[Current management of heart failure].

Heart failure has emerged as a major cardiovascular public health syndrome with increasing incidence, reduced quality life, risk of progression, and high mortality. It's therapy still continues to pose a major clinical problem. The main goals of therapy are: improving the quality life and prolonging the survival. For many years digitalis and diuretics have been the cornerstones of pharmacologic treatment recently completed with vasodilators. Regarding the results of experimental and clinical investigations efforts to refine therapy have focused on choosing a combination of drugs particularly those that effectively inhibit the renin-angiotensin-aldosterone (RAA) system. The ACE inhibitors proved to be effective in managing heart failure of all degrees of severity including left ventricular dysfunction and end-stage of syndrome and in prolonging survival in patients. Spironolactone which inhibits the activity of aldosterone may exert an independent and additive effect to that of ACE inhibitors. The standard therapy of heart failure became: digitalis, diuretics--including spironolactone--and ACE inhibitors. In end-stage of heart failure refractory to therapy the only choice is heart transplantation.