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Kalziumantagonisten bei Herzinsuffizienz?

Calcium antagonists for congestive heart failure?

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Summary

Although beneficial acute hemodynamic effects of calcium antagonists in heart failure have been reported, their use in this setting is still controversial because of the negative inotropic effects produced by these agents. The direct actions of calcium antagonists, that is direct depression of myocardial contractility and coronary and peripheral vasodilatation, are modulated by systemic hypotension-induced baroreceptor activation of autonomic reflexes. Thus, at clinically relevant dosages, the baroreceptor-mediated cardiac stimulatory effects may counterbalance or override the direct negative-inotropic effects, as usually observed with nifedipine or diltiazem. By contrast, with verapamil significant depression of contractility may occur. Newer calcium antagonists with higher vasoselectivity such as nisoldipine or felodipine may be particularly interesting in the setting of congestive heart failure because of pronounced arterial vasodilatation and their additional effects on coronary blood flow, LV-regional wall motion and diastolic function and peripheral blood flow distribution with negligible myocardial effects. Due to their marked vasodilatating properties, newer derivatives may be advantageous in the treatment of heart failure due to coronary artery disease and hypertension. Although limited data concerning long-term efficacy are available, preliminary studies suggest long-term benefit in selected patients. It appears that verapamil should not be used for vasodilator therapy of severe heart failure, since deterioration of LV function may occur.

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Abbreviations

ASS:

Angiotensin System

C:

Kontrolle

CI:

Herzminutenvolumen

CO:

Cardiac output=Herzminutenvolumen

DTZ:

Diltiazem

EDP:

enddiastolischer Druck

EDV:

enddiastolisches Volumen

EF:

Ejektionsfraktion

HF:

Herzfrequenz

HR:

Herzfrequenz

HMV:

Herzminutenvolumen

LV:

linker Ventrikel

LVFP:

LV-Füllungsdruck

MAP:

mittlerer arterieller Druck

MBP:

mittlerer arterieller Blutdruck

MPAP:

mittlerer Pulmonalarteriendruck

MRAP:

mittlerer rechter arterieller Druck

Na-Nitroprussid:

Natrium-Nitroprussid

N:

Nifedipin

PCW:

Pulmonalkapillardruck

PVR:

Pulmonalarterienwiderstand

RA:

rechter Vorhofsdruck

RAP:

Rechtsradialer Druck

SVR:

systemisch peripherer Widerstand

SVI:

Schlagvolumenindex

SWI:

Herzarbeit

TSVR:

peripherer Widerstand

V:

Verapamil

VCF:

Faserverkürzungsgeschwindigkeit

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  1. Medizinische Klinik III der Universität Freiburg, Germany

    H. Drexler & H. Just

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Herrn Prof. Dr. W. Gerok zum 60. Geburtstag gewidmet

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Drexler, H., Just, H. Kalziumantagonisten bei Herzinsuffizienz?. Klin Wochenschr 64, 993–1002 (1986). https://doi.org/10.1007/BF01757206

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