Hein J.J. Wellens – författare

The electrocardiogram (ECG) remains the most accessible and inexpensive diagnostic tool to evaluate the patient presenting with symptoms suggestive of acute myocardial ischemia. It plays a crucial role in decision making about the aggressiveness of therapy especially in relation to reperfusion therapy, because such therapy has resulted in a considerable reduction in mortality from acute myocardial infarction. Several factors play a role in the amount of myocardial tissue that can be salvaged by reperfusion therapy, such as the time interval between onset of coronary occlusion and reperfusion, site and size of the jeopardized area, type of reperfusion attempt (thrombolytic agent or an intracoronary catheter intervention), presence or absence of risk factors for thrombolytic agents, etc. Most important in decision making on reperfusion therapy and the type of intervention is to look for markers indicating a higher mortality rate from myocardial infarction. The ECG is a reliable, inexpensive, non-invasive instrument to obtain that information. Recently it has become clear that both in anterior and inferior myocardial infarction, the ECG frequently allows not only to identify the infarct related coronary artery, but also the site of occlusion in that artery and therefore the size of the jeopardized area. Obviously, the more proximal the occlusion, the larger the area at risk and the more aggressive the reperfusion attempt.

The electrocardiogram (ECG) remains the most accessible and inexpensive diagnostic tool to evaluate the patient presenting with symptoms suggestive of acute myocardial ischemia. It plays a crucial role in decision making about the aggressiveness of therapy especially in relation to reperfusion therapy, because such therapy has resulted in a considerable reduction in mortality from acute myocardial infarction. Several factors play a role in the amount of myocardial tissue that can be salvaged by reperfusion therapy, such as the time interval between onset of coronary occlusion and reperfusion, site and size of the jeopardized area, type of reperfusion attempt (thrombolytic agent or an intracoronary catheter intervention), presence or absence of risk factors for thrombolytic agents, etc. Most important in decision making on reperfusion therapy and the type of intervention is to look for markers indicating a higher mortality rate from myocardial infarction. The ECG is a reliable, inexpensive, non-invasive instrument to obtain that information. Recently it has become clear that both in anterior and inferior myocardial infarction, the ECG frequently allows not only to identify the infarct related coronary artery, but also the site of occlusion in that artery and therefore the size of the jeopardized area. Obviously, the more proximal the occlusion, the larger the area at risk and the more aggressive the reperfusion attempt.

As arrhythmias may be transient in nature and not seen during the shorter recording times of the standard ECG, ECG Holter monitoring allows the physician to make better informed decisions for the cardiac patient. The devices are worn by patients on an outpatient basis for days or weeks and can also be implanted subcutaneously. ECG Holter recordings are especially useful since they can be programmed individually for activation and specific tracing analysis.Designed for rapid study, this book contains 100 illustrative cases in ECG Holter monitoring. Each case consists of a tracing followed by a brief explanation of the findings. 100 Cases in ECG Holter is the perfect resource for busy physicians looking to optimize their skills at interpreting ECG Holter readings.

As arrhythmias may be transient in nature and not seen during the shorter recording times of the standard ECG, ECG Holter monitoring allows the physician to make better informed decisions for the cardiac patient. The devices are worn by patients on an outpatient basis for days or weeks and can also be implanted subcutaneously. ECG Holter recordings are especially useful since they can be programmed individually for activation and specific tracing analysis.Designed for rapid study, this book contains 100 illustrative cases in ECG Holter monitoring. Each case consists of a tracing followed by a brief explanation of the findings. 100 Cases in ECG Holter is the perfect resource for busy physicians looking to optimize their skills at interpreting ECG Holter readings.

