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  • 1
    Electronic Resource
    Electronic Resource
    Medical treatment of eng-stage heart failure (1996)
    Springer
    Cardiovascular drugs and therapy 10 (1996), S. 617-622 
    Details
    ISSN: 1573-7241
    Keywords: end-stage heart failure ; congestive heart failure ; vasodilators ; diuretics
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary Congestive heart failure is a lethal condition that affects an increasing number of patients. In recent years a great amount of data have accumulated on the pathophysiology and medical and surgical therapy of this condition. In spite of the advances in its management and the great number of patients affected, common errors are still made by internists and cardiologists in the use of drugs and therapeutic strategies. Digitalis has only recently been shown to affect hemodynamics, exercise capacity, and clinical symptoms, but the effects on survival still have to be demonstrated. Loop diuretics, eventually combined with thiazides and antialdosterone drugs in patients with clinical signs and symptoms of fluid retention, are the mainstays of therapy of congestive heart failure. In order to make diuretic therapy efficacious, moderate salt and water intake restriction is mandatory. Angiotensin-converting enzyme (ACE) inhibitors are now considered unavoidable drugs in the management of heart failure, and an attempt to reach the doses that have been shown to be efficacious for survival in the large trials has to be made in every patient with this condition. Other vasodilators, such as hydralazine and nitrates, which show a less pronounced effect on survival but more effective hemodynamic actions than ACE inhibitors, may be used to control mitral insufficiency or to improve hemodynamics in very sick patients. Hemodynamic instability refractory to increasing doses of vasodilators and diuretics is a severe condition that requires hospital admission to administer drugs parenterally. These patients are usually treated with the combination of catecholamines and phosphodiesterase inhibitors associated with intravenous diuretics until clinical stability is again achieved and oral therapy is resumed and restructured. The use of aggressive pharmacological therapy and phosphodiesterase inhibitors has reduced the need for assisted circulatory support in these patients. Beta-blockers have shown promising results when administered to patients with heart failure, although a definitive demonstration of their effects on survival is still lacking. Other additional measures that need to be considered in patients with end-stage congestive heart failure are the use of antiarrhythmic drugs and anticoagulation.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF00052508
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    Paper (German National Licenses)
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  • 2
    Electronic Resource
    Electronic Resource
    Hemodynamic effects of felodipine in congestive heart failure (1987)
    Springer
    Cardiovascular drugs and therapy 1 (1987), S. 161-167 
    Details
    ISSN: 1573-7241
    Keywords: felodipine ; congestive heart failure ; vasodilators
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary The hemodynamic effects of increasing dosages of felodipine, a new calcium antagonist with selective vasodilator properties, were studied in 13 patients with chronic cardiac failure. A Swan-Ganz thermodilution catheter was positioned in the pulmonary artery and hemodynamic parameters were monitored from 9 am to 6 pm for five days. On the first and the fifth day patients received placebo (P) and on the second, third, and fourth day patients received felodipine 5, 10, and 20 mg, respectively. Symptom-limited exercise tests with a bicycle ergometer were performed on both days of P and on the fourth day. A marked reduction of systemic vascular resistance (SVR) and a significant increase of cardiac index without increments of heart rate (HR) were observed after felodipine at rest. A dose response effect could be demonstrated. During exercise a significant increment of cardiac index and decrease of pulmonary wedge pressure was observed after felodipine. Felodipine showed a potent vasodilator action on systemic circulation with significant changes on both stroke volume and filling pressures at rest and during exercise without side effects.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF02125469
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    Paper (German National Licenses)
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  • 3
    Electronic Resource
    Electronic Resource
    Felodipine in severe chronic congestive heart failure: Acute effects on central hemodynamics and regional blood flow distribution (1989)
    Springer
    Cardiovascular drugs and therapy 3 (1989), S. 903-911 
    Details
    ISSN: 1573-7241
    Keywords: felodipine ; congestive heart failure ; regional blood flow
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary In order to assess the effect of felodipine, a new calcium antagonist with vascular selectivity, on regional blood flow distribution at rest in chronic congestive heart failure, ten patients were studied during an acute test. Right heart catheterization allowed the evaluation of hemodynamic parameters; renal blood flow was calculated using paraamino-hippuric acid clearance; hepatic blood flow measurement was based on indocyanine green clearance; and limb blood flow was assessed with venous occlusion plethysmography. Blood samples were collected for the analysis of plasma catecholamines, renin, and aldosterone. All parameters were recorded in duplicate under basal conditions and after felodipine infusion. The infusion of felodipine induced a significant increase in cardiac index, stroke work index, and limb blood flow. Systemic and pulmonary arterial blood pressure, pulmonary wedge pressure, and systemic resistance underwent a significant decrease. The heart rate, pulmonary resistance, renal blood flow, and hepatic blood flow were not changed. In conclusion, felodipine was of benefit in congestive heart failure at rest in an acute test, acting through a marked decrease in vascular resistance and a consequent improvement in cardiac output and limb blood flow. No changes in renal and hepatic blood flow were observed.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF01869580
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    Paper (German National Licenses)
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  • 4
    Electronic Resource
    Electronic Resource
    Myocardial, coronary, and peripheral effects of xamoterol (ICI 118,587) in open-chest pigs (1989)
    Springer
    Cardiovascular drugs and therapy 3 (1989), S. 91-97 
    Details
    ISSN: 1573-7241
    Keywords: xamoterol ; noradrenaline ; beta receptors ; cardiac actions ; vascular effects ; coronary effect
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary The hemodynamic and coronary effects of increasing doses of xamoterol, a beta-adrenoceptor partial agonist, were assessed in an anesthetized pig preparation in which cardiovascular reflexes were abolished and sympathetic tone was modified by infusion of noradrenaline (NA). Xamoterol, in basal conditions, increased heart rate (HR) from 104±12 to 120±13 beats/min (p〈.001); systolic, diastolic, and mean blood pressure, respectively, from 77±8 to 103±17 mmHg (p〈.01), from 48±7 to 70±12 mmHg (p〈.01), and from 58±7 to 84±14 mmHg (p〈.01); left ventricular dP/dT max from 2098±564 to 4205±937 mmHg/sec (p〈.001); and systemic vascular resistance (SVR) from 1745±564 to 2270±739 dynes sec cm−5 (p〈.01). The increase in HR and dP/dT max brought about by xamoterol was about 37% and 56%, resectively, of the maximum increase produced by NA. At the highest level of sympathetic tone, xamoterol reduced HR from 148±11 to 122±11 beats/min (p〈.001) and no significant change was observed in dP/dT max. The increase in blood pressure and SVR induced by xamoterol was maintained at each level of sympathetic tone. On the contrary, SVR did not change after NA, as expected, since receptors were fully blocked. For a given inotropic effect, xamoterol and NA produced a similar increase in coronary blood flow and myocardial O2 consumption. In conclusion, the results indicate that, in the areflexic pig, xamoterol acts as a partial beta1-agonist, with a more potent positive inotropic than chronotropic effect in basal conditions. At the highest level of sympathetic tone, it does antagonize the chronotropic, but not the inotropic, effect of NA. Xamoterol increases peripheral resistance and blood pressure possibly through a beta2 vascular blocking action, and the increase in contractility induced by xamoterol is paralleled by an increase in myocardial O2 consumption. No direct effects on coronary circulation are observed.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF01881533
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    Paper (German National Licenses)
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