Vasodilators in Chronic Heart Failure

ISBN-13: 9783642686078 / Angielski / Miękka / 2011 / 236 str.

H. Just; W. -D Bussmann; F. Burkart

Opis

The therapeutic principle of pharmacological vasodilation in congestive heart failure is based upon established physiological and pathophysiological mechanisms and has been proved to be effective and useful. In acute heart failure this method of treatment has assumed importance as the first measure to be taken. In chronic heart failure a sizeable increase in cardiac output can be achieved with a number of vasodilating drugs. This effect can be maintained over several weeks or months. The adjustments of the heart and the circulation to the arteriolar and/or venous unloading effect of vasodilatation in the situation of acute and chronic heart failure are well understood. However, long-term adaptations of the organism to the vasodilat- ing intervention have not yet fully been described. In many instances of chronic ad- ministration of vasodilators, attenuation of the response has been observed. The mech- anisms responsible have not been fully elucidated, nor has there been a satisfactory demonstration of improved exercise performance or of life expectancy under this mode of treatment in the patient with chronic heart failure. In an attempt better to understand the pathophysiological mechanisms of chronic congestive heart failure as they apply to long-term treatment with vasodilators, the working group on vasodilator therapy of the Deutsche Gesellschaft fUr Herz- und Kreis- laufforschung has assembled a group of physiologists, pharmacologists, and clinicians. The Proceedings of their Symposium held in Hinterzarten in June 1981 are presented here.

Spis treści

I. Physiology.- Vasoconstrictor Mechanisms and the Effects of Nitrates.- Functional and Metabolic Consequences of Chronic Alterations in Preload and Afterload in the Hypertrophied and Dilated Heart.- The Sympathetic Nervous System in Chronic Heart Failure and Its Response to Vasodilator Therapy.- Regulation of Renal Hemodynamics in Congestive Heart Failure.- The Renin-Angiotensin-Aldosterone System in Congestive Heart Failure.- Endogenous Catecholamines Under Chronic Vasodilator Treatment.- Effects of Hydralazine and Isosorbide Dinitrate on Vasoconstrictor Mechanisms in Patients with Heart Failure.- II. Pharmacology.- Cellular Mechanism of Action of Directly Acting Vasodilator Drugs.- Pharmacokinetics of Nitrates.- Isosorbide Dinitrate: Pharmacokinetics After Intravenous Administration.- Prazosin and ?-Blocking Agents.- III. Clinical Experience.- Promises and Disappointments of Vasodilator Treatment of Chronic Heart Failure.- Nitrates in Chronic Heart Failure.- The Long-Term Effects of Dihydralazine and Hydralazine on Intractable Cardiac Failure.- The Use for Hydralazine in Chronic Cardiac Failure: Results and Unanswered Questions.- Prazosin Therapy in Severe Chronic Congestive Heart Failure.- Early Experience with Captopril in Congestive Heart Failure.- Acute Effect of Nifedipine on Left Ventricular Performance at Rest and During Exercise in Patients with Left Ventricular Dysfunction.- Treatment of Congestive Heart Failure with Dipyridamole.- Therapeutic Agents with Combined Inotropic and Vasodilating Properties.- Hemodynamic Effects of Combined Inotropic and Vasodilator Drugs in Severe Congestive Heart Failure: Hydralazine and Prenalterol.- AR-L 115 BS, a Substance with Inotropic and Vasodilating Effects.- Efficacy of AR-L 115 BS on Hemodynamics, Contractility, and Myocardial Oxygen Consumption in Man.- Treatment of Cardiac Failure with AR-L 115 BS.- IV. Conception and Planning of Future Studies.- Can Vasodilator Treatment Improve Life Expectancy and Physical Performance Heart Failure?.- Vasodilators in Chronic Heart Failure: Problems of Design and Analysis of Controlled Clinical Trials.