Drug treatment of heart failure

In my early years in Lancaster I remember my senior colleague Dr W J Hay asking whether or not digoxin and diuretics remained routine treatment for congestive cardiac failure; in fact there had been little change, in that digoxin was being used less often. Recently there have been three important alterations in management. These are:-( 1) improved diagnostic capabilities,(2) the introduction of new drugs, particularly ACE inhibitors, and(3) the reappraisal of older drugs including hydralazine, nitrates and digitalis. Finally we have seen the establishment of cardiac transplantation, various attempts at mechanical cardiac assistance and cardiomyoplasty which are out ide the scope of this article but which need to be borne in mind when drugs fail.