Overview
- Editors:
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Hj. Just
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Ch. Holubarsch
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H. Scholz
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Table of contents (25 papers)
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Cellular and subcellular mechanisms, energy turnover
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- Jan-Bjørn Osnes, H. Aass, T. Skomedal
Pages 9-17
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- A. M. Watanabe, F. Green, Z. Ahmad
Pages 19-22
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- Wilhelm Schmitz, C. Kohl, J. Neumann, H. Scholz, J. Scholz
Pages 23-33
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- Norman R. Alpert, E. M. Blanchard, L. A. Mulieri, R. Nagai, A. Zarain-Herberg, M. Periasamy
Pages 55-66
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Pharmacology of positive inotropic substances
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- A. E. Farah, C. J. Frangakis
Pages 85-103
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- M. Bechem, R. Gross, S. Hebisch, M. Schramm
Pages 105-116
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- J. W. Herzig, L. H. Botelho, R. J. Solaro
Pages 117-124
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- Otto-Erich Brodde, H.-R. Zerkowski
Pages 135-144
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Clinical experience with positive inotropic substances
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Front Matter
Pages 145-145
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- Gerd Hasenfuss, C. Holubarsch, E. M. Blanchard, L. A. Mulieri, N. R. Alpert, Hj. Just
Pages 147-155
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- H. Pouleur, C. van Eyll, J. Etienne, H. van Mechelen, A. Vuylsteke, M. F. Rousseau
Pages 157-162
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About this book
Inotropic stimulation of the myocardium, as well as vasodilation and diuresis as essential principles in the treatment of congestive heart failure have recently met with considerable criticism and reevaluation. It is generally agreed that unloading of the heart, either through vasodilation and/or diuresis, improves the working conditions of the dilated, failing heart. It reduces myocar dial oxygen consumption through reduction of chamber radius and, thereby, wall tension as the major determinants of myocardial oxygen consumption. Inotropic stimulation, quite in contrast, does not conserve oxygen. It rather consumes energy and that may be disadvantageous in situations of compromised oxygen supply and energy metabolism of the working myocardium. However, under conditions of suf ficient oxygen supply and metabolic support inotropic stimulation may bring about in creased pumping and subsequent improvement of myocardial failure. In recent years it could convincingly be demonstrated that vasodilation leads to symp tomatic improvement of congestive heart failure, improvement of exercise tolerance, and it prolongs life - especially in the case of ACE-inhibitors and the combination of hydra lazine with long-acting nitrates. Quite in contrast, equally beneficial effects could not be demonstrated for inotropic agents in congestive heart failure. Only for the cardiac glyco sides has it been shown that beneficial effects can be achieved, especially if atrial fibril lation with absolute arrhythmia is present. The influence of the cardiac glycosides on the latter represents an effect which is independent of the inotropic action.
