THE EFFECT OF THEOPHYLLINE WITH ETHYLENEDIAMINE (AMINOPHYLLINE) ON CEREBRAL HEMODYNAMICS IN THE PRESENCE OF CARDIAC FAILURE WITH AND WITHOUT CHEYNE-STOKES RESPIRATION 1
Authors: John H. Moyer, Sam I. Miller, Arthur B. Tashnek, Russel Bowman, Miss C. P. Smith
Journal: Journal of Clinical Investigation (1952)

Cheyne-Stokes respiration, found associated with cardiac failure, has been attributed to cerebral anoxia (1) on the basis of decreased cerebral blood flow, which is depressed in proportion to the de- crease in cardiac output (2).Since Aminophylline increases cardiac output (3) and at the same time arrests Cheyne-Stokes respiration (4), it seems logical to conclude that the latter response occurs as a result of improvement of the cerebral circulation.However, Wechsler, Kleiss, and Kety (5) have observed that in normal individuals Aminophylline actually decreases cerebral blood flow.The following study was undertaken in or- der to clarify this problem.An attempt has been made to evaluate the effect of Aminophylline on the cerebral hemodynamics in 16 patients with car- diac failure, four of whom had Cheyne-Stokes respiration. METHODS AND MATERIALSixteen cerebral blood flow studies were done on pa- tients with definite clinical and laboratory evidence of congestive heart failure.Their ages ranged from 38 to 70.All showed peripheral edema and signs of pulmonary congestion.The arm to tongue circulation times ranged between 17 and 55 seconds, and the venous pressures taken at the jugular bulb were above 10 cm.water in all but two patients (Table I).Four presented the typical respiratory pattern of Cheyne-Stokes respiration (Table II).Azotemia, with blood urea nitrogens of 34 and 42 mg.per cent, was present in two patients (J.D. and D. B.).This was due to renal disease in the case of J. D. but was apparently secondary to the heart failure in the case of D. B., since there was no evidence of primary kidney disease in the latter.All but four patients had previously received treatment, but had become decom- pensated because of an inadequate regimen.The hemo- globin was not less than 10 gm. per cent in any of the B. W.35.0 32.4 42.2 44.3 15.2 15.4 6.5 4.1 8.7 11.3 -31 21 -2.7 2.4 3.0 4.2 E. P.48.4 47.7 55.0 56.6 14.7 14.8 7.5 6.5 7.2 8.3 -57 35 -4.1 2.9 1.9 2.8 E. W.34.2 34.9 42.0 42.8 15.6 16.1 7.7 8.0 7.9 8.1 37 34 -2.9 2.8 1.8 2.2 S. T. 36.7 34.3 40.2 42.8 11.8 13.3 7.3 5.8 4.5 7.5 -61 32 2.7 2.4 1.9 4.4 A. J.41.9 38.5 47.4 47.5 16.6 13.2 9.7 5.2 6.9 8.0 8.8 50 30 24 3.5 2.4 2.2 3.3 M. Y.31.1 30.8 39.5 39.2 15.6 16.6 6.8 5.8 8.8 10.8 9.7 47 54 48 4.1 5.8 3.3 2.3 A. L. § 29.5 24.6 35.0 33.5 17.6 17.8 10.8 9.7 6.8 8.1 6.2 44 30 36 3.0 2.4 3.0 4.5 E. M. § 20.6 19.8 28.2 29.4 14.7 17.9 6.3 5.3 8.4 12.6 -39 16 -3.3 2.0 1.5 3.9 J. Y. § 26.7 26.2 31.0 32.0 12.7 13.2 8.0 8.2 4.7 5.0 -40 36 -1.9 1.8 2.4 2.5 E. K. § 24.9 22.8 33.7 31.1 16.6 15.9 9.4 8.4 7.2 7.5 -58 35 -4.2 2.6 3.0 4.5 J. D.jI 19.2 18.8 25.8 26.0 11.9 12.8 5.4 4.1 6.5 8.7 -55 25 -3.6 2.2 2.8 5.4 D. B.l 31.7 32.8 38.6 39.4 12.7 12.2 4.3 3.5 8.4 8.7 -41 33 3.4 2.9 3.2 4.1 W. H. ¶ 33.4 31.0 38.2 39.5 13.4 13.2 7.7 5.0 5.7 8.2 -51 33 -2.9 2.7 2.0 2.8 A. S. ¶ 38.5 33.7 42.5 42.3 17.8 17.6 11.0 9.9 6.8 7.7 6.1 45 30 36 3.1 2.3 2.0 2.8 C. M. ¶ 41.0 39.0 47.4 47.5 15.7 16.3 7.6 7.2 8.1 9.1 9.7 35 20 22 2.8 1.8 2.5 4.2 C. J.** 30.8 27.5 37.8 37.0 15.9 16.4 7.9 7.4 8.0 9.0 9.7 32 18 20 2.6 1.6 4.8 6.9Mean 32.7 30.9 39.0 39.4 14.9 15.2 7.7 6.5 7.2 8.7tt 8.4 45tt 30tf 31 3.2 2.6tf 2.6 3.8tf C Control.A-Five minutes after 0.5 gm.Aminophylline intravenously.Al-Forty-five minutes after Aminophylline.* CBF-Cerebral blood flow, ml./100 gm./min.t CMRO2-02 consumption, ml./100 gm./min.CVR-Cerebrovascular resistance, MBP/CBF/min.§ Patient received ammonium chloride as diuretic for prolonged period but discontinued three or more days before present study.Associated uremia-J.D., 34 mg.%; D. B., 42 mg.%. ¶ Cheyne-Stokes respiration present which was relieved by Aminophylline.** Cheyne-Stokes respiration not relieved by Aminophylline.. Mean value in normal subjects = 54 ml./100 gm./min.(6, 10).Statistically significant p<0.01.