Essential Medicine

69 but usually such a condition is terminal, and denotes irreversible pump failure. Many patients can, however, return to useful activity, avoiding sudden unaccustomed exertion, and being maintained on diuretics, potassium and digoxin with suitable surveillance. Curative surgery may be possible in those with heart valve lesions. Heart transplantation. Remarkable technical success has been achieved, and patients have survived for up to two years after opera­ tion. It is, however, difficult to decide which cases are suitable, for early cases may benefit from less drastic measures, and late cases have involvement of lungs and liver, lessening the changes of success. There are problems too, of transplant rejection, immunosuppression and of the ethics of obtaining donor hearts. There may be a greater place for the use of plastic pumps, which are being developed for use as temporary supports to the circulation, e.g. in myocardial infarction, until the heart function improves. Prevention of cardiac disease; a summary Congenital heart disease should be recognized early, for cure is often possible. Rheumatic heart disease has diminished with the conquest of the streptococcus, but where it has occurred, early recognition and treat­ ment of valvular complications will prevent heart failure. Hyper­ tension and its effects can be remedied before the stage of heart failure. We are left with arteriosclerotic heart disease, and while alleviation of its effects is possible, prevention awaits understanding of the arteriosclerotic process. Meantime, we can advise the control of obesity and the cessation of cigarette smoking.