title: [Pharmacotherapy of acute heart failure: update and perspectives].
abstract: In acute decompensated heart failure rapid diagnosis and causal therapy are                     necessary to avoid cardiogenic shock. Treatment goals are to decrease                     congestion, afterload, and neurohormonal activation in order to improve                     hemodynamics and symptoms and, perhaps, reduce in-hospital events,                     re-hospitalizations, and mortality. A combined medical therapy of diuretics and                     / or vasodilators should be favoured in order to protect organs and to avoid                     toxicities of therapy such as hypotension, arrhythmias and renal dysfunction.                     Intravenous inotropes, such as dobutamine and milrinone, should be limited to                     hypotensive patients with evidence of poor tissue perfusion. They improve                     hemodynamics and organ perfusion but result in a higher mortality due to to                     proarrhythmogenic effects. Therefore, they should be given in lowest doses and                     should be withdrawn as early as possible. A preexisting therapy with                     betablockers should be continued if there is no hemodynamic instability. Before                     demission any patient should be on betablockers and ACE inhibitors according to                     national guidelines resulting in a decrease of re-hospitalization and mortality                     rates. New medical therapies should at least improve clinical symptoms and                     favourably reduce re-hospitalization and mortality rates.
authors.affiliation: Klinik für Innere Medizin III, Universitätsklinikum des Saarlandes, Homburg/Saar. andreas.link@uks.eu
authors.forename: A
authors.initials: A
authors.lastname: Link
authors.forename: J
authors.initials: J
authors.lastname: Pöss
authors.forename: M
authors.initials: M
authors.lastname: Böhm
mesh_terms: D000208:Acute Disease; D002316:Cardiotonic Agents / Q000009:adverse effects / Q000627:therapeutic use; D002317:Cardiovascular Agents / Q000009:adverse effects / Q000627:therapeutic use*; D003131:Combined Modality Therapy; D004232:Diuretics / Q000009:adverse effects / Q000627:therapeutic use; D005544:Forecasting; D006333:Heart Failure / Q000175:diagnosis / Q000188:drug therapy* / Q000209:etiology; D006801:Humans; D007362:Intensive Care Units; D014662:Vasoconstrictor Agents / Q000009:adverse effects / Q000627:therapeutic use; D014665:Vasodilator Agents / Q000009:adverse effects / Q000627:therapeutic use
chemical_list: D002316:Cardiotonic Agents; D002317:Cardiovascular Agents; D004232:Diuretics; D014662:Vasoconstrictor Agents; D014665:Vasodilator Agents