The electrocardiogram (ECG) remains the most accessible and inexpensive diagnostic tool to evaluate the patient presenting with symptoms suggestive of acute myocardial ischemia. It plays a crucial role in decision making about the aggressiveness of therapy especially in relation to reperfusion therapy, because such therapy has resulted in a considerable reduction in mortality from acute myocardial infarction. Several factors play a role in the amount of myocardial tissue that can be salvaged by reperfusion therapy, such as the time interval between onset of coronary occlusion and reperfusion, site and size of the jeopardized area, type of reperfusion attempt (thrombolytic agent or an intracoronary catheter intervention), presence or absence of risk factors for thrombolytic agents, etc. Most important in decision making on reperfusion therapy and the type of intervention is to look for markers indicating a higher mortality rate from myocardial infarction. The ECG is a reliable, inexpensive, non-invasive instrument to obtain that information. Recently it has become clear that both in anterior and inferior myocardial infarction, the ECG frequently allows not only to identify the infarct related coronary artery, but also the site of occlusion in that artery and therefore the size of the jeopardized area. Obviously, the more proximal the occlusion, the larger the area at risk and the more aggressive the reperfusion attempt.

"Cardiovascular Medicine, 3rd edition" offers the most up-to-date, user-friendly guidance on the evaluation, diagnosis and medical and surgical treatment of heart and vascular disease and will be relevant to the practice of every cardiologist, cardiac surgeon, vascular surgeon, diabetologist, cardiac radiologist and any physician who manages cardiac patients. Drs Willerson, Cohn, Wellens and Holmes – and over 150 world authorities – offer their decades of scientific and clinical experience. The book and DVD are designed to provide comprehensive coverage of every aspect of cardiovascular medicine from cardiac signs and symptoms and the full range of cardiac imaging techniques through management of peripheral vascular disease and the genetic basis for cardiovascular disease to preventive cardiology.DVD content: Video imagery for selected chapters; Full text of the book; Interactive narrated heart sounds database containing correlative videos and images

The interplay between the careful analysis of clinical electrocardiograms and results from animal experiments have in the past 60 years resulted in provo­ cative and brill ant concepts on the mechanisms of cardiac arrhythmias in man. Many of the animal experiments however were done on open-chested dogs with cut cardiac nerves and under the influence of pharmaca. It is doubtful, therefore whether these results can be transferred without reser­ vation to the human situation. The introduction of electrical stimulation of the heart in clinical cardiology has opened new ways to study some aspects of cardiac arrhythmias directly in the unaesthesized patient. This study reports observations on patients who were admitted to the University Department of Cardiology, Wilhelmina Gasthuis, Amsterdam, for the evaluation and treatment of tachycardias. Electrically induced premature beats were used in an effort to elucidate the origin and mechanism of these tachycardias. The first chapter is on classification and diagnosis of tachy­ cardias with special emphasis on our current knowledge of the differential diagnosis between supraventricular tachycardias with aberrant conduction and ventricular tachycardias. This is followed by theoretical considerations on tachycardias especially in relation to the methods used in this study. After an outline of these methods the results of our studies in patients with atrial flutter, A-V junc­ tional tachycardias and tachycardias related to the pre-excitation syndrome are reported. A discussion on the value of electrical stimulation for the treatment of tachycardias is followed by a summary of our results.

This monograph had its genesis in a workshop on the specific conduction held in the spring of 1975. The meeting was organized to discuss present knowledge on structure and function of the cardiac specialized tissues with emphasis on their clinical implications. Since much new information was presented, the participants agreed to prepare manuscripts and make their material available for publication. This has resulted in a book in which the cardiac specialized tissues are discussed by different specialists: the electron-microscopist, anatomist, pathologist, physiologist, physicist and clinician. Apart from their interest in the cardiac conduction system the participants shared the opinion that their contribu­ tion should be relevant to the understanding and treatment of patients with cardiac arrhythmias. The book should be useful for the clinician, the morphologist and the physio­ logist. The workshop took place at the University Department of Cardiology, Wilhelmina Gasthuis, Amsterdam, The Netherlands. This is the home ground of one of the most outstanding electro cardiologists of our time, Dr. Dirk Durrer. By pairing genius and originality with endless fund of energy and dogged persistence he made several important contributions to modern cardiac electrophysiology. In recent years he created a cardio­ logical institute where workers from various disciplines cooperate in the study and treat­ ment of cardiac disease. Several of his pupils participated in the workshop and contributed to this volume. In appreciation and thankfulness we want to dedicate this book to Dr. Dirk Durrer.

