Combined use of ultra-short acting beta-blocker esmolol and intravenous phosphodiesterase 3 inhibitor enoximone.
In patients with impaired myocardial contractility associated with downregulation of the beta-receptors, compounds inhibiting phosphodiesterase (PDE) 3 may be useful to increase contractility. The PDE3 inhibitor enoximone has been shown to improve pump-function independent from the beta-receptor pathway. A simultaneous decrease in ventricular preload and afterload by vasodilation has led to the term 'inodilator'. Esmolol is the only available ultra-short acting intravenous beta-blocking agent. Due to its half-life of approximately 9 min, beta-blockade, and thus, heart rate, can easily be titrated. Esmolol appears to be a helpful tool to avoid myocardial ischemia (e.g., in the perioperative setting). As with all other beta-blockers, it has dose-dependent negative inotropic effects, and this limits its use in patients with severe heart failure showing low cardiac output. It seems reasonable that an intravenous combination of both approaches, enoximone-induced positive inotropy and esmolol-associated protection from myocardial ischemia, might offer advantages by producing beneficial hemodynamic effects and by compensating each other's limitations in a complementary way. In spite of some promising results, the place of a combination of enoximone and esmolol in the process of treating patients with (acute) heart failure showing low output is still not entirely clear, and needs further confirmation.
Boldt
Joachim
J
Department of Anesthesiology and Intensive Care Medicine, Klinikum der Stadt Ludwigshafen, Ludwigshafen, Germany. BoldtJ@gmx.net
Suttner
Stephan
S
D000319:Adrenergic beta-Antagonists / Q000008:administration & dosage*; D000818:Animals; D002318:Cardiovascular Diseases / Q000188:drug therapy / Q000378:metabolism; D004359:Drug Therapy, Combination; D017335:Enoximone / Q000008:administration & dosage*; D006801:Humans; D007262:Infusions, Intravenous; D010726:Phosphodiesterase Inhibitors / Q000008:administration & dosage*; D011412:Propanolamines / Q000008:administration & dosage*; D013997:Time Factors
D000319:Adrenergic beta-Antagonists; D010726:Phosphodiesterase Inhibitors; D011412:Propanolamines; D017335:Enoximone; C036604:esmolol