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Vasopressors in Acute Severe Heart Failure

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Acute Heart Failure

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Abstract

The management of heart failure has traditionally rested on a paradigm centering on reducing cardiac work load, and more recently on the antagonism of endogenous chronic pathogenic (over)stimulation with stress hormones such as angiotensin, catecholamines, and aldosterone. Depending on the individual patient, cardiac work load is decreased through a combination of modulating the heart rate, contractility, and perhaps most importantly afterload. As the pressure against which the left ventricle must eject is a main determinant of energy expended, afterload reduction has been a foundation of modern therapy. It is thus counterintuitive that in severe heart failure there is a role for agents whose main effect is to increase afterload. There are, however, clinical situations in which acute heart failure coexists with shock states requiring the use of pressor agents. This chapter discusses the pharmacology of the vasopressor agents approved for use and the clinical situations in which they are useful, and offers general recommendations for their use in acute severe heart failure.

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Author information

Authors and Affiliations

  1. Division of Critical Care, Department of Medicine, The University of British Columbia, St Paul’s Hospital, Vancouver, BC, Canada

    John H. Boyd MD & Keith R. Walley MD

Authors
  1. John H. Boyd MD
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  2. Keith R. Walley MD
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Editor information

Editors and Affiliations

  1. Department of Anesthesiology and Critical Care Medicine, Lariboisière University Hospital, Assistance Publique-Hôpitaux de Paris, Université Paris Diderot, Paris, France

    Alexandre Mebazaa MD, PhD (Professor of Medicine) (Professor of Medicine)

  2. Feinberg School of Medicine, Northwestern University, Chicago, IL, USA

    Mihai Gheorghiade MD, FACC (Professor of Medicine and Surgery, Associate Chief, Division of Cardiology and Chief, Cardiology Clinical Service) (Professor of Medicine and Surgery, Associate Chief, Division of Cardiology and Chief, Cardiology Clinical Service)

  3. Department of Cardiology Centre d’Investigation Clinique (CIC), INSERM U-684, Centre Hospitalier Universitaire, University Henri Poincaré, Nancy, France

    Faiez M. Zannad MD, PhD, FESC (Professor of Medicine) (Professor of Medicine)

  4. Robert Wood Johnson Medical School, University of Medicine and Dentistry of New Jersey, Camden, NJ, USA

    Joseph E. Parrillo MD (Professor of Medicine, Chief, Department of Medicine Edward D. Viner MD Chair, Department of Medicine and Director) (Professor of Medicine, Chief, Department of Medicine Edward D. Viner MD Chair, Department of Medicine and Director)

  5. Cooper Heart Institute, Cooper University Hospital, Camden, NJ, USA

    Joseph E. Parrillo MD (Professor of Medicine, Chief, Department of Medicine Edward D. Viner MD Chair, Department of Medicine and Director) (Professor of Medicine, Chief, Department of Medicine Edward D. Viner MD Chair, Department of Medicine and Director)

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© 2008 Springer-Verlag London Limited

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Boyd, J.H., Walley, K.R. (2008). Vasopressors in Acute Severe Heart Failure. In: Mebazaa, A., Gheorghiade, M., Zannad, F.M., Parrillo, J.E. (eds) Acute Heart Failure. Springer, London. https://doi.org/10.1007/978-1-84628-782-4_54

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  • DOI: https://doi.org/10.1007/978-1-84628-782-4_54

  • Publisher Name: Springer, London

  • Print ISBN: 978-1-84628-781-7

  • Online ISBN: 978-1-84628-782-4

  • eBook Packages: MedicineMedicine (R0)

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