Chronic cardiac failure treatment in an internal medicine ambulance

Authors: J. Vítovec 1;  L. Špinarová 1;  J. Špinar 2
Authors‘ workplace: I. interní kardio- angiologická klinika Lékařské fakulty MU a FN u svaté Anny Brno, přednosta prof. MU Dr. Jiří Vítovec, CSc., FESC, 2Interní kardiologická klinika Lékařské fakulty MU a FN Brno, pracoviště Bohunice, přednosta prof. MU Dr. Jindřich Špinar, 1
Published in: Vnitř Lék 2009; 55(Suppl 1)(Supplementum 1): 9-12


Management of chronic heart failure in an internal medicine ambulance at present is based on blockade of the rennin-angiotenzin-aldosterone system (RAAS) with angiotenzin-converting enzyme inhibitors (ACEI) or angiotenzin II receptor1 (AT1) blockers –sartans (ARB) or, alternatively, aldosterone receptor blockers (BAR) and, in addition, blockade of the sympathetic nervous system with beta-blockers (BB). When water retention occurs, diuretics are added to this combination. Should this treatment be ineffective, or in case of atrial fibrillation, digoxine is added. Further therapeutic modalities are more suitable for specialized cardiology and hospital care where drugs are administered intravenously or approaches other than pharmacological are used, including resynchronization therapy and internal defibrillator implantation or, in indicated cases, inclusion of the patient in a transplantation programme.

Key words:
heart failure – ACE inhibitors – angiotenzin receptor blockers – aldosterone blockers – beta-blockers – digoxine – diuretics


1. Cleland JG, Swedberg K, Follath F et al. The Euro Heart Failure Survey Programme –  a survey on the quality of care among patients with heart failure in Europe. Part 1: patient characteristics and diagnosis. Eur Heart J 2003; 24: 442– 463.

2. Goldberg LR, Jessup M. Stage B heart failure. Circulation 2006; 113: 2851– 2860.

3. Hradec J. Srdeční selhání –  epidemie 21. století. Vnitř Lék 2004; 50 (Suppl 1): S23– S31.

4. Rosolova H, Cech J, Simon J et al. Short to long term mortality of patients hospitalised in the Czech republic –  report from the EuroHeart Failure Survey. Eur J Heart F 2005; 7: 780– 783.

5. Widimský J et al. Srdeční selhání. 3. vyd. Praha: Triton 2003.

6. Task Force Members. ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure. Eur Heart J 2008; 29: 2388– 2442.

7. Špinar J, Hradec J, Meluzín J et al. Doporučení pro diagnostiku a léčbu chronického srdečního selhání ČKS 2006. Cor Vasa 2007; 49: K5– K34.

8. Widimský J. Chronické srdeční selhání –  umí se správně rozpoznat a léčit v klinické praxi? Prakt Lék 1999; 79: 202– 206.

9. The CONSENSUS Trial Study Group. Effects of enalapril on mortality in severe congestive heart failure. Results of the Cooperative North Scandinavian Enalapril Survival Study (CONSENSUS). N Engl J Med 1987; 316: 1429– 1435.

10. Flather MD, Yusuf S, Kober L et al. Long‑term ACE‑inhibitor therapy in patients with heart failure or left- ventricular dysfunction: a systematic overview of data from individual patients, Lancet 2000; 355: 1575– 1581.

11. Špinar J, Vítovec J. Betablokátory a závažné chronické srdeční selhání. Cor Vasa 2000; 42: 491– 492.

12. Špinar J, Vítovec J. Blokáda RAAS a sympatiku –  základ farmakologické léčby srdečního selhání. Kardiol prax 2006; 3: 13– 19.

13. Vítovec J, Špinar J et al. Kardiovaskulární farmakoterapie. 2. vyd. Praha: Grada 2004.

14. Widimský J. Betablokátory v léčbě srdečního selhání. JAMA- CS 1999; 7: 375– 377.

15. Rahimtoola SH. Digitalis Therapy for Patients in Clinical Heart failure. Circulation 2004; 109: 2942– 2946.

16. Vítovec J, Špinarová L. Srdeční glykosidy a diuretika v léčbě srdečního selhání. Kardiol prax 2006; 4: 231– 233.

17. Young JB. Whither Withering’s Legacy? Digoxin’s Role in Our Contemporary Pharmacopeia for Heart failure Editorial Comment. J Am Coll Cardiol 2005; 46: 505– 507.

18. Anand IS, Florea VG. Diuretics in chronic heart failure –  benefits and hazards. Eur Heart J 2001; 3 (Suppl G): G8– G18.

19. Vítovec J, Špinar J. Diuretika u srdečního selhání. Kapit Kardiol 2002; 4: 90– 92.

20. Opie LH, Gersh BJ et al. Drugs for the Heart. 7th ed. Saunders Elsevier 2009.

Diabetology Endocrinology Internal medicine

Article was published in

Internal Medicine

Issue Supplementum 1

2009 Issue Supplementum 1

Most read in this issue

This topic is also in:

Forgotten password

Don‘t have an account?  Create new account

Forgotten password

Enter the email address that you registered with. We will send you instructions on how to set a new password.


Don‘t have an account?  Create new account