Ventricular Fibrillation and Sudden Coronary Death

Developments in Cardiovascular Medicine

Book 219
Springer Science & Business Media
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The publication embodied here represents the life work of a premier Russian scientist studying Sudden Cardiac Death. As one can gather from more than 35 first authored publications cited in the References, Dr. Rajskina has been involved with the investigation of mechanisms responsible for Sudden Cardiac Death for over 30 years. She has brought a classical approach to the sub ject, considering the effects of blood supply disturbances, electrophysiological changes that occur after regional ischemia, metabolic alterations, and the role of the autonomic nervous system in modulating these changes. These studies naturally lead to a consideration of interventions, based on her research, to prevent ventricular fibrillation after coronary artery occlusion. This is a wide ranging treatise indicative of a lifetime of study of the problem and filled with the richness of scientific experiments generated in its pursuit. There is so much in here that will be of interest to the arrhythmologist interested in Sudden Cardiac Death, whether this is on a single channel level, in vitro study of hearts, in vivo investigation of intact animals, or at the bedside. And throughout it all, statements are copiously documented with more than 850 references. That alone is worth hours of computer searching. I am very proud to have been asked by this outstanding scientist to write a brief Preface to her monumental contribution. All of us involved in the study of arrhythmic mechanisms responsible for Sudden Cardiac Death can hold Dr.
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Publisher
Springer Science & Business Media
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Published on
Dec 6, 2012
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Pages
213
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ISBN
9781461552536
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Language
English
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Genres
Medical / Cardiology
Medical / Clinical Medicine
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Content Protection
This content is DRM protected.
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Accurate diagnosis of arrhythmias is the goal of this volume. Before the clinician can accurately classify the multiple permutations of cardiac rhythm encountered in daily practice, several essential preconditions must be met. At the most basic level, the clinician must know the diagnostic criteria for each rhythm. Without a clear understanding of these criteria, an accurate differential diagnosis is impossible, and without accurate diagnosis, correct intervention is a mere matter of chance.
A second precondition of accurate rhythm diagnosis is an understanding of the mechanism of arrhythmias. Not uncommonly, two or more arrhythmic mechanisms coexist, confronting the clinician with a baffling mixture of apparently unrelated complexes and intervals. Without an understanding of the various arrhythmic mechanisms, simple and complex, the tangled skein of data can never be unraveled.
Finally accurate arrhythmia diagnosis depends on skill attained through practice. The competent electrocardiographer combines the skills of precise measurement and rational application of logic with broad theoretical knowledge. The pleasure of electrocardiography is seeing through the surface appearance to the inner workings.
Interpretation of Cardiac Arrhythmias presupposes no prior knowledge of arrhythmias, and progresses from basic to the complex. The didactic sections focus extensively on the mechanism of arrhythmia, using laddergrams and other diagramatic devices to help the student visualize what is happening with the cardiac conduction system. Extensive self-assessment sections enable students to apply critical skills and test their grasp of the diagnostic criteria.
Cardiac surgery is performed on hundreds of thousands of patients a year, and can have an important beneficial impact on the outcomes of patients with coronary and valvular heart diseases. Despite the favorable recovery of most patients, some will have their post-operative period interrupted by the development of atrial fibrillation, with a host of potential complications including stroke. High risk subgroups may develop atrial fibrillation in more than half of cases, and often despite aggressive prophylactic measures. Treatment of atrial fibrillation and its aftermath can also add days to the hospital stay of the cardiac surgical patient. In an era of aggressive cost cutting and optimization of utilization of health care resources, the financial impact of this arrhythmic complication may be enormous.
Experimental studies have led to a greater understanding of the mechanism of atrial fibrillation and potential precipitating factors in the cardiac surgical patient. Prophylactic efforts with beta-blockers, antiarrhythmic drugs and atrial pacing are being used, or are being investigated in clinical trials. New methods of achieving prompt cardioversion with minimal disruption of patient care, and prevention of the thromboembolic complications of atrial fibrillation, are also important therapeutic initiatives. This text is designed to aid health care professionals in the treatment of their patients in the recovery period after cardiac surgery, and to instigate additional research efforts to limit the occurrence of, and the complications following, this tenacious postoperative arrhythmia.
