Inotropic therapy for heart failure: paradise postponed

Article Abstract:

In heart failure, the heart muscle is unable to contract properly. In an effort to improve the heart muscle contractibility, the use of positive inotropic drugs seemed promising, especially in patients with severe heart failure. In a recent study, two drugs, milrinone and digoxin, were administered both independently and in combination to determine their effectiveness in treating chronic heart failure. Function in the left ventricle, the main pumping chamber, improved with digoxin but not milrinone. Digoxin and milrinone were both found to improve exercise tolerance. The use of milrinone alone tended to have more side effects and produced a higher incidence abnormal ventricular heart beats. Milrinone and digoxin together offered no additional benefits. In the study, some patients' withdrawal from the digoxin 10 days prior to the study may have affected results. The difficulty in interpreting the data is that the kind of exercise testing used may not prove to be an accurate measurement of chronic heart failure, especially in those milrinone patients who dropped out of the study. It is suggested that patients needing extra therapy to control symptoms and not patients already stable or using lower doses could improve the study. Physicians can still use digoxin therapy and add other drugs on carefully selected patients. There appears to be no clear cut regime which can be followed by all chronic heart patients and each patient should be evaluated separately.

Evaluation, Testing, Digoxin, Cardiotonic agents, editorial, Milrinone

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Racial differences in the outcome of left ventricular dysfunction

Article Abstract:

Blacks with congestive heart failure seem to have a higher risk of death than whites even after adjusting for other factors. This was the conclusion of researchers who analyzed data from the Studies of Left Ventricular Dysfunction (SOLVD) trial. Black patients had higher mortality rates after adjusting for age, coexisting diseases, cause of and severity of heart failure and the use of certain drugs. Blacks even had a higher risk of death from all causes.

Analysis, Demographic aspects, African Americans, Congestive heart failure

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Lesser response to angiotensin-converting-enzyme inhibitor therapy in black as compared with white patients with left ventricular dysfunction

Article Abstract:

Black patients with heart failure may not respond to treatment with ACE inhibitors. This was the conclusion of a study of 1,196 white patients and 800 black patients with heart failure who all took the ACE inhibitor enalapril.

Research, ACE inhibitors, Angiotensin converting enzyme inhibitors

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