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European Heart Journal 1988 9(6):602-609;
Copyright © 1988 by the European Society of Cardiology.
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© 1988 The European Society of Cardiology

Personal view Congestive heart failure: how to evaluate efficacy of treatment

W. KÜBLER*, J. MANTHEY{dagger} and K. J. OSTERZIEL*

*Department of Cardiology, University of Heidelberg Bergheimer StraBe 58, 6900 Heidelberg, F.R.G.
{dagger}Kreiskrankenhaus am Plattenwald 7107 Bad FriedrichshaII, F.R.G.

Received 16 February 1987; revised 26 November 1987; .

Abstract

Vasodilators are widely used in the therapy of congestive heart failure. Different mechanisms responsible for a failure of vasodilator therapy are discussed. Tolerance and/or diminished reabsorption or a less than optimal choice of the drug may be responsible for the lack of acute response. In addition, counter-regulation, mainly by the sympathetic nervous system, may decrease the drug effect. Furthermore, the initial beneficial effect of each vasodilator can be diminished with long-term therapy. Based on a clinical assessment and on invasive and noninvasive techniques a proposal is made as to how to treat an individual patient efficaciously.

Key Words: Heart failure • treatment • vasodilators • efficacy


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