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Article |

Vasodilators in the Treatment of Heart Failure

Jawahar Mehta, MD
JAMA. 1977;238(23):2534-2536. doi:10.1001/jama.1977.03280240080034.
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DURING the last few years, there has been a great deal of interest in vasodilator therapy in cases of acute and chronic heart failure. Better understanding of cardiac physiology and development of bedside hemodynamic monitoring techniques using flowdirected catheters have provided impetus to evaluate different physiologic and pharmacologic interventions in acutely ill patients. Most patients with congestive heart failure have elevation of the left ventricular filling pressure (LVFP) and low cardiac output. Elevated LVFP (index of blood volume) is a compensatory phenomenon in the early stage of heart failure to maintain cardiac output. This beneficial effect may later result in excessive myocardial oxygen demand, decreased coronary flow, and symptoms of pulmonary congestion. Similarly, arterial constriction occurring initially in heart failure may be appropriate to maintain circulation to vital organs, but may eventually result in a decrease in cardiac output because of the elevated systemic vascular resistance.1

Experimental evidence shows


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The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
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