Advertisement

Afterload reduction with phentolamine in patients with acute pulmonary edema

      This paper is only available as a PDF. To read, Please Download here.

      Abstract

      Phentolamine in amounts of 10 to 40 μg/kg/min was infused intravenously for the emergency treatment of acute pulmonary edema due to left ventricular failure. Fourteen patients with arteriosclerotic heart disease, ranging in age from 52 to 87 years, had clinical and roentgenographic signs of pulmonary edema. The pulmonary artery wedge pressure was increased to an average of 24 mm Hg and the cardiac index was decreased to 1.9 liters/min/m2 or less prior to the administration of phentolamine. A reduction in the pulmonary artery wedge pressure to 14 mm Hg and an increase in the cardiac index to 2.5 liters/min/m2 was observed in response to this alpha adrenergic blocking agent. Reduction in peripheral resistance with phentolamine was associated with reversal of pulmonary edema.
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to The American Journal of Medicine
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Cohn JN
        Vasodilator therapy for heart failure. The influence of impedance on left ventricular performance.
        Circulation. 1973; 48: 5
        • Zelis R
        • Mason DT
        Compensatory mechanisms in congestive heart failure: the role of the peripheral resistance vessels.
        N Engl J Med. 1970; 282: 962
        • Spann JF
        • Mason DT
        • Zelis RF
        Recent advances in the understanding of congestive heart failure.
        Modern Concepts of Cardiovasc Dis. 1970; 39: 79
        • Cohn JN
        Vasodilator therapy of myocardial infarction.
        N Engl J Med. 1974; 290: 1433
        • Goodman CS
        • Gilman A
        The Pharmacological Basis of Therapeutics.
        in: MacMillan Publishing Co., Inc, New York1975: 541
        • Turner AF
        • Lau FJ
        • Jacobson G
        A method for the estimation of pulmonary venous and arterial pressures from the routine chest roentgenograms.
        Am J Roentgenol, Radium Ther Nuclear Med. 1972; 116: 97
        • Forrester JS
        • Ganz W
        • Diamond G
        • et al.
        Thermodilution cardiac output determination with a single flow directed catheter.
        Am Heart J. 1972; 83: 306
        • Rystrom L
        • Weil MH
        • Shubin H
        • et al.
        Technique of measurement of the plasma volume and red blood cell mass during acute circulatory failure.
        Surg Gynec Obstet. 1971; 133: 621
        • Shubin H
        • Weil MH
        The mechanisms of shock following suicidal doses of barbiturate, narcotics and tranquilizing drugs, with observations on the effects of treatment.
        Am J Med. 1965; 38: 853
        • Braunwald E
        • Ross J
        • Sonnenblick EH
        Myocardial Energetics in Mechanisms of Contraction of the Normal and Failing Heart.
        in: Little, Brown and Co, Boston1976: 166
        • Miller RR
        • Vismara LA
        • Zelis R
        • et al.
        Clinical use of nitroprusside in chronic ischemic heart disease.
        Circulation. 1975; 51: 328
        • Guiha N
        • Cohn JN
        • Mikulic E
        • et al.
        Treatment of refractory heart failure with infusion of nitroprusside.
        N Engl J Med. 1974; 291: 589
        • Chatterjee K
        • Swan HJC
        Vasodilator therapy in acute myocardial infarction.
        Mod Concepts Cardiovasc Dis. 1974; 43: 119
        • da Luz PL
        • Forrester JS
        • Wyatt HL
        • et al.
        Hemodynamic and metabolic effects of sodium nitroprusside on performance and metabolism of regional ischemic myocardium.
        Circulation. 1975; 52: 400
        • da Luz PL
        • Shubin H
        • Weil MH
        Effectiveness of phentolamine for the reversal of circulatory failure.
        Crit Care Medicine. 1973; 1: 135
        • Nourok DS
        • Glassock RJ
        • Solomon DH
        • et al.
        Hypothyroidism following prolonged sodium nitroprusside therapy.
        Am J Med Sci. 1964; 248: 129
        • Brodie TS
        • Gray R
        • Swan HJC
        • et al.
        Effect of nitroprusside on arterial oxygenation, intrapulmonic shunts, and oxygen delivery.
        Am J Cardiol. 1976; 37: 123
        • Chatterjee K
        • Swan HJC
        Vasodilator therapy in acute myocardial infarction.
        Mod Concepts Cardiovasc Dis. 1974; 43: 119
        • Palmer RF
        • Lasseter KC
        Sodium nitroprusside.
        N Engl J Med. 1975; 292: 294
        • Gould L
        • Zahir M
        • Ettingu S
        Phentolamine and cardiovascular performance.
        Br Heart J. 1969; 31: 154
        • Taylor SH
        • Sutherland GR
        • MacKenzie GJ
        • et al.
        The circulatory effects of intravenous phentolamine in man.
        Circulation. 1965; 31: 741
        • Taylor SH
        • MacKenzie GJ
        • George M
        • et al.
        Effects of adrenergic blockade on the pulmonary circulation in man.
        Br Heart J. 1965; 27: 627
        • Villani F
        • Perret C
        • Jaquier E
        • et al.
        Effect of phentolamine on peripheral venous distensability in congestive heart failure.
        Eur J Clin Pharmacol. 1974; 7: 11
        • Zelis R
        • Mason DT
        • Braunwald E
        A comparison of the effects of vasodilator stimuli on peripheral resistance vessels in normal subjects and in patients with congestive heart failure.
        J Clin Invest. 1968; 47: 960
        • Williams DC
        • Hillard GK
        • Cantor SA
        • et al.
        Comparative effects of ventricular unloading by systemic vasodilator agents in therapy of cardiac failure: nitroprusside vs. phentolamine.
        Am J Cardiol. 1975; 35: 175
        • Miller RR
        • Williams DO
        • DeNaria AN
        • et al.
        Ventricular afterload-reducing agents in congestive heart failure. Congestive Heart Failure.
        in: Yorke Medical Books, New York1976: 343
        • Nickerson M
        Sympathetic blockage in the therapy of shock.
        Am J Cardiol. 1963; 12: 619
        • Cohn JN
        Relationship of plasma volume changes to resistance and capacitance vessels, effects of sympathomimetic amines and angiotensin in man.
        Clin Sci. 1966; 30: 267