Pharmacological treatments of congestive heart failure: A look at yesterday, today and tomorrow.

概要

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Digitalis glycosides have been used for more than 200 years to treat chronic congestive heart failure although they often fail to provide adequate support in a patient with a severely depressed heart at the dose that does not cause toxicity. Improvement of this class of drugs is not feasible because both the therapeutic and toxic actions are caused by the same mechanism, i.e., inhibition of the sarcolemmal sodium pump. Despite the initial optimism with "newer" positive inotropic drugs, they are not free from toxicity which is caused by Ca2+ overload or from their tendency to inhibit relaxation. Moreover, these drugs fail to reduce risk factors in patients with advanced heart failure. Mortality of these patients is reduced by vasodilator therapy combined with digitalis and a diuretic. This therapy reduces preload and afterload, and hence workload, in addition to increasing the force of myocardial contraction, and minimizes deficiencies of failing heart. In this regard, importance of nonpharmacologic therapies for re-duction of cardiac workload should also be emphasized. All these treatments, however, are palliative. We know very little about the basic changes that lead to heart failure, and treatments to prevent those changes are presently unavailable.
The Keio Journal of Medicineの論文