[Treatment of cardiac insufficiency in ischemic heart disease].
Over 30 per cent of coronary patients die of cardiac failure excluding the acute phase of myocardial infarction. With the exception of preexisting hypertension, there is no compensatory hypertrophy in ischemic heart disease. However, hypertrophy is a costly adaptation in terms of myocardial oxygen demand and, therefore, coronary flow. Fibrous zones are unresponsive to inotropic drugs and so the treatment of cardiac failure due to ischemic heart disease consists in limiting or preventing episodes of ischemia. Each mechanism of ischemia has an appropriate treatment: the preload is reduced by trinitrin and its derivatives and by molsidomine; the after-load by calcium antagonists and angiotensin converting enzyme inhibitors; tachycardia and hypercontractile states by betablockers. The risk of arrhythmia, aggravated by many inotropic therapies, constitutes the major danger to ischemic heart failure; amiodarone, betablockers and preventive nitrate therapy are the most effective and least dangerous antiarrhythmics. Revascularisation is effective for permanently ischemic segments or for ischemia on effort but does not improve large plaques of fibrosis which sometimes require surgical ablation or plastic procedures. But these measures are incomplete if all aspects of the disease are not taken in consideration: loss of excessive body weight, exercise rehabilitation by modern techniques, limitation of bed rest at the ultimate stage of the disease allowing patients with ischemic cardiac failure a better quality of life without aggravating the prognosis.
Broustet
J P
JP
Hôpital cardiologique Haut-Lévêque, Pessac.
Douard
H
H
Koch
M
M
Oysel
N
N
Massière
J P
JP
D001145:Arrhythmias, Cardiac / Q000209:etiology / Q000503:physiopathology; D002317:Cardiovascular Agents / Q000627:therapeutic use; D003327:Coronary Disease / Q000150:complications* / Q000503:physiopathology / Q000628:therapy; D006333:Heart Failure / Q000209:etiology* / Q000503:physiopathology / Q000628:therapy; D006801:Humans; D009204:Myocardial Revascularization; D005082:Physical Exertion
D002317:Cardiovascular Agents
Traitement de l'insuffisance cardiaque des cardiopathies ischémiques.