Vasopressin in vasodilatory shock: is the heart in danger?
In patients with hyperdynamic hemodynamics, infusing arginine vasopressin (AVP) in advanced vasodilatory shock is usually accompanied by a decrease in cardiac output and in visceral organ blood flow. Depending on the infusion rate, this vasoconstriction also reduces coronary blood flow despite an increased coronary perfusion pressure. In a porcine model of transitory myocardial ischemia-induced left ventricular dysfunction, Müller and colleagues now report that the AVP-related coronary vaso-constriction may impede diastolic relaxation while systolic contraction remains unaffected. Although any AVP-induced myocardial ischemia undoubtedly is a crucial safety issue, these findings need to be discussed in the context of the model design, the dosing of AVP as well as the complex direct, afterload-independent and systemic, vasoconstriction-related effects on the heart.
Hauser
Balázs
B
Sektion Anästhesiologische Pathophysiologie und Verfahrensentwicklung, Universitätsklinikum, Parkstrasse 11, 89073 Ulm, Germany. bhauser1@gmail.com
Asfar
Pierre
P
Calzia
Enrico
E
Laporte
Régent
R
Georgieff
Michael
M
Radermacher
Peter
P
D000818:Animals; D001127:Arginine Vasopressin / Q000494:pharmacology*; D001921:Brain / Q000098:blood supply*; D002302:Cardiac Output / Q000187:drug effects*; D003326:Coronary Circulation / Q000187:drug effects*; D007668:Kidney / Q000098:blood supply*; D008297:Male; D009131:Muscle, Smooth, Vascular / Q000187:drug effects*; D017202:Myocardial Ischemia / Q000188:drug therapy; D015425:Myocardial Reperfusion; D013552:Swine; D014662:Vasoconstrictor Agents / Q000494:pharmacology*
D014662:Vasoconstrictor Agents; D001127:Arginine Vasopressin