Treatment of congestive heart failure a neuroendocrine disorder.
The understanding of heart failure is no longer based on a supply and demand model of pump failure. Rather, heart failure is seen as a complex pathophysiological process with activation of various neuroendocrine systems. The goals of treatment have changed towards modifying these counterproductive neuroendocrine systems and slowing myocardial maladaptation. Angiotensin converting enzyme inhibitors are the only licensed drugs in veterinary practice that have a direct effect on neurohormones in heart failure. The range of drug options in human medicine is greater and some of these drugs are also increasingly being used in veterinary cardiology practice. This review describes the neuroendocrine systems involved in heart failure and discusses the range of drugs available in human and veterinary medicine. In doing so, it concentrates on the evidence available from good quality randomised trials in both the veterinary field and, where relevant, the human medical field.
Martin
M W S
MW
Veterinary Cardiorespiratory Centre, Thera House, Waverley Road, Kenilworth, Warwickshire CV8 1JL.
D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use; D000818:Animals; D002316:Cardiotonic Agents / Q000627:therapeutic use; D004232:Diuretics / Q000627:therapeutic use; D004283:Dog Diseases / Q000188:drug therapy*; D004285:Dogs; D016232:Endothelins / Q000037:antagonists & inhibitors; D006333:Heart Failure / Q000188:drug therapy / Q000662:veterinary*; D006801:Humans; D015260:Neprilysin / Q000037:antagonists & inhibitors; D009490:Neurosecretory Systems; D016032:Randomized Controlled Trials as Topic; D014409:Tumor Necrosis Factor-alpha / Q000037:antagonists & inhibitors; D014665:Vasodilator Agents / Q000627:therapeutic use; D019155:Veterinary Drugs
D000319:Adrenergic beta-Antagonists; D000806:Angiotensin-Converting Enzyme Inhibitors; D002316:Cardiotonic Agents; D004232:Diuretics; D016232:Endothelins; D014409:Tumor Necrosis Factor-alpha; D014665:Vasodilator Agents; D019155:Veterinary Drugs; D015260:Neprilysin