COMBINED INFUSION OF NITROPRUSSIDE AND DOBUTAMINE IN THE TREATMENT OF SEVERE CONGESTIVE HEART-FAILURE

In 20 patients with coronary artery disease and congestive heart failure III/IV (NYHA) we studied the effects of a combined infusion of Natriumnitroprusside (NP) c 20-80 μg/min) and Dobutamine (Db) (5 μg/min/kg) comparing this with changes found by infusing NP or Db alone. Combined infusion had the following results: a decrease of mean aortic pressure from 103±13 {Mathematical expression} to 93±7 mmHg, of LVEDP from 22.6±5 mmHg to 16±2 mmHg, and of SVR from 1,793±394 to 1,326±199 dyn s cm-5. Cl increase from 2.37±0.42 l/min/m2 to 2.93±0.41 l/min/m2. In contrast, NP infusion alone showed a fall in mean aortic pressure to 87±6 mmHg, of LVEDP to 13.4±2 mmHg and of SVR to 1,424±173 dyn s cm-5. On NP, there was only a small rise of Cl to 2.51±0.41 l/min/m2. Isolated Db infusion had a rise of Cl to 2.86±0.39 l/min/m2, a small decline in LVEDP to 19.2±3 mmHg, and in SVR to 1,530±264 dyn s cm-5 and no change in mean aortic pressure. Heart rate stayed constant in each of the three treatment modes. The individually adjusted, combined infusion of NP and Db accentuates the therapeutic advantages of either agent alone: NP primarily lowers LVEDP (preload) and SVR (afterload), Db effects a rise of Cl. It is note worthy that this increase of Cl in combined therapy is higher than the rise caused by Db alone. We recommend the simultaneous administration of NP and Db especially in the therapy of patients with coronary artery disease, pulmonary congestion and hypotension. © 1979 Springer-Verlag.