More related to cardiology

The purpose of this book is not to discuss in depth various topics in medicine nor to describe in detail all possible controversial subjects in car diology. The primary intention is to describe common cardiac problems with significant controversial viewpoints frequently encountered in our daily practice. This book presents 19 chapters, including the Coronary Arteries in Fatal Coronary Events, Prophylactic Antiarrhythmic Therapy in Acute Myocar dial Infarction, Mobile Coronary Care-Is It Really Needed?, The Use of Artificial Pacemakers in Acute Myocardial Infarction, Treatment of Car diogenic Shock, Serum Digitalis Level-Practical Value, Factors Modifying the Efficacy of Digitalis, Hyperlipidemia and Vascular Disease, Antianginal Agents for Coronary Heart Disease, Anticoagulation Therapy for Coronary Heart Disease, When to Operate on Congenital Heart Diseases, Indications for Coronary Artery Surgery and Patient Selection, Car diomyopathy: Diagnostic Criteria and Classification, Therapeutic Approach to Idiopathic Hypertrophic Sub aortic Stenosis, Current Concepts of Hemiblocks, Physical Activity and Coronary Heart Disease, His Bundle Electrocardiography-Its Clinical Value, Computerized Electrocar diography-Its Practical Value, and Echocardiography-Its Practical Value. As the title of the book indicates, the "pro and con" viewpoints are described in each chapter, and the authors final conclusions are expressed at the end of each. It is hoped that the book will be provocative as well as educational and practical. The contents are intended to be clinical, concise, and practical, so that this book will provide all physicians with up-to-date materials that will assist them directly in the daily care of their patients with common cardiac problems.
Coronary flow reserve is a functional measure of stenosis severity re flecting the integrated effects of its geometry including percent stenosis, absolute lumen area, length and shape. Its clinical application has been primarily qualitative in non-invasive, perfusion imaging. Measurement of coronary flow reserve during routine coronary arte riography has been an elusive goal. Transit time and indicator dilution techniques for assessing coronary flow reserve at cardiac catheteriza tion are associated with marked variability compared to microspheres or flow meters, thereby making their use questionable in comparison to the precision of good quantitative arteriography. Coronary flow reserve measured by special Doppler catheters as an adjunct to coronary arte riography shows in man the value of this integrated functional measure of stenosis severity and the limitations of percent diameter narrowing as a measure of its physiologic significance. However, Doppler catheters require additional instrumentation that is not yet an integral part of coronary arteriography and provide measures of absolute coronary flow reserve only. Relative maximum flow or relative flow reserve has been demon strated to be an important independent, complimentary descriptor of stenosis severity independent of fluctuating hemodynamic conditions. The method developed for DSA by Nico Pijls, described in this book is the first approach for assessing relative coronary flow reserve as a part of routine coronary arteriography by DSA. The theory and basic con cepts are well developed, experimental validation thorough and clinical applications timely.
Many noninvasive examination methods of the heart have not held out against the invasive methods, which modern cardiac therapy, surgically or with catheterization, requires. They have disappeared completely or are only used by isolated groups of researchers. However, there is an obvious tendency to apply the invasive procedures as the last diagnostic possibility. In the attempt to select clinically relevant methods, the expert authors of this book demonstrate that echocardiography, expanded with contrast and Doppler, has been developed into one of the most important noninvasive methods. The results with tissue characterization show that the possibilities of this method have not yet been fully explored. Nuclear procedures are widely used, although they should only be applied in direct connection with clinical cardiology. The new lead methods of the ecg, such as ecg-mapping, show that standard electrocardiography of electrical functions is not yet fully exploited. The rapidly developing method of computer tomography is also being applied to cardiology. Since nuclear magnetic resonance requires extensive equipment con struction, its future is as yet unsure. Of course, a book like this does not intend to treat the subject of noninvasive cardiology in extensive detail. Established methods like standard electrocardio graphy, phonocardiography and sphygmography are not discussed. The aim of this book is rather to demonstrate the trend of present developments in the field. LIST OF CONTRIBUTORS Ameling, W., Rogowski-Institut fUr Elektronik, Rheinisch-Westfalische Technische Hochschule, Goethestrasse 27/29, D-5100 Aachen, FRG. Bachmann, K., Medizinische Poliklinik, Universitat Eriangen-NUrnberg, Ostliche Stadtmauerstrasse 29, D-8520 Erlangen, FRG.
