Bolus versus Continuous Low Dose of Enalaprilat in Congestive Heart Failure with Acute Refractory Decompensation

Podbregar, Matej; Voga, Gorazd; Horvat, Matija; Žuran, Ivan; Krivec, Bojan; Skale, Rafael; Parežnik, Roman

doi:10.1159/000006875

Cited by 16 publications

(4 citation statements)

References 20 publications

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“…Lower doses of enalaprilat (Ͻ0.5 mg/hr) also may be effective, as has been shown in acute intractable heart failure after myocardial infarction (19) and in congestive heart failure with acute refractory decompensation (20). The ideal dosage for the continuous infusion of enalaprilat has not yet been clearly defined for our patient group.…”

Section: Discussionmentioning

confidence: 90%

Beneficial hemodynamic and renal effects of intravenous enalaprilat following coronary artery bypass surgery complicated by left ventricular dysfunction*

Wagner

Yeter

Bisson

et al. 2003

Critical Care Medicine

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Section: Discussionmentioning

confidence: 90%

Beneficial hemodynamic and renal effects of intravenous enalaprilat following coronary artery bypass surgery complicated by left ventricular dysfunction*

Wagner

Yeter

Bisson

et al. 2003

Critical Care Medicine

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“…The only significantly large investigation evaluated a subset of patients with AHF after acute myocardial infarction in the medical intensive care unit, and this cohort is not representative of the typical ED patients with H‐AHF. While other studies suggest that enalaprilat is safe and well tolerated and may be efficacious in patients with AHF, the studies suffer from small sample sizes, and study designs lack contemporary treatment reflective of standard ED treatment . Such observations make it difficult to translate these prior findings to the ED setting.…”

Section: Treatmentmentioning

confidence: 99%

Clinical and Research Considerations for Patients With Hypertensive Acute Heart Failure: A Consensus Statement from the Society for Academic Emergency Medicine and the Heart Failure Society of America Acute Heart Failure Working Group

Collins

Levy

Martindale

et al. 2016

Academic Emergency Medicine

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Management approaches for patients in the emergency department (ED) who present with acute heart failure (AHF) have largely focused on intravenous diuretics. Yet, the primary pathophysiologic derangement underlying AHF in many patients is not solely volume overload. Patients with hypertensive AHF (H-AHF) represent a clinical phenotype with distinct pathophysiologic mechanisms that result in elevated ventricular filling pressures. To optimize treatment response and minimize adverse events in this subgroup, we propose that clinical management be tailored to a conceptual model of disease that is based on these mechanisms. This consensus statement reviews the relevant pathophysiology, clinical characteristics, approach to therapy, and considerations for clinical trials in ED patients with H-AHF. ACADEMIC EMERGENCY MEDICINE 2016;23:922-931 © 2016 by the Society for Academic Emergency Medicine PATHOPHYSIOLOGY OF HYPERTENSION IN ACUTE HEART FAILUREH ypertensive acute heart failure (H-AHF) is defined as the rapid onset of pulmonary congestion in the setting of a systolic blood pressure over 140 mm Hg and often times over 160 mm Hg. 1Many patients with H-AHF have a history of poorly controlled hypertension.2 The consequences of longstanding hypertension include changes to both the vasculature and the left ventricle (LV), resulting in increased stiffness and reduced compliance across the cardiovascular system.3,4 Such stiffening increases systolic load on the LV

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“…In practice, when patients are hospitalized with decompensated heart failure, ACE inhibitors are sometimes withdrawn temporarily for fear of their potentially deleterious effects on blood pressure, renal function, and electrolytes. However, clinical trials have consistently demonstrated the safety of administering ACE inhibitors to patients with acutely decompensated heart failure 63, 67 . Safe dosing regimens of enalaprilat include 0.004 mg/kg as an intravenous bolus, or 1 mg by continuous intravenous infusion over 2 hours.…”

Section: Pharmacologic Therapymentioning

confidence: 99%

Evaluation and Management of Acutely Decompensated Chronic Heart Failure in the Emergency Department

Kosowsky

Abraham

Storrow

2001

Congestive Heart Failure

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Symptoms of acutely decompensated heart failure commonly cause patients to seek care in the emergency department (ED). Decompensated heart failure can arise de novo-for example, in the setting of acute myocardial infarction (MI). More commonly, however, symptomatic heart failure presents in the context of pre-existing left ventricular dysfunction. An underlying diagnosis of chronic heart failure having already been established, one or more precipitating factors lead to clinical decompensation.Acutely decompensated chronic heart failure is a poorly defined clinical entity, and no universal definition exists. 1 Chronic heart failure is itself a complex and multifaceted clinical syndrome, encompassing conditions of both systolic and diastolic dysfunction. An acute decompensation can manifest over a period of minutes, hours, or days and can range in severity from mild symptoms of volume overload or decreased cardiac output to frank pulmonary edema or cardiogenic shock.However defined, the number of patients who present to the ED with decompensated chronic heart failure is likely to increase over the coming years. With the aging of the United States' population, the overall prevalence of heart failure is rising. 2 At the same time, advances in outpatient therapy are allowing patients with chronic heart failure to live longer with more advanced stages of hemodynamic compromise. Nearly five million Americans with heart failure are alive today, and approximately 550,000 new cases arise each year. Heart failure now accounts for close to one million inpatient admissions annually, is a secondary diagnosis associated with another two million hospitalizations each year, and represents the number one reason for hospital admission among the growing elderly population. 3 Short-term outcomes for patients admitted with decompensated heart failure have remained fairly constant over the past two decades. In-hospital mortality remains at approximately 7%, 4,5 with major adverse events occurring in up to 18% of patients. 6 For those who present with frank pulmonary edema, the corresponding rates of morbidity and mortality are approximately doubled. 7-10 Meanwhile, hospital

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Bolus versus Continuous Low Dose of Enalaprilat in Congestive Heart Failure with Acute Refractory Decompensation

Cited by 16 publications

References 20 publications

Beneficial hemodynamic and renal effects of intravenous enalaprilat following coronary artery bypass surgery complicated by left ventricular dysfunction*

Beneficial hemodynamic and renal effects of intravenous enalaprilat following coronary artery bypass surgery complicated by left ventricular dysfunction*

Clinical and Research Considerations for Patients With Hypertensive Acute Heart Failure: A Consensus Statement from the Society for Academic Emergency Medicine and the Heart Failure Society of America Acute Heart Failure Working Group

Evaluation and Management of Acutely Decompensated Chronic Heart Failure in the Emergency Department

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