[Congestive heart insufficiency. Prophylactic aspects]

Since the therapeutic advances prolong survival of many patients suffering from cardiovascular pathology--the prevalence of chronic heart failure (CHF) had just doubled, being a common entity in a world whose individuals present a great increase in longevity. These considerations justify the renewed interest in this particular syndrome. Concepts, pathophysiology and compensatory mechanisms are briefly summarized, putting emphasis on the advantage of pharmacologically interrupt the vicious loop of the compensatory mechanisms, that could play a deleterious role in the syndrome. Neurohormonal responses and the "pivotal" role of angiotensine II in CHF pathology are also discussed, emphasizing the benefits of angiotensin converting enzyme inhibitors (ACEI) when treating patients presenting heart failure. Questions addressed to its prescription at an early stage, (classes II and III of NYHA--to prevent the progressive exhaustion of the failing heart) are also considered. When approaching the preventive measures in a wide perspective, primary, secondary and tertiary types of preventive options are described. ACEI use for the least advanced clinical stages of CHF (class II and III) would represent a tertiary type of CHF prevention.