NONPHARMACOLOQICAL MANAGEMENT OF HEART FAILURE



Mechanical support of the failing heart by intra-aortic balloon counterpulsation is sometimes use­ful. The balloon is inserted either surgically or percutaneously into a femoral artery and ad­vanced to the descending aorta. Timed from the electrocardiogram, the balloon is deflated imme­diately before ventricular ejection to decrease aor­tic pressure (afterload) during ventricular systole and inflated in early diastole to increase aortic pressure and to maintain coronary perfusion. Thus, the hemodynamic benefits of balloon coun­terpulsation are greater than those of vasodilatory drugs alone. Balloon counterpulsation is useful to stabilize patients before an intervention designed to provide long-term benefit (PTCA or surgical re­vascularization; surgical correction of acute mi­tral regurgitation or ventricular septal defect). It may be used prophylactically during cardiac cath­eterization in severely ill patients, as an aid during or after open heart surgery, during treatment of some life-threatening ventricular arrhythmias, and for relieving angina pectoris in patients in whom medical therapy has been unsuccessful.
The role of surgery in patients with congestive heart failure depends on the etiology; surgically correctable lesions should be identified and cor­rected if possible. In patients with end-stage myo­cardial dysfunction, the results with cardiac transplantation have recently improved with the introduction of cyclosporine and other improved immunological support. In addition, develop­ment of mechanical cardiopulmonary apparatus is promising.





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