The saying, "What one does not know, one does not recognize", applies to the interpretation of the electrocardiogram. Recently a wealth of new information on the electrocardiogram has become avail­ able by correlating electrocardiographic findings with information from new techniques such as His bundle recordings, programmed stimulation of the heart, 24-hour record­ ing~, and cardiac scintigraphy. Also, our knowledge about the electrocardiogram has been extended by acquiring new epidemiologic data and by follow-up studies on patients with myocardial infarction and bundle branch block. Unfortunately, this new information has to be dug out of several different journals and books. This book brings together this information and ,helps the practicing physi­ cian in updating his or her knowledge about the 12-lead electrocardiogram as a diagnostic, therapeutic, and prognostic tool. Hein J.1. WELLENS Henri E. KULBERTUS ACKNOWLEDGMENTS Originally, the contents of this book were presented in a workshop on "What is new in electrocardiography?" This workshop was made possible by the generous financial support and assistance of Roussel Nederland. Each of the speakers at the workshop kindly consented to produce a manuscript. We want to express our gratitude to them. The preparation of the workshop, and this book, required a great amount of secretarial assistance: Mrs. Bea Leliveld, Miss Anja Smeets, and Mrs. Thea Niemeyer did this with dedication and efficiency. They surely deserve our thanks. Mr. B.F. Commandeur and Martinus Nijhoff Publishers were responsible for the rapid and expert production of this book.

A unique overview of all major angiographic lipid intervention trials, presented by their principal investigators. Basic mechanisms and methodological aspects, including biochemical as well as angiographic aspects, are discussed by experts in these fields. A careful comparison of all available data permits an analysis to be made of what may currently be considered proved, which aspects merit further investigation, and which hypotheses should be rejected. Audience: Clinicians involved in the practice of lipid lowering and investigators involved in lipid-lowering clinical trials. Scientists involved in other areas of lipid research and investigators conducting coronary angiographic trials designed to study the influence of different interventions will find a wealth of information and practical guidelines in this book.

The saying, "What one does not know, one does not recognize", applies to the interpretation of the electrocardiogram. Recently a wealth of new information on the electrocardiogram has become avail­ able by correlating electrocardiographic findings with information from new techniques such as His bundle recordings, programmed stimulation of the heart, 24-hour record­ ing~, and cardiac scintigraphy. Also, our knowledge about the electrocardiogram has been extended by acquiring new epidemiologic data and by follow-up studies on patients with myocardial infarction and bundle branch block. Unfortunately, this new information has to be dug out of several different journals and books. This book brings together this information and ,helps the practicing physi­ cian in updating his or her knowledge about the 12-lead electrocardiogram as a diagnostic, therapeutic, and prognostic tool. Hein J.1. WELLENS Henri E. KULBERTUS ACKNOWLEDGMENTS Originally, the contents of this book were presented in a workshop on "What is new in electrocardiography?" This workshop was made possible by the generous financial support and assistance of Roussel Nederland. Each of the speakers at the workshop kindly consented to produce a manuscript. We want to express our gratitude to them. The preparation of the workshop, and this book, required a great amount of secretarial assistance: Mrs. Bea Leliveld, Miss Anja Smeets, and Mrs. Thea Niemeyer did this with dedication and efficiency. They surely deserve our thanks. Mr. B.F. Commandeur and Martinus Nijhoff Publishers were responsible for the rapid and expert production of this book.

Over the last ten years, it has become increasingly obvious that sudden death represents the major challenge confronting cardiology in the last part of the XXth Century. Careful epidemiologic studies have established the magnitude of this overall important problem of public health. The frequent association of sudden death with coronary artery disease has been demonstrated. Some of the electrophysiologic mechanisms underlying lethal arrhythmias have been unveiled. In addition, clinical markers permitting identifica­ tion of high risk individuals have emerged. Finally, different studies have raised some hope as to the ability of therapeutic interventions to protect these patients against a premature and possibly evitable demise. Over the years, a sizable amount of new and relevant information, both basic and clinical, has become available. We felt therefore that a conference on sudden death might be timely. It was decided to organize a small gathering during which experts from different disciplines in cardiology could sit together in a quiet retreat to share their knowledge and discuss issues pertaining to research and therapy that might be of benefit to patients. The conference was held in Liege, on May 7, 8 and 9, 1979. This three day meeting in which re­ presentatives from seven different countries participated was extremely stimulating. The discussions were very lively and sometimes reflected the divergence of opinion which may persist on some topics.

