PMID: 9558423Apr 29, 1998Paper

Catecholamines and their blockade in congestive heart failure

American Journal of Health-system Pharmacy : AJHP : Official Journal of the American Society of Health-System Pharmacists
C M White

Abstract

The hemodynamic effects of sympathetic nervous system stimulation and the benefits of catecholamine blockade in patients with congestive heart failure (CHF) are discussed. Prolonged stimulation of the sympathetic nervous system promotes disease progression in patients with CHF. The level of circulating norepinephrine is the factor most closely correlated with prognosis. Long-term catecholamine stimulation of beta-receptors in the myocardium reduces the ability of catecholamines to improve cardiac contractility. CHF patients have higher vascular resistance (afterload) than healthy persons, increasing the strain on the heart. Also, beta 1-adrenergic activity stimulates renin release, which is deleterious in CHF. Clinical trials suggest that long-term (greater than one month), carefully dose-adjusted therapy with beta-blockers improves symptoms, ventricular ejection fraction, exercise time, and quality of life in patients with CHF, but it is unclear whether beta-blockers reduce mortality. Some patients cannot tolerate even the lowest starting dosages of beta-blockers, and withdrawal of these agents may result in clinical and hemodynamic deterioration. Carvedilol, which has beta-blocking, alpha-blocking, and antioxidant properties,...Continue Reading

Citations

Mar 21, 2002·Clinical and Experimental Pharmacology & Physiology·P BousquetJ Feldman
Jan 31, 2003·Congestive Heart Failure·Kenneth M Leclerc, Wayne C Levy
Sep 7, 2019·American Journal of Physiology. Heart and Circulatory Physiology·Hong ZhengKaushik P Patel
Dec 17, 2010·American Journal of Physiology. Renal Physiology·Hong ZhengKaushik P Patel
Jan 31, 2018·Journal of Nuclear Cardiology : Official Publication of the American Society of Nuclear Cardiology·Kevin Curl, Christopher L Hansen
Apr 4, 2000·AACN Clinical Issues·J Gilbert, L Lazio
Oct 26, 2002·The Annals of Pharmacotherapy·James S Kalus, C Michael White
Mar 2, 2021·Journal of Molecular and Cellular Cardiology·Xenia KaidonisRobert M Graham

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