Pathophysiology of congestive heart failure. Role of angiotensin-converting enzyme inhibitors.
The benefits derived from inhibition of the renin-angiotensin system in chronic heart failure are mediated through multiple mechanisms that can be directly related to the pathophysiology of the syndrome of congestive heart failure. At the stage of myocardial failure, angiotensin-converting enzyme inhibition may reverse myocardial hypertrophy and lower left ventricular filling pressure, and decrease ventricular size, thereby reducing ventricular wall remodeling. At the later stages of congestive heart failure, the cardiac effects of angiotensin-converting enzyme inhibition may have added benefits in the periphery. Normalization of the vasodilatory response to exercise, increase in renal blood flow, and possibly urinary sodium excretion, as well as prevention of hypokalemia tend to improve exercise capacity, quality of life, and survival in patients with severe congestive heart failure.
Sonnenblick
E H
EH
Department of Medicine, The Albert Einstein College of Medicine, Bronx, New York.
LeJemtel
T H
TH
D000806:Angiotensin-Converting Enzyme Inhibitors / Q000494:pharmacology*; D006332:Cardiomegaly / Q000503:physiopathology; D006333:Heart Failure / Q000503:physiopathology*; D006801:Humans; D013318:Stroke Volume / Q000187:drug effects; D014655:Vascular Resistance / Q000187:drug effects
D000806:Angiotensin-Converting Enzyme Inhibitors