Over the last ten years, it has become increasingly obvious that sudden death represents the major challenge confronting cardiology in the last part of the XXth Century. Careful epidemiologic studies have established the magnitude of this overall important problem of public health. The frequent association of sudden death with coronary artery disease has been demonstrated. Some of the electrophysiologic mechanisms underlying lethal arrhythmias have been unveiled. In addition, clinical markers permitting identifica­ tion of high risk individuals have emerged. Finally, different studies have raised some hope as to the ability of therapeutic interventions to protect these patients against a premature and possibly evitable demise. Over the years, a sizable amount of new and relevant information, both basic and clinical, has become available. We felt therefore that a conference on sudden death might be timely. It was decided to organize a small gathering during which experts from different disciplines in cardiology could sit together in a quiet retreat to share their knowledge and discuss issues pertaining to research and therapy that might be of benefit to patients. The conference was held in Liege, on May 7, 8 and 9, 1979. This three day meeting in which re­ presentatives from seven different countries participated was extremely stimulating. The discussions were very lively and sometimes reflected the divergence of opinion which may persist on some topics.

This monograph had its genesis in a workshop on the specific conduction held in the spring of 1975. The meeting was organized to discuss present knowledge on structure and function of the cardiac specialized tissues with emphasis on their clinical implications. Since much new information was presented, the participants agreed to prepare manuscripts and make their material available for publication. This has resulted in a book in which the cardiac specialized tissues are discussed by different specialists: the electron-microscopist, anatomist, pathologist, physiologist, physicist and clinician. Apart from their interest in the cardiac conduction system the participants shared the opinion that their contribu­ tion should be relevant to the understanding and treatment of patients with cardiac arrhythmias. The book should be useful for the clinician, the morphologist and the physio­ logist. The workshop took place at the University Department of Cardiology, Wilhelmina Gasthuis, Amsterdam, The Netherlands. This is the home ground of one of the most outstanding electro cardiologists of our time, Dr. Dirk Durrer. By pairing genius and originality with endless fund of energy and dogged persistence he made several important contributions to modern cardiac electrophysiology. In recent years he created a cardio­ logical institute where workers from various disciplines cooperate in the study and treat­ ment of cardiac disease. Several of his pupils participated in the workshop and contributed to this volume. In appreciation and thankfulness we want to dedicate this book to Dr. Dirk Durrer.

The interplay between the careful analysis of clinical electrocardiograms and results from animal experiments have in the past 60 years resulted in provo­ cative and brill ant concepts on the mechanisms of cardiac arrhythmias in man. Many of the animal experiments however were done on open-chested dogs with cut cardiac nerves and under the influence of pharmaca. It is doubtful, therefore whether these results can be transferred without reser­ vation to the human situation. The introduction of electrical stimulation of the heart in clinical cardiology has opened new ways to study some aspects of cardiac arrhythmias directly in the unaesthesized patient. This study reports observations on patients who were admitted to the University Department of Cardiology, Wilhelmina Gasthuis, Amsterdam, for the evaluation and treatment of tachycardias. Electrically induced premature beats were used in an effort to elucidate the origin and mechanism of these tachycardias. The first chapter is on classification and diagnosis of tachy­ cardias with special emphasis on our current knowledge of the differential diagnosis between supraventricular tachycardias with aberrant conduction and ventricular tachycardias. This is followed by theoretical considerations on tachycardias especially in relation to the methods used in this study. After an outline of these methods the results of our studies in patients with atrial flutter, A-V junc­ tional tachycardias and tachycardias related to the pre-excitation syndrome are reported. A discussion on the value of electrical stimulation for the treatment of tachycardias is followed by a summary of our results.