The use of vasoactive therapy for acute decompensated heart failure: hemodynamic and renal considerations.
Although diuretics remain the most commonly used intravenous medication for acute decompensated heart failure, vasoactive agents play an important role in select patient populations. Inotropes and pressor agents are critical in order to maintain blood pressure and cardiac output in a small subset of patients, and can preserve and even improve renal function. However, they should not be used in the majority of patients with preserved cardiac output. Vasodilators improve hemodynamics and symptoms in normotensive individuals. Their influence on renal function is less clear cut, although more recent data suggest a neutral effect.
Heywood
J Thomas
JT
Heart Failure Recovery and Research Program, Scripps Clinic, La Jolla, California, USA.
Khan
Tariq A
TA
D000208:Acute Disease; D002302:Cardiac Output / Q000187:drug effects; D002316:Cardiotonic Agents / Q000494:pharmacology* / Q000627:therapeutic use; D006333:Heart Failure / Q000188:drug therapy* / Q000503:physiopathology*; D006439:Hemodynamics / Q000187:drug effects; D006801:Humans; D007668:Kidney / Q000187:drug effects*; D020105:Milrinone / Q000494:pharmacology / Q000627:therapeutic use; D045283:Natriuretic Agents / Q000627:therapeutic use; D020097:Natriuretic Peptide, Brain / Q000627:therapeutic use; D009566:Nitrates / Q000494:pharmacology / Q000627:therapeutic use; D013566:Sympathomimetics / Q000627:therapeutic use*; D014665:Vasodilator Agents / Q000494:pharmacology* / Q000627:therapeutic use*
D002316:Cardiotonic Agents; D045283:Natriuretic Agents; D009566:Nitrates; D013566:Sympathomimetics; D014665:Vasodilator Agents; D020097:Natriuretic Peptide, Brain; D020105:Milrinone