Open AccessBridge to ß Blockade in Severe Heart Failure: The Use of Phosphodiesterase Inhibitors
Author(s) -
Muhammad Khalid,
Ventura Hector O.,
Stapleton Dwight D.,
Smart Frank W.
Publication year - 2000
Publication title -
congestive heart failure
Language(s) - English
Resource type - Journals
eISSN - 1751-7133
pISSN - 1527-5299
DOI - 10.1111/j.1527-5299.2000.80154.x
Subject(s) - milrinone , medicine , heart failure , inotrope , blockade , carvedilol , cardiology , placebo , pharmacology , receptor , alternative medicine , pathology
The authors describe the use of milrinone as a bridge to β blockade in a patient with severe heart failure. This case is clinically important because in patients with severe heart failure phosphodiesterase inhibitors, unlike β agonists, will retain their positive inotropic and vasodilator effects in the presence of β blockade and, in addition, these agents will attenuate the negative inotropic side effects of β blockers. Conversely, a β blocker associated with a phosphodiesterase inhibitor will protect against myocyte loss and arrhythmias, may prevent sudden death, and will improve long term symptoms and exercise tolerance. This combination is being investigated in a large, multicenter, double‐blind, randomized trial of intravenous milrinone vs. placebo as a therapeutic tool to allow the initiation of carvedilol orally in patients hospitalized with Class III/IV heart failure.