Hypertension is the major cause of left ventricular hypertrophy. While the electrocardiogram is an extremely insensitive measure of anatomic left ven tricular hypertrophy, it provides a time-tested important marker of an adverse cardiovascular outcome. There has been a recent temporal decrease in the incidence of electrocardiographic evidence of L VH even within the hyperten sive population; no doubt this is the result of large antihypertensive treatment experts. Anatomical evidence of left ventricular hypertrophy is best docu mented pre-morbidly using echocardiographic techniques. It therefore ap pears that between 20 and 50 percent of the hypertensive population has left ventricular hypertrophy by echo cardiographic techniques. The prognostic significance of the echocardiographically determined increase in left ventric ular mass is just beginning to be evaluated. Early information suggests that there is an increased rate of cardi~)Vascular morbidity in patients with echo car diographic evidence of increased left ventricular mass. However, this in formation is only preliminary, and as yet only a limited number of events have been reported. Far more supporting information will be required before the full impact of echocardiographically-detected left ventricular hypertrophy can be determined. Nevertheless, it must be stated that the electrocardiogram still has the greatest predictive value of cardiovascular morbid and mortal events when the pattern of left ventricular hypertrophy plus repolarization abnormal ities are present.
Since it was introduced less than 100 years ago, analysis of the circulatory response to exercise as a measure of cardiac function has undergone remarkable development. Most recently this approach has incorporated the burgeoning technology of the last half of the 20th century to meet the physiological and diagnostic needs of scientist and clinicians. The ease of administration, economy and abundant data that characterize exercise testing for its relative staying power as the most frequently utilized noninvasive method of cardiovascular evaluation. The basic modalities of exercise electrocardiography of treadmill and bicycle have been extended by noninvasive cardiac imaging techniques, including scintigraphy and echocardiography, that have provided new insights in myocardial function during exertion and pharmacologic stress. At the same time, traditional exercise electrocardiography has also been refined by innovations that have broadened its applications.
Exercise Testing: Current Concepts and Recent Advances affords the reader a state-of-the-art presentation of the diverse and expanding methods of exercise testing and their roles in patient management. The contributors to this volume include individuals who have made seminal contributions to the field during the last several decades. Indeed, it is legitimate to designate this group as a `Who's Who of Exercise Testing'. It is our hope that this book will enhance the reader's understanding of contemporary methods of exercise testing, as well as provide a glimpse into future directions of this science, that this knowledge is applied to optimal diagnosis and management of our patients.
This book is an edited compilation of the scientific presentations given at a symposium on cardiovascular hemodynamics and the contemporary practice of cardiology which was organized in Malta, April 1989. The field of cardio vascular medicine has undergone an extraordinary explosion of knowledge regarding the basic biology of the heart and circulation in health and disease, as well as technologic innovations for probing and assessing cardiac geometry and physiology. This edition addresses such issues which are key problems in current management of patients with heart disease. For example, the classic notion that severe myocardial ischemia is invariably followd by either recovery of normal function or the progression to cell death has been challenged by experimental studies and clinical observations of patients undergoing throm bolysis and revascularization. This growing body of observations clearly indicates that the consequences of ischemia and reperfusion are much more complex and variable, and include several states of abnormal metabolism and contractile function which are distinct from either 'health' or 'death'. This book presents current issues of both consensus and controversy regarding the effects of myocardial ischemia and reperfusion, including irreversible cell loss (infarction), myocardial stunning, and myocardial hibernation. Particular attention is paid to the assessment and differentiation of such patients in the coronary care unit, catheterization suite, or following surgical revascula rization. Secondly, this book addresses the hemodynamic evaluation of the patient with valvular heart disease in today's cardiology practice.
