Cardiology
Vantaggio della terapia combinata con captopril e nitrati nell·insuff icienza cardiaca congestizia graveHalon D.A. · Rosenfeld T. · Hardoff R. · Lewis B.S.Lady Davis Carmel Hospital, Haifa, Israel
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Article / Publication Details
Published online: November 18, 2008
Issue release date: 1994
Number of Print Pages: 9
Number of Figures: 0
Number of Tables: 0
ISSN: 0008-6312 (Print)
eISSN: 1421-9751 (Online)
For additional information: https://www.karger.com/CRD
Abstract
We compared the acute hemodynamic effects of captopril and nitrates in 11 patients with severe congestive heart failure and grade IV cardiac disability. Pressures were measured using a Swan-Ganz catheter system; cardiac output and stroke index were measured by thermodilution, and left-ventricular (LV) volumes and ejection fraction were calculated simultaneously with the hemodynamic measurements from radionuclide ventri-culography. Measurements were made in each of 4 treatment states: control, sublingual isosorbide dinitrate (ISDN; 5 and 15 mg), oral captopril (50-200 mg daily) and during combined therapy with captopril and ISDN. Captopril produced a fall in mean arterial pressure (p < 0.01) from 81 ± 14 to 72 ± 13 mm Hg and a rise in stroke index from 30 ± 5 to 35 ± 91/min/m2 (p < 0.05), while LV ejection fraction increased from 18 + 5 to 21 ± 7% (p < 0.05). ISDN reduced mean arterial, pulmonary arterial, right-atrial and wedge pressure. The combination of captopril and ISDN produced a greater fall in mean arterial pressure, a further rise in ejection fraction to 22 ± 8% (p < 0.05), a fall in systemic (p < 0.05) and pulmonary vascular resistance (p < 0.01) and a rise in cardiac (p < 0.01) and stroke work index (p < 0.01), while the beneficial effects of ISDN on right-atrial, pulmonary arterial and wedge pressure were again achieved. LV contractility, assessed from end-systolic stress-shortening relations, was essentially unaltered or decreased very slightly. The study showed that combined therapy with captopril and nitrates produced acute hemodynamic benefits superior to those achieved by treatment with captopril or nitrates alone.
© 1994 S. Karger AG, Basel
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Article / Publication Details
Published online: November 18, 2008
Issue release date: 1994
Number of Print Pages: 9
Number of Figures: 0
Number of Tables: 0
ISSN: 0008-6312 (Print)
eISSN: 1421-9751 (Online)
For additional information: https://www.karger.com/CRD
Copyright / Drug Dosage / Disclaimer
Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher.Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
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