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Complementary combined captopril and terbutaline therapy in severe chronic congestive heart failure
Insights
Captopril (CPT) and terbutaline (TBT) significantly improve cardiac function in severe congestive heart failure (CHF). Their combined use offers additive benefits, enhancing the failing heart
Area of Science:
- Cardiology
- Pharmacology
Background:
- Severe chronic congestive heart failure (CHF) presents significant challenges in improving cardiac function.
- Pharmacological interventions aim to enhance the performance of the failing heart.
Purpose of the Study:
- To evaluate the hemodynamic effects of captopril (CPT) alone and in combination with terbutaline (TBT) in patients with severe CHF.
- To determine if the combination therapy provides additive benefits to CPT's effects.
Main Methods:
- Hemodynamic parameters were assessed in 10 patients with severe CHF.
- Measurements included heart rate, systemic blood pressure, left ventricular filling pressure, cardiac index (CI), stroke index (SI), and total systemic vascular resistance.
- Patients received CPT alone and then in combination with TBT.
Main Results:
- CPT significantly lowered blood pressure and left ventricular filling pressure while increasing cardiac index and stroke index.
- TBT added to CPT did not alter blood pressure or filling pressures but further augmented cardiac index and stroke index.
- CPT reduced total systemic vascular resistance, an effect not further enhanced by TBT.
Conclusions:
- Both captopril and terbutaline markedly augment cardiac function in patients with severe CHF.
- The beneficial effects of the systemic vasodilator (CPT) appear additive to the beta-adrenergic agonist (TBT).
- Combination therapy provides substantial augmentation of function in the failing heart.
Abstract:
The hemodynamic effects of captopril (CPT) alone and in combination with the beta-adrenergic receptor agonist terbutaline (TBT) were evaluated in 10 patients with severe chronic congestive heart failure (CHF). The heart rate remained unchanged, while CPT lowered mean systemic blood pressure from 86 to 64 mm Hg (p less than 0.001) and decreased left ventricular filling pressure markedly from 27 to 19 mm Hg (p less than 0.001). The addition of TBT produced no further change in these variables (p greater than 0.05). Simultaneously, CPT augmented cardiac index (CI) from 2.1 to 2.9 L/min/m2 (p less than 0.001) and stroke index (SI) from 27 to 37 ml/beat/m2 (p less than 0.001). Concomitant CPT-TBT further raised CI to 3.2 L/min/m2 and SI to 40 ml/beat/m2 (both less than 0.001). Further, the CPT-effected decline in total systemic vascular resistance from 1577 to 841 dynes . sec . cm-5 (p less than 0.001) was not reduced additionally by CPT-TBT combination (p greater than 0.05). These results indicate than both CPT and TBT markedly augment cardiac function in CHF. Moreover, the salutary effects of the systemic vasodilator appear additive to the beneficial actions of the beta-adrenergic receptor agonist, thereby providing substantial augmentation of the function of the failing heart.