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P&S Journal

P&S Journal: Spring 1994, Vol.14, No.2
Centering on Heart Failure
"Heart Failure"

Although the term "heart failure" seems to imply that the heart has stopped beating, heart failure actually means that the body's needs for oxygen-rich blood during exercise and rest are not being met because of a damaged heart and circulatory system. Breathlessness and fatigue at the slightest exertion result. Destruction of the heart's pumping mechanism causes fluid to seep out of blood vessels, leading to fluid build-up in tissues, such as the legs, feet, lungs, and abdomen.
Various conditions can lead to heart failure: narrowing of the arteries supplying the heart muscle (coronary artery disease); a previous heart attack with scar tissue interfering with normal heart function; high blood pressure; heart valve or muscle disease; congenital heart disease; and heart valve and muscle infection. One-third of heart failure problems, however, have no known causes.
Physicians at P&S have played and continue to play an important role in changing the way the medical profession views and treats heart failure. From the 1940s through the 1960s, says Dr. Packer, heart failure was thought to be a problem with the heart's pump that caused kidney failure and fluid build-up in the body. Doctors used such treatments as digitalis to stimulate the heart pump and diuretics to reduce fluids.
In the last 10 to 20 years, however, research has shown the heart is not singularly involved in heart failure. "The heart's function and survival are determined by an environment regulated by neurohormonal factors that act on the heart and the peripheral blood vessels that supply blood to the organs," says Dr. Packer. Instead of using drugs that treat only the heart or the edema symptoms, doctors now use drugs targeted to blood vessels (vasodilators) and to neurohormonal imbalances (beta-blockers).
"It is not that the older models are wrong or that old drugs are worthless," says Dr. Packer.
"It is just that the older models are incomplete and that by giving both new drugs and old drugs, more people with heart failure can be treated successfully."

copyright ©, Columbia-Presbyterian Medical Center

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