OUTPATIENT TREATMENT OF CHRONIC HEART-FAI LURE

Considerable progress has been made in the medical treatment of chroni c heart failure. A large number of patients with NYHA class II and III heart disease can be improved to class I and II. Treatment is maintai ned on an outpatient basis in order to prevent episodes of acute failu re, while avoiding the adverse effects of drugs at high doses or in co mbination. Diuretics are still the drug class most frequently prescrib ed, especially loop diuretics (furosemide) which have the advantage of being able to be used in patients with renal failure. Aldosterone ant agonists have the pathophysiological value of reducing the development of myocardial fibrosis. Digitalis alkaloids have a positive inotropic effect, which is even observed in the presence of sinus rhythm and wh ich is associated with slowing of the heart rate in tachyarrhythmias. Angiotensin converting enzyme inhibitors are among the most recently u sed drugs. They decrease the left ventricular post-load and prevent ac tivation of the renin-angiotensin-aldosterone system. Phosphodiesteras e inhibitors cannot be administered orally in the long-term and are th erefore not suitable for outpatient treatment. However, they are very effective by intravenous injection during the acute phase of heart fai lure and cardiogenic shock in hospital.