Difficult cases in heart failure: Bridge to β blockade in severe heart failure: The use of phosphodiesterase inhibitors

Abstract

The authors describe the use of milrinone as a bridge to β blockade in a patient with severe heart failure. This case is clinically important because in patients with severe heart failure phosphodiesterase inhibitors, unlike β agonists, will retain their positive inotropic and vasodilator effects in the presence of β blockade and, in addition, these agents will attenuate the negative inotropic side effects of β blockers. Conversely, a β blocker associated with a phosphodiesterase inhibitor will protect against myocyte loss and arrhythmias, may prevent sudden death, and will improve long term symptoms and exercise tolerance. This combination is being investigated in a large, multicenter, double-blind, randomized trial of intravenous milrinone vs. placebo as a therapeutic tool to allow the initiation of carvedilol orally in patients hospitalized with Class III/IV heart failure. © 2000 by CHF, Inc.