​This book traces the development of the basic concepts in cardiovascular physiology in the light of the accumulated experimental and clinical evidence and, rather than making the findings fit the standard pressure-propulsion mold, let the phenomena ‘speak for themselves’. It starts by considering the early embryonic circulation, where blood passes through the valveless tube heart at a rate that surpasses the contractions of its walls, suggesting that the blood is not propelled by the heart, but possesses its own motive force, tightly coupled to the metabolic demands of the tissues. Rather than being an organ of propulsion, the heart, on the contrary, serves as a damming-up organ, generating pressure by rhythmically impeding the flow of blood. The validity of this model is then confirmed by comparing the key developmental stages of the cardiovascular system in the invertebrates, the insects and across the vertebrate taxa. The salient morphological and histological features of the myocardium are reviewed with particular reference to the vortex. The complex, energy-dissipating intracardiac flow-patterns likewise suggest that the heart functions as an organ of impedance, whose energy consumption closely matches the generated pressure, but not its throughput. Attention is then turned to the regulation of cardiac output and to the arguments advanced by proponents of the ‘left ventricular’ and of the ‘venous return’ models of circulation. Hyperdynamic states occurring in arteriovenous fistulas and congenital heart defects, where communication exists between the systemic and pulmonary circuits at the level of atria or the ventricles, demonstrate that, once the heart is unable to impede the flow of blood, reactive changes occur in the pulmonary and systemic circulations, leading to pulmonary hypertension and Eisenmenger syndrome. Finally, the key points of the nook are summarized in the context of blood as a ‘liquid organ’ with autonomous movement.​
The cardiac system represents one of the most exciting challenges to human ingenuity. Critical to our survival, it consists of a tantalizing array of interacting phenomena, from ionic microscopic transport, membrane channels and receptors through cellular metabolism, energy production to fiber mechanics, microcirculation, electrical activation to the global, clinically observed, function, which is measured by pressure, volume, coronary flow, heart rate, shape changes and responds to imposed loads and pharmaceutical challenges. It is a complex interdisciplinary system requiring the joint efforts of the life sciences, the exact sciences, engineering and technology to understand and control the pathologies involved. The Henry Goldberg Workshops were set up to address these challenges. Briefly, our goals are: 1. To foster interdisciplinary interaction between scientists from different areas of cardiology, identify missing links, and catalyze new questions. 2. To relate micro scale cellular phenomena to the global, clinically manifested cardiac function. 3. To relate conceptual modeling and quantitative analysis to experimental and clinical data. 4. To encourage international cooperation so as to disperse medical and technological know how and lead to better understanding of the cardiac system. Today we celebrate the 7th birthday of a dream come true; a dream to bring together the diversified expertise in the various fields of science, engineering and medicine, to relate to the numerous interactive parameters and disciplines involved in the performance of the heart.
It is quite natural that literature related to car heart disease, cardiomyopathy, pulmonary and diac structure, function, pathology, and patho pulmonary vascular disease, trauma, acquired valvular disease, congenital disease, and surgi physiology has emphasized the left heart and systemic circulation. The relative lack of im cal considerations. The pathologic and clinical relevance of myocardial infarction of the right portance of the right ventricle was supported by studies performed in the 1940s and 1950s ventricle has only been documented over the which suggested that the right ventricular free last 15 years. The chapter on right ventricular wall could be effectively destroyed in an animal infarction integrates clinical, functional, patho model without detectable untoward hemody physiologic, and pathologic observations to pro namic consequences. The relative inadequacy vide the reader with a thorough review, equally of noninvasive tools to study right ventricular relevant to the clinician and investigator. The contribution on dilated cardiomyopathy pro structure and function obviated detailed and systematic investigation. However, over the vides novel insight into the impact of right ventricular performance on the functional in past 15 years there has been a resurgence of interest in the right ventricle by a variety of capacity accompanying left heart failure. A book dealing with the right ventricle would investigators. The skeptic would argue that this renewed interest resulted from an exhaustion be incomplete without at least cursory reference we have of clinically-related observations that could be to the pulmonary circulation.
In recent years methods have been developed to study cardiac function, myocardial blood flow and myocardial metabolism with radionuclides. These developments have been facilitated through the introduction of new radiopharmaceuticals, the design of special gamma cameras and dedicated computer systems. However, part of the information provided by nuclear cardiology can also be obtained through other investigations such as echocardiography, exercise electrocardiography and cardiac catheterisation with ventriculography and coronary arteriography. Thus the practising physician must select the most appropriate methodes) of investigation for each patient. Such choices should be based on proper understanding of both the value and the restrictions of each method. In this book the state-of-the-art in nuclear cardiology is reviewed, including radionuclide angiography for analysis of left and right ventricu lar function and for measurement of shunts and regurgitation volumes, perfusion scintigraphy and other methods for measurement of myocardial bloodflow and metabolism and computer processing of radio nuclide Images. Each chapter has been written by an expert from either Europe or the USA, who has contributed to the developments in his particular field. The principles of each method of investigation are described, as well as the precautions that should be taken in order to obtain high quality data. Guidelines are provided for the interpretation ofthe data based on studies in various centers where the methods were developed and tested.
