Treatment of Advanced Heart Disease PDF

Preface

Congestive heart failure affects approximately five million people in the United States, with over 500,000 new cases per year, and is the most common diagnosis-related group for hospitalizations of patients over 65 years of age. As the population ages, and as thrombolitic therapy and other interventions prolong the lives of patients with heart disease, the number of patients with congestive heart failure is increasing dramatically.

As patients' heart dysfunction advances, they require a proportionate response, including increased medical therapy, insertion of devices, and occasionally surgical therapy, in their management.

As a result, the number of physicians caring for this group of patients will also expand beyond the capability of heart failure specialists and cardiologists. Additional physicians, nurse practitioners, and physicians assistants will be needed to care for this population, including those in general internal medicine, general practitioners, general pediatricians, and surgical specialties who will be responsible for these patients intermittently before and after surgical intervention. Physicians caring for the patients will need a compendium of current management options and some sense of the new and experimental therapies soon to be available.

This book is meant to serve as a single-source guide to the care of patients with heart failure. The text begins with an overview of the current heart failure population and anticipated growth in the future. The authors guide the clinician through a consideration of the causes of advanced heart disease, in particular an algorithm for newly diagnosed patients to guide the assessment of potentially reversible etiologies. Medical management is considered from the most fundamental of interventions, including diet and exercise, to a consideration of the appropriate use of diuretics, afterload reduction therapy, and beta-blockers. The use of statin therapy in ischemic and nonischemic dilated cardiomyopathy is considered.

The appropriate treatment of both superventricular and ventricular arrhythmias is addressed. Intravenous inotropes are considered as a bridge to more definitive therapy with careful assessment of the risks and benefits of this form of treatment. The appropriate use of biventricular pacing and selection of candidates for implantable cardioverter defibrillators are addressed utilizing the most recently published data. Less frequently considered but equally important device therapies, including external and internal counterpulsation and treatment of sleep-disordered breathing, are considered to complete the evaluation of currently available device therapy.

No text on the management of advanced heart disease would be complete without consideration of surgical therapy, particularly heart transplantation. In view of the limited number of patients who will receive heart transplantation in the United States, all other surgical options are considered. These include high-risk revascularization, valve replacement or repair, ventricular reconstruction, and laser therapy.

In addition, bridge and destination utilization of all forms of ventricular assist devices and total artificial hearts receive consideration in this comprehensive yet easy-to-understand book. In addition to cutting-edge application of currently available therapy, the text explores the potential therapies of the future. These include cell therapy, gene therapy, genetics and heart failure, new drugs, new devices, and new surgical approaches. These sections will place the reader in the advantageous position of having awareness of therapies that will be introduced in the next three to five years. Unique to this text is the attention given to the management of the pediatric patient, including medical, device, and surgical therapies in patients less than 18 years of age.

Of special importance are sections dealing with the education and counseling of patients with heart failure and their families. This includes appropriate determination of prognosis and end-of-life issues.

The book provides readers with exposure to all of the currently available and nearterm future therapies for patients with progressive heart failure. Readers have not only currently available therapy, but also a practical algorithm of management options and when each form of therapy is utilized in the care of an individual patient. Although all inclusive, the text is succinct, organized, readable, and provides the consumer with a single source for complete management of the most straightforward to the most difficult patients.

This book was written to have appeal to internists, cardiologists, cardiology fellows, general practitioners, cardiac surgery residents, cardiac surgery attendees, and pediatric cardiovascular specialists. As noted above, the book is also of interest to an expanded group of physicians who will have initial or intermittent responsibility for this patient population, including general practitioners, general pediatricians, and non-cardiovascular surgeons.