[Treatment of heart failure]

Heart failure is a disease which involves not only the heart but the entire circulatory system. Progression is directly related to interactions between myocardial disorders and neurohormonal and circulatory phenomena. Advances in treatment have resulted more from the development of vasodilator drugs with neurohormonal effects than from drugs with a direct effect on the myocardium. Diuretics are essential due to their rapid functional effect and the reduction in pressure on the ventricle wall. The effectiveness of digitalics is recognized not only in patients with atrial fibrillation, but also in those in sinus rhythm with ischemic heart disease. Conversion enzyme inhibitors are useful in all stages of heart failure, improving both quality of life and life expectancy as well as limiting myocardial and vascular remodeling and retarding progression of ventricular dysfunction. As current progress in the treatment of heart failure has not greatly reduced mortality, prevention is the major challenge facing all physicians. Treatment of asymptomatic ventricular function is one rational approach.