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Following remarkable advances in medical care. the past decade has
witnessed a significant improvement in the survival of patients
with many different forms of heart disease. In the majority
ofcases. however. the advances have been pa lIiative and not
curative. The resu It has been the prod uction of an
ever-increasing population of patients with heart disease. many of
whom suffer from myocardial dysfunction and latent or overt heart
failure. Heart failure is now a major cause of morbidity and
mortality in cardiac patients. This book aims to combine in a
single volume data relating to both pathophysiological mechanisms
and the clinical management of the patient with heart failure. It
includes chapters dealing with molecular. biochemical. and
pathophysiological aspects of heart failure. ven tricular function
and its assessment. and the clinical aspects of heart failure in
different cardiac disorders, including ischemic heart disease.
valvular heart disease. and the cardiomyopathies. There are
sections on pharmacotherapy. the role of arrhythmias, exercise
physiology. and neurohumoral mechanisms. The book also deals with
newer inter ventional techniques. newer surgical procedures and
some current problems relating to cardiac assist devices and heart
and heart-lungs transplantation."
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."
This book deals with heart failure in all its aspects, in- cluding
chapters relating to receptor physiology and patho- physiological
mechanisms, ventricular function and its assessment and the
clinical aspects of heart failure in ischemic heart failure,
cardiomyopathy, rheumatic heart disease and the timing of valve
replacement. The pharmaco- therapy of heart failure deals with
inotropic drugs, ACE in- hibitors, nitrates and calcium
antagonists. Extending into the newer interventional techniques and
surgical techniques the book includes chapters on balloon
valvuloplasty, the po- tential use of the laser, the Jarvik
artificial heart, car- diomyoplasty, left ventriculoplasty and
heart and heart/lung transplantation.
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