Detailed analyses of regional myocardial blood flow, function, metabolism and morphology in ischemic and reperfused myocardium have led to the identifi cation of important phenomena, i. e. , myocardial hibernation, myocardial stun ning and ischemic preconditioning. Both the hibernating and the stunned myocardium characterize viable though dysfunctional as distinguished from necrotic tissue. With the advent of reperfusion procedures, the distinction between reversibly injured, hypofunctional myocardium from irreversibly injured, hypofunctional myocardium is of utmost clinical importance. The pathophysiological distinction of hibernating and stunned myocardium is con troversial, but reperfusion is mandatory anyway. Ischemic preconditioning is the most powerful maneuver known so far to delay infarct development. Its clinical significance has been suggested from retrospective analyses of data from patients suffering a myocardial infarction as well as from controlled PTCA studies. Whether or not preconditioning can be achieved pharmacologically in the clinical setting remains to be established. The mechanisms and signal cascade underlying myocardial hibernation, myocardial stunning and ischemic preconditioning are not clear in detail. Over the last year, focussed issues on myocardial hibernation, myocardial stunning and ischemic preconditioning were published in Basic Research in Car diology; they have received great interest and a good response. Therefore, these focussed issues are now combined and published as a separate monograph. We express our gratitude once more to all our colleagues who contributed to this monograph, to Ms. Ibkendanz of Steinkopff, and to Ms. Philipp and Mr. Heinrichs from Bayer AG Germany, who supported this additional publication.
Nature is totally amoral! There are at least 3-4 million people in France alone who suffer from arterial hypertension, and whose cardiovascular system is submitted day and night to both a haemodynamic and hormonal stress. In all cases, the vasculature hypertrophies as does the myocardium. This growth process is obviously mainly detrimental at the outset since it lowers compliance of the arteries and makes them stiffer. In contrast, myocardial hypertrophy is initially beneficial since the growth process multiplies the number of contractile units and by so doing improves external work. In addition, according to Starling's law, wall stress is lowered. Growth factors playa major role in this amoral process as a trigger for hypertrophy at the vascular level, and very likely at the level of the myocardium. Another major point of interest is the role of growth factors as determinants of restenosis after angioplasty and also of atherogenesis. Several chapters in this book are directly or indirectly concerned with this problem which is far from being purely academic since several groups are currently trying to control these processes by gene transfer. Certainly, one of the major clinical questions arising from such studies is why restenosis is not more frequent in clinical practice. After de-endotheliazation, the biologist would predict on the basis of recent studies on growth factors, and in contrast with current clinical opinion, that hypertrophy would occur in all cases with more or less complete restenosis.
To accomplish these objectives, the book is Body surface electrocardiographic mapping is not a new technique. It is one initially de divided into five sections. In Part I, the deve veloped many decades ago, but it has only lopment of electrocardiographic leads as well as recently matured into a powerful tool for surface mapping is viewed from an historical studying the cardiac electrical field. This book perspective. This is followed in Part II by a is intended to review, both critically and in review of the fundamental physiologic and detail, the applications of this unique method biophysical principles of electrocardiography in both clinical and experimental environments. and a discussion of basic mapping techniques. A comprehensive description of reported re Applications of these methods to the normal sults is, however, only a first goal. An equally and the abnormal heart are then presented in important objective is to explore the elec Parts III and IV, respectively. Finally, the trophysiologic and biophysical bases for the work concludes (Part V) with a consideration empirically observed electrocardiographic pat of possible future directions that body surface terns. It is only after considering these basic mapping may follow. The final result is, hope foundations that the values and the limitations fully, a thorough statement defining the cur of any electrocardiographic method can be rent s~atus of body surface electrocardiographic understood. This is particularly true for body mappmg.
As the majority of cardiovascular deaths are related to myocardial ischemia, it is necessary to understand the various aspects of ischemic heart disease. In this regard, it is noteworthy that ischemic heart disease is commonly associated with atherosclerosis, coronary spasm, as well as thrombosis leading to the development of arrhythmias, cardiovascular cell damage, myocardial infarction, cardiac hypertrophy and congestive heart failure. Furthermore, it is also important to appreciate various physiological, electrophysiological and biochemical processes in the normal heart if we are to understand their significance under pathological situations.
Heart Function in Health and Disease has been organized in five sections to provide an outline of a complex problem in a convenient manner. One section of this book is devoted to shedding light on the restructuring and ontogenic changes in the developing heart whereas in the next section some hypertrophic alterations due to chronic hypoxia are described. The third and fourth sections of this book are concerned with the regulation of cardiac channels as well as signal transduction mechanisms and cardiac electric field. The fifth section contains some pathophysiological events during the development of cardiac hypertrophy and heart failure. All of these areas encompass a significant body of new information that will be invaluable to those who work in the field of cardiovascular sciences, as well as those who treat people with heart disease.
