"Unfortunately some authors suggest that the development is the result of some intrinsic cardiac process, while in reality its course is importantly determined by extrinsic, controllable factors, i.e. the way of treatment. Dialysis provides a unique opportunity to correct some of these disturbances and thus slow down, improve, ore even cure complications, which once were considered inevitable."
The authors describe detailed: Methods of investigation, prevention and treatment of cardiac dilatation, left ventricular hypertrophy, congestive heart failure, valvular disease, dilated cardiomyopathy, sudden cardiac death and arrhythmias in iremic patients
Whatever structural alterations in the heart are present, fluid retention plays a contributory and pivotal role. When a normal heart can fail with volume overload, a diseased heart will suffer even more, and good volume control is more urgent than ever. Remarkable improvements in clinic and echocardiographic disturbances can be achieved by judicious ultrafiltration, anginal complaints can be relieved , appetite can improve. When severe dilated cardiomyopathy is present, hypertension disappears and blood pressure may become subnormal, strengthening te conviction that the condition is beyond repair.
Particularly when gross cardiac dilatation and systolic dysfunction are present, patience and perseverance by the dialysis team are required, because adaption and ´remodeling´ of the stretched heart muscle take time to complete. But as every patient is different, treatment is necessarily empirical, guided by close clinical observation. The authors describe examples of patients illustrating the relevant points.