Intravenous vasodilator therapy in congestive heart failure.
The prevalence of congestive heart failure (CHF) is increasing in the US and worldwide, partly because patients are living longer. Treatment of CHF is mostly on an outpatient basis, but inpatient care is required for decompensated CHF, acute CHF or poor response to outpatient treatment. Control of symptoms is usually achieved by diuresis. Intravenous (IV) vasodilators are an important adjunct to the inpatient treatment of CHF. They work mainly by reducing the afterload on the myocardium although preload reduction also occurs. After clinical stabilisation, the goal is to switch to a maintenance oral regimen to be continued as outpatient therapy. The range of IV vasodilators available for inpatient treatment of CHF includes nitrates, phosphodiesterase inhibitors, dobutamine, morphine, ACE inhibitors, B-type natriuretic peptides and endothelin receptor antagonists. As each agent may have a different mechanism or site of action, each agent may affect preload, contractility or afterload to a different extent and it may be desirable to choose one over the other in a particular clinical setting. Examples of standard therapy include dobutamine, milrinone and nitroglycerin. Nesiritide, a B-type natriuretic peptide, is a newer vasodilator and US FDA approved for use in acute CHF. However, most studies with this agent have been in small numbers of patients with anecdotal findings. Larger studies are warranted to pinpoint the efficacy and adverse effects of this agent. It is primarily used to reduce the acuity of decompensated CHF on admission to hospital.Endothelin receptor antagonists show promise in the management of acute CHF, but continue to be investigational. Long-term data on their efficacy and safety are limited. None of the endothelin receptor antagonists are FDA approved for use in patients with CHF.
Carle Foundation Hospital, University of Illinois College of Medicine at Urbana-Champaign, Urbana, Illinois 61801, USA.
Kourosh
K
Moazemi
Jatinder S
JS
Chana
Anna Marie
AM
Willard
Abraham G
AG
Kocheril
D004280:Dobutamine / Q000009:adverse effects / Q000494:pharmacology / Q000627:therapeutic use; D065128:Endothelin Receptor Antagonists; D006333:Heart Failure / Q000188:drug therapy*; D006801:Humans; D007275:Injections, Intravenous; D005996:Nitroglycerin / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use; D010726:Phosphodiesterase Inhibitors / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use; D013921:Thrombocytopenia / Q000139:chemically induced; D014665:Vasodilator Agents / Q000008:administration & dosage / Q000627:therapeutic use*
D065128:Endothelin Receptor Antagonists; D010726:Phosphodiesterase Inhibitors; D014665:Vasodilator Agents; D004280:Dobutamine; D005996:Nitroglycerin