Ventricular failure, left acute

Morphine is used as an analgesic for acute and severe pain, as a sedative, as an antitussive, and for treatment of dyspnea in left ventricular failure and acute pulmonary edema. It is DEA Class II and has high drug abuse potential. 

Enalaprilat 1.25-5 mg every 6 hours 1 5-30 minutes 6-12 hours Precipitous fall in pressure in high-renin states variable response Acute left ventricular failure avoid in acute myocardial infarction... 

The most common cause of acute respiratory failure in COPD is acute exacerbation of bronchitis with an increase in sputum volume and viscosity. This serves to worsen obstruction and further impair alveolar ventilation, resulting in worsening hypoxemia and hypercapnia. Additional causes are pneumonia, pulmonary embolism, left ventricular failure, pneumothorax, and CNS depressants. 

IV Relief of severe pain pain of Ml used preoperatively to sedate the patient and allay apprehension, facilitate anesthesia induction, and reduce anesthetic dosage control postoperative pain relieve anxiety and reduce left ventricular work by reducing preload pressure treatment of dyspnea associated with acute left ventricular failure and pulmonary edema produce anesthesia for open-heart surgery. 

Ml Exercise caution in the IV use of pentazocine for patients with acute Ml accompanied by hypertension or left ventricular failure. Use the oral form with caution in Ml patients who have nausea or vomiting. 

Sodium nitroprusside is used in the management of hypertensive crisis. Although it is effective in every form of hypertension because of its relatively favorable effect on cardiac performance, sodium nitroprusside has special importance in the treatment of severe hypertension with acute myocardial infarction or left ventricular failure. Because the drug reduces preload (by venodila-tion) and after load (by arteriolar dilation), it improves ventricular performance and in fact is sometimes used in patients with refractory heart failure, even in the absence of hypertension. 

The usual cause of pulmonary edema is acute left ventricular failure. The sequelae of events after left heart failure roughly follow the pattern of reduced stroke volume, leading to increased end-systolic and diastolic volume, which elevates left ventricular end-diastolic pres-... 

IV administration of furosemide produces prompt relief in acute pulmonary edema (acute left ventricular failure, following myocardial infarction). This is due to the vasodilator action that precedes the saluretic action. 

Cardiovascular Effects. A 56-year-old female gardener, dermally exposed to spilled diazinon of unknown purity, developed sinus tachycardia with no evidence of infarction and showed increased cardiac enzyme (serum glutamate oxalate transaminase, total lactate dehydrogenase creatine phosphokinase) levels. The victim was diagnosed on discharge with acute left ventricular failure (Lee 1989). 

Certain forms of dyspnea yield only to opiates. Especially in this category is the dyspnea of acute left ventricular failure and pulmonary edema. Most authorities agree that morphine is contraindicated in patients with pulmonary edema caused by chemical respiratory irritants. If needed in such cases for severe pain, its use should be combined with oxygen inhalation and positive-pressure therapy. In bronchial asthma, morphine is usually contraindicated because there is danger of addiction, the drug tends to depress respiration and to constrict bronchioles, and patients with asthma may be allergic to the drug. Deaths have occurred from the use of morphine in asthma. 

Cardiovascular system. Both caffeine and theophylline directly stimulate the myocardium and cause increased cardiac output, tachycardia and sometimes ectopic beats and palpitations. This effect occurs almost at once after i.v. injection and lasts half an hour. Theophylline contributes usefuUy to the relief of acute left ventricular failure. There is peripheral (but not cerebral) vasodilatation due to a direct action of the drugs on the blood vessels, but stimulation of the vasomotor centre tends to counter this. Changes in the blood pressure are therefore somewhat unpredictable, but caffeine 250 mg (single dose) usually causes a transient rise of blood pressure of about 14/10 mmHg in occasional coffee drinkers (but has no additional effect in habitual drinkers) this effect can be used advantageously in patients with autonomic nervous system failure who experience postprandial hypotension (2 cups of coffee with breakfast may suffice for the day). In occasional coffee drinkers 2 cups of coffee (about 160 mg caffeine) per day raise blood pressure by 5/4 mmHg. Increased coronary artery blood flow may occur but increased cardiac work counterbalances this in angina pectoris. 

