Acute hemodynamic effects of norepinephrine inhibition in patients with severe chronic congestive heart failure

AbstractThe pathophysiologic role of high levels of circulating catecholamines in patients with congestive heart failure remains unclear. To assess the hemodynamic contribution of circulating catecholamines, metyrosine (alpha-methylp-tyrosine), an inhibitor of catecholamine synthesis, was administered to nine patients with acutely decompensated chronic congestive heart failure. Baseline left ventricular ejection fraction averaged 23.3 ± 9.9%, whereas cardiac output averaged 3.69 ± 1.03 liters/min, with a pulmonary wedge pressure of 27.4 ± 8.5 mm Hg.After 48 h of metyrosine administration, plasma norepinephrine concentration decreased from 919.4 ± 810.6 to 335.4 ± 143.1 pg/ml (p < 0.05). Plasma epinephrine concentration averaged 176.4 ± 166.0 pg/ml at baseline, and was unchanged during metyrosine administration. Despite the significant decrease in circulating norepinephrine, no significant hemodynamic changes were observed during metyrosine administration.These results suggest that high levels of circulating norepinephrine may be more a marker of severe congestive heart failure than an important contributor to the underlying pathophysiology at this advanced stage of the disease process

Massachusetts Water Resource Outreach Project Center: Water Management in Leicester

All towns and municipalities face the task of ensuring that public water systems have safe and adequate supplies of drinking water to protect the health and well-being of its consumers. Working with the Massachusetts Department of Environmental Protection and the Town of Leicester, our project goal was to identify the challenges Leicester's three water districts face and provide an analysis for available improvements in order to meet the water quality standards and water demand in Leicester. Our recommendations provide short and long term goals working towards improving communication and efficiency of the districts' operations