The main aspects of symptomatic therapy of chronic heart failure

Diana Žaliaduonytė-Pekšienė, Lina Mikuckaitė, Aušra Kavoliūnienė

Department of Cardiology, Kaunas University of Medicine, Lithuania

Key words: heart failure; diuretics; resistance to diuretics; digoxin.

Summary. The main aims of the treatment of chronic heart failure are to improve and to maintain the quality of life, to increase duration of life, to decrease mortality, to prevent diseases leading to the heart failure development, and to prevent the progression of heart failure.

Diuretics are the drugs of first choice for the treatment of congestive heart failure. They can improve the quality of patient’s life quite quickly. Noncompliance to methodological diuretic use can cause a serious damage such as metabolic disorders, arrhythmias, and even sudden death.

Loop diuretics are the drugs of choice. Resistance to diuretics occurs in 10–20% of the cases during the course of treatment; therefore, drug combination as well as dose modification is required. Diuretics are not recommended to use alone for a symptomatic relief. They are prescribed in combination with beta-blockers, angiotensin-converting-enzyme inhibitors, and/or angiotensin receptor blockers for a continuous pathogenetic therapy of congestive heart failure.

Digoxin in combination with diuretics is the drug of choice for treatment of heart failure when tachyarrhythmia or severe systolic left ventricular dysfunction appears or it is impossible to administer beta-blockers.

In this article, the guidelines of European Society of Cardiology and also American College of Cardiology and American Heart Association for the symptomatic management of congestive heart failure, updated in 2005, are reviewed.

Correspondence to D. Žaliaduonytė-Pekšienė, Department of Cardiology, Kaunas University of Medicine, Eivenių 2, 50009 Kaunas, Lithuania. E-mail: dianazal@yahoo.com

Received 13 January 2006, accepted 10 October 2006