Document Detail


Calcium channel blockers in congestive heart failure: theoretic considerations and clinical experience.
MedLine Citation:
PMID:  3976695     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
Although it has been suggested that calcium channel blocking agents may be utilized as vasodilators in patients with congestive heart failure, these agents also have the potential to cause a deterioration in cardiac function because of their negative inotropic actions. There is considerable variation among the available agents with regard to their relative effects on the vasculature, myocardial inotropy, and myocardial chronotropy. Thus, at clinically relevant dosages, nifedipine is a potent systemic and coronary vasodilator, but it has little or no direct effect on inotropy and chronotropy. In contrast, verapamil exerts significant negative inotropic and chronotropic effects at vasodilatory dosages, whereas diltiazem is a potent vasodilator with a negative chronotropic action at dosages that do not affect inotropy. In patients with heart failure, the largest experience so far has been with nifedipine. Data derived from over 100 patients with moderate to severe congestive heart failure indicate a generally beneficial net hemodynamic response to nifedipine, with substantial improvements in cardiac index (+24 percent) and left ventricular filling pressure (-15 percent). The major effect seems to be on arteriolar resistance vessels, resulting in a reduction in afterload, with relatively little effect on venous pressures. Limited data suggest that the initial effect is sustained during long-term therapy. The clinical experience with verapamil and diltiazem in patients with heart failure is at present limited. In patients with normal or mildly impaired left ventricular function, verapamil's vasodilator and negative inotropic effects are counterbalanced. With severe left ventricular dysfunction, however, treatment with verapamil can result in abrupt decompensation and development of overt pulmonary edema and hypotension. Diltiazem's relative lack of negative inotropic effects may allow it to be used safely in patients with congestive heart failure, particularly when control of supraventricular tachyarrhythmia is required.
Authors:
W S Colucci; M A Fifer; B H Lorell; J Wynne
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  The American journal of medicine     Volume:  78     ISSN:  0002-9343     ISO Abbreviation:  Am. J. Med.     Publication Date:  1985 Feb 
Date Detail:
Created Date:  1985-03-26     Completed Date:  1985-03-26     Revised Date:  2007-11-15    
Medline Journal Info:
Nlm Unique ID:  0267200     Medline TA:  Am J Med     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  9-17     Citation Subset:  AIM; IM    
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MeSH Terms
Descriptor/Qualifier:
Calcium / physiology
Calcium Channel Blockers / adverse effects,  therapeutic use*
Heart Failure / drug therapy*,  physiopathology
Hemodynamics / drug effects
Humans
Muscle, Smooth, Vascular / physiology
Myocardial Contraction / drug effects
Nifedipine / administration & dosage,  therapeutic use
Retrospective Studies
Time Factors
Chemical
Reg. No./Substance:
0/Calcium Channel Blockers; 21829-25-4/Nifedipine; 7440-70-2/Calcium

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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