Pharmakotherapie der akuten schweren Herzinsuffizienz View Full Text


Ontology type: schema:ScholarlyArticle     


Article Info

DATE

2007-02

AUTHORS

J. Boldt, A. Lehmann

ABSTRACT

The severe acute heart failure is characterized by the heart's limited ability to sustain adequate organ perfusion. Acute heart failure is based on myocardial dysfunction, a patient's negative outcome often results from peripheral circulatory derangements. The positive inotropic effect of beta-receptor agonists is associated with chronotropic and arrhythmogenic properties by which myocardial oxygen demand is increased. Moreover, myocardial beta-adrenoceptor population may be reduced in patients with myocardial heart disease (“down regulation”). Compounds inhibiting phosphodiesterase (PDE) may be useful to increase contractility. They improve cardiac performance without increasing myocardial oxygen demand, because the expected increase in myocardial oxygen consumption is compensated by a decrease in ventricular pre- and afterload. Combination of PDE III inhibitors and catecholamines appears to be useful because PDE inhibitors inhibit the destruction of cAMP, whereas catecholamines stimulate cAMP production. The Ca++-sensitizer levosimendan is another promising approach to treat acute heart failure aside from catecholamines. Levosimendan simultaneously increases myocardial contractility while additionally protecting the heart from ischemia. Levosimendan was proposed especially for patients requiring inotropic support showing myocardial ischemia simultaneously. Aside from exclusively using increasing doses of catecholamines, both classes of substances seem tobe an alternative or additive tool for treating acute heart failure. More... »

PAGES

11-19

Identifiers

URI

http://scigraph.springernature.com/pub.10.1007/s00390-006-0730-1

DOI

http://dx.doi.org/10.1007/s00390-006-0730-1

DIMENSIONS

https://app.dimensions.ai/details/publication/pub.1046637373


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