It is remarkable how quickly systemic vasodilator therapy has become established as an important new medical treatment for both acute and chronic heart failure. Perhaps no other recent therapeutic concept in cardiovascular medicine has been so rapidly translated into practical clinical management as that of reducing left ventricular afterload by means of vasodilator drugs. Over the past decade, the focus has changed from principal emphasis on contractility to innovative considerations of cardiac unloading by agents that primarily relax vascular smooth muscle without direct actions on the heart. At the same time, reexamination of the proper role of the digitalis glycosides is taking place. Some clinicians maintain that the vasodilators are important as adjuncts in severe heart failure for use when traditional means are inadequate, to be added only in combination with digitalis and diuretics; others already view the vasodilators as equal or even better alternatives than the conventional agents. In the difficult circumstance of refractory acute or chronic heart failure, the combination of vasodilators and powerful cardiotonics - such as dopamine or dobutamine in hospital situations, and digitalis or promising new oral positive inotropics in outpatient settings - provide the most potent pharmacologic enhancement of pump function possible. It is probable that as more experience is gained with the vasodilators and as newer such agents become available, the systemic vasodilators will be utilized as frequently as digitalis in the standard treatment of congestive heart failure.
|Original language||English (US)|
|Number of pages||9|
|State||Published - 1979|
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