Restoring function in failing hearts: the effects of beta blockers

The American Journal of Medicine
E J Eichhorn

Abstract

Until recently, clinical management of congestive heart failure was purely palliative. The drugs used in patients with failing hearts--digoxin, vasodilators, and positive inotropic agents--improved contractility, reversed hemodynamic abnormalities, and enhanced functional status, but they failed to confer a survival benefit. Indeed, the use of inotropic agents often resulted in excess mortality--a paradox explained in part by the pharmacological properties of these agents, which increase production of cAMP, the intracellular messenger for the beta-adrenergic system. The short-term pharmacological benefits of these drugs may be offset by deleterious long-term biological effects on the heart muscle itself. The use of beta-blockers in heart failure is counterintuitive, given that their initial pharmacological effect is to reduce heart rate and contractility in a faltering heart, thus producing an effect diametrically opposed to that of inotropic agents. However, it is becoming more clear that beta-blocker therapy in patients with heart failure not only improves left ventricular function, but may actually reverse pathological remodeling in the heart. Accumulating clinical evidence indicates that these beneficial changes are the res...Continue Reading

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Citations

Jun 21, 2001·The Journal of Clinical Hypertension·M A Moore
Mar 8, 2003·Progress in Cardiovascular Nursing·Luann G Richardson
Dec 10, 1998·The New England Journal of Medicine·W H Frishman
Aug 30, 2001·European Journal of Clinical Investigation·G G BelzU Osowski
Jun 2, 2005·Expert Opinion on Investigational Drugs·John T ParissisDimitrios Kremastinos
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Jan 5, 2001·Expert Opinion on Investigational Drugs·M Kukin, R Moskowitz
Jan 10, 2018·Frontiers in Physiology·Aude AngeliniLiang Xie
Apr 3, 2003·Critical Care Nursing Quarterly·Karen A Tarolli
Jun 8, 1999·Current Opinion in Cardiology·B Bozkurt
Mar 10, 2001·Journal of Magnetic Resonance Imaging : JMRI·O StrohmM G Friedrich

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