Treatment of Refractory Heart Failure with Infusion of Nitroprusside

Guiha, Nabil H.; Cohn, Jay N.; Mikulic, E.; Franciosa, Joseph A.; Limas, Catherine

doi:10.1056/nejm197409192911201

Cited by 371 publications

(75 citation statements)

References 24 publications

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“…It has been almost 30 years since Guiha et al 11 demonstrated the efficacy of intravenous vasodilator therapy, specifically nitroprusside, in the management of decompensated heart failure. Subsequently, oral vasodilator therapy in various forms has been proven to be effective both for symptom improvement and decreasing mortality.…”

Section: Discussionmentioning

confidence: 99%

Sustained use of nesiritide to aid in bridging to heart transplant

Hill

Hsu

Pauly

et al. 2003

Clinical Cardiology

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Summary:Patients with end-stage heart failure awaiting heart transplant are often maintained on continuous intravenous inotropic therapy. However, this therapy alone is often inadequate for maintenance of appropriate pulmonary artery pressure and stable clinical course. Nesiritide, B-type natriuretic peptide, is a recently released intravenous vasodilator for short-term use in patients with decompensated heart failure. This report details experience in four patients in whom this agent was used to bridge to transplant for prolonged periods (11-35 days) with added clinical benefit and without obvious tolerance. This suggests that new strategies for pretransplant management may be needed.

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Section: Discussionmentioning

confidence: 99%

Sustained use of nesiritide to aid in bridging to heart transplant

Hill

Hsu

Pauly

et al. 2003

Clinical Cardiology

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“…I was so impressed by the favorable hemodynamic effect of vasodilator drugs in the setting of pump failure 13 that I thought impedance increase could in fact be the major factor contributing to progressive chronic heart failure. This hypothesis was supported by an experience in a 57-year-old man who remained in severe pump failure after an acute myocardial infarction.…”

Section: The Investigator's Agendamentioning

confidence: 99%

Clinical Research

Cohn

2004

Circulation

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“…The following hemodynamic variables were determined for at least 3 Twenty-four hours thereafter, the responses to nitroprusside and nitrate therapy were reevaluated in four patients, who were pretreated with a continuous infusion of phentolamine (0.3 mg/min). The infusion of phentolamine was begun 1 hour before and continued through the period of readministration of nitroprusside and isosorbide dinitrate, which were performed in a manner identical to the initial evaluation.…”

Section: Drug Administrationmentioning

confidence: 99%

Determinants of drug response in severe chronic heart failure. 1. Activation of vasoconstrictor forces during vasodilator therapy.

Packer¹,

Meller²,

Medina³

et al. 1981

Circulation

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SUMMARY Vasodilator drugs activate neurohumoral forces that produce peripheral vasoconstriction and tachycardia and probably cause the rebound events observed upon abrupt withdrawal of therapy. To determine their role in limiting therapeutic vasodilator responses, these reactive forces were measured in 40 patients with severe chronic heart failure by quantifying the magnitude of rebound change (MRC) after nitroprusside withdrawal. Group 1 patients (n = 22), who had minimal reactive vasoconstriction (MRC 27%), showed marked hemodynamic effects with nitroprusside (4.5 ,g/kg/min) and isosorbide dinitrate (40 mg orally), associated with significant decreases in heart rate with both drugs (p < 0.001). Despite administration of the same doses of both drugs, group 2 patients (n = 18), who had marked rebound changes (MRC > 27%), showed significantly smaller changes in cardiac index, systemic vascular resistance and mean arterial pressure (p < 0.001), associated with no change or increases in heart rate. Rebound events were attenuated and the responses to nitroprusside and nitrates were enhanced in four patients in whom these drugs were readministered after pretreatment with i.v. phentolamine (0.3 mg/min). We conclude that activation of neurohumoral forces can limit the hemodynamic responses to vasodilator administration; this supports the use of combination therapy of direct-acting vasodilators and neurohumoral antagonists in selected patients with severe chronic heart failure.

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Treatment of Refractory Heart Failure with Infusion of Nitroprusside

Cited by 371 publications

References 24 publications

Sustained use of nesiritide to aid in bridging to heart transplant

Sustained use of nesiritide to aid in bridging to heart transplant

Clinical Research

Determinants of drug response in severe chronic heart failure. 1. Activation of vasoconstrictor forces during vasodilator therapy.

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