Update 1990 pp 350-357 | Cite as

Management of Severe Heart Failure

  • T. H. LeJemtel
  • R. Nisi
  • E. H. Sonnenblick
Conference paper
Part of the Update in Intensive Care and Emergency Medicine book series (UICM, volume 10)


When undertaken in the setting of an intensive care unit (ICU), the therapeutic goals for patients suffering from severe heart failure are to immediately increase cardiac output without exacerbating or precipitating myocardial ischemia and to distribute the enhanced cardiac output to the kidneys, heart and brain.


Severe Heart Failure Systemic Arterial Pressure Left Ventricular Filling Pressure Chronic Congestive Heart Failure Ventricular Filling Pressure 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


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  1. 1.
    Aquirre FV, Pearson AC, Lewen MK, McCluskey M, Labowitz AJ (1989) Usefulness of Doppler echocardiography in the diagnosis of congestive heart failure. Am J Cardiol 63:1098–1103CrossRefGoogle Scholar
  2. 2.
    Swan HJC, Ganz W, Forrester JS, et al (1970) Catheterization of the heart in man with the use of a flow directed balloon-tipped catheter. N Engl J Med 283:447–451PubMedCrossRefGoogle Scholar
  3. 3.
    Rubin SA, Siemienczuk D, Nathan MD, Pranse J, Swan HJC (1982) Accuracy of cardiac output, oxygen uptake, and arteriovenous difference at rest, during exercise, and after vasodilator therapy in patients with severe chronic heart failure. Am J Cardiol 50:973–978PubMedCrossRefGoogle Scholar
  4. 4.
    Cohen JN, Mathew JK, Franciosa JA, et al (1974) Chronic vasodilator therapy in the management of cardiac shock and intractable left ventricular failure. Ann Intern Med 81:777–781Google Scholar
  5. 5.
    Chatterjee K, Parmley WW, Ganz W, et al (1973) Hemodynamic and metabolic responses to vasodilator therapy in acute myocardial infarction. Circulation 48:1183–1187PubMedGoogle Scholar
  6. 6.
    Kirk ES, LeJemtel TH, Nelson GR, et al (1978) Mechanisms of beneficial effects of vasodilators and inotropic stimulation in the experimental failing ischemic heart. Am J Med 65:189–194PubMedCrossRefGoogle Scholar
  7. 7.
    Kovowitz C, Parmley WW, Donoso R, et al (1971) Effects of isometric exercise on cardiac performance: the grip test. Circulation 44:994–999Google Scholar
  8. 8.
    Strobeck JE, Ross J Jr (1985) Afterload mismatch in the failing heart. Heart Failure 1:84Google Scholar
  9. 9.
    Cohn JN (1973) Vasodilator therapy for heart failure: the influence of impedance on left ventricular performance. Circulation 48:5–11PubMedGoogle Scholar
  10. 10.
    Ross J Jr, Braunwald E (1964) The study of left ventricular function in man by increasing resistance to ventricular ejection with angiotensin. Circulation 29:739–745PubMedGoogle Scholar
  11. 11.
    Daly P, Rouleau JL, Cousineau D, et al (1984) Acute effects of Captopril in the coronary circulation of patients with angina and hypertension. Am J Med 76:111–115PubMedCrossRefGoogle Scholar
  12. 12.
    Mettauer B, Rouleau JL, Daly P (1986) The effects of Captopril on the coronary circulation and myocardial metabolism of patients with coronary artery disease. Postgrad Med J 62 (Suppl 1):54PubMedGoogle Scholar
  13. 13.
    Daly P, Mettauer B, Rouleau JL, et al (1985) Lack of reflex increase in myocardial sympathetic tone after Captopril: protein antianginal effect. Circulation 71:317–323PubMedCrossRefGoogle Scholar
  14. 14.
    Magrini F, Reggiani P, Branzi G, et al (1989) Effects of angiotensin converting enzyme inhibition on coronary blood flow. In: Sonnenblick EH, Laragh JH, Lesch M (eds) New frontiers in cardiovascular therapy: focus on angiotensin converting enzyme inhibitors. Excerpta Medica: Princeton p 298Google Scholar
  15. 15.
    Stern L, Henry DP, Weinberger MH (1981) Increase in plasma norepinephrine during prazosin therapy for congestive heart failure. Am J Med 70:825–830CrossRefGoogle Scholar
  16. 16.
    Manthey J, Dietz R, Leinberger H, et al (1980) Vasodilator therapy in heart failure: limited by activation of vasoconstrictor mechanisms? Circulation 62 (Suppl 3):259 (abstr)Google Scholar
