Effects of Isoproterenol on the Pulmonary Circulation in Patients with Chronic Obstructive Lung Disease

Ferrer, M. Irené; Enson, Yale; Kilcoyne, Margaret M.; Harvey, Réjane M.

doi:10.1161/01.cir.43.4.528

Cited by 11 publications

(2 citation statements)

References 15 publications

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“…When volume loading and pacing are not effective in maintaining adequate cardiac index from the right ventricle, inotropic support from isoproterenol, dobutamine, or dopamine can be used to increase RV contractility. Usually, isoproterenol is the best drug for this purpose, since it will increase contractility and also result in pulmonary vascular vasodilatation [92], thereby reducing right ventricular afterload. Bernhard and co-workers [20] have suggested high doses of isoproterenol to maintain right veutricular function during left ventricular assistance.…”

Section: Inotropic Supportmentioning

confidence: 99%

Right heart interaction with the mechanically assisted left heart

et al. 1985

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Right ventricular (RV) failure has been reported to be a problem in 49 of 213 patients who received left ventricular assist devices (LVAD) at 12 different centers. Although the pathology of the problem is not understood, it is clear that the effect of an LVAD on hemodynamic ventricular interactions due to the right and left hearts being in series, and on mechanical ventricular interactions due to the anatomic coupling between the ventricles, could play a role in determining the ultimate fate of the right ventricle. Six hypotheses were generated concerning beneficial and detrimental effects of an LVAD on the determinants of right ventricular function (preload, afterload, contractility). The major potential effect on RV preload is increased venous return produced by the LVAD which can overload a marginal RV; but beneficial effects on RV preload and filling also can be produced by the LVAD unloading a dilated LV, thereby shifting the interventricular septum, which had encroached into the RV, back to the left. A significant beneficial effect on RV afterload can be produced with an LVAD by passive reductions in pulmonary artery (PA) pressure secondary to reductions in left atrial pressure; with pulmonary obstructive disease, however, PA pressures can increase due to the greater blood flow through the fixed pulmonary vascular resistance. The major effects on RV contractility produced by an LVAD are significantly beneficial since aortic and, therefore, coronary perfusion pressure is maintained. There also is a potential detrimental effect on RV contractility produced by decreased septal contribution to RV contraction during complete LV unloading with an LVAD. The initial therapy for the failing right ventricle in patients with an LVAD is volume loading. Isoproterenol, dobutamine, and dopamine can be used for inotropic support, and atrial pacing can improve the atrial contribution to filling. If these modalities fail, surgical techniques including pulmonary artery balloon pump or extracorporeal membrane oxygenation can be tried, but the recommended mechanical support is a right ventricular assist device.

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Section: Inotropic Supportmentioning

confidence: 99%

Right heart interaction with the mechanically assisted left heart

et al. 1985

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“…The drug has an inotropic effect on the heart, and a vasodilator effect on the peripheral circulation. A rise in pulmonary blood volume has been noted in supine subjects with chronic obstructive lung disease [Ferrer et al, 1971] and patients with mitral valve disease [Schreiner et al, 1968]. Gibson and Coltart [1971] demonstrated a small but significant increase in central blood volume as well as a reduction in systolic ejection time in response to isoprenaline.…”

Section: Discussionmentioning

confidence: 99%

The Effect of Isoprenaline on the Cardiac and Respiratory Responses to Exercise

et al. 1973

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The effects of intravenous isoprenaline on the response to exercise were studied in five normal adults. Each subject exercised on a bicycle ergometer at work loads of 50, 100, 150 watts. At each work load ventilation and gas exchange were measured; cardiac output and stroke volume were calculated using the Indirect (C02) Fick method.Isoprenaline produced no significant changes in oxygen consumption or in minute ventilation. Heart rate was significantly increased by isoprenaline in all subjects, the increment becoming smaller at higher workloads. In four of the subjects cardiac output was increased by isoprenaline, stroke volume being virtually unchanged. In the remaining subject cardiac output was unchanged with a fall in stroke volume.

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Pharmacologic Treatment of Primary and Secondary Pulmonary Hypertension

Brown

1991

Pharmacotherapy

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A variety of diseases are associated with elevation of pressure within the pulmonary circulation. Pulmonary hypertension is considered a contributor to the morbidity and mortality associated with these conditions. An understanding of the pathophysiology and consequences of pulmonary hypertension is required when considering pharmacologic treatment. Information regarding the potential benefits and toxicities of the drug therapy for primary and secondary hypertension is necessary when considering the use of specific agents for an individual patient.

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Effects of Isoproterenol on the Pulmonary Circulation in Patients with Chronic Obstructive Lung Disease

Cited by 11 publications

References 15 publications

Right heart interaction with the mechanically assisted left heart

Right heart interaction with the mechanically assisted left heart

The Effect of Isoprenaline on the Cardiac and Respiratory Responses to Exercise

Pharmacologic Treatment of Primary and Secondary Pulmonary Hypertension

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