Successful weaning from milrinone of a patient with severe congestive heart failure using carvedilol

Cardiovascular effects of a phosphodiesterase III inhibitor in the presence of carvedilol in dogs

The aim of this study was to determine whether dobutamine, dopamine, or milrinone (a phosphodiesterase [PDE] III inhibitor) would support cardiac function that had been attenuated by administration of the beta-blocker, carvedilol (0.2, 0.4, or 0.8 mg/kg). Hemodynamic and cardiac parameters including the heart rate (HR), left-ventricular fractional shortening (FS), and arterial pressure were measured in six healthy dogs without cardiac disease. Carvedilol did not affect FS or arterial pressure, but decreased the HR significantly. The positive inotropic and chronotropic responses to dobutamine and dopamine were attenuated by carvedilol, whereas arterial pressure was unaffected. Milrinone did not affect the HR and decreased arterial pressure, whereas FS was significantly greater both in the control and carvedilol-treated groups. Although milrinone affect the negative chronotropic effects of carvedilol, milrinone increased FS and prevented the decrease in arterial pressure. These results suggest that inhibition of PDE III preserves cardiac contractility and hemodynamic function in the presence of carvedilol.

Heart failure and treatment: part 1

Diagnosis of heart failure is increasingly prevalent. Each year, 550,000 new cases are anticipated. To provide quality outcomes, nurses and physicians must understand the etiology and pathophysiology of heart failure. Research into heart failure provides information about treatment and drug therapies that reduce heart failure symptoms and improve quality of life. PACU nurses care for heart failure patients in various stages of this syndrome. Determining the plan of care for this high acuity population requires nurses with skills to manage complex patients in the perianesthesia period.