By Michael R. Rosen, Brian F. Hoffman
Cardiac remedy has turn into ever extra complicated prior to now area century. for instance, 25 years in the past, the remedy of cardiac failure was once mostly restricted to digitalis, a truly few diuretics, salt limit, and common supportive measures. Antiarrhythmic treatment concerned - mostly - quinidine, procainamide, and digitalis, and questions resembling which arrhythmia to regard and the way to degree drug efficacy have been addressed in uncomplicated type basically. Cardiac surgical procedure was once restricted mostly to congenital and valvular center ailment; the components of cardiac pacemaker remedy, defibrillation and different kinds of electric prognosis and remedy have been rudimentary. the growth of aid of cardiovascular learn through the nationwide Institutes of overall healthiness in addition to by means of institutional resources following international warfare II has ended in significant successes in medical future health care supply and stronger know-how made on hand to medical investigators. In reviewing growth during the last 25 years, now we have been fairly inspired by way of one commentary: this can be the real interplay that has constructed among experiences of pathophysiology and the supply of applicable cardiac therapy.
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Extra resources for Cardiac therapy
An interesting relation between the mechanics of contraction and actomyosin ATPase activity has been noted. There is a relatively direct correlation between maximum velocity of muscle shortening, (V max)' and actomyosin ATPase activity . This relationship also holds with the development of congestive heart failure, in that both the maximum velocity of shortening and the actomyosin ATPase activity are reduced . There are two primary mechanisms whereby cardiac muscle can alter its force development.
By dilating these constricted veins one can increase their volume, thus redistributing blood in the circulatory system. With more blood in the peripheral veins and less blood in the chest, there is a marked reduction in right and left atrial pressures, which results in a reduction of the signs and symptoms of nght and left heart failure. In general, however, venodilators do not alter cardiac output. Thus, combina37 tion arteriolar dilators and venodilators are extremely helpful in increasing cardiac output and reducing right and left heart filling pressures.
This points out the importance of reducing heart size in patients with congestive heart failure by the appropriate administration of diuretics, vasodilators, or inotropic agents. The LaPlace relation also helps us to understand the reason for a different wall thickness in different parts of the heart. In general, wall stress (force per cross-sectional area) tends to remain relatively constant throughout the heart. A simplified formula for the LaPlace relation is: Wall stress (force/cross-sectional area) PR = 2h' where P = intraventricular pressure, R = radius of curvature, and h is wall thickness.
Cardiac therapy by Michael R. Rosen, Brian F. Hoffman