Congestive heart failure

Abstract

Summary: We determined hemodynamics and myocardial lactate extraction in 11 patients with severe coronary disease after 0.010 (D1), 0.015 (D2), and 0.025 nmol/min (D3) of the arteriolar dilator felodipine during pacing-induced angina pectoris. Plasma concentrations of felodipine after the 3 doses were 12 (5), 25 (6) and 43 (8) nmol/ L, respectively. At corresponding pacing rates, mean blood pressure fell from 126 (24) to 90 (15) mm Hg at D3 (p < 0.01) and pulmonary capillary wedge pressure was reduced from 14 (10) to 9 (8) mm Hg (p < 0.05). Cardiac output increased at all three doses (p < 0.01). The reduction of systemic vascular resistance at D3 was 49% (p < 0.01) and of coronary vascular resistance 35% (p < 0.05). At D1, there was no change in lactate extraction, while 8/10 lactate producers improved at D2 and D3. ST depression was diminished at all three doses (p < 0.05) at the control pacing rate. During maximal pacing rate at D3, the myocardial oxygen consumption was 14% above control level (N.S.). Thus, felodipine was beneficial in most patients at higher dosage. Ventricular unloading and improved coronary perfusion might explain some of these positive effects.