0
ARTICLE |

Vasodilator Therapy for Congestive Heart Failure—New Use for Old Drugs FREE

Rex N. MacAlpin, MD
[+] Author Affiliations

Address editorial communications to the Editor, 535 N Dearborn St, Chicago, IL 60610.


JAMA. 1978;240(5):461-462. doi:10.1001/jama.1978.03290050051018
Text Size: A A A
Published online

The magnitude of systolic shortening of cardiac muscle is related directly to the diastolic length of the muscle and to its contractile state, and inversely to the force against which it must shorten (afterload). The normal heart in diastole operates on a compliant part of its tension-length curve, ie, a small increase in distending force (filling pressure or preload) stretches the muscle a relatively large amount and causes a relatively great increase in diastolic volume. If the afterload remains unchanged, this distended ventricle will in systole eject an increased stroke volume. This is a means whereby the normal heart can increase its stroke output in response to an increase in input without resorting to an increase in heart rate or basic contractile state. By the same mechanism it can also maintain its stroke volume in the face of an increased afterload at the expense of a small increase in diastolic

REFERENCES

Johnson JB, Gross JF, Hale E:  Effects of sublingual administration of nitroglycerin on pulmonary-artery pressure in patients with failure of the left ventricle . N Engl J Med 257:1114-1117, 1957;.
Sarnoff SJ, Berglund E:  Neurohemodynamics of pulmonary edema: IV. Effect of systemic vasoconstriction and subsequent vasodilation on flow and pressures in systemic and pulmonary vascular beds . Am J Physiol 170:588-600, 1952;.
Guiha NH, Cohn JN, Mikulic E, et al:  Treatment of refractory heart failure with infusion of nitroprusside . N Engl J Med 291:587-592, 1974;.
Chatterjee K, Parmley WW:  The role of vasodilator therapy in heart failure . Prog Cardiovasc Dis 19:301-325, 1977;.
Ross J Jr:  Effects of afterload or impedence on the heart: Afterload reduction in the treatment of cardiac failure . Cardiovasc Med 2:1115-1132, 1977;.
Awan NA, Miller RR, Maxwell KS, et al:  Prazosin—An oral nitroprusside: Demonstration of similar peripheral circulatory actions on systemic resistance and capacitance beds with marked hemodynamic improvement in severe chronic congestive heart failure patients , abstracted. Circulation 56( (suppl 3) ):223, 1977;.
Kovick RB, Tillisch JH, Berens SC, et al:  Vasodilator therapy for chronic left ventricular failure . Circulation 53:322-328, 1976;.
Chatterjee K, Parmley WW, Massie B, et al:  Oral hydralazine therapy for chronic refractory heart failure . Circulation 54:879-883, 1976;.
Jacobs W, Henrick A, Loeb H, et al:  Non-invasive assessment of daily hydralazine therapy in patients with advanced cardiac failure , abstracted. Circulation 56( (suppl 3) ):225, 1977;.
Franciosa JA, Pierpont GL, Cohn JN:  Acute postural and exercise hemodynamic effects of vasodilators in heart failure , abstracted. Circulation 56( (suppl 3) ):175, 1977;.

Figures

Tables

Interactive Graphics

Video

Country-Specific Mortality and Growth Failure in Infancy and Yound Children and Association With Material Stature

Use interactive graphics and maps to view and sort country-specific infant and early dhildhood mortality and growth failure data and their association with maternal

Johnson JB, Gross JF, Hale E:  Effects of sublingual administration of nitroglycerin on pulmonary-artery pressure in patients with failure of the left ventricle . N Engl J Med 257:1114-1117, 1957;.
Sarnoff SJ, Berglund E:  Neurohemodynamics of pulmonary edema: IV. Effect of systemic vasoconstriction and subsequent vasodilation on flow and pressures in systemic and pulmonary vascular beds . Am J Physiol 170:588-600, 1952;.
Guiha NH, Cohn JN, Mikulic E, et al:  Treatment of refractory heart failure with infusion of nitroprusside . N Engl J Med 291:587-592, 1974;.
Chatterjee K, Parmley WW:  The role of vasodilator therapy in heart failure . Prog Cardiovasc Dis 19:301-325, 1977;.
Ross J Jr:  Effects of afterload or impedence on the heart: Afterload reduction in the treatment of cardiac failure . Cardiovasc Med 2:1115-1132, 1977;.
Awan NA, Miller RR, Maxwell KS, et al:  Prazosin—An oral nitroprusside: Demonstration of similar peripheral circulatory actions on systemic resistance and capacitance beds with marked hemodynamic improvement in severe chronic congestive heart failure patients , abstracted. Circulation 56( (suppl 3) ):223, 1977;.
Kovick RB, Tillisch JH, Berens SC, et al:  Vasodilator therapy for chronic left ventricular failure . Circulation 53:322-328, 1976;.
Chatterjee K, Parmley WW, Massie B, et al:  Oral hydralazine therapy for chronic refractory heart failure . Circulation 54:879-883, 1976;.
Jacobs W, Henrick A, Loeb H, et al:  Non-invasive assessment of daily hydralazine therapy in patients with advanced cardiac failure , abstracted. Circulation 56( (suppl 3) ):225, 1977;.
Franciosa JA, Pierpont GL, Cohn JN:  Acute postural and exercise hemodynamic effects of vasodilators in heart failure , abstracted. Circulation 56( (suppl 3) ):175, 1977;.
CME Course for:


You need to register in order to view this quiz.


To understand the clinical management of acute heart failure syndromes.
Accreditation Information 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.
Note: You must get at least of the answers correct to pass this quiz.
Note: You must get at least of the answers correct to pass this quiz.
You have not filled in all the answers to complete this quiz
The following questions were not answered:
Sorry, you have unsuccessfully completed this CME quiz with a score of
The following questions were not answered correctly:
For CME Course: A Proposed Model for Initial Assessment and Management of Acute Heart Failure Syndromes
Indicate what changes(s) you will implement in your practice, if any, based on this CME course.
To view and print your certificate and access a summary of your CME courses go to My CME.
NOTE:
Citing articles are presented as examples only. In non-demo SCM6 implementation, integration with CrossRef’s “Cited By” API will populate this tab (http://www.crossref.org/citedby.html).
Submit a Response

Some tools below are only available to our subscribers or users with an online account.

Related Content

Customize your page view by dragging & repositioning the boxes below.