Heart Failure [antikvár]

FOREWORD Many years of physiological and clinical study have confirmed that the heart is not anxious to disclose its innermost workings. Even in the normal heart, particularly at the ultrastructural level, large conceptual jumps have to be made in order to relate structure and function. The bridges of hypotheses become longer and more tenuous when one or both ventricles begin to fail. Recently there has been a renaissance of research into heart failure. As a result, much has been learned about the assessment of ventricular performance, the effects of different types of loads on the behavior of the affected ventricle, the energetics of the normal and failing heart, the determination of contractility, and the contributions of autonomic control to the function of the cardiac pump. But many enigmas remain. How do the anatomic and biochemical transformations that are operative in the normal heart operate in hearts that are hypertrophied or dilated or failing? Indeed, are the same mechanisms operative? What are the ultrastructural bases for heart failure? What are the biochemical and physiological consequences of unloading a failing ventricle? How does failure of one ventricle affect the behavior of the other? How do pharmacological agents exert their distinctive inotropic effects on the failing heart? For the symposium to honor Dr. Isaac Starr, experts were drawn from near and far to review the current understanding of heart failure. In the essays that follow these experts have drawn clear pictures of the scientific bases for clinical practice. In doing so they have made a sharp distinction between empirical and scientific practice, identified pathogenetic gulfs that separate fundamental science from bedside diagnosis and treatment, and highlighted the exciting new frontiers in concept and technology. It is difficult to escape the impression that we are on the brink of important new discoveries in heart failure and that fresh approaches are destined to be important bridgeheads on the way to new understanding. The major purpose of this foreword is to acknowledge indebtedness to those who have paved the way for this book: Dr. Starr for allowing us to dedicate this volume in his honor, the University of Pennsylvania and School of Medicine for encouraging this exchange of ideas, and the Steering Committee (Alfred P. Fishman, M.D., James J. Ferguson, Jr., M.D., Lee D. Peachey, M.D., Karl T. Weber, M.D., and Francis C. Wood, M.D.) for attracting the distinguished participants. A special word of thanks is also due to Ms. Susanna Doyle for the painstaking editorial assistance that made this publication possible. Alfred P. Fishman, M.D.