One of the major biomedical triumphs of the post-World War II era was the defmitive demonstration that hypercholesterolemia is a key causative factor in atherosclerosis; that hypercholesterolemia can be effectively treated; and that treatment significantly reduces not only coronary disease mortality but also all cause mortality. Treatment to lower plasma levels of cholesterol - primarily low density lipoprotein (LDL) cholesterol - is now accepted as best medical practice and both physicians and patients are being educated to take aggressive measures to lower LDL. We can confidently look forward to important decreases in the toll of coronary artery disease over the coming decades. However, there is still uncertainty as to the exact mechanisms by which elevated plasma cholesterol and LDL levels initiate and favor the progression of lesions. There is general consensus that one of the earliest responses to hypercholesterolemia is the adhesion of monocytes to aortic endothelial cells followed by their penetration into the subendothelial space, where they differentiate into macrophages. These cells, and also medial smooth muscle cells that have migrated into the subendothelial space, then become loaded with mUltiple, large droplets of cholesterol esters . . . the hallmark of the earliest visible atherosclerotic lesion, the so-called fatty streak. This lesion is the precursor of the more advanced lesions, both in animal models and in humans. Thus the centrality of hypercholesterolemia cannot be overstated. Still, the atherogenic process is complex and evolves over a long period of time.
Despite the significant decline in heart disease mortaht>' rates over the last 25 years, heart failure has remained a significant problem. We are now confronted with large numbers of terminally ill patients for whom conventional therapies for heart failure have been exhausted and for whom repeated hospital visits are necessary. There now is a major thrust towards a management strategy which embraces a comprehensive approach including vigorous preventive measures and earlier surgical interventions. This book outlines the major surgical options for the treatment of heart failure and brings together a very broad base of opinions with contributions from several outstanding individuals. With the improved knowledge and techniques to control rejection, transplantation has become the central pillar in the surgical management of this group of patients. Unfortunately, because of limited donor supply the teclmique cannot be applied to large numbers of patients. A great deal of excitement, however, exists in the potential for xenotransplantation as a supplement to homotransplantation. The use of cardiac assist devices has become a reality with several hundred LVADS and BiVADS implanted throughout the world and cardiac replacement with total artificial hearts continues to be used successfully as a bridge to transplantation. We are on the thieshold of the broad application of assist devices to provide prolonged relief of heart failure and restore patients to an ambulatoiy home environment and hopefully return to the work force in significant numbers.
The detection of ischemic myocardium is one of the major problems in modern cardiology. Exercise has long been used to detect latent myocardial ischemia by enhancing oxygen de mand, but different cardiologists perform exercise tests in dif ferent ways. In addition, many new techniques for detection of ischemia have been developed in the past decade. For these reasons, a symposium on this topic was organized in Dusseldorf under the auspices of the European Society of Cardiology. The papers from this symposium contained herein provide an up-to-date review of the different forms of exercise tests, including their advantages and disadvantages. Indications for study, recording techniques and evaluation of exercise ECG, including computer techniques, are extensively discussed. The results of exercise ECG are compared with those of other me thods, especially coronary angiography. Finally, the prognostic value of exercise ECG is assessed. Additional chapters deal with complementary methods for detection of myocardial ischemia, presenting techniques and results of angiographic, isotopic and metabolic studies under exercise. The symposium demonstrates that exercise testing has a primary role in the detection of the disease, but there is still no unanimity on how to carry it out. The results of some new approaches are promising, even if their clinical relevance has not yet been fully established. We hope that this book will be of interest to all our colleagues taking care of cardiac patients. We wish especially to thank Mr. M. Giicker and Mrs. B.
Since the introduction of coronary angioplasty in 1977, this procedure has gained a steadily increasing position in the treatment of coronary artery obstmction. From the available evidence it can be estimated, that this thera peutic tool will get even more additional momentum of many ten-thousands of patients to be treated in the next few years, due to a growing fraction of patients who are candidates for this intervention. Information about the indications, benefits and risks of coronary angioplasty is accumulating rapidly in addition to publications about refinements of the technique itself. Recently, a number of investigators have realized that coronary angioplasty is not only a therapeutic tool, but can, during the procedure, be used as a source of diagnostic information. When the catheter is placed in a coronary artery obstruction, inflation of the balloon produces transient myocardial ischemia. Before, during, and after this period of severe ischemia, studies of the perfor mance of the myocardium at risk can be carried out. The fact that therapeutic coronary angioplasty is carried out in a cardiac catheterization laboratory which is by definition optimally equipped for the measurement of hemodynamic parameters, has probably also contributed to the effectuation of these investigations. The combination of hemodynamic and biochemical parameters with morphological information from the coronary angiogram can be utilized for the quantification of myocardial involvement and the success of coronary dilatation with angioplasty. Studies of interactions with pharmacological substances are also feasible and informative.
