Unloading effects of vasodilators on peripheral circulation and cardiac hemodynamics in patients with acute myocardial infarction.

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概要

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• Effects of three representative vasodilators on peripheral and cardiac hemodynamics were studied in 20 patients with heart failure due to acute myocardial infarction (PCWP>18mmHg, Cl>2.20L/min/m2) using venous occlusion plethysmography and a Swan-Ganz catheter. Sublingual isosorbide dinitrate (ISDN) significantly increased calf venous capacitance (CVC) from 5 to 60min (p<0.01) and calf blood flow (CBF) in the initial 15min (p<0.05), while simultaneously lowering PCWP (p<0.05) and central venous pressure (p<0.05). Calf vascular resistance (CVR), cardiac index, blood pressure, and total systemic peripheral resistance (TSPR) were not affected significantly. Nitroglycerin ointment (NGO) significantly decreased CVR (p<0.05) and increased CVC (p<0.05) from 60 to 240min, simultaneously with lowering of PCWP (p<0.01), central venous pressure (p<0.05), and TSPR (p<0.05). Oral prazosin (Pz) increased CBF (p<0.01) and CVC (p<0.05) from 60 to 240min, simultaneously with significant lowering of PCWP (p<0.01) and TSPR (p<0.05), resulting in increased stroke work index (p<0.05). These data confirm that ISDN predominantly causes capacitance vessel dilatation and reduce excessive venous return, while Pz and NGO dilate not only capacitance vessels but also resistance vessels, consequently reducing systemic vascular resistance and resulting in increased peripheral blood flow and cardiac performance. It was observed that the higher the base-line calf vascular resistance rose, the better the response to the vasodilator treatment appeared in terms of a decrease in calf vascular resistance.

• International Heart Journal刊行会の論文

著者

• Endo Takao

  First Department Of Internal Medicine Nippon Medical School

• Takano Teruo

  First Department Of Internal Medicine Nippon Medical School

• Seino Yoshihiko

  First Department Of Internal Medicine Nippon Medical School

• Hayakawa Hirokazu

  First Department Of Internal Medicine Nippon Medical School

• KIMURA Eiichi

  First Department of Internal Medicine, Nippon Medical School

• TAKANO Teruo

  First Department of Medicine and Section of Coronary Care Unit, Nippon Medical School

• OBAYASHI Kanji

  First Department of Medicine and Section of Coronary Care Unit, Nippon Medical School

• VYDEN John

  First Department of Medicine and Section of Coronary Care Unit, Nippon Medical School

• ROSE Harold

  First Department of Medicine and Section of Coronary Care Unit, Nippon Medical School

• HAYAKAWA Hirokazu

  First Department of Medicine and Section of Coronary Care Unit, Nippon Medical School

• KIMURA Eiichi

  First Department of Medicine and Section of Coronary Care Unit, Nippon Medical School

• SEINO Yoshihiko

  First Department of Medicine and Section of Coronary Care Unit, Nippon Medical School

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