title: [First-line treatment of cardiac insufficiency: digitalis glycosides, diuretics, vasodilator agents or new cardiotonic agents?].
abstract: The advent of vasodilator therapy and new cardiotonic agents has modified the medical treatment of heart failure. First-line treatment is no longer standard; its choice must take into account a number of individual factors such as patient's age, causative cardiopathy, severity of the disease, response to treatment, contra-indications and side-effects of drugs. The aim is to obtain an improvement not only in the patient's comfort but also in long-term prognosis. The prescription of digitalis compounds to heart failure patients with sinus rhythm has been questioned. Alternatives to the conventional therapeutic approach based on cardiac glycosides and diuretics are now available. They include the use at an early stage of vasodilator therapy, and notably angiotensin-converting enzyme inhibitors, in the hope of avoiding gradual reduction of cardiac performance.
authors.affiliation: Service de Cardiologie, CHU Pitié Salpêtrière, Paris.
authors.forename: M
authors.initials: M
authors.lastname: Komajda
authors.forename: P
authors.initials: P
authors.lastname: Lechat
authors.forename: Y
authors.initials: Y
authors.lastname: Grosgogeat
mesh_terms: D002316:Cardiotonic Agents / Q000627:therapeutic use*; D004071:Digitalis Glycosides / Q000627:therapeutic use; D004232:Diuretics / Q000627:therapeutic use*; D006333:Heart Failure / Q000188:drug therapy*; D006801:Humans; D014665:Vasodilator Agents / Q000627:therapeutic use*
chemical_list: D002316:Cardiotonic Agents; D004071:Digitalis Glycosides; D004232:Diuretics; D014665:Vasodilator Agents
vernacular_title: Traitement de première intention de l'insuffisance cardiaque: digitaliques, diurétiques, vasodilatateurs, ou nouveaux tonicardiaques?