[Indications for ACE inhibitors in chronic heart failure]

Chronic systolic heart failure after coronary heart disease or dilated cardiomyopathy is characterized by an increasing dilatation of the left ventricle and raised intracardial pressures. The higher the NYHA class, the higher are usually preload and afterload of the left ventricle. Concomitantly, the renin-angiotensin-aldosterone-system is stimulated, leading to neurohormonal activation of vasoconstrictive hormones. This will reduce the already depressed myocardial function even more. The addition of ACE-inhibitors to diuretics and digitalis has improved the prognosis of patients with severe and moderate heart failure. Thus, there is no question today that ACE-inhibitors are needed in chronic heart failure, irrespective of the origin. New investigations indicate that diuretics and digitalis are also needed in severe or moderate heart failure. They certainly lead to a decrease of symptoms. The significance of the local ACE-system seems to be greater than that of the circulating ACE-system, when chronic heart failure after myocardial infarction has to be treated. The prophylactic use of ACE-inhibitors after myocardial infarction with decreased ejection fraction will reduce the necessity of admittance to hospital and will also improve the prognosis.