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J Thorac Cardiovasc Surg 2001;121:628-637
© 2001 The American Association for Thoracic Surgery

Editorials

Congestive heart failure: Treat the disease, not the symptom—Return to normalcy

From the University of California Medical Center, Thoracic and Cardiothoracic Surgery, Los Angeles, Calif.

Received for publication Dec 28, 2000. Accepted for publication Jan 10, 2001. Address for reprints: Gerald D. Buckberg, MD, Thoracic and Cardiothoracic Surgery, University of California Medical Center, Box 951741, Los Angeles, CA 90095-1741 (E-mail: gbuckberg@mednet.ucla.edu).

For related article, see p. 675.

Pathology is the dilemma that physicians confront daily in patient care. The consequences of any distortion of structure become the symptoms of the disease created by abnormal processes. Treatment is directed toward alleviation of these results that "remodel away" from normal structure and biochemistry. This confrontation over symptoms occurs in the health care community (medicine, surgery, pharmacology, medical devices, and through annual health care costs). Medical students cannot wait to leave their learning curve–established normal principles. To many, these are an astounding roadblock between the basic and clinical areas. The obligatory study of normality is a "brief hurdle" they must pass on the real road to becoming a physician. Fundamental basic sciences are thought to reflect the unimpeachable camp of the "preclinical school." The motivational objective is to deal with the dilemma of the sick patient.

The purpose of this report is to show that departure from normality and lack of focus on its importance are very expensive and less effective ways to deal with pathologic conditions. The result of this focus on abnormality caused by disease is an explosive development of drugs, operations, machines, and health care personnel to minimize the physical and biochemical derangements of such diseases. A prominent example is congestive heart failure (CHF), which affects 4.9 million persons in the United States. The disease constitutes loss of the normal elliptical ventricular architecture, to produce a dilated spherical ventricle with limited contractile and filling capacities. The consequences are fatigue, pulmonary congestion, associated arrhythmias, repeated hospitalizations, and eventually death.

The pathologic derangement is called remodeling due to heart diseases in which the blood flow, valve, and muscle itself are damaged. This term remodel is used extensively in medical and surgical circles to define the diseased state, but the definition of this word . . . [Full Text of this Article]

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