Origin of heart failure: cardiac or generalized myopathy?

v the neuroendocrine response, which was once believed to be a compensatory reaction of the organism to counteract the ‘failure’ conditions, is now considered a detrimental response of the body. As such, it is recommended that this response be treated; v positive inotropic drugs, which were considered the logical treatment solution for the failing heart, do — paradoxically — increase mortality when used chronically. As such, they are now dismissed as treatment of choice; v Beta-blockers, previously considered as dangerous drugs due to their negative inotropic effects, are now thought to exert positive inotropic effects, when administered as long-term treatment; these drugs also improve prognosis. As such, their use is recommended; v the old and logical recommendation ‘of-restingin-bed’ is now considered obsolete and patients are submitted to routine physical training programmes.