Inotropes and β-blockers: Is there a need for new guidelines?

Michael R. Bristow, Simon F. Shakar, Jennifer V. Linseman, Brian D. Lowes

Research output: Contribution to journalArticle

59 Citations (Scopus)

Abstract

β-Adrenergic blocking agents are standard treatment for patients with mild-to-moderate heart failure. When patients receiving β-blockers decompensate they often need treatment with a positive inotropic agent. The β-agonist dobutamine may not produce much increase in cardiac output during full-dose β-blocker treatment and may increase systemic vascular resistance via α-adrenergic stimulation. In contrast, phosphodiesterase inhibitors (PDEIs) such as milrinone or enoximone retain full hemodynamic effects during complete β-blockade because the site of action of PDEIs is beyond the β-adrenergic receptor and because β-blockade reverses some of the desensitization phenomena that account for the attenuation of PDEI response in heart failure related to upregulation in Gαi. Inotrope-requiring subjects with decompensated heart failure who are undergoing long-term therapy with β-blocking agents should be treated with a type III-specific PDEI, not a β-agonist such as dobutamine.

Original languageEnglish (US)
Pages (from-to)8-12
Number of pages5
JournalJournal of Cardiac Failure
Volume7
Issue number2 PART II
DOIs
StatePublished - Jan 1 2001

Fingerprint

Phosphodiesterase Inhibitors
Guidelines
Dobutamine
Heart Failure
Enoximone
Milrinone
Adrenergic Antagonists
Therapeutics
Cardiac Output
Vascular Resistance
Adrenergic Agents
Adrenergic Receptors
Up-Regulation
Hemodynamics

Keywords

  • Contractility
  • Heart failure
  • Inotropes
  • β-blockers

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Inotropes and β-blockers : Is there a need for new guidelines? / Bristow, Michael R.; Shakar, Simon F.; Linseman, Jennifer V.; Lowes, Brian D.

In: Journal of Cardiac Failure, Vol. 7, No. 2 PART II, 01.01.2001, p. 8-12.

Research output: Contribution to journalArticle

Bristow, Michael R. ; Shakar, Simon F. ; Linseman, Jennifer V. ; Lowes, Brian D. / Inotropes and β-blockers : Is there a need for new guidelines?. In: Journal of Cardiac Failure. 2001 ; Vol. 7, No. 2 PART II. pp. 8-12.
@article{94625bd431684dc390422784e10235d2,
title = "Inotropes and β-blockers: Is there a need for new guidelines?",
abstract = "β-Adrenergic blocking agents are standard treatment for patients with mild-to-moderate heart failure. When patients receiving β-blockers decompensate they often need treatment with a positive inotropic agent. The β-agonist dobutamine may not produce much increase in cardiac output during full-dose β-blocker treatment and may increase systemic vascular resistance via α-adrenergic stimulation. In contrast, phosphodiesterase inhibitors (PDEIs) such as milrinone or enoximone retain full hemodynamic effects during complete β-blockade because the site of action of PDEIs is beyond the β-adrenergic receptor and because β-blockade reverses some of the desensitization phenomena that account for the attenuation of PDEI response in heart failure related to upregulation in Gαi. Inotrope-requiring subjects with decompensated heart failure who are undergoing long-term therapy with β-blocking agents should be treated with a type III-specific PDEI, not a β-agonist such as dobutamine.",
keywords = "Contractility, Heart failure, Inotropes, β-blockers",
author = "Bristow, {Michael R.} and Shakar, {Simon F.} and Linseman, {Jennifer V.} and Lowes, {Brian D.}",
year = "2001",
month = "1",
day = "1",
doi = "10.1054/jcaf.2001.26655",
language = "English (US)",
volume = "7",
pages = "8--12",
journal = "Journal of Cardiac Failure",
issn = "1071-9164",
publisher = "Churchill Livingstone",
number = "2 PART II",

}

TY - JOUR

T1 - Inotropes and β-blockers

T2 - Is there a need for new guidelines?

AU - Bristow, Michael R.

AU - Shakar, Simon F.

AU - Linseman, Jennifer V.

AU - Lowes, Brian D.

PY - 2001/1/1

Y1 - 2001/1/1

N2 - β-Adrenergic blocking agents are standard treatment for patients with mild-to-moderate heart failure. When patients receiving β-blockers decompensate they often need treatment with a positive inotropic agent. The β-agonist dobutamine may not produce much increase in cardiac output during full-dose β-blocker treatment and may increase systemic vascular resistance via α-adrenergic stimulation. In contrast, phosphodiesterase inhibitors (PDEIs) such as milrinone or enoximone retain full hemodynamic effects during complete β-blockade because the site of action of PDEIs is beyond the β-adrenergic receptor and because β-blockade reverses some of the desensitization phenomena that account for the attenuation of PDEI response in heart failure related to upregulation in Gαi. Inotrope-requiring subjects with decompensated heart failure who are undergoing long-term therapy with β-blocking agents should be treated with a type III-specific PDEI, not a β-agonist such as dobutamine.

AB - β-Adrenergic blocking agents are standard treatment for patients with mild-to-moderate heart failure. When patients receiving β-blockers decompensate they often need treatment with a positive inotropic agent. The β-agonist dobutamine may not produce much increase in cardiac output during full-dose β-blocker treatment and may increase systemic vascular resistance via α-adrenergic stimulation. In contrast, phosphodiesterase inhibitors (PDEIs) such as milrinone or enoximone retain full hemodynamic effects during complete β-blockade because the site of action of PDEIs is beyond the β-adrenergic receptor and because β-blockade reverses some of the desensitization phenomena that account for the attenuation of PDEI response in heart failure related to upregulation in Gαi. Inotrope-requiring subjects with decompensated heart failure who are undergoing long-term therapy with β-blocking agents should be treated with a type III-specific PDEI, not a β-agonist such as dobutamine.

KW - Contractility

KW - Heart failure

KW - Inotropes

KW - β-blockers

UR - http://www.scopus.com/inward/record.url?scp=0035376795&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=0035376795&partnerID=8YFLogxK

U2 - 10.1054/jcaf.2001.26655

DO - 10.1054/jcaf.2001.26655

M3 - Article

C2 - 11605160

AN - SCOPUS:0035376795

VL - 7

SP - 8

EP - 12

JO - Journal of Cardiac Failure

JF - Journal of Cardiac Failure

SN - 1071-9164

IS - 2 PART II

ER -