Congestive heart failure specific agents

Expert opinion is a source, frequently elicited by survey, that is used to obtain information where no or few data are available. For example, in our experience with a multicountry evaluation of health care resource utilization in atrial fibrillation, very few country-specific published data were available on this subject. Thus the decision-analytic model was supplemented with data from a physician expert panel survey to determine initial management approach (rate control vs. cardioversion) first-, second-, and third-line agents doses and durations of therapy type and frequency of studies that would be performed to initiate and monitor therapy type and frequency of adverse events, by body system and the resources used to manage them place of treatment and adverse consequences of lack of atrial fibrillation control and cost of these consequences, for example, stroke, congestive heart failure. This method may also be used in testing the robustness of the analysis [30]. 

Some PHOSPHODIESTERASE INHIBITORS (e.g. cnoximone and milrinone) are valuable, and some exert most of their effect on the myocardium (those acting at a heart-specific subtype of this enzyme (type III phosphodiesterase) to raise the intracellular concentration of cAMP) and may be used as positive INOTROPIC AGENTS in the short-term treatment of severe congestive heart failure. 

Inhibitors of a heart-specific subtype (type III) phosphodiesterase, which are positive inotropics, may be used in the short-term treatment of severe congestive cardiac failure, e.g. amrinone, enoximone and milrinone. However, developments of oral formulations of drugs of this type have been halted by the results of the PROMISE trial (Prospective Randomised Milrinone Survival Evaluation trial) which documented a paradoxical increase in mortality in class IV heart failure patients randomised to receive milrinone. However, some benzimidazole derivatives with class III phosphodiesterase inhibitor actions seem to be beneficial in heart failure. The agent vesnarinone is an orally active compound that may act as a class III phosphodiesterase inhibitor but appears to be a vasodilator with multiple mechanisms. See HEART FAUURE TREATMENT INOTROPIC AGENTS. 

Edema and specific drugs for its treatment have long been problems of the physician and of the chemist interested in medicinal products. Digitalis and the many related cardiac glycosides were the first effective agents for the treatment of dropsy associated with congestive heart failure. However, it was soon recognized that the mobilization of the excess tissue fluid associated with this condition was due to a primary action on the heart with improved cardiovascular hemodynamics and only secondarily to an action upon the kidney. 

Furosemide possesses relatively high effieaey, rapid onset of action, short duration of action, and 1 10 ratio between the minimum and maximum diuretie dose. It is used for the treatment of oedema associated with renal disease, nephrotic syndrome, cirrhosis of the liver and congestive heart failure. It has an edge over other commonly used diuretic agents specifically when a greater diuretic potential is required. It may also be employed towards the management of hypertension. 

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