[Heart failure and the clinician at the end of the 20th century]

Congestive heart failure represents a clinical syndrome whose symptoms and signs result from different etiopathogenic and pathophysiological mechanisms. Diagnosing congestive heart failure remains mainly a matter for accurate clinical methodology. Therapeutical approaches to congestive heart failure require a profound knowledge of the behaviour of each system and mechanism involved in the process, namely neurohumoral activation, dysautonomia and endothelial responses, besides renal, skeletal muscle, cardiac and pulmonary participation. So, the treatment of congestive heart failure is always multifactorial. Preventing heart failure requires also an accurate knowledge of those mechanisms, in order to apply the most appropriate measures to stop vascular and cardiac remodeling.