[Treatment of chronic heart failure in the child].
Medical therapy for chronic heart failure has recently been extensively revised on the basis of a reduction of mortality in randomized trials. However, there are almost no available trials in children whose treatment for heart failure is adapted from what is known in adults. Digitalis play a role in heart rate variability but there is no evidence for an effect on mortality. Angiotensin-converting enzyme inhibitors lead to an improvement of left ventricular function and reduces mortality; in addition, they are well tolerated in children. Diuretics are useful in congestive heart failure but chronic administration may have deleterious effects. Beta-blocking agents reduce mortality and improve symptoms and the ejection fraction; however, they must be given cautiously and the up-titration phase must be very progressive. New promising drugs are emerging (calcium sensitizers, phosphodiesterase inhibitors, angiotensin receptor [AT1] blockers) but at the present time their use in chronic heart failure has not proven to be efficient.
Bonnet
D
D
Service de cardiologie pédiatrique, hôpital Necker-enfants malades, 149, rue de Sèvres, 75743 Paris, France. damien.bonnet@nck.ap-hop-paris.fr
D002316:Cardiotonic Agents / Q000009:adverse effects / Q000627:therapeutic use; D002648:Child; D002908:Chronic Disease; D015316:Genetic Therapy; D006333:Heart Failure / Q000209:etiology / Q000401:mortality / Q000628:therapy*; D016027:Heart Transplantation; D006801:Humans; D015996:Survival Rate
D002316:Cardiotonic Agents