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To the Editor:—
In reply to the comment by Drs. Berkowitz and Greene, isoproterenol is, in general, a depressor drug; at times, through its inotropic effect, it may produce elevation of the systolic pressure, with a widening of the pulse pressure. Methoxamine, on the other hand, has almost a purely peripheral action (Goldberg and others: Comparative Heart Contractile Force Effects of Equipressor Doses of Several Sympathomimetic Amines, J Pharmacol Exp Ther108:177-185 [June] 1953).In regard to the occurrence of ventricular tachycardia induced by methoxamine, it is well known that any maneuver producing reflex increase in vagal tone can initiate ventricular arrhythmias, including such things as carotid sinus stimulation or the Valsalva maneuver. Certainly any of the sympathomimetic drugs, whether their action is predominantly peripheral or central, can induce such arrhythmia. One needs to keep in mind not only the inotropic effect, with stimulation of ventricular pacemakers, but also
Logue B. Arrhythmias and Cardiac Arrest-Reply. JAMA. 1961;176(4):388–389. doi:10.1001/jama.1961.03040170134027
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