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Essential Medicine (Paperback, 1971 ed.)
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Essential Medicine (Paperback, 1971 ed.)
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69 but usually such a condition is terminal, and denotes
irreversible pump failure. Many patients can, however, return to
useful activity, avoiding sudden unaccustomed exertion, and being
maintained on diuretics, potassium and digoxin with suitable
surveillance. Curative surgery may be possible in those with heart
valve lesions. Heart transplantation. Remarkable technical success
has been achieved, and patients have survived for up to two years
after opera tion. It is, however, difficult to decide which cases
are suitable, for early cases may benefit from less drastic
measures, and late cases have involvement of lungs and liver,
lessening the changes of success. There are problems too, of
transplant rejection, immunosuppression and of the ethics of
obtaining donor hearts. There may be a greater place for the use of
plastic pumps, which are being developed for use as temporary
supports to the circulation, e.g. in myocardial infarction, until
the heart function improves. Prevention of cardiac disease; a
summary Congenital heart disease should be recognized early, for
cure is often possible. Rheumatic heart disease has diminished with
the conquest of the streptococcus, but where it has occurred, early
recognition and treat ment of valvular complications will prevent
heart failure. Hyper tension and its effects can be remedied before
the stage of heart failure. We are left with arteriosclerotic heart
disease, and while alleviation of its effects is possible,
prevention awaits understanding of the arteriosclerotic process.
Meantime, we can advise the control of obesity and the cessation of
cigarette smoking.
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