Chronic Vasodilator Therapy in the Management of Cardiogenic Shock and Intractable Left Ventricular Failure

Abstract

A patient with cardiogenic shock and intractable left ventricular failure due to coronary artery disease was treated with a 21-day infusion of sodium nitroprusside followed by chronic administration of nitrates by mouth and topically. Heart size has returned nearly to normal, and functional status has markedly improved. Hemodynamic and clinical deterioration occurred initially whenever the nitroprusside infusion was stopped and more recently when the chronic vasodilator therapy was discontinued. These observations suggest that chronic reduction of impedance to left ventricular ejection may be a useful approach to the treatment of severe left ventricular failure.