Congestive Heart Failure

Abstract

Since it was realized that vasodilation might be beneficial in congestive heart failure [151], nitrates have become the cornerstone of this therapeutic modality. Even at low doses nitrates produce venodilation, resulting in decreases in left and right ventricular filling pressures. At higher doses nitrates cause, in a majority of patients, a decrease in afterload, resulting in an increase in cardiac output. Nitrates are effective both in acute and chronic congestive heart failure, and they may be used, usually as combination therapy, in the extreme presentations of this condition — pulmonary edema and cardiogenic shock. The hemodynamic response to nitrates is often associated with symptomatic improvement, particularly in symptoms related to congestion but also in those resulting from inadequately low cardiac output.