[Long-term drug treatment of chronic heart failure]

After reversible causes have been excluded and precipitating factors eliminated therapy of chronic heart failure is performed to achieve the following goals: A reduction of cardiac work by physical restriction; the increased risk of thromboembolic complications should be met by special physical exercises, elastic stockings and a low-dose heparin therapy in hospitalized patients. To improve the contractility of the heart muscle by digitalis. The efficacy of digitalis has been demonstrated by a double-blind study. It cannot be excluded, however, that digitalis therapy may be associated with an increased mortality in patients with coronary artery disease and complex ventricular arrhythmias. To eliminate symptoms of congestion. To reduce pre- and afterload by vasodilators. The application of vasodilators has become an established therapy in patients who do not respond to conventional therapy with digitalis and diuretics. By activation of the adrenergic nervous system and the renin-angiotensin system-an initially useful compensatory mechanism to sustain blood pressure and stroke volume-peripheral vascular resistance and end-diastolic volume increase in patients with chronic heart failure. Both factors contribute to an increase in afterload, thereby further diminishing left ventricular function. In this situation vasodilators are particularly effective. According to their main mode of action they alter venous capacity and/or systemic vascular resistance to a different degree. Knowledge of their effects is necessary for a successful application in individual patients.