Congestive heart failure (CHF) is a major contributor to morbidity and mortality worldwide. Drug therapies historically have focused on the endpoint components of this syndrome, volume overload (congestion) and myocardial dysfunction (heart failure), with treatment strategies emphasizing the use of diuretics and cardiac glycosides. While effective in relieving symptoms and in stabilizing patients with hemodynamic decompensation, such therapies have not improved survival. Recent work has provided new insights into the induction and propagation of CHF, building a conceptual framework in which heart failure is viewed as a consequence of disordered circulatory dynamics and pathologic cardiac remodeling. These developments have had a major positive impact on the treatment of CHF that has improved survival.
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