Hemodynamic effects of nisoldipine in chronic congestive heart failure

The hemodynamic effects of 10 and 20 mg isobutyl methyl 1,4-dihydro-2,6-dimethyl-4-(2-nitrophenyl)-3,5-pyridinecarboxylate (nisoldipine, Bay k 5552) p.o. were studied in 15 patients with chronic congestive heart failure due to ischemic heart disease or cardiomyopathy. The dose of 10 mg elicited only a decrease of pulmonary wedge pressure during exercise, all other parameters remained unaffected. After 20 mg nisoldipine arterial blood pressure was reduced already at rest. During exercise, arterial as well as pulmonary artery and wedge pressures were significantly reduced. Heart rate remained unaffected and cardiac index increased slightly. It is concluded, that nisoldipine improves the hemodynamic situation in chronic congestive heart failure by simultaneously reducing cardiac pre- and afterload.     

Intravenous captopril in congestive heart failure

Hemodynamic and neurohumoral effects of intravenous captopril were studied in ten patients with severe chronic congestive heart failure (NYHA Functional Class III and IV). Incremental bolus doses of captopril, titrated to a maximum cumulative dose of 15 mg, were given at 10-minute intervals. Systemic arterial pressure, mean pulmonary capillary wedge pressure, systemic vascular resistance, mean pulmonary artery pressure, and heart rate decreased (P less than .05). Cardiac index and stroke volume index increased (P less than .05). Maximum hemodynamic effects occurred after cumulative doses of 7 mg and were seen within 30 minutes after initiation of therapy; responses persisted for 30-90 minutes after the last dose. Plasma renin activity increased, and plasma atrial natriuretic factor concentration decreased. No adverse effects were observed with the use of intravenous captopril. Thus, intravenous captopril produces rapid and favorable hemodynamic improvement in advanced heart failure patients.     

Acute haemodynamic and neurohumoral effects of intravenous nisoldipine in patients with severe congestive heart failure

Summary Twenty patients (5 females, 15 males) with severe heart failure (NYHA IV), due to coronary artery disease in 14, and congestive cardiomyopathy in 6, received an intravenous bolus of the calcium blocker nisoldipine 0.2 mg followed by a continous infusion of 0.2 g · kg^–1 · min^–1. Haemodynamic measurements were performed at baseline and after 30 min.The mean arterial pressure fell from 91 to 73 mm Hg, pulmonary capillary wedge pressure from 31 to 26 mm Hg and systemic vascular resistance from 1695 to 1040 dyn · s · cm^–5.The cardiac index (2.2 to 2.71 · min^–1 · m^–2, and stroke volume index (25 to 33 ml · m^–2) were markedly increased. There was no reflex tachycardia as the heart rate dropped from 92 to 85 beats · min^–1. Plasma renin activity and norepinephrine concentration did not change significantly.The findings indicate that nisoldipine acts as a strong vasodilator and that it has a beneficial acute haemodynamic effect in patients with severe left heart failure irrespective of its aetiology.     

Intravenous vasodilator therapy in congestive heart failure

The prevalence of congestive heart failure (CHF) is increasing in the US and worldwide, partly because patients are living longer. Treatment of CHF is mostly on an outpatient basis, but inpatient care is required for decompensated CHF, acute CHF or poor response to outpatient treatment. Control of symptoms is usually achieved by diuresis. Intravenous (IV) vasodilators are an important adjunct to the inpatient treatment of CHF. They work mainly by reducing the afterload on the myocardium although preload reduction also occurs. After clinical stabilisation, the goal is to switch to a maintenance oral regimen to be continued as outpatient therapy. The range of IV vasodilators available for inpatient treatment of CHF includes nitrates, phosphodiesterase inhibitors, dobutamine, morphine, ACE inhibitors, B-type natriuretic peptides and endothelin receptor antagonists. As each agent may have a different mechanism or site of action, each agent may affect preload, contractility or afterload to a different extent and it may be desirable to choose one over the other in a particular clinical setting. Examples of standard therapy include dobutamine, milrinone and nitroglycerin. Nesiritide, a B-type natriuretic peptide, is a newer vasodilator and US FDA approved for use in acute CHF. However, most studies with this agent have been in small numbers of patients with anecdotal findings. Larger studies are warranted to pinpoint the efficacy and adverse effects of this agent. It is primarily used to reduce the acuity of decompensated CHF on admission to hospital.Endothelin receptor antagonists show promise in the management of acute CHF, but continue to be investigational. Long-term data on their efficacy and safety are limited. None of the endothelin receptor antagonists are FDA approved for use in patients with CHF.     

