Therapeutische Umschau. Revue thérapeutique
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In acute as well as in chronic ischemic heart disease, congestive heart failure indicates a poor prognosis. Treatment after acute myocardial infarction should differentiate between specific subsets. In cardiogenic shock due to extensive ischemic damage, acute revascularization by PTCA or CABG improves the otherwise poor outcome substantially. ⋯ In chronic ischemic heart disease, congestive heart failure is a clearly defined indication for complete revascularization, if possible. As to drug treatment, progression of the disease characterized by a cardiomyopathy of overload as well as neurohormonal and peripheral maladaptation should be stopped in parallel with symptom relief. Therefore, ACE-Inhibitors are combined very early with diuretic treatment, and digitalis should be added in refractory patients.
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Nitrates, molsidomin, betablockers, calcium antagonists, inhibitors of platelet aggregation and anticoagulants are the most important drugs for the management of the different forms of angina pectoris. Their use in chronic stable, unstable and vasospastic angina pectoris and for secondary prophylaxis are discussed.