By Michael R. Rosen, Brian F. Hoffman
Cardiac remedy has turn into ever extra complicated in the past zone century. for instance, 25 years in the past, the treatment of cardiac failure was once principally constrained to digitalis, a truly few diuretics, salt limit, and basic supportive measures. Antiarrhythmic treatment concerned - in most cases - quinidine, procainamide, and digitalis, and questions equivalent to which arrhythmia to regard and the way to degree drug efficacy have been addressed in easy type in simple terms. Cardiac surgical procedure used to be restricted principally to congenital and valvular center ailment; the components of cardiac pacemaker treatment, defibrillation and different kinds of electric prognosis and remedy have been rudimentary. the growth of aid of cardiovascular learn by means of the nationwide Institutes of wellbeing and fitness in addition to through institutional resources following international struggle II has ended in significant successes in medical wellbeing and fitness care supply and stronger expertise made to be had to medical investigators. In reviewing growth over the last 25 years, we now have been quite inspired via one statement: this is often the real interplay that has constructed among experiences of pathophysiology and the supply of acceptable cardiac therapy.
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Extra resources for Cardiac therapy
This increase in peripheral vascular resistance is responsible for a vicious cycle in heart failure. This is illustrated schematically in Figure 12. As shown, a decrease in cardiac output leads to a reflex increase in systemic vascular resistance by the mechanisms indicated. In turn, this increased systemic vascular resistance acts as an increased afterload to the left ventricle / +CARDIAC OUTPUT t RESISTANCE TO EJECTION ~ t SYSTEMIC VASCULAR RESISTANCE Figure 12. The vicious cycle of chronic heart failure is illustrated: With a decrease in cardiac output there is a reflex and neurohumeral increase in systemic vascular resistance in an attempt to maintain arterial blood pressure.
When this occurs under resting conditions, ventricular performance is usually markedly depressed. Lesser degrees of heart failure result only in an inability to meet peripheral demands during times of stress such as exercise. The common symptoms associated with left heart failure include dyspnea on exertion, orthopnea, and paroxysmal nocturnal dyspnea. Occasionally, elevated pulmonary venous pressures can result in an asthma-like syndrome with severe bronchial constriction. At other times, troublesome cough may be the only evidence for elevated pulmonary venous pressures.
R-I=~- sol/IJ H,D In/ok' 01 sol/ IJ H,D ... ,,,,,, (80 % blood volume' Figure 10. Schematic representation ofthe circulation system: The four factors affecting cardiac performance are shown inside the heart at the lower left. The distribution of cardiac output to major organ systems is shown in the upper right, with central nervous system reflexes in the center of the diagram. On the right-hand side of the diagram are those factors affecting extracellular fluid and blood volume. (See text for further details) (reproduced by permission ).