Comparative haemodynamic effects of intravenous nisoldipine and hydralazine in congestive heart failure.

The acute haemodynamic effects of intravenous nisoldipine and hydralazine were compared in nine patients with heart failure. Both agents caused qualitatively similar effects, reducing both left ventricular preload and afterload, with reductions in systemic vascular resistance and increases in cardiac output. However, the effect of hydralazine was significantly greater and of longer duration than nisoldipine, and was associated with side effects in four patients. This, and previously reported data, suggests that nisoldipine may be useful in patients with ischaemia and concomitant heart failure.     

BiPAP在充血性心力衰竭治疗中的应用

目的 探讨无创双水平气道正压通气(BiPAP)对重度充血性心力衰竭(CHF)的作用.方法 60例CHF患者随机均分为常规药物治疗(B)组和BiPAP治疗(A)组.A组在常规药物治疗的基础上,应用BiPAP呼吸机无创通气.两组疗程均为3 d.观察治疗前后左心室射血分数(EF)、血气分析及脑型利钠肽(BNP)的变化.结果 A组治疗显效率63.3%,明显高于B组的36.7%(P<0.05).与B组相比,治疗后A组PaO_2、SaO_2和EF改善更明显,A组BNP水平下降更明显(P<0.05).结论 BiPAP不仪能改善CHF患者的通气功能,也能改善CHF患者的心功能及降低BNP水平.     

beta-Blockers in congestive heart failure

Recent advances in the understanding of the basic mechanisms underlying congestive heart failure (CHF) have focused on the role of neurohormonal activation. Chronic adrenergic overstimulation is directly toxic to myocardial cells, impairs function, causes peripheral vasoconstriction and may induce programmed cell death via apoptosis. beta-Adrenergic blockade can interrupt this pathological process. Accumulating evidence now points to a clear role for beta-blocking agents in the management of heart failure, reducing both the morbidity and mortality associated with CHF. This report will review the recent clinical trials supporting the use of beta-blockers in CHF, briefly highlight some practical considerations in the use of these drugs in patients with CHF and discuss several areas of controversy in which further study is needed.     

Bumetanide in congestive heart failure

Summary

Bumetanide, a new diuretic exerting its major effect on the ascending limb of the loop of Henle, was evaluated in 20 patients with congestive heart failure. Dosage ranged from 1 mg to 3 mg daily depending on the patient's condition. The results after 3 and 8 days' treatment showed that bumetanide caused a significant diuresis, an increased excretion of sodium, potassium and chloride, and a comparable fall in the serum levels of these electrolytes. Changes in electrolyte levels were directly related to the dose of the drug. The resultant hypochloraemia was accompanied by a slight metabolic alkalosis.

A comparative crossover study between placebo, bumetanide and frusemide using equipotent doses was performed in 10 patients. Both drugs had a similar effect upon water excretion and the serum and urinary electrolytes.     

卡维地洛对重症充血性心力衰竭患者的临床疗效评价

目的：评价第三代β受体阻滞剂卡维地洛对重症充血性心力衰竭患者的临床疗效。方法：将33例重症充血性心力衰竭患者随机分为2组,卡维地洛组17例,应用卡维地洛及心衰常规治疗,卡维地洛起始剂量为2．5－5mg,Bid,如患者能耐受,在2－4周内逐渐将剂量增加至20mg,Bid,维持治疗3个月。对照组16例,用心衰常规治疗。结果：卡维地洛组能显著改善重症充血性心力衰竭患者的左、右室心功能,使心率、心搏量、左室射血分数、肺动脉收缩压（右室后负荷）与组内治疗前比较差异有显著意义;心搏量、心排血量、左室射血分数与对照组治疗后比较差异有显著意义。卡维地洛组未见明显不良反应。结论：卡维地洛治疗重症充血性心力衰竭是安全、有效的药物。     

