[Terminal heart failure; therapeutic strategies. Drug therapy in cases of absence of possibility of heart transplantation: dobutamine therapy, aspects of compassion?].
Terminal cardiac failure, despite the gain obtained by angiotensin converting enzyme inhibitors, continues to carry a high annual mortality. Cardiac transplantation, with a 1 year survival of about 80% (a result which is sustained at 5 years), constitutes the treatment of choice for these patients. However, in view of the contraindications to transplantation and the cruel lack of donors organs, many cases of terminal cardiac failure are unable to benefit from transplantation. What are the pharmacological means available for these patients? This is a real therapeutic challenge. The essential objective in the management of these patients with a poor short-term prognosis is the reduction of mortality. However, this aim is not easily attained, at least in the short or medium-term in the present state of our knowledge. Other objectives can therefore by legitimately considered in the management of patients with cardiac failure in the terminal phase: the most important ones are to improve symptomatology and the quality of life. Terminal cardiac failure is a complex syndrome implicating a number of non-cardiac abnormalities. They may not only participate in the symptomatology and high mortality, but also make therapeutic management a delicate operation. Nevertheless, the abnormalities of cardiovascular function remain the cardinal problem. The treatment which we use aims to correct them. The authors propose a review of the possibilities available with reference to data in the medical literature.
Roul
G
G
Service de cardiologie, Hôpital de Hautepierre, Strasbourg.
Bareiss
P
P
D000318:Adrenergic beta-Agonists / Q000627:therapeutic use*; D002316:Cardiotonic Agents / Q000627:therapeutic use; D004280:Dobutamine / Q000627:therapeutic use*; D006333:Heart Failure / Q000401:mortality / Q000523:psychology / Q000628:therapy*; D006440:Hemofiltration; D006801:Humans; D007262:Infusions, Intravenous; D010726:Phosphodiesterase Inhibitors / Q000627:therapeutic use; D011788:Quality of Life; D013727:Terminal Care / Q000379:methods; D014665:Vasodilator Agents / Q000627:therapeutic use
D000318:Adrenergic beta-Agonists; D002316:Cardiotonic Agents; D010726:Phosphodiesterase Inhibitors; D014665:Vasodilator Agents; D004280:Dobutamine
Insuffisance cardiaque terminale; stratégies thérapeutiques. Moyens médicaux en l'absence de possibilité de greffe cardiaque: cure de dobutamine, aspects compassionnels?