[Calcium antagonists and heart failure. Critical review of the literature].

Calcium antagonists impede the entry of calcium into myocytes and inhibit myocardial contraction. Calcium antagonists differ in their relative negative inotropic potency and can provoke baroreceptor stimulation that modulates left ventricular (LV) performance. Calcium antagonists are uniformly well tolerated in patients with normal LV function. Use of these agents in patients with suspected LV function impairment has yielded results ranging from hemodynamic improvement to clinical deterioration and increased mortality. Although calcium antagonists are potent vasodilatators and produce short-term hemodynamic improvement, they are non use full as primary treatment in patients with congestive heart failure (CHF). They may have a place in the treatment of coexistent problems in patients with LV dysfunction. Short-term use of calcium antagonists for myocardial ischemia or severe hypertension is probably safe in the presence of LV dysfunction and overt CHF. Calcium antagonists appear to have a role in the treatment of patients with diastolic dysfunction of diverse etiologies.