Ibopamine in very severe congestive heart failure: Pilot haemodynamic invasive assessment

The acute effects of ibopamine, a new, orally active dopaminergic agent, were assessed invasively in 8 patients with congestive heart failure (NYHA Class IV). The cardiac Index increased (P less than 0.01) and preload and afterload decreased (P less than 0.05) after a single mean dose of ibopamine 1.4 mg/kg. The peak effect occurred after 1 to 3 h and activity was still demonstrable after 4 to 6 h. There was no change in blood pressure, heart rate or rhythm. No clinical evidence of cardiac toxicity or side effects was noted. Oral ibopamine shows promise in the treatment of congestive heart failure, but more extensive studies after chronic treatment are desirable.     

持续静脉微量注射呋塞米对严重充血性心力衰竭患者治疗效果

目的观察对比持续静脉微量注射呋塞米对严重充血性心力衰竭（CHF）患者疗效是否优于传统的间断注射疗效。方法在常规防重构、强心、扩血管的基础上,观察分析72例NYHA心功能Ⅲ-Ⅳ级患者,分为持续静脉微量注射呋塞米组（观察组）35例和间断注射呋塞米组（对照组）37例,两组使用呋塞米剂量大致相同,比较两组治疗前后尿量、血压波动、血液电解质浓度、超声心动图心功能指标、症状缓解时间和水肿消退时间的差别。结果观察组治疗后尿量多于对照组,心功能指标FS和LVEF改善显著优于对照组,症状缓解时间和水肿消退时间短于对照组（P〈0.01或0.05）;血压和血液电解质浓度无显著差异（P〉0.05）。结论持续静脉微量注射呋塞米治疗严重CHF,疗效明显优于传统的间断静脉注射法。     

二磷酸果糖治疗重症充血性心力衰竭的临床疗效

目的 :分析二磷酸果糖 (FDP)对重症充血性心力衰竭 (CHF)的治疗效果。方法 :16 2例心功能Ⅲ～Ⅳ级的重症CHF患者 ,分为FDP治疗组和对照组。对照组用常规抗CHF药物治疗 ,FDP治疗组在常规治疗上加用FDP。比较 2组临床症状改善、左室射血分数 (LVEF)、左室短轴缩短率 (FS)、二尖瓣快速充盈期和心房收缩期血流速率比值 (E/A)、以及地高辛和呋塞米人均日需量的变化。结果 :加用FDP能显著改善患者的临床症状 ,治疗 2wk后 ,总有效率达 91% ,而对照组为 71.4 % (P <0 .0 1)。同时 ,LVEF ,FS ,E/A明显改善 (P <0 .0 5 ) ,地高辛和呋塞米的人均日需要量明显降低 (P <0 .0 5 )。结论 :对于心功能Ⅲ～Ⅳ级的重症CHF患者 ,在常规抗CHF药物治疗的基础上 ,加用FPD ,可以明显缓解患者的临床症状 ,显著提高心功能 ,减少地高辛和呋塞米的用量     

Magnesium deficiency in congestive heart failure

Abstract: In congestive heart failure several compensatory mechanisms are operating, and may cause severe disturbances of both the internal and external electrolyte balance. The medical treatment prescribed in congestive heart failure also leads to changes in the handling of electrolytes. These combined effects may prove critical to the patient, especially with regard to the emergence of cardiac arrhythmias.     

