Left ventricular dysfunction and remodelling after myocardial infarction : pathophysiological anf therapeutic aspects

textabstractCongestive heart failure is the only major cardiovascular syndrome of which the incidence and prevalence are currently increasing in the western world. This increase is in part due to the successful treatment of acute myocardial infarction in conjunction ffith an ageing population) and as a result myocardial infarction has replaced hypertension as the major cause of heart failure. Between 1950-1980 the treatment of congestive heart failure was solely based on the "hemodynamic model". which led to inotropic stimulation with sympathomimetics and/or unloading of the heart with vasodilators or inodilators in order to restore cardiac output. Between 1980-2000 the concept of congestive heart failure shifted and now encompasses the "neurohormonal model11 in which the progressive remodeling with impaired cardiac chamber performance is considered to be a central feature. Consequently producing a change in the initiation of treatment. from decompensated state of ventricular dysfunction to one of compensation in order to prevent deterioration of myocardial function and thereby improving survival. Therefore. heart failure patients are now treated with blockers of neurohormones such as Angiotensin Converting Enzyme inhibitors and fi-adrenergic receptor blockers