Document Detail

Levosimendan as rescue therapy in severe cardiogenic shock after ST-elevation myocardial infarction.
MedLine Citation:
PMID:  18972629     Owner:  NLM     Status:  MEDLINE    
Data on the use of levosimendan in patients with myocardial infarction related cardiogenic shock already under combined catecholamine treatment and intra-aortic balloon counterpulsation (IABP) are scarce. Seven consecutive patients with refractory cardiogenic shock after ST-elevation myocardial infarction, multi-organ dysfunction syndrome and under maximal intensive care (combined catecholamine treatment, IABP) were treated with levosimendan (bolus 12 microg/kg i.v., thereafter 0.1 microg/kg over 24 h). Hemodynamic effects were registered invasively and monitored over 72h post infusion. Therapy with levosimendan significantly reduced required epinephrine dose after 48h (P=0.02 versus baseline). Norepinephrine dose had to be increased during the first 12 h of levosimendan (+25%; P=ns), but was significantly reduced at 72 h compared to baseline (median 0.14 versus 0.06 microg/kg/min after 72 h; P<0.05). Cardiac power output increased (baseline 0.6 versus 1.1 > or = 48 h after infusion; P<0.01) and systemic vascular resistance decreased (median 1294 dyn*s*cm-5 at baseline versus 858 dyn*s*cm-5 at 24 h; P<0.05) after levosimendan infusion. IABP therapy could be weaned in all patients during 5 days after infusion and all patients survived the cardiogenic shock (ICU mortality 29%). Levosimendan as an adjunctive, rescue therapy in patients with severe cardiogenic shock may be safe with beneficial effects on hemodynamics over 72 h.
Martin Greif; Ludwig Zwermann; Christopher Reithmann; Michael Weis
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Acute cardiac care     Volume:  10     ISSN:  1748-2941     ISO Abbreviation:  Acute Card Care     Publication Date:  2008  
Date Detail:
Created Date:  2008-10-29     Completed Date:  2009-01-13     Revised Date:  2009-11-17    
Medline Journal Info:
Nlm Unique ID:  101276603     Medline TA:  Acute Card Care     Country:  Sweden    
Other Details:
Languages:  eng     Pagination:  185-90     Citation Subset:  IM    
Medizinische Klinik und Poliklinik I, University Medical Center Munich-Grosshadern, Ludwig-Maximilians University of Munich, Munich, Germany.
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MeSH Terms
Cardiac Output
Cardiotonic Agents / therapeutic use*
Combined Modality Therapy
Hydrazones / therapeutic use*
Intra-Aortic Balloon Pumping
Middle Aged
Myocardial Infarction / complications
Norepinephrine / administration & dosage
Prospective Studies
Pyridazines / therapeutic use*
Shock, Cardiogenic / drug therapy*,  etiology,  physiopathology,  therapy
Vasoconstrictor Agents / administration & dosage
Ventricular Dysfunction, Left / etiology
Reg. No./Substance:
0/Cardiotonic Agents; 0/Hydrazones; 0/Pyridazines; 0/Vasoconstrictor Agents; 131741-08-7/simendan; 51-41-2/Norepinephrine

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