title: Hypercontractile heart failure caused by catecholamine therapy in premature neonates.
abstract: Catecholamine treatment for hypotension is common practice in neonatal intensive care units. In the presence of left ventricular hypertrophy, the positive inotropic action of catecholamines with mainly beta-receptor specificity can lead to excessive hypercontractility and paradoxical hypotension. This reports presents two cases of hypercontractile heart failure during beta-agonist treatment in very low birthweight (VLBW) infants. Both patients (27 wk, 5 d; and 26 wk, 6 d of gestation) underwent surgical arterial duct ligation and coarctation repair. After operation they developed arterial hypotension that failed to respond to epinephrine (adrenaline) or dobutamine treatment. Echocardiography demonstrated a complete systolic obliteration of the left ventricular cavity. Epinephrine and dobutamine were stopped, and norepinephrine (noradrenaline) was successfully used to control the hypotension.
  
  
  CONCLUSIONS
  Treatment of hypotension with beta-agonists in VLBW infants with left ventricular hypertrophy can lead to hypercontractility and left ventricular obliteration with paradoxical hypotension. Careful echocardiographic monitoring is indicated in such cases.
authors.affiliation: Department of Congenital Heart Disease, Albert-Ludwigs-University Hospital, Freiburg, Germany.
authors.forename: I
authors.initials: I
authors.lastname: Germanakis
authors.forename: C
authors.initials: C
authors.lastname: Bender
authors.forename: R
authors.initials: R
authors.lastname: Hentschel
authors.forename: K
authors.initials: K
authors.lastname: Braun
authors.forename: S
authors.initials: S
authors.lastname: Dittrich
authors.forename: D
authors.initials: D
authors.lastname: Kececioglu
mesh_terms: D000322:Adrenergic Agonists / Q000009:adverse effects* / Q000627:therapeutic use; D000318:Adrenergic beta-Agonists / Q000009:adverse effects* / Q000627:therapeutic use; D004280:Dobutamine / Q000009:adverse effects* / Q000627:therapeutic use; D004359:Drug Therapy, Combination; D004837:Epinephrine / Q000009:adverse effects* / Q000627:therapeutic use; D005260:Female; D006333:Heart Failure / Q000139:chemically induced* / Q000188:drug therapy*; D006339:Heart Rate / Q000502:physiology; D006801:Humans; D017379:Hypertrophy, Left Ventricular / Q000000981:diagnostic imaging / Q000188:drug therapy* / Q000503:physiopathology; D007022:Hypotension / Q000188:drug therapy* / Q000209:etiology*; D007231:Infant, Newborn; D007234:Infant, Premature; D019102:Infant, Very Low Birth Weight; D008297:Male; D009200:Myocardial Contraction / Q000187:drug effects*; D009638:Norepinephrine / Q000009:adverse effects* / Q000627:therapeutic use; D014463:Ultrasonography
chemical_list: D000322:Adrenergic Agonists; D000318:Adrenergic beta-Agonists; D004280:Dobutamine; D009638:Norepinephrine; D004837:Epinephrine