The stepped-care approach to the drug therapy of chronic congestive heart failure
Duan Wenquan Department of Internal Medicine, The First Affiliated Hospital, Henan Medical College
According to the pathaphysiology and the circulatory nature of the development of heart falure, the drug administration may be diveded into 5stages, and drugs should be added in every stage. 1. Dyspnea during mod-est physical exercise: Isosorbide dinitrate(ISDN)should be administered toimprove exercise tolerance. 2. Paraxysmal noctural dyspnea and/or mildperiphery edema: Diuretic (dihydrochlorothiazide or spironolactone) are ta-ken intermittenly besides ISDN. 3. Dyspnea during mild physical exerciseand marked periphery edema:Hydralazine is added to ISDN and diuretics inthis stage. 4. dyspnea at rest: Cardiac glycosides are added to the drugsused in the 3rd stage. 5. Reluctant heart failure:On the basis of the drugtherapy in the 4th stage, some of prednisore, adrerergic beta receptor ago-nists, new vasodilator agents and GIK are administered selectively.