Vasodilator and inotropic agents in treatment of chronic cardiac failure: clinical experience and response in...

The sensations of breathlessness and fatigue limit the capacity of patients with chronic congestive cardiac failure (CHF) to participate in physical activities. As a result, patients with CHF gauge quality of life in terms of symptom-free activities they can undertake. Physicians attempt to alleviate these limiting symptoms and increase the exercise capacity of patients with CHF by therapeutic interventions. In recent years a variety of systemic vasodilators and inotropic agents have been introduced to aid digitalis and diuretics in improving cardiac performance in patients with CHF. Although the pumping function of the heart is enhanced at rest, it remains to be determined whether exercise tolerance is also improved. In this paper we review our clinical experience with a number of systemic vasodilators and positive inotropic agents, focusing particular attention on their influence on exercise performance in patients with CHF. This experience includes (1) 28-week double-blind study of hydralazine vs placebo in 19 patients with CHF, (2) 52-week double-blind crossover study of trimazosin (alpha 1 blockade) vs placebo in 27 patients with CHF of varying severity, and (3) open study of amrinone (positive inotropic agent) in 12 patients with CHF.