Congestive heart failure in coronary artery disease

Congestive heart failure (CHF) affects approximately 1% of the United States population and its incidence continues to increase. Next to hypertension, coronary artery disease (CAD) is the second most frequent cause of CHF. Important distinction should be made between systolic dysfunction and diastolic dysfunction in CAD. The diagnostic and therapeutic challenges posed by both have stimulated much investigation into the pathophysiologic mechanisms involved and have led to innovative pharmacologic interventions to forestall progression of the disease. The challenge in the 1990s is prevention. In the meantime, results of completed and ongoing randomized controlled trials will determine the most effective forms of therapy, which will not only improve symptoms but also hopefully extend survival.