Clinical and hemodynamic effects of cortisone in patients with rheumatic heart disease and congestive heart failure

1. 1. The clinical and hemodynamic effects of cortisone were studied in a group of 6 patients having rheumatic heart disease, pulmonary congestion, and right heart failure. Three patients had mitral stenosis; the other 3 had mitral stenosis and insufficiency, and 2 of the latter had left ventricular enlargement. 2. 2. Clinical evaluation and right heart catheterization were performed before and at variable periods of time (25 to 63 days in 5 patients, and 8 months in 1 patient) during steroid therapy. 3. 3. Four patients had slight improvement in cardiovascular hemodynamics characterized by decreases in pulmonary artery, pulmonary “wedge,” and/or right ventricular end-diastolic pressures without significant changes in cardiac output while on cortisone therapy. In 3 of these patients plasma volumes decreased. In 2 patients symptomatic improvement in cardiac status occurred. In 3 patients body weights decreased; in 1 patient there was a gain of 15 pounds, which probably represented an increase in tissue mass. 4. 4. Two patients had deterioration in cardiovascular hemodynamics characterized by increases in pulmonary artery, pulmonary “wedge,” and/or right ventricular end-diastolic pressures without any significant changes in cardiac output. In one of these patients, plasma volume increased; it was not measured in the other patient. Subjective improvement was noted in one patient. Body weights increased in both patients. 5. 5. Possible mechanisms by which cortisone could have influenced cardiovascular hemodynamics are discussed.