[Treatment of cardiogenic shock with the Ca2+ sensitizer levosimendan].
BACKGROUND
First-line therapy of acute heart failure consists of intravenous diuretics and vasodilators. If this regimen fails, patients are usually treated with positively inotropic drugs like the beta-receptor antagonist dobutamine or inhibitors of the phosphodiesterase enzyme (milrinone, enoximone). Although these drugs result in an improvement of the acute hemodynamic situation, they have no positive in. uence on survival in the long run.


METHODS
A young male patient with a cardiogenic shock was transferred to the authors' clinic for coronary angiography, after he had presented to another hospital with acute myocardial infarction. The angiography revealed a subtotal stenosis of the left anterior descending artery. Even after successful angioplasty and implantation of an intraaortic balloon pump as well as treatment with dobutamine, the patient was still unstable. It was therefore decided to use the Ca(2+) sensitizer and vasodilator levosimendan. Application of this new drug resulted in a quick and sustained improvement of hemodynamic parameters and allowed simultaneous treatment with beta-blockers.


CONCLUSIONS
Levosimendan can be used in addition to beta- and alpha-agonistic agents as well as in the presence of beta-blockers. If the promising results of smaller studies (LIDO, RUSSLAN) with respect to the mortality of the treated patients can be supported by a larger, already initiated study (SURVIVE), levosimendan would be a valuable alternative and/or addition to the conventional therapy of cardiogenic shock.
Zobel
Carsten
C
Labor für Herzmuskelphysiologie und Molekulare Kardiologie, Klinik III für Innere Medizin der Universität zu Köln, Joseph-Stelzmann-Strasse 9, 50924, Köln. carsten.zobel@uni-koeln.de
Reuter
Hannes
H
Schwinger
Robert H G
RH
D000328:Adult; D015906:Angioplasty, Balloon, Coronary; D002316:Cardiotonic Agents / Q000627:therapeutic use*; D002407:Catheterization, Swan-Ganz; D023921:Coronary Stenosis / Q000150:complications / Q000601:surgery; D004359:Drug Therapy, Combination; D006439:Hemodynamics / Q000187:drug effects; D006801:Humans; D006835:Hydrazones / Q000627:therapeutic use*; D007423:Intra-Aortic Balloon Pumping; D008297:Male; D009203:Myocardial Infarction / Q000150:complications / Q000601:surgery; D011724:Pyridazines / Q000627:therapeutic use*; D044169:Receptors, Calcium-Sensing / Q000037:antagonists & inhibitors*; D012770:Shock, Cardiogenic / Q000188:drug therapy*; D000077464:Simendan; D015607:Stents; D014665:Vasodilator Agents / Q000627:therapeutic use*
D002316:Cardiotonic Agents; D006835:Hydrazones; D011724:Pyridazines; D044169:Receptors, Calcium-Sensing; D014665:Vasodilator Agents; D000077464:Simendan