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Pharmacological Intervention In The Failing Heart

  • Conference paper
Book cover Oxygen Transport in the Critically Ill Patient

Abstract

Heart failure is a major public health problem with worldwide more than 12 million people having symptoms of heart failure and an additional 40 million people having important degrees of left ventricular dysfunction being at risk of progressive hemodynamic or electrophysiologic deterioration [1]. It can be defined as a State of inability of the myocardium to circulate blood at a rate sufficient to maintain the needs of the peripheral, metabolizing tissues [2]. In this Situation, a complex interaction between the underlying cause and a number of precipitating factors is involved which lead to progressive deterioration. The pathophysiological adaptation in congestive heart failure (CHF) involves a number of neurohumoral aspects [3] such as changes of nor–epinephrine kinetics, catecholamine action and receptor function, vasoconstriction, impaired renal function influenced by the sympathetic nervous system, activation of the renin–angiotensin– aldosterone system and Vasopressine release and the role of the atrial natriuretic factor. An alteration of norepinephrine kinetics could be demonstrated in patients with mild to moderate CHF [4] as well as in severe heart failure [5]. In patients with mild to moderate heart failure an increased norepinephrine spillover was shown in the presence of a normal norepinephrine clearance, whereas patients with severe heart failure additionally showed a reduced norepinephrine clearance. The degree of plasma noradrenaline elevation is closely related with the prognosis of patients suffering from CHF [6]. A downregulation of myocardial beta–adrenoceptors and a more or less selective reduction in beta 1–receptor density in severe CHF has been documented [7].

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Authors
  1. Th. Budde
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  2. M. Block
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  3. Th. Wichter
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  4. G. Breithardt
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Editors and Affiliations

  1. Klinik und Poliklinik für Anästhesiologie und operative Intensivmedizin, Westfälische Wilhelms-Universität Münster, Albert-Schweitzer-Strasse 33, D-4400, Münster, Germany

    M. Wendt  & P. Lawin  & 

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© 1990 Springer-Verlag Berlin Heidelberg

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Budde, T., Block, M., Wichter, T., Breithardt, G. (1990). Pharmacological Intervention In The Failing Heart. In: Wendt, M., Lawin, P. (eds) Oxygen Transport in the Critically Ill Patient. Anaesthesiologie und Intensivmedizin Anaesthesiology and Intensive Care Medicine, vol 215. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-642-75646-7_14

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  • DOI: https://doi.org/10.1007/978-3-642-75646-7_14

  • Publisher Name: Springer, Berlin, Heidelberg

  • Print ISBN: 978-3-540-52498-4

  • Online ISBN: 978-3-642-75646-7

  • eBook Packages: Springer Book Archive

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