To the Editor. —
In his letter (227:1263, 1974), Dr. Ko succinctly analyzed the dilemma of the elderly patient in whom mesenteric ischemia developed secondary to congestive heart failure. While it is probably true that digitalis preparations can intensify mesenteric vasoconstriction in these patients, it is equally clear that the continued decrease in cardiac output is also detrimental. In addition to the adrenergic mechanism suggested by Ko, it has been appreciated recently that in low cardiac output states the renin-angiotensin system is stimulated,1 and the elevated level of circulating angiotensin II may well contribute to the mesenteric vaso constriction seen with low cardiac output.The specific agents that block the action of the renin-angiotensin system (eg, the Bothrops nonapeptide that inhibits the enzymatic conversion of angiotensin I to II and 1-sar, 8-ala, angiotensin that competitively inhibits angiotensin II) are available at present for experimental use.1 In our laboratory,
Adar R, Salzman EW. Intestinal Ischemia and Digitalis. JAMA. 1974;229(12):1577. doi:10.1001/jama.1974.03230500013004
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