CURRENT GUIDELINES FOR THE TREATMENT OF CONGESTIVE-HEART-FAILURE

Overt congestive heart failure (CHF) has a prevalence of 1% of the pop ulation. The predominant symptoms of patients with CHF are fatigue and dyspnoea. Fatigue is thought to result from changes in peripheral mus cle metabolism secondary to decreased vasodilative capacity and physic al inactivity. An increase of peripheral perfusion by vasodilator ther apy and physical activity are therefore recommended. Beside overt deco mpensation, where dyspnoea results from acute pulmonary congestion due to backward failure, increased physiological dead space ventilation c aused by pulmonary ventilation/perfusion mismatch accounts, to a large degree, for dyspnoea, and can be improved by vasodilator therapy. Acc ording to the pathophysiology of CHF, normalisation of loading conditi ons and myocardial inotropy are the parameters addressed by various ph armacological agents in order to alleviate symptoms and slow progressi on of the disease. Diuretics are rapidly acting and effective agents t o improve congestion and decrease filling pressures. Digitalis improve s haemodynamics and symptomatology by increasing inotropy and slowing resting heart rate in atrial fibrillation; however, prognostic effects have yet to be proved. The introduction of vasodilators has significa ntly improved the prognosis of the disease, and the administration of ACE inhibitors in particular has been shown to slow progression of CHE This results in a substantial decrease in morbidity and mortality. Th e present article appraises the role of the currently used drugs in th e treatment of CHF, considering effects on pathophysiology and clinica l outcome and provides an approach to a differential drug regimen.