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[Therapeutic possibilities in terminal heart failure]
1Klinik für Innere Medizin, Bereich Medizin der Wilhelm-Pieck-Universität Rostock.
Zeitschrift Fur Die Gesamte Innere Medizin Und Ihre Grenzgebiete
|October 1, 1988
Summary
Severe cardiac insufficiency presents challenges, with current treatments offering only temporary stabilization and failing to correct underlying neurohumoral dysregulation. Cardiac transplantation remains the primary alternative for improved cardiovascular function.
Area of Science:
- Cardiology
- Pharmacology
Context:
- Severe and terminal cardiac insufficiency, characterized by myogenic failure and neurohumoral dysregulation, poses significant clinical challenges in both chronic and acute forms.
- Current therapeutic strategies involve basic treatments with glycosides and saluretics, often augmented by vasodilators or adrenergic agonists to stabilize the cardiovascular system.
Purpose:
- To evaluate the efficacy of existing and novel pharmacological interventions in managing severe cardiac insufficiency.
- To assess the potential of new inotropic and vasodilating agents in altering the prognosis of cardiac insufficiency.
- To review alternative treatment options, including cardiac transplantation and mechanical circulatory support systems.
Summary:
- Medicamentous treatment can temporarily stabilize cardiovascular function but does not resolve persistent neurohumoral dysregulation, perpetuating a cycle of decline.
- The long-term impact of novel inotropic and vasodilating pharmaceuticals on cardiac and vascular dysfunction, as well as neurohumoral imbalances, remains uncertain.
- Cardiac transplantation offers a distinct alternative for improving cardiovascular function, while artificial hearts and ventricular assist devices serve as temporary measures.
Impact:
- Current medical treatments provide limited improvement in maximum stress tolerance and do not address the fundamental neurohumoral dysregulation.
- Cardiac transplantation represents a definitive therapeutic option, though challenges remain with mechanical circulatory support systems.
- Further research is needed to determine if new pharmacological agents can significantly alter the prognosis for patients with severe cardiac insufficiency.