bras Cardiol, V. 62 (4), 1994 (Official Journal of Brazilian Cardiology Society) - Translation to English 4. Efeitos do cardiotônico + dilatador coronário na coronário-miocardiopatia crônica estável, com e sem enfarte prévio, a longo prazo, Quintiliano H. de Mesquita, Cláudio A S Baptista, Sóstenes V Kerbrie, Sônia Mendonça Mari, Maria Consuelo B M Grossi e José Monteiro, Ars Cvrandi,setembro de 2002;35:7 5. Digital na Clínica Diária: Comodidade, Eficiência e Segurança, Mesquita, Quintiliano H. de Mesquita, ICEM - Seção Artigos ,1999 (Digital)
Note: More articles about the Myogenic Theory of Myocardial Infarction at http://www.infarctcombat.org/MyogenicTheory.html
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