Many pathophysiological processes are activated in patients with congestive 
heart failure, and several of these have been implicated in the progression of 
the disease. The most important processes to be activated in heart failure are 
the neurohormonal systems, which include the reninangiotensin system, the 
sympathetic nervous system and the endothelin system. In addition to the 
neurohormonal systems, the formation of reactive oxygen free radicals is 
increased in congestive heart failure. It has been proposed that the activation 
of neurohormonal pathways and the formation of oxygen free radicals ultimately 
lead to the activation of a family of transcription factors that are involved in 
cardiac and vascular remodelling which are hallmarks of congestive heart 
failure. In addition, the formation of oxygen free radicals has been implicated 
in the process of apoptosis, or programmed cell death, which may contribute to 
the continued loss of myocardial cells resulting in progressive decreases in 
left ventricular function, while at the same time contributing to the cardiac 
remodelling process which subsequently creates a pro-arrhythmic environment in 
the myocardium. Carvedilol is a novel multiple-action neurohormonal antagonist 
that has been shown to be effective in the management of congestive heart 
failure. Carvedilol also possesses a number of additional activities which may 
inhibit many of the chronic pathophysiological processes that are involved in 
the progression of congestive heart failure.