硝酸甘油微量注射器持续泵注治疗重症充血性心力衰竭临床观察

目的：观察治疗重症充血性心力衰竭（CHF）的疗效方法。方法：选择50例充血性心力衰竭心功能Ⅲ～Ⅳ级住院患者,均进行病因和对症治疗并按CHF常规处理,包括低盐饮食,在应用洋地黄、利尿剂和血管紧张素转换酶抑制剂（ACEI）的基础上,应用硝酸甘油微量注射器以2～7mg/h持续泵注,连续7d。动态观察血压、临床症状、体征。结果：治疗1周后,总有效率为94%。结论：硝酸甘油注射液可有效治疗重症CHF,能明显改善患者心脏功能,短期应用副作用少、安全性好。     

Acute haemodynamic effects of ibopamine in patients with severe congestive heart failure.

Ten patients with congestive heart failure (CHF), in III and IV NYHA Class, were treated orally with a single dose of ibopamine ranging from 1.2-3.3 mg/kg, and were studied using the Swan-Ganz catheter and thermodilution technique. Cardiac index (CI) and stroke volume index (SVI) were increased, and mean pulmonary pressure (PAP), systemic vascular resistances (SVR) were lowered. Ibopamine increased CI (+33%) and SVI (+26%), and decreased PAP (-17%) and SVR (-24%). All changes were statistically significant. The maximum haemodynamic effect occurred 180 min after ibopamine administration. Blood pressure and heart rate were unaffected. Tolerability was good. This study shows that ibopamine when orally administered to human subjects improves cardiac performance and further investigations on its use as a therapeutic agent in the long term treatment of CHF are recommended.     

Perindopril: in congestive heart failure

Perindopril is a long-acting ACE inhibitor, acting through its only active metabolite perindoprilat. It inhibits the renin-angiotensin system by preventing both the conversion of angiotensin I to angiotensin II and the degradation of bradykinin, thereby reducing the vasoconstriction and left ventricular remodelling characteristic of heart failure. Perindopril 4mg significantly improved a range of haemodynamic parameters in single-dose and long-term (8 weeks and 3 months) studies involving patients with congestive heart failure (CHF), with little or no effect on blood pressure or heart rate. In randomised, double-blind, placebo-controlled clinical trials conducted over 3 months and a large noncomparative study (up to 30 months), perindopril 4mg once daily significantly increased exercise tolerance and reduced symptoms of heart failure in patients with mild to moderate CHF. Perindopril 4mg once daily is generally well tolerated in patients with mild to moderate CHF. In a large noncomparative study the most commonly reported adverse clinical event was cough, which led to 2.8% of patients discontinuing treatment. In short-term comparative trials there was a significantly lower incidence of first-dose hypotension following the recommended starting dose of perindopril 2mg than after the equivalent starting doses of captopril, enalapril and lisinopril.     

Aldosterone antagonists in congestive heart failure

The role of aldosterone in the pathophysiology of congestive heart failure (CHF) has long been recognized. The recent RALES (Randomized Aldactone Evaluation Study) trial demonstrated early reduction in morbidity and mortality using spironolactone, an aldosterone receptor antagonist, in combination with angiotensin converting enzyme (ACE) inhibitor and loop diuretic, in patients with heart failure. This effect of spironolactone highlighted the importance of understanding the contributions of the renin-angiotensin-aldosterone system (RAAS) in the progression of CHF, and increased interest in the use of aldosterone antagonists. While ACE inhibitors have had the largest impact on adverse events in CHF, numerous studies have shown that these drugs fail to completely suppress aldosterone. Blocking the effects of residual aldosterone has now been demonstrated to affect prognosis in these patients. This review will discuss the role of aldosterone in the pathophysiology of CHF, with an emphasis on both known and potential therapeutic benefits of aldosterone antagonism.     

左旋多巴治疗充血性心力衰竭

左旋多巴０．２５－０．７５ｇ，ｐｏ，ｔｉｄ治疗４２例（男性２５例，女性１７例，年龄５４±ｓ１３ａ）充血性心力衰竭病人，４ｗｋ为一个疗程。结果，临床显效率为６２％，总有效率为９０％。二维超声心动图测定心功能（ＣＯ、Ｃｌ、ＥＦ）改善，心脏Ｘ线正位片心胸比率缩小，与治疗前比较均有显著性差异（Ｐ＜０．０５），不良反应小。