A Cardiologist's Perspective on Evolving Concepts in the Management of Congestive Heart Failure

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Abstract
The conceptual framework for treatment of congestive heart failure has changed dramatically in the past 30 years. The 1950s and 1960s were characterized by manipulation of the left ventricular function curve by digitalis and diuretics. The 1970s focused on relief of symptoms by afterload reduction with vasodilators. Then stimulation of cardiac output with inotropes was shown to relieve symptoms, but patients died sooner. Now the focus is on the neurohumeral milieu and methods to counteract excess renin-angiotensin and sympathetic nervous system stimulation. Angiotensin-converting enzyme inhibitors are the drugs of choice because they also improve survival, but beta-blockers are becoming popular. The effect of molecular cardiology on practice guidelines for congestive heart failure is yet to be seen.