Pathophysiology and current therapy of congestive heart failure.

Congestive heart failure is a common clinical syndrome, with a relatively poor prognosis in its advanced stages. During the development of heart failure, there is a decline in myocardial contractility and activation of neurohormonal systems. An overshoot of some of these compensatory mechanisms sets the stage for therapeutic interventions. Any of the three therapeutic classes of drugs (inotropic drugs, diuretics or vasodilators) can be used as first-line therapy. Other classes can be added to produce additive effects on ventricular function. Because vasodilators have been shown to prolong life, they should be used routinely in patients with heart failure. Arrhythmias and sudden death are relatively common in heart failure, although the value of antiarrhythmic therapy is less certain. Although current therapy is very helpful in patients with heart failure, it is clear that preventive approaches will be more effective in decreasing morbidity and mortality.