Vasodilator Therapy in Chronic Congestive Heart Failure

Abstract

Method:

Ten patients suffering from intractable chronic congestive heart failure due to coronary atherosclerotic heart disease who did ot respond to conventional anticongestive treatrncnt (digit alis, diuretics, salt restriction and bed rest) were selected for vasodilator, therapy.  Routine anticongestive treatment as Cont inued. Isosorbide dinitrate was initially given in closes ol 10 mg. six hourly by mouth and was later inercased to 20 mg. six hourly depending Ofl the response. Prazocin ‘as given initially in doses of 1 nig. six hourly and later increased to 3 to 5 mg. six hourly depending on the response. The patients were followed for six weeks to 3 months.

Results:

Seven patients improved. Three patients showed no response. Those who improved showed decrease in heart rate, fall in jugular venous pressure and increase in dieresis reduction in weight and decrease in pulmonary congestion and heart size. Blood pressure decreased but remained above 100 mm.Ha. systolic in all.

Discussion:

Vasodilator therapy shows salutary effects in chronic congestive heart failure by reducing the after load and/or preload. Reduction of after load by dilatation of resistance vessels (arterioles) reduses impedance to left ventricular ejection promoting increase in stroke volume, elevation of ejection fraction, reduction of left ventricular end-diastolic volume and filling pressure and decrease in left ventricular end-systolic volume.  It is suggested that vasodilator therapy may be used with benefit in patients suffering from chronic congestive heart failure who fail to respond to convendonal anticongestive treatment.