PMID: 2125411Nov 1, 1990Paper

Symptomatic treatment of chronic cardiac insufficiency

Archives des maladies du coeur et des vaisseaux
F Zannad

Abstract

Given the absence of curative and preventive treatment of cardiac failure, symptomatic therapy is very important. In severe "non-ambulatory" cardiac failure, symptoms depend on the patient's resting hemodynamic status. This can be improved by diuretics, digitalis and vasodilators. A combination of these three drug groups is often required. However, the respective value of each group is unknown. Their use is limited by their specific undesirable secondary effects which are particularly common and severe at this advanced stage. Their effects on survival are unknown with the exception of angiotension converting enzyme inhibitors which have been shown to be beneficial. At the ambulatory stage symptoms occur on effort. In order to improve exercise capacity, the treatment chosen should increase the patient's reserve of cardiac output, limit the increase in pulmonary pressures, respect systemic arterial pressure, decrease venous pressure, dilate the muscular arterioles and improve oxygen extraction by skeletal muscle during physical exercise. Diuretics and angiotensin converting enzyme inhibitors can fulfill these objectives. The effects of the other vasodilators are more variable, due to a vasodilatation which is often inappropriate ...Continue Reading

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