Bøger i Developments in Cardiovascular Medicine serien

Because the constant flow of information makes it nearly impossible to construct a timely book on advances in cardiology, the chapters in this volume describe the current concepts in cardiology and their underlying rationale, rather than attempting a comprehensive review of the most recent papers in each discipline.

Apart from risk factors of relevance in primary prevention, secondary prevention is dependent on the extent of the disease itself; This concept truly is the nucleus of secondary prevention, sine only a life worth living generates the motivitation needed to take all the steps necessary in secondary pre vention.

This atlas presents over 160 illustrations, with 116 in color, and illustrates the capacity of multidetector CT for the analysis of the anatomy of the coronary arteries. The multidetector CT scanner speeds diagnosis and treatment of patients. Multidetector CT provides clear pictures and takes less time than other non-invasive techniques.

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.

Although clinicians have recognized the importance of inflammatory mediators in the pathogenesis of heart disease for well over 200 years, it has taken nearly as many years for clinicians and scientists to focus on the basic biological mechanisms by which inflammatory mediators contribute to the pathogenesis of cardiac disease states.

Within the last thirty years, by Sperelakis IS a potent reminder of the almost for the rift between clinical and investigative cardiology gotten fact that cardiology has twO sites, inextrica has widened, because of the overwhelming devel bly related.

* Richly illustrated with over 200 illustrations* Contains a Glossary of Terms* Very practical and user-friendly guide

Autopsy derives from the greek word autopsia, which means act of seeing with one's own eyes. It remains the most objective and accurate method to understand human. disease. Unfortunately, the volume of autopsies in teaching hospitals has decreased dramatically over the past years. The crucial factors that account for this are the recent progress and development of new technologies, especially in diagnostic imaging, immunology, cell biology and genetics. Additionally, the perpetual fear of legal liability by physicians accounts for its further decline. Consequently, physicians and medical students are engaged in fewer autopsies and are not reaping the rich educational rewards that accompany these examinations. The purpose of the autopsy is not only to establish the cause of death, but also to determine the nature and course of the disease process. Our goal with this book is to emphasize the importance of the post-mortem exam and the correlation between pathologic material and clinical data by analyzing actual cases with problem-based methodology. The focus of this handbook is on cardiovascular disease, and when appropriate, other disease categories are included if they have an impact on cardiovascular function. The approach is more than the usual clinico-pathological correlation. Rather, we attempt to present the material from the perspective of the autopsy table. We use the clinical data as the initial framework and the autopsy findings to develop a true understanding of the disease and the associated pathophysiology of the condition.

Catheter-delivered therapeutic ultrasound angioplasty is a new technique for use in the treatment of obstructive vascular disease. The treatment differs from balloon angioplasty in that it has been shown experimentally to cause disintegration of calcific and fibrotic atherosclerotic plaques, thrombus dissolution and arterial vasodilation. In contrast to laser technology, ultrasound systems are relatively inexpensive and simple to use and maintain. In the clinical trials detailed in this text, ultrasound angioplasty has been shown to be feasible and safe. Ultrasound Angioplasty is a comprehensive text, addressing the theoretical, experimental and clinical issues. The international contributions reflect the excitement, interest, spirit and cooperation in the research and development of therapeutic ultrasound.

From the Proceedings of the Meeting of the American Section of the International Society for Heart Research (ISHR) at Hilton Head, South Carolina, September 21-24, 1983

