The syndrome of congestive heart failure was seen as a hemodynamic disorder of the 80’s. In the 90’s neurohormonal system play a central role in the progression of heart failure. Sympathetic stimulation, ventricular remodeling, cytokines and apoptosis exerts a direct deleterious effect on the heart and have to be emphasized as patthophysiologic fators.
The analysis of the heart failure therapeutic allows us to conclude that for many patients it will be necessary the prescription of different drugs to control all the multiple active mechanism in the progression of heart failure.
Several inotropic non digitalis agents were developed and tested, however, the results of studies showed increased mortality with their chronic utilization. Digitalis has a neutral effect on mortality and reduced hospitalizations. Compensating chronic heart failure with diuretics leads to a significant improvement in physical capacity. The renin-angiotensin-aldosterone system blockade with angiotensin-converting enzyme inhibitors in patients with ventricular dysfunction results in clinical and hemodynamic benefits and reduces mortality in this population.