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      Captopril in Refractory Heart Failure: Clinical and Hemodynamic Observations

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      S. Karger AG

      Captopril, Heart failure, Hemodynamic effects

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          10 patients suffering from refractory heart failure were treated with an oral angiotensin converting enzyme inhibitor captopril. The etiology of heart failure in 9 patients was related to ischemic heart disease, and to valvular heart disease in 1 patient. All patients experienced subjective improvement and feeling of well-being. The functional capacity improved to class II-IIB. Serial chest X-ray films showed improvement in pulmonary congestion. The time course of the hemodynamic effect appeared to 0.5–1.5 h after intake, and tended to disappear about 6 h later. The optimal dose of the drug achieving maximal hemodynamic benefit without excessive hypotension was 50 mg. Some of the patients exhibited a triphasic response. The cardiac index increased from 1.99 ± 0.1 to 2.69 ± 0.151/min/m (p < 0.001), while pulmonary capillary wedge pressure decreased from 25.3 ± 5.86 to 13.67 ± 4.14 mm Hg (p < 0.001). Mean peripheral arterial blood pressure decreased from 90.06 ± 3.7 to 71.4 ± 2.7 mm Hg. The total peripheral resistance decreased from 1,942 ± 169 to 1,170 ± 109 dyn × s × cm<sup>-5</sup>. The total pulmonary resistance decreased from 272.6 ± 42.9 to 142.34 ± 13.76 dyn × s × cm<sup>-5</sup>. Heart rate decreased from 83.4 ± 10.9 to 70.8 ± 10.14 bpm (p < 0.01). During a 6-month follow-up period the beneficial clinical effects of captopril were sustained, without late vasodilator tolerance. 1 death, unrelated to captopril, occurred. 2 patients developed transient rash, and 1 experienced transient dysgeusia.

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          Author and article information

          S. Karger AG
          07 November 2008
          : 70
          : 6
          : 326-332
          Heart Institute and Intensive Coronary Care Unit, Haifa City Medical Center (Rothschild), and Faculty of Medicine, Technion Haifa, Israel
          173615 Cardiology 1983;70:326–332
          © 1983 S. Karger AG, Basel

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          Pages: 7
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