  17. 17.
    Schrier RW (1988) Pathogenesis of sodium and water retention in high output and low output cardiac failure, nephrotic syndrome, cirrhosis and pregnancy. N Engl J Med 319:1065–1069PubMedCrossRefGoogle Scholar
  18. 18.
    Packer M, Medina N, Yushak M (1984) Relation between serum sodium concentration and the hemodynamic and clinical responses to converting enzyme inhibition with Captopril in heart failure. J Am Coll Cardiol 3:1035–1040PubMedCrossRefGoogle Scholar
  19. 19.
    Errington ML, Rocha E, Silva M Jr (1974) The role of vasopressin and angiotensin in the development of irreversible shock. J Physiol 242:119PubMedGoogle Scholar
  20. 20.
    Abboud FM, Heistad DE, Mark AL, et al (1976) Reflex control of the peripheral circulation. Prog Cardiovasc Dis 18:371–385PubMedCrossRefGoogle Scholar
  21. 21.
    LeJemtel TH, Maskin CS, Mancini D, et al (1985) Systemic and regional hemodynamic effects of Captopril and milrinone administered alone and concomitantly in patients with heart failure. Circulation 72:364–369CrossRefGoogle Scholar
  22. 22.
    Captopril Multicenter Research Group (1983) A placebo-controlled trial of Captopril in refractory chronic congestive heart failure. J Am Coll Cardiol 2:755–760CrossRefGoogle Scholar
  23. 23.
    The Consensus Trial Study Group (1987) Effects of enalapril on mortality in severe congestive heart failure: Results of the Cooperative North Scandinavian Enalapril Survival Study (CONSENSUS). N Engl J Med 316:1429–1432CrossRefGoogle Scholar
  24. 24.
    Keren G, Katz S, Strom J, et al (1988) Non-invasive quantification of mitral regurgitation in dilated cardiomyopathy: correlation of two Doppler echocardiographic methods. Am Heart J 116:758–762PubMedCrossRefGoogle Scholar
  25. 25.
    Zelis RT, Mason DT (1969) Demonstration of nitrate tolerance attenuation of the venomotor response to nitroglycerin by the chronic administration of isosorbide dinitrate. Circulation 39–40 (Suppl 3):211–215Google Scholar
  26. 26.
    Needleman P, Johnson EM Jr (1973) Mechanisms of tolerance development to organic nitrates. J Pharmacol Exp Ther 184:709–713PubMedGoogle Scholar
  27. 27.
    Sonnenblick EH, Frishman WH, LeJemtel TH (1979) Dobutamine: A new synthetic cardioactive sympathetic amine. N Engl J Med 300:17–20PubMedCrossRefGoogle Scholar
  28. 28.
    Kupper W, Waller D, Haurath P, et al (1982) Hemodynamic and cardiac metabolic effects of inotropic stimulation with dobutamine in patients with coronary artery disease. Eur Heart J 3:29–33PubMedGoogle Scholar
  29. 29.
    Tuttle RR, Pollock GD, Todd G, et al (1977) The effect of debutamine on cardiac oxygen balance, regional blood flow, and infarction severity after coronary artery narrowing in dogs. Circ Res 41:357 (abstr)PubMedGoogle Scholar
  30. 30.
    Colucci WS, Alexander W, Williams GH, et al (1981) Decreased lymphocyte ß-adrenergic receptor density in patients with heart failure and tolerance to the ß-adrenergic agonist pirbuterol. N Engl J Med 305:185–189PubMedCrossRefGoogle Scholar
  31. 31.
    Bristow MR, Ginsburg R, Minobe W, et al (1982) Decreased catecholamine sensitivity and ß-adrenergic receptor density in failing human hearts. N Engl J Med 307:205–209PubMedCrossRefGoogle Scholar
  32. 32.
    Bristow MR, Hershberger RE, Post JD, et al (1989) ß1 and ß2-adrenergic receptor-mediated adenylate cyclase stimulation in non-failing and failing human ventricular myocardium. Mol Pharmacol 35:295–305PubMedGoogle Scholar
  33. 33.
    Unverferth DV, Blanford M, Kates RE, et al (1980) Tolerance to dobutamine after a 72 hour continuous infusion. Am J Med 69:762–769CrossRefGoogle Scholar
  34. 34.
    Allwood MJ, Ginsburg J (1964) Peripheral vascular and other effects of dopamine in man. Clin Sci 27:271–277PubMedGoogle Scholar
  35. 35.
    Goldberg LI (1972) Cardiovascular and renal actions of dopamine: potential clinical applications. Pharmacol Rev 24:1–15PubMedGoogle Scholar
  36. 36.
    Maskin CS, Ocken S, Chadwick B, LeJemtel TH (1985) Comparative systemic and renal effects of dopamine and angiotensin converting enzyme inhibition with enalaprilat in heart failure. Circulation 72:364–369PubMedCrossRefGoogle Scholar
