[Medical and ventilatory treatment of acute heart failure]

Traditional medical treatment of acute heart failure has remained unchanged for many years. It has been based on oxygen supplementation and mechanical ventilatory support as well as the administration of morphine, diuretics, nitrates and inotropic agents. In 2005 the European Society of Cardiology published new guidelines on diagnosis and treatment. Also, new therapies have been introduced recently, giving rise to changes in therapeutic concepts.

The article is based on these new guidelines and recent studies selected from the literature.

Mechanical ventilatory support reduces the number of patients who require endotracheal intubation. Nitrates in higher dosages than employed today appear to be beneficial to patients with pulmonary congestion, probably because of the pronounced afterload reducing effect. Nesiritide has shown better haemodynamic effects than common nitrate dosages in patients with congestive heart failure. Tezosentan was tested in the biggest trial ever which, however, was terminated prematurely, because of futility with regard to the endpoints dyspnoea and death. Dobutamine and milrinone are associated with increased mortality in patients with pronounced chronic and acute congestive heart failure. Levosimendan has shown lower mortality compared to dobutamine in patients with acute congestive heart failure.

New concepts have finally emerged, including the application of old drugs such as nitrates in new (i.e., higher) dosages, as well as the novel compound levosimendan, and hypoperfused organs without severe hypotension. The new European Society of Cardiology classification provides a valuable and long-awaited guideline to diagnosis and treatment.