[Captopril in the treatment of congestive heart failure in acute myocardial infarct]

Abstract

The extent of affection of the heart muscle by infarction with subsequent left-ventricular dilatation, remodelling and congestive failure is the decisive prognostic indicator of mortality. Inhibitors of ACE influence congestive heart failure in a favourable way and captopril reduces the morbidity and mortality in patients with still asymptomatic left ventricular dysfunction. The authors administered to a group of 23 patients with acute myocardial infarction and congestive heart failure (grade II according to Killip) small doses of captopril (4 x 6.25 mg/day)for a period of 10 days from the 1st-4th day after the onset of the disease). From ACE serum levels the effectiveness of these doses was assessed in keeping with data in the literature. As compared with a control group of 26 patients with similar haemodynamic conditions the authors did not find significant differences as regards improvement of the decompensation and in the mortality (à 3 patients in both groups). As to undesirable effects, arterial hypotension was recorded three times, twice minor proteinuria, once asymptomatic thrombocytopenia. Decisive for future therapeutic decision making are above all the results of the SAVE study which prefers captopril in patients with a yet asymptomatic left ventricular dysfunction. The authors are not quite convinced on the necessity to administer larger doses of captopril (up to 3 x 50 mg/day) in this indication.