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Journal of veterinary internal medicine2025; 39(6); e70254; doi: 10.1111/jvim.70254

Effect of N-Butylscopolammonium Bromide and Metamizol Sodium on Heart Rate, Blood Pressure, and Echocardiographic Measurements in Warmblood Horses With Aortic and Mitral Valve Regurgitation.

Abstract: Administration of N-butylscopolammonium bromide (NBB) with metamizol sodium (NBBM) causes tachycardia and hypertension, and has been associated with accentuated cardiac murmurs. Objective: To evaluate the effect of a pharmacological challenge using NBBM on valvular regurgitation and cardiac murmurs in horses with aortic (AR) and mitral valve regurgitation (MR). Methods: Twenty Warmblood horses with AR and 20 with MR. Methods: Cardiac auscultation and two-dimensional (2D), M-mode, color flow, pulsed wave Doppler flow, and tissue Doppler echocardiography were performed with simultaneous ECG recording and non-invasive blood pressure measurements during rest and pharmacological challenge using 0.2 mg/kg NBB and 25 mg/kg metamizol sodium. Cardiac dimensions and functional parameters were assessed. Regurgitant jet size was subjectively evaluated, and jet area was measured. Data at rest and during pharmacological challenge were compared using repeated measures analysis or related samples Wilcoxon signed rank test. p-values were adjusted using the Benjamini-Hochberg method. Results: Compared with rest, pharmacological challenge resulted in decreased atrial and ventricular dimensions and increased aortic and pulmonary dimensions (P ≤ 0.02). Left ventricular end-diastolic diameter decreased in horses with AR (P < 0.02) but not in horses with MR. Pharmacological challenge resulted in increased median cardiac murmur intensity (P = 0.03 and P < 0.02) and jet area (P ≤ 0.02 and P = 0.03) in horses with AR and MR, respectively. Conclusions: Pharmacological challenge with NBBM affects cardiac chamber sizes, regurgitant jet, and cardiac murmur intensity in horses with AR and MR. Influences on heart rate and blood pressure should be considered during longitudinal follow-up examinations.
© 2025 The Author(s). Journal of Veterinary Internal Medicine published by Wiley Periodicals LLC on behalf of American College of Veterinary Internal Medicine.
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Publication Date: 2025-10-10 PubMed ID: 41070729PubMed Central: PMC12511949DOI: 10.1111/jvim.70254Google Scholar: Lookup
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Summary

This research summary has been generated with artificial intelligence and may contain errors and omissions. Refer to the original study to confirm details provided. Submit correction.

Overview

  • This study investigated how the administration of a drug combination, N-butylscopolammonium bromide (NBB) and metamizol sodium (NBBM), affects heart function, blood pressure, and heart murmurs in Warmblood horses diagnosed with aortic and mitral valve regurgitation.
  • The research aimed to understand changes in heart chamber sizes, valvular leakage severity, and murmur intensity when horses are given these drugs, which are known to induce increased heart rate and blood pressure.

Background

  • Valvular regurgitation in horses involves leaking of blood backward through the heart valves, specifically the aortic (AR) and mitral (MR) valves, which can impact cardiac function and cause murmurs.
  • N-butylscopolammonium bromide (NBB) combined with metamizol sodium is used pharmacologically but is known to cause tachycardia (increased heart rate) and hypertension (increased blood pressure), which may make heart murmurs more pronounced.
  • Understanding how these drugs influence echocardiographic parameters and murmur intensity is important for correct clinical assessment during diagnostic or follow-up procedures.

Study Design and Methods

  • A total of 40 Warmblood horses were selected, with 20 diagnosed with aortic valve regurgitation and 20 with mitral valve regurgitation.
  • Cardiac evaluations included:
    • Cardiac auscultation (listening to heart sounds).
    • Two-dimensional (2D) and M-mode echocardiography to visualize heart structures and movements.
    • Color flow and pulsed wave Doppler to assess blood flow and regurgitant jets.
    • Tissue Doppler echocardiography to examine myocardial movements.
    • Simultaneous ECG (electrocardiogram) recording to monitor heart rhythm.
    • Non-invasive blood pressure measurements.
  • Measurements were taken at rest and after administration of the pharmacological challenge: 0.2 mg/kg NBB and 25 mg/kg metamizol sodium.
  • Cardiac chamber dimensions and functional parameters were quantified, while regurgitant jet size was assessed both subjectively and by measuring jet area.
  • Comparative statistics between rest and post-drug conditions involved:
    • Repeated measures analysis.
    • Related samples Wilcoxon signed-rank test for non-parametric data.
    • Control of false discovery rate using the Benjamini-Hochberg method for p-value adjustment.

