Léčba chronického srdečního selhání – nedlužíme našim nemocným nic?

Therapy of Patients with Heart Failure – Do we Owe Anything to Our Patients?

In hardly any other field of treatment of a chronic disease more evident progress can be seen than in the therapy of hearth failure. Till the end of eighties of the previous century we were not able to influence the adverse development of the disease. With the critical prognosis, chronic heart disease represents more serious case than majority of tumours. In the meantime the only approach to decrease mortality has been modulation of the maladaptively activated regulatory mechanisms – the rennin, angiotensin, aldosteron axis and the sympatoadrenal system. During the previous decades we became witnesses of the development of new pharmacologic approaches aimed at the heart failure: New inotropics (e.g. lavosimendan and pomobendan) have been introduced, effects of anti-arrhythmiatics (amiodaron, dronedaron and others) and metabolically active drugs (trimetazidine, ranolazine and others) has been tested as well as methods decreasing fluid retention (aquaarretics) has been used. It is too early to conclude that such ethiopathogenetical approach can decrease mortality or morbidity. Along with the advance of new possibilities to interfere directly with the pathogenesis of the heart failure, approaches aimed at the treatment of deteriorating processes have been developing: prothrombotic state, atherogenesis or complications of anaemia. 

Key words:
chronic heart failure, pharmacotherapy, intropics, beta-blockers, ACE inhibitors, aldosteron receptor blockers.