Although there are many books on angina, few are devoted to the important problem of how to evaluate drug efficacy in angina pectoris. Drug Evaluation in Angina Pectoris has two fundamental aims: the first is to review the methodological aspects of drug evaluation in stable and unstable angina pectoris; the second is to provide a logical and methodological background for future studies aimed at assessing the ability of medical treatment to improve prognosis. Part I updates the pathophysiology, clinical presentation and prognosis of angina pectoris. Part II aims to `put in numbers' the symptoms and signs of myocardial ischemia, starting from a revision of the currently used parameters. It is extremely important to quantify the variability of the disease for the correct design of clinical trial, a subject dealt with in Part III, which also discusses some clinico-pharmacological aspects of therapy. Part IV is a critical review of the drugs currently used for the treatment of stable and unstable angina, and particularly considers some important unresolved issues concerning their use. The current FDA and EC guidelines for the evaluation of antianginal drugs are briefly discussed in Part V, giving clinical investigators insight into how antianginal drugs are evaluated by regulatory agencies and what is considered as proof of a valid efficacy/tolerability ratio. Drug Evaluation in Angina Pectoris will assist discerning cardiologists, pharmacologists, and advanced students of cardiology as well as innovative pharmaceutical companies, all of whom need to understand what angina is, how to evaluate treatment, and how to judge the agents used in its treatment.

This book is based on papers presented at a Symposium held in Seoul, Korea in 1992. The idea for the symposium developed naturally from work in which Professor Yung E Earm, at Seoul National University, had been involved both in my laboratory in Oxford and in his own laboratory in Seoul concerning the possible role of certain amino acids, like taurine that are strongly concentrated by the cells of the heart, and the relationship between such acids and membrane ionic currents. The first obvious question was whether it is possible to identify the transport mechanisms involved for taurine and whether they are electrogenic. The second question is what function could be served by such processes: does taurine play an essential role in cardiac tissue and is this important in protecting the heart from disease? With his colleagues in the Korean Physiological Society, Professor Earm set about the task of fmancing and organizing a meeting at which some of the world's leading cardiac electrophysiologists and taurine specialists could discuss these questions. The fmance was generously provided by the Dong-A Pharmaceutical Company, one of the leading scientific companies in Korea.

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 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.

This book is timely and challenging. Within its pages are commentaries and opinions on the scientific background and explanatory ideas for a complex of symptoms and investigations known as syndrome X. The commonest cause by far of angina pectoris is coronary artery obstruction due to atheromatous lesions both within the wall of the artery and intruding into the lumen; in such patients it is expected that there maybe ST segment depression on atrial pacing or on an exercise test indicating myocardial ischemia. Syndrome X was a term first used in an editorial written by Kemp in 1973. He was referring to patients in group X in a paper from Arbogast and Bourassa. Patients in group X had three features, namely angina as judged on a clinical history, alterations of the ST segment on the electrocardiogram during atrial pacing and smooth unobstructed coronary arteries (presumed normal) as assessed by the technique of coronary angiography. The changes on the electrocardiogram, conventionally indicative of myocardial ischemia, could not be explained on the basis of any abnormality of the coronary arteries and Kemp named the complex of fmdings syndrome X because of this seeming paradox and the lack of a single explanation. In the last thirty-one years there has been substantial scientific interest in this syndrome giving rise to a large number of publications. The name syndrome X has led to considerable confusion. Physicians are familiar with the X chromosome and with X linked congenital disorders.

Angioplasty has completely transformed the treatment of coronary artery disease and is widely used, with more than 800,000 procedures performed worldwide per year. However, the enthusiasm for angioplasty is shadowed by restenosis, which remains a critical problem after the procedure, resulting in clinical recurrence in over a third of patients. Recently, the mechanisms of restenosis have been completely reappraised with an enriched understanding that the original concept of neointimal hyperplasia may not be accounting for the bulk of the problem. There is a desperate need to heighten understanding of the remodeling process at the molecular, cellular, and arterial level. Vascular remodeling is a well established concept in the field of atherosclerosis and hypertension, but only in recent years has its applicability to the field of restenosis become pivotal. Accordingly, the editors perceived the need to assemble the first book dedicated to the concept of coronary artery remodeling in restenosis, in order to clearly review the experiments leading to the remodeling hypothesis and integrate this with the neointimal hyperplasia (tumor) model for the development of the restenotic lesion. The authors of this book present their experience to facilitate the understanding of the mechanisms for coronary restenosis and remodeling. The various experimental models, clinical issues, and basic mechanisms are reviewed in detail, resulting in a fresh approach to a vexing clinical problem. Arterial Remodeling: A Critical Factor in Restenosis will be useful to the physician and trainee who have an interest in restenosis, and specifically in the major pathophysiologic process which determines the fate of arterial healing in patients following percutaneous coronary revascularization. It is hoped that this book will lay the foundation for more effective therapies that will reduce the chance of constrictive remodeling and improve the long-term efficacy of non-surgical coronary revascularization in the future.

