Lege Artis Medicinae

[Lorenzo da Ponte The Librettist of Mozart]

KÖVES Péter

JULY 14, 2007

Lege Artis Medicinae - 2007;17(06-07)

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Lege Artis Medicinae

[THE USE OF DIRECT VASODILATORS AND DIGITALIS IN CHRONIC HEART FAILURE]

DÉKÁNY Miklós

[For the optimal treatment of heart failure patients with systolic dysfunction, supplementation of the standard diuretics plus neurohormonal antagonists treatment with the direct vasodilator combination dihydralazine+nitrate, as well as with digitalis may be necessary. Addition of hydralazine/dihydralazine+nitrate to the treatment of chronic heart failure is recommended if ACE-inhibitors or angiotensin-receptor blockers cannot be administered. Beta blockers should also be used in these cases. If symptoms persist or worsen, addition of this combination to the standard therapy is reasonable. Supplementation with digitalis, mostly digoxin should be considered in similar conditions. It can be especially beneficial for patients with high-ventricular-rate atrial fibrillation. To achieve maximal survival benefit, the dose of digoxin must not exceed 0.125 mg/day. Low body weight or muscle mass, significantly reduced renal function may make further dose reduction necessary. If renal function is severely limited, digitoxin instead of digoxin may be used.]

Lege Artis Medicinae

[More Effective Metabolic Control – Better Quality of Life]

WINKLER Gábor

Lege Artis Medicinae

[ANGIOTENSIN-CONVERTING ENZYME INHIBITORS AND ANGIOTENSIN-2 RECEPTOR BLOCKERS IN CHRONIC HEART FAILURE]

ZÁMOLYI Károly

[The rennin-angiotensin system plays a major role in cardiovascular diseases. In the past decade, extensive research investigated the possible clinical benefit of the use of angiotensin-converting enzyme inhibitors in various clinical conditions. Their benefits have been clearly demonstrated in many cardiovascular conditions and agreement as to their potential usefulness has been established in chronic heart failure, asymptomatic left ventricular dysfunction, acute myocardial infarction and hypertension, and in the primary prevention in patients with high risk for cardiovascular events. Numerous randomised clinical trials over the past two decades established their efficacy in reducing adverse outcomes (mortality, hospitalitazion, and physical limitation) in patients with heart failure and left ventricular systolic dysfunction. Based on these results, angiotensin-converting enzyme inhibitors are indicated in all patients with left ventricular systolic dysfunction regardless of etiology, in the absence of intolerance or a contraindication. Despite the recent improvements in the treatment of heart failure, mortality remains high, with approximately 50% patients dead at five years. Although angiotensinconverting enzyme inhibitors decrease mortality, they incompletely suppress angiotenzin-2 when used chronically. Since angiotensin receptor blockers block the biologic effects of angiotenzin-2 more completely than angiotensin-converting enzyme inhibitors, they may be beneficial in the treatment of heart failure. In comparison trials, angiotensin receptor blockers were found to have no benefit over angiotensin-converting enzyme inhibitor therapy. Thus, angiotensin-converting enzyme inhibitors should remain first-line treatment for heart failure. However, in case of intolerance, angiotensin receptor blocker therapy is a reasonable substitute and provides excellent tolerability.]

Lege Artis Medicinae

[CARDIOLOGIC REHABILITATION IN CHRONIC HEART FAILURE]

SZÁSZ Károly

[The past decade has seen a considerable change in the approach to manage heart failure. In chronic heart failure, physical training primarily improves peripheral circulation rather than the function of the left ventricle. Regular training of patients with stable NYHA II-III stages improves physical stress tolerance and respiratory function, and also reduces the over-activated sympathetic tone. It has beneficial effects on the biochemical processes of the skeletal muscles. The duration, intensity and frequency of the training are individually set and can be changed according to the clinical state of the patient. The recommended intensity of the training is 60 to 70% of the peak oxygen use. The duration and frequency of the training depends on the clinical state of the patient and it can be raised to 3 to 6 occasions and the duration can vary between 30 to 60 minutes. For safety reasons the patient should be monitored before, during and after physical training. Cardiological rehabilitation should be a team work, with the physician as the co-ordinator, but the physiotherapist, the dietician, the psychologist and the social worker all have important, indispensable roles in achieving the optimal state of the patient.]

Lege Artis Medicinae

[Meditation]

DONÁTH Tibor

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