This Article Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Dell'Italia, L. J. Articles by O'Rourke, R. A. Search for Related Content PubMed PubMed Citation Articles by Dell'Italia, L. J. Articles by O'Rourke, R. A. Pubmed/NCBI databases Compound via MeSH Substance via MeSH Medline Plus Health Information Heart Attack

Circulation, Vol 72, 1327-1335, Copyright © 1985 by American Heart Association

ARTICLES

Comparative effects of volume loading, dobutamine, and nitroprusside in patients with predominant right ventricular infarction

LJ Dell'Italia, MR Starling, R Blumhardt, JC Lasher and RA O'Rourke

To assess the value of volume loading and to determine the relative efficacy of dobutamine compared with nitroprusside therapy in acute right ventricular infarction (RVMI), 13 patients with clinical, hemodynamic, and radionuclide angiographic evidence of RVMI were evaluated. In 10 patients who had an initial pulmonary arterial wedge pressure less than 18 mm Hg, volume loading did not improve cardiac index (1.9 +/- 0.5 [SD] to 2.1 +/- 0.4 liters/min/m2), despite significant increases in mean right atrial pressure (11 +/- 2 to 15 +/- 2 mm Hg, p less than .001) and pulmonary arterial wedge pressure (10 +/- 4 to 15 +/- 2 mm Hg, p less than .001). Nine patients received dobutamine or nitroprusside in random order, while hemodynamic measurements and radionuclide angiograms were obtained simultaneously. Compared with nitroprusside, dobutamine produced a statistically significant increase in cardiac index (2.0 +/- 0.4 to 2.7 +/- 0.5 vs 2.1 +/- 0.4 to 2.3 +/- 0.5 liters/min/m2, p less than .001), stroke volume index (29 +/- 6 to 36 +/- 8 vs 29 +/- 6 to 30 +/- 6 ml/m2, p = .02), and right ventricular ejection fraction (30 +/- 8% to 42 +/- 7% vs 34 +/- 8% to 37 +/- 4%, p less than .01) by two-way analysis of variance. We conclude that volume loading does not improve cardiac index in patients with acute RVMI despite a rise in cardiac filling pressures and that infusion of dobutamine, after appropriate volume loading, produces a significant improvement in cardiac index and right ventricular ejection fraction over those after infusion of nitroprusside.

This article has been cited by other articles:

				S. M. Hollenberg Acute Coronary Syndromes ACCP Crit Care Med Brd Rev, January 1, 2009; 20(0): 129 - 144. [Full Text] [PDF]

				J. P. Kress Shock ACCP Crit Care Med Brd Rev, January 1, 2009; 20(0): 145 - 156. [Full Text] [PDF]

				F. Haddad, R. Doyle, D. J. Murphy, and S. A. Hunt Right Ventricular Function in Cardiovascular Disease, Part II: Pathophysiology, Clinical Importance, and Management of Right Ventricular Failure Circulation, April 1, 2008; 117(13): 1717 - 1731. [Full Text] [PDF]

				S Bassi, R Amersey, and R Andrews Right ventricular infarction complicated by right to left shunting through an atrial septal defect: successful treatment with an Amplatzer septal occluder Heart, April 1, 2005; 91(4): e28 - e28. [Abstract] [Full Text] [PDF]

				I. Inglessis, J. T. Shin, J. J. Lepore, I. F. Palacios, W. M. Zapol, K. D. Bloch, and M. J. Semigran Hemodynamic effects of inhaled nitric oxide in right ventricular myocardial infarction and cardiogenic shock J. Am. Coll. Cardiol., August 18, 2004; 44(4): 793 - 798. [Abstract] [Full Text] [PDF]

				A. K. Jacobs, J. A. Leopold, E. Bates, L. A. Mendes, L. A. Sleeper, H. White, R. Davidoff, J. Boland, S. Modur, R. Forman, et al. Cardiogenic shock caused by right ventricular infarction: A report from the SHOCK registry J. Am. Coll. Cardiol., April 16, 2003; 41(8): 1273 - 1279. [Abstract] [Full Text] [PDF]

				J. A. Goldstein Pathophysiology and management of right heart ischemia J. Am. Coll. Cardiol., September 4, 2002; 40(5): 841 - 853. [Abstract] [Full Text] [PDF]

				S. M. Hollenberg, C. J. Kavinsky, and J. E. Parrillo Cardiogenic Shock Ann Intern Med, July 6, 1999; 131(1): 47 - 59. [Abstract] [Full Text] [PDF]

				A. Jerzewski, P. Steendijk, P. M.T. Pattynama, B. P.J. Leeuwenburgh, A. de Roos, and J. Baan Right ventricular systolic function and ventricular interaction during acute embolisation of the left anterior descending coronary artery in sheep Cardiovasc Res, July 1, 1999; 43(1): 86 - 95. [Abstract] [Full Text] [PDF]

				W. H. Devlin, J. Petrusha, K. Briesmiester, D. Montgomery, and M. R. Starling Impact of Vascular Adaptation to Chronic Aortic Regurgitation on Left Ventricular Performance Circulation, March 2, 1999; 99(8): 1027 - 1033. [Abstract] [Full Text] [PDF]

				H. S. Mueller, K. Chatterjee, K. B. Davis, M. A. Fifer, C. Franklin, M. A. Greenberg, A. J. Labovitz, P. K. Shah, K. J. Tuman, M. H. Weil, et al. Present use of bedside right heart catheterization in patients with cardiac disease J. Am. Coll. Cardiol., September 1, 1998; 32(3): 840 - 864. [Full Text] [PDF]

				L. J. Dell'Italia Reperfusion for Right Ventricular Infarction N. Engl. J. Med., April 2, 1998; 338(14): 978 - 980. [Full Text]

				J. W. Kinch and T. J. Ryan Right Ventricular Infarction N. Engl. J. Med., April 28, 1994; 330(17): 1211 - 1217. [Full Text]

				V. Courtney Broaddus, Y. Berthiaume, J. W. Biondi, and M. A. Matthay Analytic Reviews : Hemodynamic Management of the Adult Respiratory Distress Syndrome J Intensive Care Med, August 1, 1987; 2(4): 190 - 213. [Abstract] [PDF]

				R. Genton and A. S. Jaffe Management of Congestive Heart Failure in Patients With Acute Myocardial Infarction JAMA, November 14, 1986; 256(18): 2556 - 2560. [Abstract] [PDF]

				L. J. Dell'Italia Analytic Review: Right Ventricular Infarction J Intensive Care Med, September 1, 1986; 1(5): 246 - 256. [Abstract] [PDF]