Myocardial Metabolic Effects of Intravenous Terbutaline in Patients with Severe Heart Failure Due to Coronary Artery Disease

Abstract

Intravenous terbutaline, 0.3 mg/kg/min for 30 minutes followed by 0.15 mg/min for 60 minutes, was studied in nine patients with severe heart failure due to documented coronary artery disease. Hemodynamic and myocardial metabolic effects were measured during terbutaline infusion. Cardiac index and stroke index increased, whereas mean pulmonary artery wedge pressure and pulmonary vascular resistance decreased significantly. No significant alterations in aortic oxygen content, coronary sinus oxygen content, myocardial oxygen extraction, and myocardial lactate extraction were observed during terbutaline infusion. No patient developed angina or electrocardiographic changes suggestive of ischemia. These results indicate that intravenous terbutaline infusion, at the dosage employed, produces beneficial hemodynamic effects without a deterioration of myocardial metabolism in patients with heart failure due to coronary artery disease.

Should Acute Treatment with Inhaled Beta Agonists be Withheld from Patients with Dyspnea Who May Have Heart Failure?

“…In a similar study, Saldías et al showed that the beta agonists intravenous isoproterenol and locally delivered (comparable to inhaled) terbutaline increased alveolar fluid resorption in rats with ventilator-associated lung injury (p Ͻ 0.001 compared to control animals) (38). McAuley et al found that in rats, locally delivered beta-2 agonists stimulated airspace fluid clearance in normal lungs and significantly reduced pulmonary edema in experimental acid-induced lung injury (30). Frank et al showed that in sheep with hydrostatic pulmonary edema, nebulized salmeterol resulted in a 60% increase in alveolar fluid clearance compared to placebo (40).…”

“…Fifteen studies with 230 patients reported on the occurrence of dysrhythmias (8 -10,13-15,18 -20,22-24,26,29). Six of these studies reported an increase in ventricular ectopy, with one reported episode of supraventricular tachycardia, and 4 patients with treatment-induced non-sustained ventricular tachycardia (8,20,22,24,29,30). No patient required treatment to terminate the dysrhythmia and all resolved with discontinuation of albuterol.…”

Terbutaline for Chronotropic Support in Heart Transplantation

“…Several small studies in healthy subjects and patients with left ventricular dysfunction, heart failure, and cardiogenic shock have demonstrated improvements in cardiac index, dosedependent increases in heart rate, and reductions in total peripheral resistance with continuous intravenous infusions of terbutaline ranging from 0.15 to 0.45 µg/kg/min. [11][12][13][14][15][16] Another small study in patients (n = 10) who had undergone valve replacement surgery showed that intramuscular injections of terbutaline produced increases in cardiac index, heart rate, and reductions in total peripheral resistance. 17 In contrast, no effects on heart rate were seen in response to the administration of subcutaneous and inhaled terbutaline to patients with previous myocardial infarctions and heart failure, respectively.…”