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A. Schneeweiss Although the syndrome of congestive heart failure
has been recognized many years ago, the approach for its evaluation
and treatment has until recently, been partial and 'fragmentary'.
Various aspects of the disease have been treated according to the
evaluation tools and therapeutic measures available at each period.
This approach resulted in some of the greatest achievements in the
management of heart failure but also left many aspects neglected
and also resulted in several paradoxes. Examples of the
achievements and limitations of the 'fragmentary' ap proach are the
use of diuretics and hemodynamic measurements. The devel opment of
diuretics has provided us with an important tool for helping pa
tients whose predominant problem was edema. The success of
diuretics masked the fact that their use may often be
hemodynamically unsound and that they may reduce cardiac output.
Only many years after their introduction has the use of diuretics
found its appropriate place. Hemodynamic monitoring has gone via
the same path. The great contribu tion of continuous bedside
hemodynamic measurements to understanding heart failure resulted in
over-usage by many clinicians, who found themselves treating
hemodynamic charts rather than patients. It took almost a decade to
realize that hemodynamic improvement, even in the chronic setting,
does not necessarily mean symptomatic improvement or an increase in
exercise capac ity."
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