Chronic Refractory Pump Failure: Effects on Hemodynamics and Circulating Catecholamines of Intravenous Isosorbide Dinitrate

Rabinowitz, Babeth; Tamari, Israel; Elazar, E.; Neufeld, Henry N.

doi:10.1007/978-3-642-68085-4_75

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“…An inverse correlation was found by several others between the hemo dynamic indices of failure (PCW, CO, heart rate) and good therapeutic response to ni trates [15,16]. In addition, we have also reported a decrease of plasma catechols on intravenous ISDN therapy in patients with acute infarction and pump failure, as well as in chronic pump failure [5,17], Our data show that in the patients from group A, the specific subset defined by us and called 'hyperkinetic-coronary-active in farction', is characterized by (1) markedly increased plasma catecholamines ( fig. 8) and (2) relatively high CO and SWI ( fig.…”

Section: Discussionmentioning

confidence: 65%

Hemodynamics, Circulating Catecholamines and Response to Intravenous Nitrate Therapy in a Specific Subset of Acute Myocardial Infarction: The Hypertensive-Hyperkinetic-Coronary-Active Group

Rabinowitz

Hod²,

Elazar³

et al. 1988

Cardiology

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A specific subset of acute myocardial infarction was defined and named ‘the hypertensive-hyperkinetic-coronary-active’ subgroup. This subgroup included patients with acute myocardial infarction without pump failure or hypovolemia who continued to have hypertension and tachycardia, after relief of pain and who also had at least two recurrent ischemic episodes in the first days after a transmural event. Fifteen patients belonging to this group (group A) were studied in comparison with 15 other patients with acute myocardial infarction complicated by pump failure (group B). The alterations in hemodynamics, in circulating catecholamine levels and the clinical course during an intravenous infusion of isosorbide dinitrate were evaluated and the data obtained in the two groups were compared. The patients in group A had tachycardia, hypertension and upper normal filling pressures (pulmonary capillary wedge pressures: 15.8 ± 1.8 mm Hg). They had high levels of circulating catecholamines (1,343 ± 407 ng/l), a cardiac output of 5.9 ± 0.6 liters/min and stroke work index of 78 ± 11 (mean ± SD). The effect of intravenous nitrates on the left ventricular function curves of the two groups was the following: a marked shift downward and slight shift to the left in group A, as opposed to a moderate but significant shift upward and marked shift to the left in group B. The episodes of recurrent ischemia subsided in 13 out of 15 patients from group A. It appears therefore that the hyperkinetic patients with acute infarction are characterized by a hypersympathetic response, a typical hemodynamic profile and a particular response to nitrate therapy directionally opposite to the changes obtained in patients with acute infarction complicated with failure.

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Section: Discussionmentioning

confidence: 65%