Recent advances in therapy of congestive heart failure.
Approximately 3 million Americans are currently diagnosed as having congestive heart failure, and nearly 400,000 deaths occur per year in these patients. Fortunately, recent clinical investigations have made important contributions to the care of patients with congestive heart failure, allowing great improvement in the morbidity and mortality associated with this syndrome. Most patients presenting with signs and symptoms of heart failure suffer from systolic dysfunction. On objective testing, however, up to 30% of patients initially thought to have heart failure due to poor systolic function actually have abnormal diastolic performance. Since treatment that is beneficial for systolic dysfunction can be harmful if applied to patients with diastolic dysfunction, differentiation of these causes of pulmonary congestion is particularly important. Echocardiography has been shown to be particularly useful in making this distinction and is very useful in guiding therapy for patients with heart failure. Vasodilator therapy has been recently shown to both relieve symptoms and lessen long-term mortality for patients with heart failure. Additionally, vasodilators may be more effective than digitalis in relieving symptoms of heart failure for patients with mild-to-moderate symptoms. Thus it appears that vasodilators should play a prominent and early role in the treatment of most patients with heart failure due to systolic dysfunction. The value of digitalis for patients with heart failure related to uncontrolled atrial arrhythmias is well appreciated. Controversy exists, however, regarding the role of digitalis for patients who remain in normal sinus rhythm. A recent double-blind trial of digoxin, milrinone, both, or placebo has confirmed the beneficial effects of digoxin for these patients.(ABSTRACT TRUNCATED AT 250 WORDS)
Harrison
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D000889:Anti-Arrhythmia Agents / Q000627:therapeutic use; D004071:Digitalis Glycosides / Q000627:therapeutic use; D006333:Heart Failure / Q000188:drug therapy*; D006801:Humans; D014665:Vasodilator Agents / Q000627:therapeutic use
D000889:Anti-Arrhythmia Agents; D004071:Digitalis Glycosides; D014665:Vasodilator Agents