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[The therapy of chronic heart failure]
1Klinik für Innere Medizin, Karl-Marx-Universität, Leipzig.
Insights
Digitalis glycosides are the primary choice for chronic cardiac insufficiency, particularly NYHA stage II to III. Other medications like diuretics and ACE inhibitors are used when glycosides are insufficient or in combination therapy.
Area of Science:
- Cardiology
- Pharmacology
Context:
- Chronic cardiac insufficiency requires a structured therapeutic approach.
- Medicamentous therapy plays a crucial role alongside general measures.
Purpose:
- To outline the rational therapeutic scheme for chronic cardiac insufficiency.
- To define the primary and secondary choices of medication for heart failure management.
Summary:
- Digitalis glycosides are the first-line treatment for latent and manifest cardiac insufficiency (NYHA stage II-III) and tachyarrhythmias.
- Diuretics are indicated for persistent insufficiency despite glycoside use.
- Angiotensin-converting enzyme (ACE) inhibitors are considered second-line agents, often in combination therapy.
Impact:
- Establishes digitalis glycosides as the cornerstone of cardiac insufficiency treatment.
- Highlights the evolving role of ACE inhibitors and the development of new inotropic agents.
- Emphasizes the importance of addressing the underlying cause of cardiac insufficiency.
Abstract:
A rational therapy of the chronic cardiac insufficiency should be performed according to a certain scheme, in which case the knowledge of the basic disease is necessary for the causal treatment. Apart from the general measures the medicamentous therapy is of particular significance. Hereby up to now the digitalis glycosides remained the remedy of primary choice. They are without doubt indicated in the latent and manifest cardiac insufficiency, consequently from the transition of the NYHA stage II into stage III, in tachycardiac disturbances of rhythm also without cardiac insufficiency in form of auricular fibrillation and auricular flutter as well as in the paroxysmal supraventricular tachycardia. Prophylactic, preoperative applications of glycosides and such ones which are performed only for reasons of age are not justified. Also a maintenance therapy is in most cases no more necessary after removal of the cause of the cardiac insufficiency. - Diuretics are to be used in an insufficiency which continues existing despite application of glycosides. Their application must be performed as protracted as possible. - The therapies with vasodilators, such as prazosin, hydralazine and nitrates, which were performed during the last years, showed, indeed, initial success, but no long-term effect. Another fact it is, however, with the angiotensin-converting enzyme (ACE) inhibitors captopril and enalapril, which are to be regarded as second grade medicaments in combination with glycosides and diuretics. Whether or not they will supersede the glycosides, is at present still an open question. Other positively inotropic medicaments which in comparison to the glycosides show a larger therapeutic breadth are still being developed.(ABSTRACT TRUNCATED AT 250 WORDS)