The participation of endothelial cells in various physiologic and pathologic processes has been hypothesized since before the turn of the century. However, until recently, direct evidence for endothelial involvement in these processes has been extremely difficult to obtain due to the inability to study endothelial cell function in vitro. Though the possibility of using cultured endothelial cells to study endothelial cell function in vitro was recognized many years ago, the inability to culture unambiguously identifiable endothelial cells limited investigators in their studies of endothelial function. As a result, the field of endothelial cell biology lay relatively fallow for many years. The development in the early 1970's of routine and easily implemented methods for culturing human endothelial cells and the demonstration that cultured endothelial cells synthesized a physiologically relevant protein, Factor VIII/von Willebrand Factor, quickly changed this state of affairs. Over the following decade the scope of endothelial cell research rapidly widened, spreading in a number of directions. First, methods were developed to culture endothelial cells from a variety of species. Second, methods were developed to culture endothelial cells from different organs and types of blood vessels (arteries, veins, and capillaries) within a single species. Third, and most important, investigators began using cultured endothelial cells as tools to study the potential involvement of endothelial cells in a wide assortment of biologically interesting processes. The net result has been a tremendous increase in our understanding of endothelial cell function.
The extension of conventional M-mode to two-dimensional echocardiography has been a major advance for the evaluation and management of cardiac disease. Their combined use is optimal for a comprehensive analysis of anatomy and structure function and thus best serving the patient. This book critically examines the validity of the applications of these ultra sound techniques in common cardiac disorders. In addition to the clinical value of contrast and Doppler echocardiography, several chapters are devoted to problems related to quantitation of both M-mode and two-dimensional echocardiography. This volume is specifically aimed at the practicing cardiologist and provides an in-depth appreciation of most recent echocardiographic advances. J. ROELANDT LIST OF CONTRIBUTORS Anliker, M., MD, Department of Cardiology, University Hospital Zurich, R!imistrasse 100, 8091 Zurich, SWITZERLAND. Carroll, J.D., MD, Department of Cardiology, University Hospital of ZUrich, R!imistrasse 100, 8091 Zurich, SWITZERLAND. Cate, F.J. ten, MD, Harbour Hospital, Haringvliet 2, 3011 TD Rotterdam, THE NETHERLANDS. Cikes, I., MD, Institute of Cardiovascular Disease, School of Medicine, University of Zagreb, Kispaticeva 12, 41000 Zagreb, YUGOSLAVIA. Domburg, R.T. van, PhD, Thoraxcenter, Academic Hospital Dijkzigt and Erasmus University, P.O. Box 1738, 3000 DR Rotterdam, THE NETHERLANDS. Ernst, A., MD, Institute of Cardiovascular Disease, School of Medicine, University of Zagreb, Kispaticeva 12, 41000 Zagreb, YUGOSLAVIA. Hanrath, P., MD, Department of Cardiology, University Hospital Hamburg-Eppendorf, Mar tinistrasse 52, 2000 Hamburg 20, BRD. Hess, D.M., MD, Department of Cardiology, University Hospital Zurich, R!imistrasse 100, 8091 ZUrich, SWITZERLAND.
Cardiac aging, like aging in general, is a complex process involving numerous cellular and molecular changes, which along the way contribute to the expression of the multiple phenotypes of aging, "the different faces" of cardiac aging. Several plausible theories have been considered to explain aging, e.g., evolution, free radical, somatic mutation, etc; and at this time it is most likely that these different theories are intertwined with each other without a definitive "winner", reflecting a mixture of genetic and epigenetic elements found in most aged individuals with cardiovascular defects. The demonstration in numerous animal models of the dramatic alterations in life-span achieved by gene engineering or dietary modifications, such as caloric restriction, further underscores the interplay of both genetic and environmental factors involved in aging, as well as acting through molecular and signaling pathways operative in the heart and the vasculature.

Aging and decreasing heart function occurring together has been amply documented, and our knowledge of age associated cardiac pathologies has outpaced our understanding of the basic mechanisms underlying these processes. At present, genomics, proteomics and recombinant DNA techniques are increasingly applied to the study of cardiac cell structure and function. Their role in aging, in general, and in the aging heart, in particular, will finally be unveiled. With the availability of the Human Genome Project, and an ever increasing number of animal models and new and exciting molecular technologies, the unraveling of the underlying basic mechanisms of cardiac aging have already begun. In this book, the genetic and molecular basis of cardiovascular aging will be discussed and a comprehensive assessment of the bioenergetics changes occurring in human and animal models of cardiac aging, current diagnostic and future therapeutic modalities will be presented.

©2020 GoogleSite Terms of ServicePrivacyDevelopersArtistsAbout Google|Location: United StatesLanguage: English (United States)
By purchasing this item, you are transacting with Google Payments and agreeing to the Google Payments Terms of Service and Privacy Notice.