Asunto(s)
Gasto Cardíaco Bajo/tratamiento farmacológico , Isradipino/uso terapéutico , Infarto del Miocardio/complicaciones , Nifedipino/uso terapéutico , Gasto Cardíaco Bajo/etiología , Estudios de Evaluación como Asunto , Femenino , Hemodinámica , Humanos , Infusiones Intravenosas , Isradipino/administración & dosificación , Masculino , Nifedipino/administración & dosificaciónRESUMEN
The impact of intravenous infusion of nifedipine and nitroglycerin on invasive central hemodynamic parameters and microcirculation was compared in 94 patients with acute myocardial infarction complicated by heart failure. The artery dilating effects of nifedipine were associated with baseline peripheral vascular tone, so the comparison was made separately in the groups with and without vasoconstriction. Nifedipine seems to be beneficial in the management of heart failure due to acute myocardial infarction in patients with systemic vasoconstriction. In patients with severe pulmonary congestion and normal left ventricular afterload, the intravenous vasodilators are preferable.
Asunto(s)
Insuficiencia Cardíaca/tratamiento farmacológico , Hemodinámica/efectos de los fármacos , Infarto del Miocardio/tratamiento farmacológico , Nifedipino/uso terapéutico , Nitroglicerina/uso terapéutico , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Insuficiencia Cardíaca/etiología , Insuficiencia Cardíaca/fisiopatología , Humanos , Infusiones Intravenosas , Masculino , Persona de Mediana Edad , Infarto del Miocardio/complicaciones , Infarto del Miocardio/fisiopatología , Nifedipino/farmacología , Nitroglicerina/farmacologíaRESUMEN
The efficacy of intravenous nifedipine was examined in 42 patients with acute myocardial infarction complicated by congestive heart failure. In patients with a higher systemic arteriolar tone, its normalization caused an increase in cardiac output and tissue oxygen supply with a concomitant decrease in pressures in the lesser circulation and the right heart. In contrast, a cardiodepressive effect of the agent was shown in more than a half of the patients with para-normal values of peripheral vascular resistance. The latter is one of the determinants in selecting patients with acute heart failure to be treated with nifedipine.
Asunto(s)
Cardiomiopatía Dilatada/tratamiento farmacológico , Infarto del Miocardio/complicaciones , Nifedipino/administración & dosificación , Anciano , Cardiomiopatía Dilatada/etiología , Cardiomiopatía Dilatada/fisiopatología , Esquema de Medicación , Femenino , Hemodinámica/efectos de los fármacos , Hemodinámica/fisiología , Humanos , Bombas de Infusión , Inyecciones Intravenosas , Masculino , Persona de Mediana EdadRESUMEN
In 40 patients with massive myocardial infarction, the central hemodynamics was examined by probing the right-sided chambers of the heart and the pulmonary artery. The cardiac output was measured by thermodilution. The gas exchange (respiratory minute volume, capnography, gas analysis of arterial and mixed venous blood) was explored. Arterial hypoxemia was found to be associated with increased intrapulmonary blood shunting in patients with acute myocardial infarction complicated by congestive heart failure. Deterioration of arterial hypoxemia was promoted by a combination of increased overall pulmonary shunting and decreased residual venous oxygenation. Abnormalities in the ventilation-perfusion relations are of great importance.