Congestive failure

Drugs with an acute positive inotropic action (e.g., catecholamines or phosphodiesterase inhibitors) may be of transient help in sudden decompensation but must not be given in chronic congestive failure. 

THERAPEUTIC USES Dopamine (intropin, others) is used in the treatment of severe congestive failure, particularly in patients with oliguria and low or normal peripheral vascular resistance. The drug also may improve physiological parameters in the treatment of cardiogenic and septic shock. While DA may acutely improve cardiac and renal function in severely iU patients with... 

The digitalis-like glycosides are the basic therapy for congestive failure. The toad poisons (bufagins, bufotalins, or bufotoxins) and the Eryth-rophleum alkaloids show promise as potentially useful drugs for this form of heart disease. 

Most of the information concerning an antifibrillatory property for quinine is to be found in clinical trial reports. Frey (17) tried quinine in 1.0-1.5-g. daily doses in patients with auricular fibrillation complicated by mitral insufficiency and congestive failure. In neither case did conversion to normal sinus rhythm occur although subsequent use of quinidine did... 

The classic publication of Frey (17) epitomizes most of the information known today about the therapy of auricular fibrillation with quinidine. He converted to normal sinus rhythm 6 of 10 patients whose auricular fibrillation was complicated by atherosclerosis, mitral stenosis or insufficiency, and rheumatic fever or congestive failure. These patients included other arrhythmias such as auricular flutter or ventricular extra systoles. Some had been digitalized. Conversion occurred after 1.0 to 1.4 g. quinidine given over 2 to 8 days. Frey (33) also distinguished between patients with paroxysmal auricular fibrillation and the more stubborn continuous fibrillation. In this latter group of patients, many of whom had serious cardiac damage, quinidine converted 11/22 to normal rhythm. 

Gluzinski reported that 20 mg. of sparteine improved patients with congestive failure and recommended its use as quicker than digitalis though weaker in action. He did not find that sparteine eliminated arrhythmias in his patients. 

F. Vasodilators Vasodilator therapy with nitroprusside or nitroglycerin is often used for acute severe congestive failure. The use of these vasodilator drugs is based on the reduction in cardiac size and improved efficiency that can be realized with proper adjustment of venous return and reduction of resistance to ventricular ejection. Vasodilator therapy can be dramatically effective, especially in cases in which increased afterload is a major factor in causing the failure (eg, continuing hypertension in an individual who has just had an infarct). Chronic congestive heart failure sometimes responds favorably to oral vasodilators such as hydralazine or isosorbide dinitrate. 

A 65-year-old woman has been admitted to the coronaiy care unit with a left ventricular myocardial infarction. If this patient develops acute severe congestive failure with pulmonary edema, which one of the following would be most useful ... 

Which of the following has been shown to prolong life in patients with chronic congestive failure but has a negative inotropic effect on cardiac contractility ... 

Which of the following is a p,-selective agonist sometimes used in acute congestive failure (A) Atenolol... 

Acute severe congestive failure with pulmonary edema often requires a vasodilator that reduces intravascular pressures in the lungs. Furosemide has such vasodilating actions in the context of acute failure. Minoxidil would decrease arterial pressure and increase the heart rate excessively. Spironolactone is useful in chronic failure but not usually in acute pulmonary edema. The answer is (A). 

Cardiac involvement was present in most patients and is certainly related to the underlying disease. Although the signs and symptoms referable to the heart vary in different subjects, angina pectoris and congestive failure occur rarely, while tachycardias and arrhythmias are frequent. Enlargement of the heart and nonspecific systolic murmurs have been described. 

Summary of results in treatment of 1070 patients with angina pectoris or congestive failure. J. Amer. med. Ass. 167,1 (1955). 

Signs of potassium deficiency are primarily those of decreased muscular irritability and disturbances of conduction and contractility in the heart muscle. Muscular weakness or paralysis are characteristic and may be accompanied by lethargy and coma. Cardiac dilatation, hypertension, congestive failure, and cardiac arrest may occur. Death may result from respiratory or cardiac failure or from paralytic ileus. 

It is noteworthy, too, that pangamic acid increases the effectiveness of strophanthin (a heart tonic) on heart function of patients with congestive failure and reduces the incidence of side effects associated with digitalis therapy. 

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