Autopsy derives from the greek word autopsia, which means act of seeing with one's own eyes. It remains the most objective and accurate method to understand human. disease. Unfortunately, the volume of autopsies in teaching hospitals has decreased dramatically over the past years. The crucial factors that account for this are the recent progress and development of new technologies, especially in diagnostic imaging, immunology, cell biology and genetics. Additionally, the perpetual fear of legal liability by physicians accounts for its further decline. Consequently, physicians and medical students are engaged in fewer autopsies and are not reaping the rich educational rewards that accompany these examinations. The purpose of the autopsy is not only to establish the cause of death, but also to determine the nature and course of the disease process. Our goal with this book is to emphasize the importance of the post-mortem exam and the correlation between pathologic material and clinical data by analyzing actual cases with problem-based methodology. The focus of this handbook is on cardiovascular disease, and when appropriate, other disease categories are included if they have an impact on cardiovascular function. The approach is more than the usual clinico-pathological correlation. Rather, we attempt to present the material from the perspective of the autopsy table. We use the clinical data as the initial framework and the autopsy findings to develop a true understanding of the disease and the associated pathophysiology of the condition.

Cardiovascular drug therapy has markedly progressed in the recent decades. Not only have new drugs been introduced to clinical practice, but new classes of drugs have been developed. While in 1960 the practicing cardiolo­ gist had a selection of about only ten drugs, in 1987 about 150 drugs are routinely used in cardiovascular diseases. Elderly patients, however, usually do not enjoy the full benefit of this progress. This might be due to lack of knowledge, a conservative approach, or the worldwide tendency not to try new drugs in the elderly. It is now clear that the majority of patients that will be treated in car­ diovascular clinics will be, in the near future, elderly patients. Even now, elderly patients form about one-third of the patients with cardiovascular diseases. These patients are approached, however, according to criteria devel­ oped for younger populations. This is despite the fact that elderly patients differ from younger ones in most aspects, including pathology, epidemiol­ ogy, pathophysiology, diagnostic approach, management, pharmacology, pharmacokinetics, rehabilitation, and supportive treatment. It is the purpose of this book to present to the clinician all drugs with which there is clinical experience in the elderly or which might be potentially useful for the elderly with cardiovascular diseases. The data are presented without the authors taking a position. This should allow the clinicians to make their own selection and individualize treatment, vii viii Preface based on a wide data base. Comparative data are presented only when specific comparative studies were performed.

It is the mark of an instructed mind to rest satisfied with the degree of precision which the nature of the subject admits, and not to seek exactness where only an approximation of the truth is possible. Aristotle With the development of imaging techniques, the in vivo study of human anatomy and physiology has become possible with increasing "e;approximation of the truth. "e; Advances have been made not only in data acquisition, but also in processing as well as visualization of functional and morphological data. Following the successful application of planar two-dimensional imaging approaches, more recently three-dimensional data acquisition and correspond- ing tomographic image reconstruction has become possible. With the rapid growth of computer support, advanced processing allows for user-friendly interaction with complex data sets. Classical x-ray imaging techniques have matured to excellent spatial resolution and contrast, which provide specific delineation of anatomical changes occurring in cardiovascular disease. In parallel, the use of tracer principles supported the successful introduction of nuclear medicine procedures for the functional characterization of physiology and pathophysiology. The application of such techniques were initially limited by relatively poor spatial resolution, but excelled in high sensitivity 30 years, scintigraphic imaging emerged from and specificity. In the last rectilinear scanning to planar gamma camera imaging and single-photon xvi Preface emISSIOn tomography (SPECT). Based on these advances and the experi- mental success of autoradiography, the potential of scintigraphy as a clinical and research tool has been well appreciated.