Accurate diagnosis of arrhythmias is the goal of this volume. Before the clinician can accurately classify the multiple permutations of cardiac rhythm encountered in daily practice, several essential preconditions must be met. At the most basic level, the clinician must know the diagnostic criteria for each rhythm. Without a clear understanding of these criteria, an accurate differential diagnosis is impossible, and without accurate diagnosis, correct intervention is a mere matter of chance.
A second precondition of accurate rhythm diagnosis is an understanding of the mechanism of arrhythmias. Not uncommonly, two or more arrhythmic mechanisms coexist, confronting the clinician with a baffling mixture of apparently unrelated complexes and intervals. Without an understanding of the various arrhythmic mechanisms, simple and complex, the tangled skein of data can never be unraveled.
Finally accurate arrhythmia diagnosis depends on skill attained through practice. The competent electrocardiographer combines the skills of precise measurement and rational application of logic with broad theoretical knowledge. The pleasure of electrocardiography is seeing through the surface appearance to the inner workings.
Interpretation of Cardiac Arrhythmias presupposes no prior knowledge of arrhythmias, and progresses from basic to the complex. The didactic sections focus extensively on the mechanism of arrhythmia, using laddergrams and other diagramatic devices to help the student visualize what is happening with the cardiac conduction system. Extensive self-assessment sections enable students to apply critical skills and test their grasp of the diagnostic criteria.
This Symposium is the third of a series of scientific meetings in the field of echocardiology, held at the Erasmus University Rotterdam. * The series was initiated by Klaas Born, who organized the first two meetings with great success. These followed the procedure of two days of parallel sessions with invited speakers only. This time, we decided to broaden the basis of the meeting and have a three-day program of parallel sessions, combining invited papers, free com munications and posters. We decided, however, to maintain one of the most striking features of the last meeting- having the complete proceedings available at the time of the meeting. We confronted the authors-to-be with a very tight schedule in order to make the book a true reflection of the state of the art in echocardiology. As a 'result, editing time was also very limited and neither terminology nor units have been completely standardized. This book has three main parts. The first, and largest, part consists of contributions on echocardiology in adults, and is divided into four sections. The first section is a general survey of various applications, whereas the remaining three centre round specific applications, i.e. ischemic disease, left ventricular function and cardiac valves, respectively. The second part con tains applications in pediatric cardiology; due to the wide variety of topics covered, no particular subdivision has been made. The last part of the book is devoted to instrumentation, methods and new developments.
Ideal for cardiologists who need to keep abreast of rapidly changing scientific foundations, clinical research results, and evidence-based medicine, Braunwald’s Heart Disease is your indispensable source for definitive, state-of-the-art answers on every aspect of contemporary cardiology, helping you apply the most recent knowledge in personalized medicine, imaging techniques, pharmacology, interventional cardiology, electrophysiology, and much more! Practice with confidence and overcome your toughest challenges with advice from the top minds in cardiology today, who synthesize the entire state of current knowledge and summarize all of the most recent ACC/AHA practice guidelines.Locate the answers you need fast thanks to a user-friendly, full-color design with more than 1,200 color illustrations. Learn from leading international experts, including 53 new authors. Explore brand-new chapters, such as Principles of Cardiovascular Genetics and Biomarkers, Proteomics, Metabolomics, and Personalized Medicine.Access new and updated guidelines covering Diseases of the Aorta, Peripheral Artery Diseases, Diabetes and the Cardiovascular System, Heart Failure, and Valvular Heart Disease.Stay abreast of the latest diagnostic and imaging techniques and modalities, such as three-dimensional echocardiography, speckle tracking, tissue Doppler, computed tomography, and cardiac magnetic resonance imaging.Consult this title on your favorite e-reader, conduct rapid searches, and adjust font sizes for optimal readability.
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