| Outpatient dobutamine therapy: the rhyme and the riddle. | |
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MedLine Citation:
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PMID: 1613124 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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Advances in critical care medicine have increased survival for victims of myocardial infarction and other acute cardiac events so that increasingly patients are receiving long-term, labor-intensive, and costly medical care. Innovations in drug delivery systems and skyrocketing health care costs have fostered the growth of home health care which has blossomed into a $2.8 billion industry. There is evidence that outpatient dobutamine therapy produces definite physical and possibly psychological improvements of variable degree and duration. Hemodynamic improvements are generally associated with improvement in functional class, and the financial savings are recognizably substantial. However, three major problems confront therapies with beta-adrenergic agonists: tendency for tolerance, ventricular arrhythmias, and increased myocardial oxygen consumption. There is a dire need for establishment of exclusionary patient criteria and for risk stratification, as well as for development of a portable radionuclide nonimaging monitor. Given the current fund of knowledge, outpatient dobutamine therapy should be undertaken cautiously after meticulous patient selection reflecting an awareness of the tremendous complexities and inherent risks. The therapeutic implications are dependent on the nature of the underlying cardiomyopathy and the fact that beta-adrenergic receptor desensitization is unlikely to be overcome by progressive dosage increases. Therapy is initiated with the understanding that treatment will remain blindly empirical and conjectural in the absence of a continuous physiologic monitor and an expanded comprehension of the molecular pathophysiology of the failing ventricle. |
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Authors:
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H L Sacher; M L Sacher; S W Landau; A Araghi; M Mene; F Dooley; K A Dietrich |
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Publication Detail:
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Type: Journal Article; Review |
Journal Detail:
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Title: Journal of clinical pharmacology Volume: 32 ISSN: 0091-2700 ISO Abbreviation: J Clin Pharmacol Publication Date: 1992 Feb |
Date Detail:
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Created Date: 1992-07-30 Completed Date: 1992-07-30 Revised Date: 2007-11-15 |
Medline Journal Info:
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Nlm Unique ID: 0366372 Medline TA: J Clin Pharmacol Country: UNITED STATES |
Other Details:
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Languages: eng Pagination: 141-7 Citation Subset: IM |
Affiliation:
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Department of Internal Medicine, Massapequa General Hospital, Seaford, LI, New York. |
Export Citation:
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APA/MLA Format Download EndNote Download BibTex |
| MeSH Terms | |
Descriptor/Qualifier:
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Ambulatory Care
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economics Arrhythmias, Cardiac / chemically induced Cardiomyopathies / drug therapy, metabolism Dobutamine / adverse effects, economics, therapeutic use* Drug Tolerance Heart Failure / drug therapy*, metabolism, physiopathology Hemodynamics / drug effects Humans Oxygen Consumption |
| Chemical | |
Reg. No./Substance:
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34368-04-2/Dobutamine |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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