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Inotropic Stimulation and Myocardial Energetics

  • Editors
  • Hj. Just
  • Ch. Holubarsch
  • H. Scholz

Table of contents

  1. Front Matter
    Pages I-IX
  2. Cellular and subcellular mechanisms, energy turnover

  3. Pharmacology of positive inotropic substances

  4. Clinical experience with positive inotropic substances

  5. Energetic aspects in the intact heart

    1. Front Matter
      Pages 235-235
    2. G. F. Leatherman, T. L. Shook, S. M. Leatherman, Wilson S. Colucci
      Pages 247-256
  6. Back Matter
    Pages 267-273

About these proceedings

Introduction

Inotropic stimulation of the myocardium, as well as vasodilation and diuresis as essential principles in the treatment of congestive heart failure have recently met with considerable criticism and reevaluation. It is generally agreed that unloading of the heart, either through vasodilation and/or diuresis, improves the working conditions of the dilated, failing heart. It reduces myocar­ dial oxygen consumption through reduction of chamber radius and, thereby, wall tension as the major determinants of myocardial oxygen consumption. Inotropic stimulation, quite in contrast, does not conserve oxygen. It rather consumes energy and that may be disadvantageous in situations of compromised oxygen supply and energy metabolism of the working myocardium. However, under conditions of suf­ ficient oxygen supply and metabolic support inotropic stimulation may bring about in­ creased pumping and subsequent improvement of myocardial failure. In recent years it could convincingly be demonstrated that vasodilation leads to symp­ tomatic improvement of congestive heart failure, improvement of exercise tolerance, and it prolongs life - especially in the case of ACE-inhibitors and the combination of hydra­ lazine with long-acting nitrates. Quite in contrast, equally beneficial effects could not be demonstrated for inotropic agents in congestive heart failure. Only for the cardiac glyco­ sides has it been shown that beneficial effects can be achieved, especially if atrial fibril­ lation with absolute arrhythmia is present. The influence of the cardiac glycosides on the latter represents an effect which is independent of the inotropic action.

Keywords

Hydra arrhythmia heart heart failure metabolism

Bibliographic information

  • DOI https://doi.org/10.1007/978-3-662-07908-9
  • Copyright Information Steinkopff-Verlag Darmstadt 1989
  • Publisher Name Steinkopff, Heidelberg
  • eBook Packages Springer Book Archive
  • Print ISBN 978-3-662-07910-2
  • Online ISBN 978-3-662-07908-9
  • Buy this book on publisher's site