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Query: UMLS:C0034063 (pulmonary edema)
 10,665 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

The use of vasodilators represents a new approach to the treatment of cardiac insufficiency, either chronic or acute. Their field of action is venous, arterial or mixed. Decreasing the pre-load, the "venous" vasodilators lighten the congestive symptoms of cardiac insufficiency. By decreasing the post-load, the "arterial" vasodilation increases the cardiac output. Some vasodilators, venously administered, imply a continuous hemodynamic checking (Sodium Nitroprussiate, Phentolamine, injectable Trinitrine). Others are active orally (Trinitrine, Isosorbide Dinitrate, Hydralazine, etc.). Vasodilating treatment is recommended for acute cardiac insufficiency, particularly during myocardium infarct and some acute valvular insufficiencies. It is also successfully used in acute lung edema. Finally it takes an increasing importance in the treatment of chronic cardiac insufficiency.
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PMID:[Vasodilators in the treatment of cardiac insufficiency (author's transl)]. 53 77

We undertook a randomised between-group comparison of the haemodynamic effects of arteriolar dilatation and venodilatation in 20 males, following acute myocardial infarction, with persisting left ventricular failure after pretreatment with intravenous frusemide. All had radiographic pulmonary oedema and a pulmonary artery occluded pressure (PAOP) exceeding 15 mm Hg. The average cardiothoracic ratio was 52% (range 48-65%). Following control haemodynamic measurements, 10 patients received intravenous hydralazine (0.15 mg/kg) and 10 received intravenous isosorbide dinitrate infusion (50-200 micrograms/kg/h). Subsequent measurements were made at 30, 60, and 90 min. Isosorbide dinitrate reduced the PAOP by 3 mm Hg (p less than 0.01) and the mean systemic arterial pressure by 9 mm Hg (p less than 0.05) without significant change in the heart rate, cardiac output, or systemic vascular resistance. In contrast, hydralazine reduced the PAOP and systemic arterial pressure by a similar amount, but this was accompanied by a reduction in the systemic vascular resistance (p less than 0.01) and an increase in the cardiac output (p less than 0.01), heart rate (p less than 0.01), and stroke volume (p less than 0.01). This randomised study defines the contrasting haemodynamic results of arteriolar dilatation and venodilation in patients with resistant left ventricular failure following acute myocardial infarction. The different pharmacodynamic effects of these two methods of circulatory manipulation suggest that they are not mutually exclusive and together may offer therapeutic advantages.
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PMID:Arteriolar or venous dilatation in left ventricular failure following acute myocardial infarction: a haemodynamic trial of hydralazine and isosorbide dinitrate. 619 53

Isosorbide dinitrate (ISDN) was administered intravenously to 21 patients with severe cardiogenic pulmonary edema. In 15 cases the condition was due to coronary heart disease (3 of them had arterial hypertension additionally), and 3 patients due to cardiomyopathy. In the remaining 3 valvular disorders were prevailing. The ISDN solution was administered as an i.v. bolus followed by continuous i.v. injection from an automatic perfusion device. Oxygen, furosemide, and in some cases digitalis were given in addition. Monitoring consisted of clinical surveillance, blood gas analyses, and repeated X-ray control. The results obtained confirm the efficacy and safety of this mode of ISDN administration. This applies particularly for patients in whose therapy is aimed at fast control of life-threatening hypoxia. Despite extreme asphyxia, only three patients needed artificial respiration, one died in cardiogenic shock, while all others were rapidly improved. It could thus be demonstrated that this type of therapy may be safely and efficiently handled by careful clinical supervision, without invasive hemodynamic monitoring.
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PMID:[Acute treatment of severe cardiogenic pulmonary edema. Effect and tolerability of ISDN as bolus and continuous infusion]. 646 76