What question did this study set out to answer?

To evaluate the hemodynamic and hormonal effects of captopril administration in patients presenting with acute left ventricular failure complicating myocardial infarction.

January 1, 1987Journal of Cardiovascular Pharmacology

Haemodynamic Effects of Captopril in Acute Left Ventricular Failure Complicating Myocardial Infarction

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Why the study?

Does captopril improve haemodynamic parameters in patients with acute left ventricular failure complicating myocardial infarction?

Population

9 patients with acute left ventricular failure complicating myocardial infarction

Design

Case_series

Follow-up

24 hours

Authors

HMHoward M. McAlpineGlasgow Royal Infirmary JMJames J. MortonWestern Infirmary BLB LeckieUniversity of Leicester

Discussion

Member takes

Implication

Captopril may reduce filling pressures in acute post-MI LV failure; hypothesis-generating and should not yet change practice.

Key Points

To evaluate the hemodynamic and hormonal effects of captopril administration in patients presenting with acute left ventricular failure complicating myocardial infarction.
Administered incremental low doses of captopril (titrated to achieve pulmonary capillary wedge pressure < 14 mm Hg or up to a maximum dose of 25 mg) in N=9 patients with acute post-infarction left ventricular failure.
Recorded invasive hemodynamic parameters (right atrial, pulmonary arterial, pulmonary wedge, and mean arterial pressures; cardiac output; systemic vascular resistance) and plasma angiotensin II levels before and after dosing, with reassessment at 24 hours in N=7 patients.
Captopril significantly decreased right atrial pressure from 12.4 (0.9) to 9.4 (0.7) mm Hg (p < 0.001), pulmonary arterial pressure from 32.7 (3) to 26.4 (2.2) mm Hg (p = 0.01), and pulmonary capillary wedge pressure from 25.7 (2.9) to 19.9 (2.2) mm Hg (p = 0.01).
Mean arterial pressure decreased from 84.8 (3.9) to 76.7 (2.7) mm Hg (p = 0.001) and systemic vascular resistance fell from 1,540 (110) to 1,330 (76) dyn/s/cm⁵, with a non-significant change in cardiac output from 3.8 (0.3) to 4.2 (0.3) l/min (NS).
Plasma angiotensin II fell significantly across all patients from a baseline mean of 16.8 (3.6) pmol/l to 3.6 (1.0) pmol/l even following the initial 3.125 mg dose, irrespective of baseline hormone levels or prior diuretic therapy.

Structured PICO

Does captopril improve haemodynamic parameters in patients with acute left ventricular failure complicating myocardial infarction?

Population

9 patients with acute left ventricular failure complicating myocardial infarction

Intervention

Repeated low doses of captopril administered to reduce pulmonary capillary wedge pressure <14 mm Hg or to a maximum total dose of 25 mg

Outcome

Haemodynamic changes (right atrial pressure, pulmonary arterial pressure, pulmonary capillary wedge pressure, systemic vascular resistance, mean arterial pressure, cardiac output) and angiotensin II levelssurrogate

Captopril exerts beneficial haemodynamic effects by reducing filling pressures and systemic vascular resistance in patients with heart failure complicating acute myocardial infarction.

Cite This Study

McAlpine et al. (1987) studied this question.

synapsesocial.com/papers/6a6fb253a7fbea1e4407d236 https://doi.org/10.1097/00005344-198700002-00007

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Haemodynamic Effects of Captopril in Acute Left Ventricular Failure Complicating Myocardial Infarction

Discussion

Member takes

Implication

Key Points

Structured PICO

Cite This Study

Haemodynamic Effects of Captopril in Acute Left Ventricular Failure Complicating Myocardial Infarction

Discussion

Member takes

Implication

Key Points

Structured PICO

Cite This Study

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