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      Bolus versus Continuous Low Dose of Enalaprilat in Congestive Heart Failure with Acute Refractory Decompensation


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          The first dose of angiotensin-converting enzyme (ACE) inhibitors may trigger a considerable fall of blood pressure in chronic heart failure. The response may be dose-related. To determine hemodynamic and systemic oxygenation effects of low-dose enalaprilat, we administered intravenous enalaprilat (0.004 mg/kg) as bolus (group B) or continuous 1-hour infusion (group C) in 20 patients with congestive heart failure due to ischemic heart disease with acute decompensation refractory to inotropic, vasodilator and diuretic therapy. Hemodynamic and systemic oxygenation variables were recorded at baseline (+0 min), +30, +60, +120, +180, and +360 min after the start of intervention. Mean arterial pressure (MAP) (p < 0.001), mean pulmonary artery pressure (MPAP) (p < 0.001), pulmonary artery occlusion pressure (PAOP) (p < 0.001), oxygen extraction ratio (ER) (p < 0.026) decreased regardless of enalaprilat application. Compared to group B, there was in group C prolonged decrease of MAP, MPAP, PAOP, ER and increase of pulmonary artery oxyhemoglobin saturation in regard to baseline values. Cardiac index, heart rate, central venous pressure and oxygen consumption index did not change. A low dose of intravenous enalaprilat (0.004 mg/kg) can be used to safely improve hemodynamics and systemic oxygenation in congestive heart failure due to ischemic heart disease with acute refractory decompensation.

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          Author and article information

          S. Karger AG
          June 1999
          18 June 1999
          : 91
          : 1
          : 41-49
          aDepartment for Intensive Internal Medicine, General Hospital, Celje, and bCentre for Intensive Internal Medicine, University Clinical Centre, Ljubljana, Slovenia
          6875 Cardiology 1999;91:41–49
          © 1999 S. Karger AG, Basel

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          Page count
          Figures: 1, Tables: 2, References: 21, Pages: 9
          Clinical Pharmacology

          General medicine,Neurology,Cardiovascular Medicine,Internal medicine,Nephrology
          Congestive heart failure,Hypotension,Systemic oxygenation,Systemic hemodynamics,Ischemic heart disease,Enalaprilat


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