Key Findings

  • Administration of NBBM caused:
    • Reduced size of atrial and ventricular chambers (smaller dimensions), suggesting altered cardiac filling or contractility.
    • Increased dimensions of the aortic and pulmonary arteries, indicating possible vascular effects due to changes in blood pressure.
    • A specific decrease in left ventricular end-diastolic diameter was observed only in horses with aortic valve regurgitation, not in those with mitral regurgitation.
  • Heart murmurs became louder (higher median intensity) in both AR and MR groups after drug administration.
  • The area of the regurgitant valve jet—indicating the volume or severity of valve leakage—increased significantly with the pharmacological challenge in both groups.

Interpretation and Clinical Significance

  • The drugs NBB and metamizol sodium influence not only heart rate and blood pressure but also directly affect heart chamber dimensions and the severity of valve regurgitation in horses with AR and MR.
  • The increase in murmur intensity and regurgitant jet area suggests that cardiovascular stress or sympathetic stimulation from the drugs exaggerates signs of valve leakage and cardiac dysfunction.
  • These findings imply that:
    • Veterinarians should be cautious when interpreting heart murmurs or echocardiographic data taken under the influence of these drugs, as the changes may not reflect the horse’s baseline cardiac status.
    • Longitudinal follow-up exams in horses with valve regurgitation should consider the effects of these drugs to avoid overestimating disease progression.

Summary

  • This research demonstrates that NBB in combination with metamizol sodium significantly alters cardiovascular parameters in Warmblood horses with aortic or mitral valve regurgitation.
  • It highlights the need for careful interpretation of cardiac evaluations performed during or after administration of these agents to avoid misjudgment regarding the severity of cardiac disease.

Cite This Article

APA
Dufourni A, Demeyere M, Vernemmen I, Van Steenkiste G, Verhaeghe LM, van Loon G, Decloedt A. (2025). Effect of N-Butylscopolammonium Bromide and Metamizol Sodium on Heart Rate, Blood Pressure, and Echocardiographic Measurements in Warmblood Horses With Aortic and Mitral Valve Regurgitation. J Vet Intern Med, 39(6), e70254. https://doi.org/10.1111/jvim.70254

Publication

Journal of veterinary internal medicine
ISSN: 1939-1676
NlmUniqueID: 8708660
Country: United States
Language: English
Volume: 39
Issue: 6
Pages: e70254
PII: e70254

Researcher Affiliations

Dufourni, Alexander
  • Equine Cardioteam Ghent University, Department of Internal Medicine, Reproduction and Population Medicine, Faculty of Veterinary Medicine, Ghent University, Merelbeke, Belgium.
Demeyere, Marie
  • Equine Cardioteam Ghent University, Department of Internal Medicine, Reproduction and Population Medicine, Faculty of Veterinary Medicine, Ghent University, Merelbeke, Belgium.
Vernemmen, Ingrid
  • Equine Cardioteam Ghent University, Department of Internal Medicine, Reproduction and Population Medicine, Faculty of Veterinary Medicine, Ghent University, Merelbeke, Belgium.
Van Steenkiste, Glenn
  • Equine Cardioteam Ghent University, Department of Internal Medicine, Reproduction and Population Medicine, Faculty of Veterinary Medicine, Ghent University, Merelbeke, Belgium.
Verhaeghe, Lize-Maria
  • Equine Cardioteam Ghent University, Department of Internal Medicine, Reproduction and Population Medicine, Faculty of Veterinary Medicine, Ghent University, Merelbeke, Belgium.
van Loon, Gunther
  • Equine Cardioteam Ghent University, Department of Internal Medicine, Reproduction and Population Medicine, Faculty of Veterinary Medicine, Ghent University, Merelbeke, Belgium.
Decloedt, Annelies
  • Equine Cardioteam Ghent University, Department of Internal Medicine, Reproduction and Population Medicine, Faculty of Veterinary Medicine, Ghent University, Merelbeke, Belgium.

MeSH Terms

  • Animals
  • Horses
  • Horse Diseases / drug therapy
  • Horse Diseases / diagnostic imaging
  • Male
  • Blood Pressure / drug effects
  • Mitral Valve Insufficiency / veterinary
  • Mitral Valve Insufficiency / drug therapy
  • Mitral Valve Insufficiency / diagnostic imaging
  • Female
  • Heart Rate / drug effects
  • Echocardiography / veterinary
  • Aortic Valve Insufficiency / veterinary
  • Aortic Valve Insufficiency / diagnostic imaging
  • Aortic Valve Insufficiency / drug therapy
  • Butylscopolammonium Bromide / therapeutic use
  • Butylscopolammonium Bromide / pharmacology
  • Butylscopolammonium Bromide / adverse effects
  • Butylscopolammonium Bromide / administration & dosage

Conflict of Interest Statement

Authors declare no off‐label use of antimicrobials. The authors declare no conflicts of interest.

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