Effects of Catecholamines on the Heart

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Abstract
THE MANAGEMENT of acute cardiac failure, following both myocardial infarction and intracardiac operations, has included the use of a variety of catecholamines such as epinephrine, levarterenol (Levophed) bitartrate, and metaraminol (Aramine) bitartrate. The basis for their choice is the inotropic effect of these substances. These amines also possess to a variable extent other characteristics which affect such circulatory functions as heart rate and vascular resistance. However, the fundamental defect in cardiac failure, from the hemodynamic viewpoint, is the inability of the heart to pump sufficient blood to maintain adequate tissue perfusion. Enhancing myocardial function with inotropic drugs may restore this pumping action. However, unless atrioventricular dissociation with a slow ventricular rhythm is responsible for the failure, it would not seem desirable to increase the heart rate. Similarly, increasing total peripheral vascular resistance will increase the stroke work of the already failing heart. The present study was designed to compare the

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