Detrimental arrhythmogenic and sustained beneficial hemodynamic effects of oral salbutamol in patients with chronic congestive heart failure

https://doi.org/10.1016/0002-8703(85)90648-9Get rights and content

Abstract

The long-term efficacy and potential side effects of oral sympathomimetic amines in the treatment of advanced congestive heart failure remain controversial. We studied the acute and chronic hemodynamic and arrhythmogenic effects of the beta-2 agonist, salbutamol, 6 mg by mouth four times/day, in 20 patients with NYHA classes III to IV congestive heart failure. Acutely, salbutamol increased the cardiac index (1.9 to 2.3 L/min/m2, p < 0.01) and heart rate (92 to 97 bpm, p < 0.01) while it decreased pulmonary capillary wedge pressure (35 to 31 mm Hg, p < 0.01). Salbutamol increased the number of patients having episodes of ventricular tachycardia from two to six and increased the number of episodes of ventricular tachycardia from 2 to 27. Once salbutamol was discontinued, no further episodes of ventricular tachycardia occurred in these six patients. Six patients did not have long-term hemodynamic studies because of serious arrhythmias and two died. In the 12 patients who had long-term studies, the initial beneficial hemodynamic effects of salbutamol were maintained. Thus, although salbutamol may have beneficial long-term hemodynamic effects, it may cause serious arrhythmias in patients predisposed to develop arrhythmias.

References (27)

  • C Kerr

    Hemodynamic effects of oral salbutamol in patients with severe LV failure (abstr)

    Circulation

    (1979)
  • PDV Bourdillon et al.

    Salbutamol in treatment of heart failure

    Br Heart J

    (1980)
  • JD Stephen et al.

    Hemodynamic effects of oral salbutamol alone and in combination with sublingual isosorbide dinitrate in patients with severe CHF

    Br Heart J

    (1980)
  • Cited by (59)

    • Should acute treatment with inhaled beta agonists be withheld from patients with dyspnea who may have heart failure?

      2011, Journal of Emergency Medicine
      Citation Excerpt :

      Fifteen studies with 230 patients reported on the occurrence of dysrhythmias (8–10,13–15,18–20,22–24,26,29). Six of these studies reported an increase in ventricular ectopy, with one reported episode of supraventricular tachycardia, and 4 patients with treatment-induced non-sustained ventricular tachycardia (8,20,22,24,29,30). No patient required treatment to terminate the dysrhythmia and all resolved with discontinuation of albuterol.

    • Cardiac cachexia: A systematic overview

      2009, Pharmacology and Therapeutics
    View all citing articles on Scopus

    Supported by the Department of Medicine of the Montreal General Hospital, and the Québec Heart Foundation.

    View full text