By Professor Dr. med. Wulf-Dirk Bussmann (auth.)
Withering verified 2 hundred years in the past within the 12 months 1784 that "drop sy" may be effectively handled with foxglove extracts. This dis covery finally resulted in the scientifically dependent remedy of middle failure with chemically outlined digitalis glycosides. In Germany, rather, the usefulness of this improvement used to be enormously exagger ated and sometimes led to the indiscrimate use of digitalis for pa tients with coronary artery ailment and its problems. at the present time, this sort of drug intervention is used extra sparingly. whilst, different healing techniques have been brought, quite that of drug-induced diuresis and the idea that of vasodilation. This publication is the results of a scientific learn of assorted therapeu tic ways for the administration of center failure and contains medical, experimental and theoretical features. For greater than a de cade, a number of healing modalities were clinically evaluated within the environment of acute center failure controlled within the extensive care unit in addition to power middle failure for inpatient and outpatient remedy. adventure has proven that during definite scientific occasions, particu larly the administration of acute affliction, particular, person drug in tervention is needed and is predicated at the underlying etiology for center failure. notwithstanding, in persistent center failure, long term luck can simply be completed through the rational mix of remedy mo dalities. the current textual content is geared toward supplying the clinically and scientif ically orientated doctor with the pathophysiologic and pharmaco common sense historical past essential to position into point of view the healing efforts for the administration of middle failure.
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Extra resources for Acute and Chronic Heart Failure: Diagnosis and Therapy
1. Is there still an Indication/or Digitalis in Acute Heart Failure? Drugs with a rapid onset of action are indicated in the treatment of acute heart failure. Although digitalis preparations have a relatively rapid onset of action, it is one to several hours before full therapeutic blood levels are attained. Selzer, San Francisco, and Pitt, Baltimore, were among the first to point out that digitalis does not qualify as an effective drug in the management of acute heart failure. Digitalis glycosides are characterized by a mild positive inotropic effect and lead to a lowering of left and right ventricular filling pressures secondary to an improvement of inotropism.
22) (Thadani et al. 1980). With continuing 140 f I Acute th erapy 120 E S ~ :J '"'~" Q. ~ (5 ¢ - ¢ Placebo ~ 0 - 0 ISDN • - . -A 80 o 2 4 6 8 o 2 4 15 mg 30 mg 60 mg 120 mg 6 8 Hours after single oral dose Fig. 22. Example for intrinsic counterregulation after drug-induced arterial blood pressure fall. In the upright position, isosorbide dinitrate (ISDN) leads to substantial arterial pressure reduction with an approximately linear dose-response curve. At one-week therapy, there is an attenuation of blood pressure fall and no longer a dose-response relationship.
The antianginal effect of nitrates, however, is maintained with chronic administration (Becker et al. 1976; Schneider et al. 1983). d) Differences in Response Lastly but not least, individual differences in response have to be considered. There are also differences in response to vasodilating agents analogous to antiarrhythmic agents where not every patient shows the same favorable response to a substance. It is therefore advantageous that we can choose from among a variety of substances such as nitrates, prazosin, hydralazine, and captopril.