[Drug therapy of heart failure]

The amelioration of symptoms and the improvement of long-term prognosis are the main objectives of drug treatment in congestive heart failure [CHF]. Digitalis, glycosides and diuretics can reduce dyspnea and increase exercise tolerance, while their influence on the course of the cardiac failure remains uncertain. Vasodilators, ACE inhibitors in particular, have in contrast not only the desirable symptomatic and hemodynamic effects, but they also delay the deterioration of LV dysfunction and reduce cardiac mortality. Vasodilators, therefore, became first-line drugs in all stages of CHF. In patients with moderate to severe heart failure the addition of diuretics and also of digoxin is usually required. Pharmacological effects, dosage, side effects and specific indications of the various drug groups in CHF are discussed.