[Clinical and hemodynamic efficacy of enalapril in severe congestive heart failure]

Evaluate the clinical and hemodynamic efficacy of enalapril in the treatment of severe congestive heart failure, refractory to the classic therapeutics with diuretics and digitalis.

Hospitalized patients (pts) of a cardiac department.

10 pts with a mean age of 57.8 years in whom a Swan-Ganz catheter was placed for 72 hours to monitor the right pressures and cardiac output, with regular control of arterial blood pressure and cardiac frequency. Low doses of enalapril (2.5 mg) were utilized at the start of the treatment and this dose was readjusted depending on the clinic and hemodynamic parameters.

the 10 pts had the following characteristics: Basal-mean pulmonary arterial pressure (PAP) 34.1 mmHg, Pulmonary wedge pressure (PWP) 21.1 mmHg, cardiac output (CO) 4.8 l/min, cardiac index (CI) 2.8 l/min/m2. After 72 hours with enalapril treatment, these measurements were: PAP-23.8 mmHg, PWP-12.6 mmHg, CO-5.2 l/min and Cl-3.0 ll/min/m2. These differences were statistically significant. With a follow-up of 18.4 months, there was also a clinical improvement; of the 4 pts in class III, 2 moved to class II and 2 to class I; the 4 pts in class IV 4 moved to class II; two pts had died.

In severe heart failure, the addition of enalapril to the classic therapy has allowed the immediate improvement of the clinical and hemodynamic indexes and this improvement was maintained in the follow-up period.