[Captopril in the treatment of refractory cardiac insufficiency]

The therapeutic efficacy of captopril, the inhibitor of the angiotensin-converting enzyme was studied in 18 patients with noticeable chronic cardiac insufficiency, who were refractory to foxglove drugs and diuretics. The use of captopril improved the patients' clinical status, significantly decreased the left ventricle volume and elevated the cardiac discharge. A simultaneous increase in diuresis during the day, favorable shifts in the electrolytic blood composition, a decrease in the concentration of blood plasma aldosterone and the level of carboxycatepsin in the blood serum were observed. Favorable changes in the hemodynamic and clinical-biochemical parameters during captopril therapy made it possible to achieve a positive therapeutic effect in 15 (83.3%) patients with refractory cardiac insufficiency. Subsequent recommendation of diuretics and maintenance doses of cardiac glycosides stabilized the therapeutic effect of captopril producing no complications. Thus, the incorporation of captopril in the management of severe refractory cardiac insufficiency was substantiated pathogenetically and found appropriate.