TREATMENT OF CHRONIC HEART-FAILURE - A RE VIEW

When there is no correctable cause, cardiac failure continues to progr ess and outcome is poor. However several controlled clinical trials ha ve shown that several therapeutic agents relieve symptoms, improve exe rcise tolerance and, for some, reduce mortality. Patients in NYHA func tional class II, III and IV, whose systolic function is impaired shoul d be treated by digitalis, diuretics and angiotensin-converting-enzyme inhibitors. These therapeutic agents are complementary and each of th em are required. Moreover a study has shown that the impairment of pat ients in NYHA functional class I (who are still axymptomatic but with a ventricular ejection fraction <35%) could be slowed by angiotensin-c onverting-enzyme inhibitors. In each case, it is of paramount importan ce to exclude treatable causes of heart failure because the best the s ymptomatic treatment can do is slow the inevitable worsening of the di sease.