caa a22 4500 477072283 CHVBK 20180405111429.0 cr unu---uuuuu 170330e19961101xx s 000 0 eng 10.1007/BF00052508 doi (NATIONALLICENCE)springer-10.1007/BF00052508 Medical treatment of eng-stage heart failure [Elektronische Daten] [Giorgio Binetti, Michele Senni, Francesca Colombo, Giordano Tasca, Filippo Mamprin, Roberto Caporale, Paolo Ferrazzi, Amando Gamba, Mattia Glauber, Gianni Troise, Roberto Fiocchi] Summary: Congestive heart failure is a lethal condition that affects an increasing number of patients. In recent years a great amount of data have accumulated on the pathophysiology and medical and surgical therapy of this condition. In spite of the advances in its management and the great number of patients affected, common errors are still made by internists and cardiologists in the use of drugs and therapeutic strategies. Digitalis has only recently been shown to affect hemodynamics, exercise capacity, and clinical symptoms, but the effects on survival still have to be demonstrated. Loop diuretics, eventually combined with thiazides and antialdosterone drugs in patients with clinical signs and symptoms of fluid retention, are the mainstays of therapy of congestive heart failure. In order to make diuretic therapy efficacious, moderate salt and water intake restriction is mandatory. Angiotensin-converting enzyme (ACE) inhibitors are now considered unavoidable drugs in the management of heart failure, and an attempt to reach the doses that have been shown to be efficacious for survival in the large trials has to be made in every patient with this condition. Other vasodilators, such as hydralazine and nitrates, which show a less pronounced effect on survival but more effective hemodynamic actions than ACE inhibitors, may be used to control mitral insufficiency or to improve hemodynamics in very sick patients. Hemodynamic instability refractory to increasing doses of vasodilators and diuretics is a severe condition that requires hospital admission to administer drugs parenterally. These patients are usually treated with the combination of catecholamines and phosphodiesterase inhibitors associated with intravenous diuretics until clinical stability is again achieved and oral therapy is resumed and restructured. The use of aggressive pharmacological therapy and phosphodiesterase inhibitors has reduced the need for assisted circulatory support in these patients. Beta-blockers have shown promising results when administered to patients with heart failure, although a definitive demonstration of their effects on survival is still lacking. Other additional measures that need to be considered in patients with end-stage congestive heart failure are the use of antiarrhythmic drugs and anticoagulation. Kluwer Academic Publishers, 1996 end-stage heart failure nationallicence congestive heart failure nationallicence vasodilators nationallicence diuretics nationallicence Binetti Giorgio Heart Failure and Transplant Program, Ospedali Riuniti, Bergamo, Italy aut Senni Michele Heart Failure and Transplant Program, Ospedali Riuniti, Bergamo, Italy aut Colombo Francesca Heart Failure and Transplant Program, Ospedali Riuniti, Bergamo, Italy aut Tasca Giordano Heart Failure and Transplant Program, Ospedali Riuniti, Bergamo, Italy aut Mamprin Filippo Heart Failure and Transplant Program, Ospedali Riuniti, Bergamo, Italy aut Caporale Roberto Heart Failure and Transplant Program, Ospedali Riuniti, Bergamo, Italy aut Ferrazzi Paolo Heart Failure and Transplant Program, Ospedali Riuniti, Bergamo, Italy aut Gamba Amando Heart Failure and Transplant Program, Ospedali Riuniti, Bergamo, Italy aut Glauber Mattia Heart Failure and Transplant Program, Ospedali Riuniti, Bergamo, Italy aut Troise Gianni Heart Failure and Transplant Program, Ospedali Riuniti, Bergamo, Italy aut Fiocchi Roberto Heart Failure and Transplant Program, Ospedali Riuniti, Bergamo, Italy aut Cardiovascular Drugs and Therapy Kluwer Academic Publishers 10(1996-11-01), 617-622 0920-3206 10<617 1996 10 10557 https://doi.org/10.1007/BF00052508 text/html Onlinezugriff via DOI 1 research-article jats NATIONALLICENCE 856 40 https://doi.org/10.1007/BF00052508 text/html Onlinezugriff via DOI NATIONALLICENCE 700 1- Binetti Giorgio Heart Failure and Transplant Program, Ospedali Riuniti, Bergamo, Italy aut NATIONALLICENCE 700 1- Senni Michele Heart Failure and Transplant Program, Ospedali Riuniti, Bergamo, Italy aut NATIONALLICENCE 700 1- Colombo Francesca Heart Failure and Transplant Program, Ospedali Riuniti, Bergamo, Italy aut NATIONALLICENCE 700 1- Tasca Giordano Heart Failure and Transplant Program, Ospedali Riuniti, Bergamo, Italy aut NATIONALLICENCE 700 1- Mamprin Filippo Heart Failure and Transplant Program, Ospedali Riuniti, Bergamo, Italy aut NATIONALLICENCE 700 1- Caporale Roberto Heart Failure and Transplant Program, Ospedali Riuniti, Bergamo, Italy aut NATIONALLICENCE 700 1- Ferrazzi Paolo Heart Failure and Transplant Program, Ospedali Riuniti, Bergamo, Italy aut NATIONALLICENCE 700 1- Gamba Amando Heart Failure and Transplant Program, Ospedali Riuniti, Bergamo, Italy aut NATIONALLICENCE 700 1- Glauber Mattia Heart Failure and Transplant Program, Ospedali Riuniti, Bergamo, Italy aut NATIONALLICENCE 700 1- Troise Gianni Heart Failure and Transplant Program, Ospedali Riuniti, Bergamo, Italy aut NATIONALLICENCE 700 1- Fiocchi Roberto Heart Failure and Transplant Program, Ospedali Riuniti, Bergamo, Italy aut NATIONALLICENCE 773 0- Cardiovascular Drugs and Therapy Kluwer Academic Publishers 10(1996-11-01), 617-622 0920-3206 10<617 1996 10 10557 Metadata rights reserved Springer special CC-BY-NC licence nationallicence BK010053 XK010053 XK010000 NATIONALLICENCE NATIONALLICENCE NL-springer