[Differential therapy of heart insufficiency]

During the last years as a result of improved diagnostic methods and new developed drugs with different mechanism of action the therapy of congestive heart failure has become more differentiated. Digitalis and diuretics constitute conventional therapy, but systemic vasodilators offer an innovative approach in acute and chronic heart failure. The vasodilators produce disparate modifications of cardiac function depending upon their differing alterations of preload and afterload. Nitrates principally cause vasodilation, nitroprusside, phentolamine and prazosin produce balanced arterial and venous dilation, whereas hydralazine predominantly causes arteriolar dilation. New positive inotropic agents like dopamine and dobutamine are still restricted to parenteral use.