2. Heart Failure
The effectiveness of ACE inhibitors in reducing mor¬tality and hospitalization in patients with severe heart fail¬ure was first proven in 1987 by the Cooperative North Scandinavian Enalapril Survival Study (CONSENSUS). The effectiveness of ACE inhibitors in reducing mortality and hospitalization in patients with a moderate degree of heart failure has been established in randomized clini¬cal trials (RCTs) carried out during the 1990s. Worldwide there is an epidemic of heart failure. ACE inhibitors are used in combination with diuretics, beta-blockers, and digoxin in the majority of patients. Although these agents have provided much relief for suffering patients and have significantly decreased mortality, the effect is still modest and newer agents must be sought (see the section Pathophysiology in the chapter Heart Failure).
3. Acute Myocardial Infarction
ACE inhibitors are particularly useful in patients with an acute myocardial infarct and in whom the left ventricular function is moderately impaired. An infarct is an area of cardiac necrosis caused by a disruption of blood supply due to blockage of the supply artery. The necrotic muscle produces an area of weak heart muscle that may impair the overall contractile force of the powerful left ventricle and culminate in heart failure within days, months, or years.

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