Abstract
Vasoactive pharmacologic agents play an important role in the management of shock. These agents can be broadly categorized as vasodilators, vasopressors, and inotropic agents. Each of these agents can variably affect myocardial preload, afterload, and inotropy to enhance cardiac performance. The choice of these agents is largely dependent on the clinical circumstances faced and a working knowledge of the pharmacologic and hemodynamic effects unique to these agents. This chapter presents the most common vasoactive pharmacologic agents used in clinical practice for the treatment of cardiogenic shock. The hemodynamic as well as pharmacologic properties of these agents are reviewed in order to provide a basis on which a practical understanding of their effects can develop and guide medical decision-making.
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References
Tuchschmidt J, Fried J, Astiz M, et al. Elevation of cardiac output and oxygen delivery improves outcome in septic shock. Chest. 1992;102(1):216–20.
Felker GM, O’Connor CM. Inotropic therapy for heart failure: an evidence based approach. Am Heart J. 2001;142(3):393–401.
Taylor RR, Covell JS, Sonnenblick EH, Ross J Jr. Dependence of ventricular distensibility on filling of the opposite ventricle. Am J Phys. 1967;213(3):711–8.
The CONSENSUS Trial Study Group. Effects of enalapril on mortality in severe congestive heart failure. Results of the Cooperative North Scandinavian Enalapril Survival Study (CONSENSUS). N Engl J Med. 1987;316(23):1429–35.
Mullens W, Abrahams Z, Francis GS, et al. Sodium nitroprusside for advanced low-output heart failure. J Am Coll Cardiol. 2008;52(3):200–7.
Gruppo Italiano per lo Studio della Sopravvivenza nell’infarto Miocardico. GISSI-3: effects of lisinopril and transdermal glyceryl trinitrate singly and together on 6-week mortality and ventricular function after acute myocardial infarction. Lancet. 1994;343(8906):1115–22.
Flather M, Pipilis A, Collins R, et al. Randomized controlled trial of oral captopril, of oral isosorbide mononitrate and of intravenous magnesium sulphate started early in acute myocardial infarction: safety and haemodynamic effects. ISIS-4 (Fourth International Study of Infarct Survival) Pilot Study Investigators. Eur Heart J. 1994;15(5):608–19.
Opie L, Gersch B, editors. Drugs for the heart. 6th ed. Philadelphia: Elsevier; 2005. p. 161–2.
Dell’Italia LJ, Starling MR, Blumhardt R, et al. Comparative effects of volume loading, dobutamine, and nitroprusside in patients with predominant right ventricular infarction. Circulation. 1985;72(6):1327–35.
Morelli A, Ertmer C, Westphal M, et al. Effect of heart rate control with esmolol on hemodynamic and clinical outcomes in patients with septic shock. A randomized clinical trial. JAMA. 2013;310(16):1683–91.
Publication committee for the VMAC Investigators. Intravenous nesiritide vs nitroglycerin for treatment of decompensated congestive heart failure. A randomized controlled trial. JAMA. 2002;287(15):1531–40.
Silver MA, Horton DP, Ghali JK, et al. Effect of nesiritide versus dobutamine on short-term outcomes in the treatment of patients with acutely decompensated heart failure. J Am Coll Cardiol. 2002;39(5):798–803.
O’Connor CM, Starling RC, Hernandez AF, et al. Effect of nesiritide in patients with acute decompensated heart failure. N Engl J Med. 2011;365:32–43.
Overgaard CB, Dzavik V. Inotropes and Vasopressors: review of physiology and clinical use in cardiovascular disease. Circulation. 2008;118:1047–56.
Leier CV, Heban PT, Huss P, et al. Comparative systemic and regional hemodynamic effects of dopamine and dobutamine in patients with cardiomyopathic heart failure. Circulation. 1978;58(3 pt 1):466–75.
Unverferth DV, Magorien RD, Lewis RP, et al. Long-term benefit of dobutamine in patients with congestive cardiomyopathy. Am Heart J. 1980;100(5):622–30.
Viskin S. Long QT syndromes and torsade de pointes. Lancet. 1999;354(9190):1625–33.
Cuffe MS, Califf RM, Adams KF Jr, et al. Short-term intravenous milrinone for acute exacerbation of chronic heart failure: a randomized controlled trial. JAMA. 2002;287(12):1541–7.
Lowes BD, Tsvetkova T, Eichhorn EJ, et al. Milrinone versus dobutamine in heart failure subjects treated chronically with carvedilol. Int J Cardiol. 2001;81:141–9.
Kumar A, Choudhary G, Antonio C, et al. Carvedilol titration in patients with congestive heart failure receiving inotropic therapy. Am Heart J. 2001;142:512–5.
Nieminem MS, Fruhwald S, Heunks LMA, et al. Levosimendan: current data, clinical use and future development. Heart Lung Vessel. 2013;5(4):227–45.
Schumann J, Henrich EC, Strobl H, et al. Inotropic agents and vasodilator strategies for the treatment of cardiogenic shock or low output syndrome. Cochrane Database Syst Rev. 2018:CD009669.pub3. https://doi.org/10.1002/14651858.
Bellomo R, Chapman M, Finfer S, et al. Low-dose dopamine in patients with early renal dysfunction: a placebo-controlled randomised trial. Australian and New Zealand Intensive Care Society (ANZICS) Clinical Trials Group. Lancet. 2000;356(9248):2139–43.
Marik PE, Iglesias J. Low-dose dopamine does not prevent acute renal failure in patients with septic shock and oliguria. NORA- SEPT II Study Investigators. Am J Med. 1999;107(4):387–90.
Kellum JA, M Decker J. Use of dopamine in acute renal failure: a meta-analysis. Crit Care Med. 2001;29(8):1526–31.
Bassi G, Radermacher P, Calzia E. Catecholamines and vasopressin during critical illness. Endocrinol Metab Clin N Am. 2006;35(4):839–57.
Barrett LK, Singer M, Clapp LH. Vasopressin: mechanisms of action on the vasculature in health and in septic shock. Crit Care Med. 2007;35(1):33–40.
Lindner KH, Dirks B, Strohmenger HU, et al. Randomised comparison of epinephrine and vasopressin in patients with out-of-hospital ventricular fibrillation. Lancet. 1997;349(9051):535–7.
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Anaya, P., Macaulay, T.E. (2019). Pressor Agents, Pure Inotropes, Mixed Function Agents. In: Askari, A., Messerli, A. (eds) Cardiovascular Hemodynamics. Contemporary Cardiology. Humana, Cham. https://doi.org/10.1007/978-3-030-19131-3_7
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DOI: https://doi.org/10.1007/978-3-030-19131-3_7
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