Physiopathological bases of the treatment of cardiac failure

Therapeutic advances have changed the mode of presentation of cardiac failu re over the last decades : the main cause, nowadays, is myocardial ischaemi a. The modern treatment of cardiac failure is based on relatively simple physi opathological mechanisms which take into account the different aspects of c ardiac physiology : a pump, a muscle, a coronary circulation supplying oxyg en to the myocardium, an automatic contraction. The concept of vasodilatati on and the blocking of vasoconstrictive systems introduced during the 70s i s the basis of modern treatment of cardiac failure which involves angiotens in converting enzyme inhibitors and, increasingly, betablockers. In the nea r future, with earlier treatment of cardiac failure, the stimulation of vas odilator systems could become a new therapeutic strategy. Early detection of ischaemia and its complications with the aim of limiting the loss of cardiac myocytes is a priority for slowing the progression of cardiac failure. The prevention of cardiac failure also depends on educatin g cardiologists to treat rapidly the factors predisposing to or prolonging episodes of even mild cardiac failure.