ABSTRACT
Dropsy is usually produced when the patient remains for a long time with impurities of the body…the fl esh is consumed and becomes water…the abdomen fi lls…, the legs and feet swell, the shoulders, clavicles, chest and thighs melt away. ––Affections XXII, Hippocrates. (410-470, BC)
INTRODUCTION Whether ischemic, viral, or infl ammatory in etiology, the clinical syndrome of heart failure begins with myocardial injury. The hemodynamic consequences of the initial injury elicit a complex humoral response involving the central nervous system, the kidney, and the vascular endothelium. Progression to the syndrome of heart failure is determined by the degree of myocardial injury and the nature and magnitude of the resultant humoral activation. Pharmacologic interventions targeted to improve cardiac contractility have not improved clinical outcomes (2,3). In contrast, all therapies that improve heart failure survival inhibit aspects of the systemic response (4-6).
