Pharmacologic treatment of chronic congestive heart failure

Abstract

Congestive heart failure (CHF) continues to be a lethal end stage of cardiovascular diseases caused by hypertension, coronary heart disease, valve deformity, diabetes and cardiomyopathy. Current therapy for CHF can maintain function, improve quality of life, and prolong survival. Diuretics, angiotensin-converting enzyme inhibitors (ACE), and digoxin remain in standards of therapy. Diuretics remains an important component of the symptomatic management of patients with CHF, but severely II patients may require additional agents. One option frequently used in patients who exhibit resistance to loop diuretics is infusion of low-dose dopamine. Combination diuretics may effectively increase urine output, with the addition of thiazide or spironolactone. Documentation of the clinical benefit of ACE inhibitors represents the most important advance in therapeutics for CHF in the last decade. ACE inhibitors improves left ventricular function, and survival and unless contraindicated, patients with left ventricular systolic dysfunction should receive high dose ACE inhibitor with diuretic if there is peripheral oedema. For patients who cannot take an ACE inhibitor the combination of hydralazine and nitrates may offer some prognostic benefit. Digoxin has been the traditional first drug of choice for CHF, but with protracted controversy about its efficacy and safety. It is hope that new agents as vesnarione, and ibopamine may improve contractility without having adverse consequences. Acceptance of beta-blockade as a potentially beneficial therapeutic intervention increase in the past year. This year, improved diastolic function and afterload reduction were reported with beta-blockade. Amiodarone unlike other antiarrhythmic drugs does not seem depress left ventricular function, and may be the best drug in patients with CHF and symptomatic arrhythmias. The correct role of anticoagulation in patients with CHF remains controversial. Although the benefits of anticoagulation for the treatment of most patients with atrial fibrillation are increasingly accepted, it has not been shown to improve outcome in patients with CHF in normal sinus rhythm.