Management of congestive heart failure is based on recognition of the specific underlying cardiac disease, understanding of the pathophysiology involved, exclusion of extracardiac complicating factors perpetuating cardiovascular dysfunction, complete information concerning available prophylactic measures, and thorough knowledge of medical and surgical therapy. Although most patients respond favorably to conventional treatment consisting of digitalis and diuretics, relatively refractory heart failure may develop in advanced myocardial heart disease (the specific, idiopathic, and ischemic cardiomyopathies) unamenable to operative intervention. The most important recent advance in the medical therapy for such patients with acute and chronic pump dysfunction has been the application of systemic vasodilator drugs to reduce excessive left ventricular afterload, thereby improving lowered cardiac output and decreasing elevated pulmonary venous pressure.
RATIONALE OF AFTERLOAD REDUCTION THERAPY
The cardiac output delivered from the intact heart is governed by integration of four principal determinants: (1) preload (ventricular end-diastolic volume), (2) contractility (variable force of