Mariano M. Alimurung

Heart disease in the Philippines: A seven-year (1947–1953) postwar survey of four Manila General Hospitals

Abstract A seven-year (1947–1953) postwar survey of the frequency of heart disease in the Philippines is reported. This survey was based on the case records from the medical and pediatric services from the Santo Tomas University Hospital, the Philippine General Hospital, and the North General Hospital; as well as the medical case records from the V. Luna General Hospital. The data were tabulated to furnish the following information: (a) frequency of heart disease among hospital admissions into these services; (b) number of deaths due to heart disease among all deaths; and (c) number of deaths among the cardiac patients. Of particular interest was the noticeable and apparently progressive rise of the yearly frequency of heart disease among hospital admissions. Rheumatic heart disease was the leading etiologic type. This was followed by hypertensive heart disease and arteriosclerotic (coronary) heart disease in the medical group, and by congenital malformations and beriberi heart disease in the pediatric group. Finally, the data were compared with similar reports from Mexico, New England, and Texas. Certain features of interest were pointed out and discused.

Heart disease in the Philippines

Abstract Heart disease affects in a prominent degree peoples of both the West and the East. The present data from the Philippines confirm this fact. The following observations are worthy of note: 1. 1. Among patients admitted to hospitals, heart disease accounts for 8 per cent of cases in the medical and pediatric services combined, 13.8 per cent of the medical cases. It appears, further, that the cases are steadily increasing year after year. 2. 2. The leading cause of heart disease is rheumatic fever, accounting for 54.9 per cent of cardiac children and 46.6 per cent of cardiac adults, giving an average prevalence of 47.1 per cent. 3. 3. Following rheumatic heart disease are hypertensive (17.2 per cent) and atherosclerotic (15.5 per cent) heart disease. 4. 4. Cor pulmonale poses an important problem in the Philippines; it is chiefly associated with bronchial asthma or pulmonary tuberculosis, and at times with pulmonary schistosomiasis; it may be found in very young children. 5. 5. Among Chinese in Manila, hypertensive heart disease is the most common finding in hospital patients, while there is a very low occurrence of cor pulmonale. Rheumatic heart disease and coronary heart disease appear less frequently among Chinese than among Filipino patients admitted to the hospital.

Oral protoveratrine in the treatment of hypertension

Abstract Protoveratrine was administered orally in 30 hyptertensive patients. These patients were unselected in so far as their age and the probable cause of the hyptertension was concerned. Twenty-five were considered as having essential hypertension, four, chronic glomerulonephritis and one, pheochromocytoma. In 29 patients who tolerated the drug, a significant reduction of the blood pressure to reasonable, often normal, levels was obtained. The drop in blood pressure was observed to be fairly consistent and closely related to the drug dosage. The cardiopulmonary effects consisted of slowing of heart rate and a dramatic relief of acute pulmonary edema. The latter, as suggested by others, may be due to the drop in pulmonary artery and “pulmonary capillary” pressures. The most frequent side-effects were nausea and vomiting, especially in patients prone to develop these manifestations as in those with renal insufficiency or cerebrovascular accident. Psychic disturbances were observed in two cases. Substernal warmth or mild tightness occurred in one case. This is probably a reflex action of the drug, although the possibility of induced angina is not to be overlooked especially when the blood pressure drops rapidly. Oral protoveratrine, administered in the dosage schedules mentioned, appears to be a useful, potent and safe drug treatment of hypertension and hypertensive heart disease.

Aberrant ventricular conduction simulating paroxysmal ventricular tachycardia during quinidine therapy

Abstract A case of aberrant ventricular conduction simulating paroxysmal ventricular tachycardia is reported. This arrhythmia occurred in a 50-year-old man with mild hypertension and atrial fibrillation, while under quinidine therapy. The etiologic role of quinidine is suggested by: (1) the occurrence of the arrhythmia during quinidine administration; (2) appearance of other clinical manifestations such as nausea, vomiting, and loose bowel movements; and (3) disappearance of both the clinical symptoms and the arrhythmia upon discontinuation of quinidine. The diagnostic, prognostic, and therapeutic importance of prompt recognition of this arrhythmia is pointed out. The criteria for electrocardiographic diagnosis and the mechanism of production of aberrant ventricular conduction are discussed.

Atabrine in Ventricular Tachycardia

The therapeutic efficacy of Atabrine in ventricular tachycardia has not yet been clearly demonstrated. In this case report, Atabrine stopped ventricular tachycardia and restored normal sinus rhythm following the fifth two-hourly oral dose of 0.30 Gm. Nausea and vomiting were the only toxic effects noted. Ventricular tachycardia, in this case, occurred as a complication of acute myocardial infarction. The latters characteristic electrocardiographic picture became obvious as the arrhythmia was corrected.

Monoamine Oxidase Inhibitor (Tersavid) in Coronary Heart Diseasea

In 1960, Abrams and co-workers8 published their observations with two other similar compounds: isocarboxazid (Marplan) and pivalylbenzhydrazine (Tersavid). As these authors stated, two types of investigation have been carried out in this field: (1) a systematic search for similar compounds to iproniazid showing greater efficacy and safety; and (2) a study of the mode of action in the amelioration of the anginal pain. Pharmacologic studies indicate that Marplan and Tersavid are less toxic than iproniazid; at the same time, they are also considerably more potent monoamine oxidase inhibitors. Abrams and his associates’ administered Marplan to 27 patients with angina pectoris and Tersavid to 78. From their clinical observations, it appeared that both agents can bring about significant relief of anginal pain in most of their cases. No serious undesirable side effects were noted, particularly with Tersavid, both clinically and by laboratory tests. In view of the foregoing, the present clinical investigation was embarked upon, with the use of Tersavid, in patients with anginal pains9. The results of this study are presented in this paper.