Acute congestive heart failure. The need for aggressive therapy

Immediate management of congestive heart failure (CHF) is directed at reduction of preload and afterload and augmentation of forward blood flow and cardiac output. A variety of pharmacologic agents (e.g., diuretics, positive inotropic agents, vasodilators, vasopressors) are available for use in the intensive care unit. For patients in cardiogenic shock after acute myocardial infarction, pharmacologic measures coupled with direct reperfusion therapy using percutaneous revascularization can be lifesaving. Unfortunately, many survivors of acute CHF require longterm therapy. Current drug therapy cannot cure CHF, but a search for useful and safe oral positive inotropic agents continues, with the hope of improving both the quantity and quality of patients' lives. Heart transplantation is an alternative for some patients with severe ventricular dysfunction.