Inotropes and beta-blockers: is there a need for new guidelines?

Abstract:

:Beta-adrenergic blocking agents are standard treatment for patients with mild-to-moderate heart failure. When patients receiving beta-blockers decompensate they often need treatment with a positive inotropic agent. The beta-agonist dobutamine may not produce much increase in cardiac output during full-dose beta-blocker treatment and may increase systemic vascular resistance via alpha-adrenergic stimulation. In contrast, phosphodiesterase inhibitors (PDEIs) such as milrinone or enoximone retain full hemodynamic effects during complete beta-blockade because the site of action of PDEIs is beyond the beta-adrenergic receptor and because beta-blockade reverses some of the desensitization phenomena that account for the attenuation of PDEI response in heart failure related to upregulation in G(alphai). Inotrope-requiring subjects with decompensated heart failure who are undergoing long-term therapy with beta-blocking agents should be treated with a type III-specific PDEI, not a beta-agonist such as dobutamine.

journal_name

J Card Fail

authors

Bristow MR,Shakar SF,Linseman JV,Lowes BD

doi

10.1054/jcaf.2001.26655

keywords:

subject

Has Abstract

pub_date

2001-06-01 00:00:00

pages

8-12

issue

2 Suppl 1

eissn

1071-9164

issn

1532-8414

pii

ajcaf00702b0008

journal_volume

7

pub_type

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