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Treatment of Acute and Chronic Congestive Heart Failure by Vasodilator-Afterload Reduction

Dean T. Mason, MD; Najam A. Awan, MD; James A. Joye, MD; Garrett Lee, MD; Anthony N. DeMaria, MD; Ezra A. Amsterdam, MD
Arch Intern Med. 1980;140(12):1577-1581. doi:10.1001/archinte.1980.00330230023008.
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Management of congestive heart failure is based on recognition of the specific underlying cardiac disease, understanding of the pathophysiology involved, exclusion of extracardiac complicating factors perpetuating cardiovascular dysfunction, complete information concerning available prophylactic measures, and thorough knowledge of medical and surgical therapy. Although most patients respond favorably to conventional treatment consisting of digitalis and diuretics, relatively refractory heart failure may develop in advanced myocardial heart disease (the specific, idiopathic, and ischemic cardiomyopathies) unamenable to operative intervention. The most important recent advance in the medical therapy for such patients with acute and chronic pump dysfunction has been the application of systemic vasodilator drugs to reduce excessive left ventricular afterload, thereby improving lowered cardiac output and decreasing elevated pulmonary venous pressure.

RATIONALE OF AFTERLOAD REDUCTION THERAPY  The cardiac output delivered from the intact heart is governed by integration of four principal determinants: (1) preload (ventricular end-diastolic volume), (2) contractility (variable force of


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The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
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