HARNESSING THE AFTERLOAD

Abstract

Pump Failure is characterised by rise in venous pressures and decrease of cardiac output. The traditional treatment of pump failure, therefore, involves therapeutic modalities aimed at countering and conquering these haemodynamic abnormalities. Improvement in cardiac output is usually obtained by increase in heart rate and pressure and by improvement in myocardila contractile state. This has been well illustrated by change in the intesity and duration of regugitant murmul by phenylephrine and amyl nitrite, the formei accentuating and the latter reducing th pansystolic murmur of mitral regurgitation. Harshaw et al. (1975) have demonstrated signif icant enhancement of forward flow with concom inant decrease in regurgitant fraction in severe mitral regurgitation during vasodilator therapy. Vasodilator therapy may be indicated in severe mitral reguargitatin, mitral regurgitation cornplicating acute myocardial infarction and in mitral reguargitation with heart failure or perhaps heart failure causing mitral regurgitation by dysfunction of subvalvular apparatus.