Comparative hemodynamic effects of inotropic and vasodilator drugs in severe heart failure

E. Mikulic, Jay N Cohn, J. A. Franciosa

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Abstract

In 12 patients with severe congestive heart failure (CHF) due to ischemic heart disease or nonischemic cardiomyopathy the hemodynamic response to intravenous infusion of sodium nitroprusside (N) was compared to that of dobutamine (D) 10 μ/kg/min. D and N produced comparable increases in cardiac output (CO) (2.8 to 5.8 L/min and 2.9 to 5.0 L/min, respectively), but, compared to N, D caused a higher arterial pressure (99.3 vs 86.2 mm Hg, P <0.01) and heart rate (102.5 vs 95.3, P <0.05) and less reduction in pulmonary wedge pressure (PWP) (28.9 to 20.2 mm Hg vs 29.1 to 16.6 mm Hg, P <0.05). In five additional patients N and D were studied separately and then were infused together. The combination resulted in a higher CO, lower PWP and greater reduction in systemic and pulmonary vascular resistances than either drug alone. Brachial arterial infusion of nitroprusside produced prominent forearm vasodilation in a dose less than 10% of the systemic dose, whereas vasodilation with dobutamine was only modest even when 50% of the systemic dose was infused. Therefore, potent inotropic and vasodilator drugs produce similar and additive augmentation of left ventricular performance in heart failure. Reduction in vascular resistance with dobutamine probably is largely of reflex origin, but the vasodilation itself may be an important determinant of the rise in cardiac output.

Original languageEnglish (US)
Pages (from-to)528-533
Number of pages6
JournalCirculation
Volume56
Issue number4
DOIs
StatePublished - Jan 1 1977

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Dobutamine
Vasodilator Agents
Vasodilation
Vascular Resistance
Pulmonary Wedge Pressure
Heart Failure
Hemodynamics
Nitroprusside
Cardiac Output
High Cardiac Output
Cardiomyopathies
Intravenous Infusions
Forearm
Myocardial Ischemia
Reflex
Arterial Pressure
Arm
Heart Rate
Pharmaceutical Preparations

Cite this

Comparative hemodynamic effects of inotropic and vasodilator drugs in severe heart failure. / Mikulic, E.; Cohn, Jay N; Franciosa, J. A.

In: Circulation, Vol. 56, No. 4, 01.01.1977, p. 528-533.

Research output: Contribution to journalArticle

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