Giornale italiano di cardiologia
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Vasodilator drugs are generally classified according to their prevalent site of action: arteriolar vasodilators (e.g. phentolamine, hydralazine, nifedipine) which reduce peripheral resistance and, therefore, increase stroke volume and cardiac output; venodilators (e.g. nitrates), which decrease filling pressure, redistributing intravascular blood volume from the central to the peripheral reservoirs and therefore relieve signs and symptoms of congestion; "balanced" vasodilators (e.g. nitroprusside, prazosin, captopril) which present both effects. Vasodilator therapy is indicated in heart failure caused by impaired contractility (congestive cardiomyopathy, ischemic heart disease) and volume overload (mitral and aortic regurgitation, ventricular septal defect). ⋯ Non-invasive studies (in particular echocardiography) don't seem actually adequate for vasodilator therapy evaluation. Finally it is not known if vasodilator treatment influence prognosis of chronic heart failure (especially survival), but there is evidence that it can lessen symptoms and increase effort tolerance.
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Electrophysiologic studies were performed in 10 patients (8 M, 2 F, mean age: 60.2 yrs) who had survived an episode of cardiac arrest due to ventricular tachycardia (VT) or ventricular fibrillation. The purpose was to evaluate the usefulness of serial acute drug testing in selecting an effective chronic antiarrhythmic regimen. The cardiac arrest had always been sudden and unexpected. ⋯ The only patient who refused serial acute drug testing and received an empiric antiarrhythmic therapy died suddenly at the 21st month of the follow-up. It is also noteworthy that amiodarone, alone or in combination, was given chronically to 6 of our patients (60%). These results 1) indicate that serial electropharmacological testing is useful in selecting an effective long-term drug regimen in survivors of cardiac arrest, and 2) suggest that amiodarone may be effective in preventing sudden death in these patients.