Treatment of Acute Left-Sided Heart Failure with Intramuscular Injection of Chlorpromazine

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  • MIFUNE Junichiro
    Department of Internal Medicine, Tokyo Metropolitan Geriatric Hospital
  • KURAMOTO Kizuku
    Department of Internal Medicine, Tokyo Metropolitan Geriatric Hospital
  • UEDA Keiji
    Department of Internal Medicine, Tokyo Metropolitan Geriatric Hospital
  • MATSUSHITA Satoru
    Department of Internal Medicine, Tokyo Metropolitan Geriatric Hospital
  • KUWAJIMA Iwao
    Department of Internal Medicine, Tokyo Metropolitan Geriatric Hospital
  • SAKAI Makoto
    Department of Internal Medicine, Tokyo Metropolitan Geriatric Hospital
  • IWASAKI Tsutomu
    Department of Internal Medicine, Tokyo Metropolitan Geriatric Hospital
  • INOUE Hiroshi
    Department of Internal Medicine, Tokyo Metropolitan Geriatric Hospital
  • SHINAGAWA Tatsuo
    Department of Internal Medicine, Tokyo Metropolitan Geriatric Hospital
  • MURAKAMI Mototaka
    Department of Internal Medicine, Tokyo Metropolitan Geriatric Hospital

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タイトル別名
  • Treatment of Acute Left Sided Heart Fai

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Hemodynamic responses to intramuscular injection of 5 to 10mg (average 8.5mg) of chlorpromazine were assessed in 10 patients with acute left-sided heart failure (treated group). Left ventricular filling pressure, blood pressure, heart rate, and cardiac index were measured before the injection and for 6 hours thereafter. In 8 patients with heart failure, the same hemodynamic monitoring was performed without the injection of chlorpromazine (control group).<br>In treated group significant reduction of left ventricular filling pressure was observed at 5min after the injection of chlorpromazine. Left ventricular filling pressure showed a peak reduction from an average of 27.2 to 18.8mmHg (-30.8%, p<0.001) at 15min, and a significant reduction persisted for 6 hours. At 15min, mean blood pressure was reduced slightly (101 to 92mmHg, -9.0%, p<0.05) and cardiac index tended to increase slightly (2.11 to 2.28L/min/M2, +7.8%, NS). Heart rate was unchanged. Relief of symptoms of pulmonary congestion was also observed within 15min. Improvement of symptoms of pulmonary congestion was more prominent particularly in 3 patients who had severe dyspnea and stridor. In control group, left ventricular filling pressure, blood pressure, and heart rate showed no significant change over 6 hours.<br>The present study suggested that intramuscular injection of chlorpromazine at the dosage of 5 to 10mg showed rapid and marked clinical improvement without significant side effects and therefore its use may be indicated in patients with acute left-sided heart failure, especially in paroxysmal episodes.

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