Pathophysiology and current therapy of congestive heart failure

Division of Cardiology, Moffitt/Long Hospital, University of California, San Francisco 94143.

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.

This article has been cited by other articles:

				R. Chang, W. A. Elatre, and J. T. Heywood Effect of Nesiritide on Length of Hospital Stay in Patients with Decompensated Heart Failure Journal of Cardiovascular Pharmacology and Therapeutics, July 1, 2004; 9(3): 173 - 177. [Abstract] [PDF]

				B. Pilz, J.-H. Brasen, W. Schneider, and F. C. Luft Obesity and Hypertension-Induced Restrictive Cardiomyopathy: A Harbinger of Things to Come Hypertension, May 1, 2004; 43(5): 911 - 917. [Full Text] [PDF]

				H. van den Berg-Emons, J. Bussmann, A. Balk, D. Keijzer-Oster, and H. Stam Level of Activities Associated With Mobility During Everyday Life in Patients With Chronic Congestive Heart Failure as Measured With an "Activity Monitor" Physical Therapy, September 1, 2001; 81(9): 1502 - 1511. [Abstract] [Full Text] [PDF]

				A. Roguin, D. M. Behar, H. B. Ami, S. A. Reisner, S. Edelstein, S. Linn, and Y. Edoute Long-term prognosis of acute pulmonary oedema -- an ominous outcome Eur J Heart Fail, June 1, 2000; 2(2): 137 - 144. [Abstract] [Full Text] [PDF]

				E. F. Philbin and T. G. DiSalvo Prediction of hospital readmission for heart failure: development of a simple risk score based on administrative data J. Am. Coll. Cardiol., May 1, 1999; 33(6): 1560 - 1566. [Abstract] [Full Text] [PDF]

				E. F. Philbin, R. Garg, K. Danisa, D. M. Denny, G. Gosselin, C. Hassapoyannes, A. Horney, D. E. Johnstone, R. M. Lang, K. Ramanathan, et al. The Relationship Between Cardiothoracic Ratio and Left Ventricular Ejection Fraction in Congestive Heart Failure Arch Intern Med, March 9, 1998; 158(5): 501 - 506. [Abstract] [Full Text] [PDF]

				S. B. Solomon, S. D. Nikolic, S. A. Glantz, and E. L. Yellin Left ventricular diastolic function of remodeled myocardium in dogs with pacing-induced heart failure Am J Physiol Heart Circ Physiol, March 1, 1998; 274(3): H945 - H954. [Abstract] [Full Text] [PDF]

				R. Ramos, B. I. Salem, M. P. DePawlikowski, M. Tariq, M. Haikal, T. Pohlman, and P. Mennes Outcome Predictors of Ultrafiltration in Patients with Refractory Congestive Heart Failure and Renal Failure Angiology, May 1, 1996; 47(5): 447 - 454. [Abstract] [PDF]

				P. M. McCarthy HeartMate implantable left ventricular assist device: Bridge to transplantation and future applications Ann. Thorac. Surg., February 1, 1995; 59(suppl_1): S46 - S51. [Abstract] [PDF]

				W. H. Gaasch Diagnosis and Treatment of Heart Failure Based on Left Ventricular Systolic or Diastolic Dysfunction JAMA, April 27, 1994; 271(16): 1276 - 1280. [Abstract] [PDF]