10 patients suffering from refractory heart failure were treated with an oral angiotensin converting enzyme inhibitor captopril. The etiology of heart failure in 9 patients was related to ischemic heart disease, and to valvular heart disease in 1 patient. All patients experienced subjective improvement and feeling of well-being. The functional capacity improved to class II-IIB. Serial chest X-ray films showed improvement in pulmonary congestion. The time course of the hemodynamic effect appeared to 0.5–1.5 h after intake, and tended to disappear about 6 h later. The optimal dose of the drug achieving maximal hemodynamic benefit without excessive hypotension was 50 mg. Some of the patients exhibited a triphasic response. The cardiac index increased from 1.99 ± 0.1 to 2.69 ± 0.151/min/m (p < 0.001), while pulmonary capillary wedge pressure decreased from 25.3 ± 5.86 to 13.67 ± 4.14 mm Hg (p < 0.001). Mean peripheral arterial blood pressure decreased from 90.06 ± 3.7 to 71.4 ± 2.7 mm Hg. The total peripheral resistance decreased from 1,942 ± 169 to 1,170 ± 109 dyn × s × cm-5. The total pulmonary resistance decreased from 272.6 ± 42.9 to 142.34 ± 13.76 dyn × s × cm-5. Heart rate
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