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Enalapril for severe heart failure in infancy
M Frenneaux1, R A Stewart, C M Newman
1Department of Cardiology, Hammersmith Hospital, London.
Insights
Enalapril shows promise in treating severe infant heart failure unresponsive to diuretics. This angiotensin-converting enzyme inhibitor improved clinical symptoms and key biomarkers in infants with heart conditions.
Area of Science:
- Pediatric Cardiology
- Pharmacology
- Critical Care Medicine
Background:
- Severe heart failure in infants often presents challenges with conventional treatments.
- Diuretic resistance necessitates exploring alternative therapeutic options for pediatric heart failure.
Purpose of the Study:
- To evaluate the efficacy and safety of enalapril in infants with severe heart failure refractory to diuretics.
- To assess the impact of enalapril on clinical status and biochemical markers in this population.
Main Methods:
- A cohort of eight infants with severe heart failure received enalapril, starting at 0.1 mg/kg/day and titrated based on response.
- Infants had conditions including congenital systemic to pulmonary shunts and aortic coarctation.
- One infant with myocarditis was excluded due to hypotension and subsequent mortality.
Main Results:
- All infants who tolerated enalapril showed clinical improvement in heart failure symptoms within two weeks.
- Mean plasma sodium levels increased significantly (129 to 136 mmol/l).
- Mean plasma urea concentrations decreased substantially (7.0 to 2.9 mmol/l).
Conclusions:
- Enalapril appears to be a potentially beneficial treatment for severe, diuretic-refractory heart failure in infants.
- The drug demonstrated positive effects on clinical status and electrolyte/renal function markers.
- Further investigation into enalapril's role in pediatric heart failure is warranted.
Abstract:
Eight infants aged between 4 days and 12 weeks with severe heart failure that was refractory to optimal conventional treatment with diuretics were treated with enalapril. The starting dose was 0.1 mg/kg/day, increasing according to response to 0.12-0.43 mg/kg/day. One infant with severe myocarditis did not tolerate enalapril because of hypotension and later died of intractable heart failure. Six of the remaining patients had congenital systemic to pulmonary shunts and one had a simple aortic coarctation. Two weeks after starting enalapril the clinical features of heart failure had improved in all the infants, the mean (SEM) plasma sodium concentration had increased from 129 (2.4) to 136 (1.1) mmol/l and plasma urea concentration had fallen from 7.0 (0.85) to 2.9 (0.85) mmol/l. These data suggest that enalapril is a potentially useful treatment for severe heart failure in infancy.