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Captopril in heart failure secondary to a left to right shunt
N J Shaw1, N Wilson, D F Dickinson
1Regional Paediatric Cardiology Unit, Killingbeck Hospital, Leeds.
Insights
Captopril improved heart failure in infants with congenital heart defects by increasing weight gain and decreasing respiratory rate. While generally safe, potential side effects like hypotension and renal issues require monitoring.
Area of Science:
- Pediatric Cardiology
- Pharmacology
Background:
- Infantile heart failure often results from congenital heart defects.
- Conventional treatments like digoxin and diuretics may not sufficiently manage these conditions.
Purpose of the Study:
- To evaluate the efficacy and safety of captopril in infants with heart failure.
- To assess captopril's impact on infant growth and respiratory status.
Main Methods:
- Captopril was administered to 20 infants under 1 year with heart failure.
- Dosage ranged from 0.88 to 2.5 mg/kg/day in divided doses.
- Outcomes measured included weight gain and respiratory rate.
Main Results:
- Captopril treatment led to a significant increase in weight gain (48 to 102 g/week).
- Mean respiratory rate decreased from 68 to 60 breaths/minute.
- Side effects included mild hypotension (2 infants) and renal issues (2 infants).
Conclusions:
- Captopril demonstrates efficacy in improving heart failure control in infants.
- It positively impacts key indicators of infant well-being.
- Careful monitoring for potential renal adverse effects is recommended.
Abstract:
Captopril was used in 20 infants aged less than 1 year with heart failure secondary to defects with predominantly a left to right shunt that was poorly controlled with digoxin and diuretics. Total daily dose of captopril ranged from 0.88 to 2.5 mg/kg (mean 1.3 mg/kg) in three divided doses. Improvement in the control of heart failure was seen mainly as an increase in the rate of weight gain from a mean of 48 g/week before treatment to 102 g/week on treatment and a decrease in the mean respiratory rate from 68 breaths/minute to 60 breaths/minute. Side effects were seen in four patients--two with asymptomatic mild hypotension, one with renal insufficiency which improved with a reduction in dose, and one with severe oliguria progressing to renal failure. Significant changes in plasma electrolyte concentration did not occur except in the infant who developed acute renal failure.