Morphine, by a central action, impairs sympathetic vascular reflexes (causing veno- and arteriolar dilatation) and stimulates the vagal centre (bradycardia) it also releases histamine (vasodilatation). These effects are ordinarily unimportant, but they can be beneficial in acute left ventricular failure, relieving mental distress by tranquillising, cardiac distress by reduction of sympathetic drive and preload (by venodilatation), and respiratory distress by rendering the centre insensitive to afferent stimuli from the congested lungs. 

Relief of dyspnoea in acute left ventricular failure, and in terminal cancer... 

The principal agents for treating acute left ventricular failure arc frusemide (furosemide). diamorphine and oxygen. 

Acute pulmonary oedema left ventricular failure... 

All cardiac glycosides are best avoided in patients with acute myocardial infarction, since they increase oxygen demand in ischemic tissue, increase peripheral vascular resistance, and carry an increased risk of dysrhythmias, especially in the presence of tissue hypoxia and acidosis. Furthermore, there is evidence that digitalis is of little value in patients with acute myocardial infarction and either left ventricular failure or cardiogenic shock (150). The evidence that mortality in patients who take digitalis after an acute myocardial infarction is increased is discussed in the section Death in this monograph. 

Danish Investigations of Arrhythmia and Mortality ON Dofetilide. Dofetilide in patients with left ventricular dysfunction and either heart failure or acute myocardial infarction rationale, design, and patient characteristics of the DIAMOND studies. Clin Cardiol 1997 20(8) 704-10. 

Keating GM, Plosker GL. Epierenone a review of its use in left ventricular systolic dysfunction and heart failure after acute myocardial infarction. Drugs 2004 64(23) 2689-707. 

Ritchie DS, Seymour JF, Roberts AW, Szer J, Grigg AP. Acute left ventricular failure following melphalan and fludarabine conditioning. Bone Marrow Transplant 2001 28(l) 101-3. 

There is a theoretical contraindication to nicorandil in patients with cardiogenic shock, acute left ventricular failure with low fiUing pressure, and hypotension. A sublingual dose of 20 mg in patients with coronary artery disease and normal left ventricular function was associated with a 12% fall in left ventricular end-systolic pressure, a 3% fall in left ventricular end-diastolic pressure, accentuated diastohc filhng, a 13% reduction in mean aortic pressure, and a reduced cardiac output at rest (9,30). However, cardiac output may be augmented by up to 60% in patients with congestive cardiac failure or... 

The authors concluded that after sudden withdrawal of inhaled nitric oxide rebound pulmonary hypertension had contributed to acute right ventricular failure and loss of left ventricular pre-load, with a fall in cardiac output leading to reduced coronary performance and near cardiac arrest. 

The reason for concern about this adverse effect is that it may easily be mistaken for myocardial infarction or acute left ventricular failure, conditions that are not uncommon in patients requiring diuretics. 

The Valsartan in Acute Myocardial Infarction Trial (VALIANT) compared the effects of valsartan, captopril, and the combination of the two agents in post-MI patients with symptomatic heart failure, left ventricular dysfunction, or both. The primary end point of total mortality occurred in 19.3% of patients receiving valsartan and captopril, 19.5% of captopril-treated patients, and 19.9% of the valsartan-treated group. Thus, in this high-risk post-MI population, valsartan was as effective as captopril in reducing the risk of death, but combination therapy only increased the risk of adverse effects and did not improve survival compared with monotherapy with either agent. 

Factors that decrease theophylline clearance and lead to reduced maintenance-dose requirements include advanced age, bacterial or viral pneumonia, left or right ventricular failure, liver dysfunction, hypoxemia from acute decompensation, and use of drugs such as cimetidine, macrolides, and fluoroquinolone antibiotics. Factors that may enhance theophylline clearance and result in the need for higher maintenance doses include tobacco and marijuana smoking, hyperthyroidism, and the use of such drugs as phenytoin, phenobarbital, and rifampin. 

Urquhart J., Epstein S.E., Patterson R.E. Comparative effects of calcium-channel blocking agents on left ventricular function during acute ischemia in dogs with and without congestive heart failure. Am. J. Cardiol. 55 (1985) 10B-16B. 

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