  37. 37.
    Alousi AA, Farah AE, Lesher GY, et al (1979) Cardiotonic activity of amrinone - WIN 40680, (5-amino-3,4-bipyridine-6lH-one). Circ Res 45:666 (abstr)Google Scholar
  38. 38.
    LeJemtel TH, Keung E, Sonnenblick EH, et al (1979) Amrinone: A new non-glycosidic, non-adrenergic cardiotonic agent effective in the treatment of intractable myocardial failure in man. Circulation 59:1098–1104Google Scholar
  39. 39.
    Millard RW, Dube G, Grupp G, et al (1980) Direct vasodilator and positive inotropic action of amrinone. J Mol Cell Cardiol 12:647–655PubMedCrossRefGoogle Scholar
  40. 40.
    Jentzer JH, LeJemtel TH, Sonnenblick EH, Kirk ES (1981) Beneficial effect of amrinone on myocardial oxygen consumption during acute left ventricular failure in dogs. Am J Cardiol 48:75–81PubMedCrossRefGoogle Scholar
  41. 41.
    Rail TW, West TC (1963) The potential of cardiac inotropic responses to norepinephrine by theophylline. J Pharmacol Exp Ther 139:269–274Google Scholar
  42. 42.
    Alousi AA, Stanhus GP, Stuart JC, et al (1983) Characterization of the cardiotonic effects of milrinone, a new and potent cardiac bipyridine on isolated tissues from several animal species. J Cardiovasc Pharmacol 5:804–809PubMedCrossRefGoogle Scholar
  43. 43.
    Gage J, Rutman H, Lucido D, et al (1986) Additive effects of dobutamine and amrinone on myocardial contractility and ventricular performance in patients with severe heart failure. Circulation 74:367–371PubMedCrossRefGoogle Scholar
  44. 44.
    Feldman MD, Copelas L, Gwathmey JK, et al (1987) Deficient production of cyclic AMP: Pharmacologic evidence of an important cause of contractile dysfunction in patients with end-stage heart failure. Circulation 75:331–338PubMedCrossRefGoogle Scholar
  45. 45.
    Colucci WS, Denniss AR, Leatherman GF, et al (1988) Intracoronary infusion of dobutamine to patients with and without severe congestive heart failure: Dose response relationships, correlation with circulating catecholamines, and effects of phosphodiesterase inhibition. J Clin Invest 81:1103–1109PubMedCrossRefGoogle Scholar
  46. 46.
    Clinical Experience with Amrinone (1982) Overall summary for NDA Amendment, Sterling Winthrop Research Institute, Rennsselaer, New YorkGoogle Scholar
  47. 47.
    Anderson JL, Baim DS, Fein SA, et al (1987) Efficacy and safety of sustained (48 hour) intravenous infusions of milrinone in patients with severe congestive heart failure: A multicenter study. J Am Coll Cardiol 9:711–714PubMedCrossRefGoogle Scholar
  48. 48.
    Maskin CS, Forman R, Klein NA, et al (1982) Long-term amrinone therapy in patients with severe heart failure. Am J Med 72:113–118PubMedCrossRefGoogle Scholar
  49. 49.
    LeJemtel TH, Sonnenblick EH (1984) Should the failing heart be stimulated? N Engl J Med 310:1384CrossRefGoogle Scholar
  50. 50.
    Dougherty AH, Naccarelli GU, Gray EL, et al (1984) Congestive heart failure with normal systolic function. Am J Cardiol 54:778–783PubMedCrossRefGoogle Scholar
  51. 51.
    Soufer R, Wohlgelemter D, Vita NA, et al (1985) Intact systolic left ventricular function in clinical congestive heart failure. Am J Cardiol 55:1032–1036PubMedCrossRefGoogle Scholar
  52. 52.
    Plehn JF, Lotuin A, Apstein CS (1987) Life-threatening pulmonary oedema due to left ventricular diastolic dysfunction. Circulation 76 (Suppl IV):411 (abstr)Google Scholar
  53. 53.
    Amsterdam EA (1973) Function of the hypoxic myocardium: experimental and clinical aspects. Am J Cardiol 32:461–467PubMedCrossRefGoogle Scholar
  54. 54.
    Fouad FM, Tarazi RC, Gallagher JH, et al (1980) Abnormal left ventricular relaxation in hypertensive subjects. Clin Sci 59 (Suppl 6):41 ISGoogle Scholar
  55. 55.
    Topol EJ, Traill TA, Fortuin NJ (1985) Hypertensive hypertrophic cardiomyopathy of the elderly. N Engl J Med 312:277–280PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 1990

Authors and Affiliations

  • T. H. LeJemtel
  • R. Nisi
  • E. H. Sonnenblick

There are no affiliations available

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