Treatment of congestive heart failure: pharmacological principles

Heart failure may result from different aetiologies: excessive afterload, depressed intrinsic contractility (generalized or regional), volume overload, and changes in diastolic properties. Compensatory mechanisms, such as the reflex increase in sympathetic tone, may initially be beneficial, but, in the long run, may become deleterious. Thus heart failure represents a very complex situation. Treatment should aim at: (a) removing the cause of heart failure; (b) improving contractile performance (by enhancement of the intrinsic contractile properties or by decreasing afterload); (c) moderating the major symptom-producing features (increased filling pressure), and decreasing peripheral demands for cardiac output.