title: Vasopressin in vasodilatory shock: is the heart in danger?
abstract: 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.
authors.affiliation: Sektion Anästhesiologische Pathophysiologie und Verfahrensentwicklung, Universitätsklinikum, Parkstrasse 11, 89073 Ulm, Germany. bhauser1@gmail.com
authors.forename: Balázs
authors.initials: B
authors.lastname: Hauser
authors.forename: Pierre
authors.initials: P
authors.lastname: Asfar
authors.forename: Enrico
authors.initials: E
authors.lastname: Calzia
authors.forename: Régent
authors.initials: R
authors.lastname: Laporte
authors.forename: Michael
authors.initials: M
authors.lastname: Georgieff
authors.forename: Peter
authors.initials: P
authors.lastname: Radermacher
mesh_terms: 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*
chemical_list: D014662:Vasoconstrictor Agents; D001127:Arginine Vasopressin