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Withering demonstrated 200 years ago in the year 1784 that "drop sy" could be successfully treated with foxglove extracts. This dis covery eventually led to the scientifically based treatment of heart failure with chemically defined digitalis glycosides. In Germany, particularly, the usefulness of this development was greatly exagger ated and often resulted in the indiscrimate use of digitalis for pa tients with coronary artery disease and its complications. Today, this type of drug intervention is used more sparingly. At the same time, other therapeutic concepts were introduced, particularly that of drug-induced diuresis and the concept of vasodilation. This book is the result of a systematic study of various therapeu tic approaches for the management of heart failure and includes clinical, experimental and theoretical aspects. For more than a de cade, various therapeutic modalities have been clinically evaluated in the setting of acute heart failure managed in the intensive care unit as well as chronic heart failure for inpatient and outpatient therapy. Experience has shown that in certain clinical situations, particu larly the management of acute disease, specific, individual drug in tervention is required and is based on the underlying etiology for heart failure. However, in chronic heart failure, long-term success can only be achieved by the rational combination of treatment mo dalities. The present text is aimed at providing the clinically and scientif ically oriented physician with the pathophysiologic and pharmaco logic background necessary to place into perspective the therapeutic efforts for the management of heart failure.
Sommario
Acute Heart Failure.- A. Overview.- B. Pathophysiology of Heart Failure With Respect to Vasodilation.- C. Acute Left Sided Heart Failure.- D. Therapy of Acute Pulmonary Edema.- E. Left-Sided Heart Failure in Acute Myocardial Infarction.- F. Left-Sided Heart Failure and Papillary Muscle Dysfunction.- G. Heart Failure Following Rupture of the Ventricular Septum.- H. Cardiogenic Shock.- I. Left-Sided Heart Failure Associated with Rheumatic Valvular Defects or Cardiomyopathies.- J. Left-Sided Heart Failure in Hypertensive Crisis.- K. Acute Right-Sided Heart Failure.- L. Pharmacokinetics of Vasodilating Agents.- Chronic Heart Failure.- A. Pathophysiologic Mechanisms of Chronic Heart Failure.- B. New Aspects in the Treatment of Chronic Heart Failure.- C. Role of Digitalis.- D. Role of Diuretic Therapy.- E. Clinical Role of Vasodilator Therapy.- F. The Use of Nitrates in Chronic Heart Failure.- G. Hydralazine for Chronic Heart Failure.- H. Prazosin in Chronic Heart Failure.- I. Converting Enzyme Inhibition: Therapy for Chronic Heart Failure.
Riassunto
Withering demonstrated 200 years ago in the year 1784 that "drop sy" could be successfully treated with foxglove extracts. This dis covery eventually led to the scientifically based treatment of heart failure with chemically defined digitalis glycosides. In Germany, particularly, the usefulness of this development was greatly exagger ated and often resulted in the indiscrimate use of digitalis for pa tients with coronary artery disease and its complications. Today, this type of drug intervention is used more sparingly. At the same time, other therapeutic concepts were introduced, particularly that of drug-induced diuresis and the concept of vasodilation. This book is the result of a systematic study of various therapeu tic approaches for the management of heart failure and includes clinical, experimental and theoretical aspects. For more than a de cade, various therapeutic modalities have been clinically evaluated in the setting of acute heart failure managed in the intensive care unit as well as chronic heart failure for inpatient and outpatient therapy. Experience has shown that in certain clinical situations, particu larly the management of acute disease, specific, individual drug in tervention is required and is based on the underlying etiology for heart failure. However, in chronic heart failure, long-term success can only be achieved by the rational combination of treatment mo dalities. The present text is aimed at providing the clinically and scientif ically oriented physician with the pathophysiologic and pharmaco logic background necessary to place into perspective the therapeutic efforts for the management of heart failure.
