[Severe cardiac decompensation: value in the early hours of a combination of amrinone and dobutamine].
Ten patients with severe chronic heart failure (class III and IV of the NYHA classification) received treatment for severe heart failure with dobutamine (10, then 15 micrograms.kg-1.min-1), then with dobutamine combined with amrinone (7.5, then 10 micrograms.kg-1.min of each). Used alone, dobutamine improves cardiac performance (cardiac index from 1.8 +/- 0.24 l.min-1.m-2 to 2.65 +/- 0.44 l.min-1.m-2). These results are further improved when amrinone is associated with dobutamine. Blood pressure increases with dobutamine and no decrease is recorded when amrinone is introduced, despite a gradual decrease in systemic arterial resistances. Pulmonary artery wedge pressure shows a significant decrease only when the strongest dose of the combined drugs is used. However, this positive effect is counterbalanced by an increase in pulse frequency. Side effects, be it on the blood count (platelets count reduced from 255,600 +/- 3974 mm-3 to 207,400 +/- 3380 mm-3 with no clinic sign) or cardiovascular activity (one case of premature ventricular contraction; one case of transient junctional rhythm), do not require the suspension of treatment. Thus, the dobutamine-amrinone combination treatment seems a promising one.
Fosse
J P
JP
Département d'Anesthésie-Réanimation, Hôpital Avicenne, Bobigny.
Pourriat
J L
JL
Hoang
P
P
Fournier
J L
JL
Aïtkaciali
F
F
Cupa
M
M
D000368:Aged; D000369:Aged, 80 and over; D000676:Amrinone / Q000009:adverse effects / Q000627:therapeutic use*; D004280:Dobutamine / Q000009:adverse effects / Q000627:therapeutic use*; D004359:Drug Therapy, Combination; D005260:Female; D006333:Heart Failure / Q000188:drug therapy* / Q000503:physiopathology; D006439:Hemodynamics / Q000187:drug effects; D006801:Humans; D008297:Male; D008875:Middle Aged; D009200:Myocardial Contraction / Q000187:drug effects; D013268:Stimulation, Chemical
D004280:Dobutamine; D000676:Amrinone
Décompensation cardiaque sévère: intérêt dans les premières heures de l'association amrinone et dobutamine.