E. Erdmann - Böcker

Herz- und kreislaufwirksame Medikamente spielen in Anästhesie, Intensiv- und Notfallmedizin eine immer wichtigere Rolle. Indikationsstellung und Dosierung oder auch die Kombination von Medikamenten müssen sich einerseits am Stand des heutigen Wissens, andererseits aber an Art und Ausmaß von kardiovaskulären Erkrankungen und Vorerkrankungen orientieren. Das vorliegende Buch stellt das Ergebnis einer interdisziplinären Bestandsaufnahme dar, welche die pathophysiologischen und pharmakologischen Grundlagen, aber auch die heute zu empfehlenden Behandlungsstrategien für die unterschiedlichen kardiovaskulären Krankheitsbilder vermittelt.

Throughout the past decades, the understanding of the pathophysiology of chronic heart failure and the therapeutic approach to this condition have un­ dergone considerable change. New developments are reported every year. Perhaps it is because of this continuing interest of researchers and physi­ th cians that the chapter on chronic heart failure of the 4 edition of Klinische Kardiologie has been so positively received. Several colleagues asked the authors to publish the chapter on chronic heart failure separately, because it would be more practical to use in daily work. When the request for an En­ glish version of this chapter reached the authors and Springer-Verlag, we were happy, on the one hand, because of the interest, but did wonder whether it would be wise to translate a typically German textbook into Eng­ lish. We invite you to send us your critical comments. Although Guidelines for the Treatment of Heart Failure have been pub­ lished recently by the WHO, by the European Society of Cardiology, and by the American Heart Association Task Force clinicians, practitioners, and stu­ dents still seem to need , a comprehensive view with emphasis on pathophys­ iology, epidemiology and therapy. The authors are grateful to Springer-Verlag for the good co-operation and tremendous personal commitment in making the English edition of Chronic Heart Failure possible. We hope to give our readers a good overview on this important clinical syndrome, one which re­ quires intelligent clinical research and sound clinical practice as weIl.

The bicentenary of William Withering's now famous medical report entitled "An Account of the Foxglove and Some of its Medical Uses" has given us the occasion to analyze the state of the art. Cardiac glycosides in 1985 are considered tobe the basis for medical treatment of myocardial failure, together with diuretics and vasodilators in the more severe cases. Nevertheless, the controversy as to their exact place in the treatment of heart failure with sinus rhythm has never ceased. Although cardiac glycosides are of unquestionable value in tachycardia caused by atrial fibrillation or atrial flutter, the chronic use of these drugs in sinus rhythm is not generally accepted. The development of tolerance has been reported. It is of interest that Withering hirnself wrote: "-let it (foxglove) be continued until it either acts on the kidneys, the stomach, the pulse, or the bowels; Iet it be stopped upon the first appearance of any of these effects, and I will maintain that the patient will not suffer from its exhibition, nor the practitioner be disappointed in any reasonable expectation. " In West Germany alone, more than three million patients (about 5% of the total population) are constantly taking cardiac glycosides. These drugs are the most prescribed medicaments in many countries. Thus, we considered it worthwhile and necessary to review in a critical way today's knowledge about the foxglove; to report new findings and to evaluate old Statements.