The heart in congestive failure

Abstract

Long-term overloading of the heart gives rise to myocardial abnormalities that play an important role in determining prognosis in patients with congestive cardiac failure. This myocardial response, which can be viewed as a cardiomyopathy of overload, results in part from energy-starvation and altered gene expression in the chronically overloaded heart. The role of vasodilator therapy in reducing symptoms and prolonging life in these patients may be due in part to reduced cardiac energy expenditure; however, the beneficial effects of some vasodilators, notably the converting enzyme inhibitors, may be due to additional effects on the cells of the hypertrophied, failing heart. Improved therapeutic strategies to slow myocardial deterioration in patients with congestive cardiac failure can be expected to come from new knowledge of the pathophysiology, biochemistry and molecular biology of the failing heart.