Despite great advances in recent years, drugs can improve heart failure, but do not stop its progression. Among the surgical options for drug-resistant heart failure, heart transplantation is the treatment of choice, but application is limited by donor shortage. Alternative procedures include partial left ven-triculectomy, mitral valve surgery, and dynamic cardiomyoplasty. Dynamic cardiomyoplasty is the […] Read more
A competent mother can make up for most of the deficiencies resulting from a father’s alcoholism. So pronounced are the capabilities of alcoholics’ wives to sustain the roles proper to their husbands that the children do not commonly suffer material privation. Myers1 found that the children of a series of London alcoholics rarely went hungry […] Read more
A critical step in the successful management of heart failure is the recognition and control of fluid retention. Disease progression is often associated with a decline in renal perfusion, and hence a decline in the response to diuretic therapy. The decrease in effective circulatory blood volume lowers the glomerular filtration rate, neurohumoral factor release increases, […] Read more
The discrepancy between donor organ availability and the number of patients with end-stage heart failure requiring transplantation led to the development of implantable mechanical devices that temporarily sustain ventricular systolic function. The devices currently available sustain left ventricular function by generating pulsatile or continuous flow, or biventricular systolic function by generating pulsatile flow. The original […] Read more
Antabuse is the well-known trade name for the chemical compound disulfiram. It comes in tablet form. By itself it produces no effects. However, it interferes with the way the body deals with alcohol. When alcohol is metabolized in the body it is oxidized to carbon dioxide and water. At an intermediate stage in this chemical […] Read more
Alcoholism is best regarded as a chronic disorder with a marked tendency towards relapse. Prolonged treatment is therefore necessary. The cure’ calls for total abstinence from alcohol. The alcoholic, this means, remains a vulnerable person even if he stops drinking. In some respects he must continue to regard himself an an alcoholic even though he […] Read more
How does the risk/benefit profile of coronary revascularization differ between diabetics and nondiabetics?
D Clinical profile in diabetic ischemic heart disease iabetics have a higher risk of dying from acute coronary syndromes than nondiabetics (5.5% vs 3%). Subgroup analysis in diabetics revealed 30-day mortality rates of 7.7% in those older than 65 vs 2.7% in those aged 65 or younger; 6.5% in insulin-dependent diabetes mellitus (IDDM) vs 5.1% […] Read more
Which patients with postischemic left ventricular dysfunction derive greatest benefit from coronary revascularization?
A large body of evidence supports the use of perfusion, metabolism, and contractile reserve markers for detecting viable myocardium. In separate studies, each has proved similarly effective in predicting regional functional recovery, although head-to-head comparisons suggest that contractile reserve is the most specific predictor. Revascularization of viable myocardial segments improves prognosis and functional status. However, […] Read more
This is a relatively infrequent question at consultation, as severe heart failure may itself impair ovarian function and depress libido and fertility. However, in those patients with preexisting heart disease who wish to become pregnant, the associated changes in cardiovascular physiology in particular, a 50% increase in cardiac output, a 40% increase in plasma volume, […] Read more
Sleep-related breathing disorders, notably obstructive and central sleep apnea associated with Cheyne-Stokes respiration, are present in 40% to 50% of heart failure patients. Central sleep apnea is the most frequent breathing disorder in heart failure and is characterized by repetitive cycles of apnea, blood oxygen desaturation, sympathetic excitation, and waking with a surge in blood […] Read more