Author/Editor		Žemva, Aleš
Title		Treatment of congestive heart failure with angiotensin-converting enzyme (ACE) inhibitors
Type		članek
Source		In: Pajer Z, Štiblar-Martinčič D, editors. International symposium on cardiovascular diseases. Proceedings of the 29th memorial meeting devoted to prof. dr. Janez Plečnik; 1998 Dec 3-5; Ljubljana. Ljubljana: Medical faculty, Institute of histology and embryology,
Publication year		1998
Volume		str. 257-62
Language		eng
Abstract		The principal disturbance of congestive heart failure is reduced cardiac output, which elicist compensatory homeostatic responses, that are mediated by neurohumoral mechanisms. Activation of sympathetic and renin-angiotensin system contribute to increased vascular tone and sodium retention. Beneficial haemodynamice and clinical effects of angiotensinconverting enzyme (ACE) inhibitors are due to reduction of angiotensin II, which either directly or indirectly results in dilatation of peripheral vessels and reduced vascular resistance. In addition, inpatients with congestive heart failure treated by ACE inhibitors, reduced capillary wedge pressure and increased cardiac output were observed. Heart rate is not altered significantly. In congestive heart failure ACE inhibitors generally incrase renal blood flow and decrease renal vascular resistance without changing glomerul filtration rate. Shortly after onset of treatment, modest natriuresis is induced, which is maintained during prolonged treatment. ACE inhibitors are indicated in all stages of symptomatic heart failure due to systolic cardiac dysfunction, irrespective of the presence or absence of volume overload. All patients with heart failure treated with diuretics, should be considered for treatment with ACE inhibitors. These drugs are the first-line therapy in patients with reduced left ventricular ejection fraction. ACE inhibitors may have beneficial effect even in asymptomatic patients with severe left ventricular dysfunction. Major adverse effects associated with ACE inhibitors are hypotension, syncope, renal insufficiency, hypokalemia and cough. At the start of the treatment several procedures are recommended to avoid complications. Regular monitoring of renal function is advisable during treatment with ACE inhibitors.
Descriptors		HEART FAILURE, CONGESTIVE ANGIOTENSIN-CONVERTING ENZYME INHIBITORS TREATMENT OUTCOME