ACE inhibitors or inotropic drugs after diuretics in heart failure--a personal critique
Ikram, H.; Nicholls, M.G.; Fitzpatrick, M.A.; Crozier, I.G.
Postgraduate Medical Journal 62(Suppl 1): 176-178
1986
ISSN/ISBN: 0032-5473 PMID: 3534858 Document Number: 3715
After a long period of stagnation, the pharmacotherapy of cardiac failure is currently in a state of rapid evolution. This has been achieved by the synchronous growth in understanding of the pathophysiology of cardiac failure and the availability of therapeutic agents capable of rectifying these derangements. There are always two issues whenever the therapy of any potentially lethal disorder is to be considered. The fi rst, and generally that attracting the greatest attention, is its effect on the quality of life. The second concerns the quantity of life. This is every bit as important as the fi rst, but since medical science often has comparatively little impact on this aspect it is usually accorded secondary importance. There is broad agreement that the agents of fi rst choice in the management of heart failure are the diuretics. They owe this status to their efficacy in relieving dyspnoea and oedema as well as their safety and lack of side effects. Unfortunately the use of increasing doses of diuretics is subject to the law of diminishing therapeutic returns, the limiting factors being either drug resistance or toxicity.
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