M. Kaltenbach – författare

The aim of this book is to give an up to date account of recent developments in the field of cardiomyopathy. Many authors, all experienced workers in their fields, - most from Germany - have contributed to this volume. It would appear that the diagnosis of cardiomyopathy is now made more often than it was 10 years ago. The reason for this is probably not that the incidence of the disease has increased, but that it is better recognized. Where conventional clinical investigation may have failed to define the underlying disease process in a given patient, improved or more widely used diagnostic tools, such as selective coronary arteriography and endomyocardial biopsies, have contributed greatly to proper diagnosis. Furthermore, uniformity of terminology has also taken place during the last few years, permitting more accurate categorization of patients suffering from this entity. The difficult subject of terminology is discussed in a special section.

The aim of this book is to give an up to date account of recent developments in the field of cardiomyopathy. Many authors, all experienced workers in their fields, - most from Germany - have contributed to this volume. It would appear that the diagnosis of cardiomyopathy is now made more often than it was 10 years ago. The reason for this is probably not that the incidence of the disease has increased, but that it is better recognized. Where conventional clinical investigation may have failed to define the underlying disease process in a given patient, improved or more widely used diagnostic tools, such as selective coronary arteriography and endomyocardial biopsies, have contributed greatly to proper diagnosis. Furthermore, uniformity of terminology has also taken place during the last few years, permitting more accurate categorization of patients suffering from this entity. The difficult subject of terminology is discussed in a special section.

First described in 1907 by Schicke but recognized as a clinical entity only as recently as 1958, when Teare published the pathologic findings in patients with hypertrophic cardiomyopathy (HeM), an explosion of knowledge about this fascinating disease has occurred, which has caused a profound evolution of our understanding of its broad pathophysiologic and clinical spectrum. Progress has been particularly rapid in the past few years when M-mode echocardiography, and more recently 2-dimen­ sional echocardiography have been applied to the study ofHCM. In addition to new insights as to what the disease is, there has been enormous progress concerning its treatment, with the application of beta-adrenergic blocking agents and surgical relief of left ventricular outflow tract obstruction. Although these approaches have led to great strides in the symptomatic control of the disease, many patients'' symptoms have remained refactory to medical and surgical therapy. Most discouragingly, sudden death still occurs, even in patients on large doses of beta-blocking agents and in patients who have had surgical relief of left ventricular outflow tract obstruction.

First described in 1907 by Schicke but recognized as a clinical entity only as recently as 1958, when Teare published the pathologic findings in patients with hypertrophic cardiomyopathy (HeM), an explosion of knowledge about this fascinating disease has occurred, which has caused a profound evolution of our understanding of its broad pathophysiologic and clinical spectrum. Progress has been particularly rapid in the past few years when M-mode echocardiography, and more recently 2-dimen­ sional echocardiography have been applied to the study ofHCM. In addition to new insights as to what the disease is, there has been enormous progress concerning its treatment, with the application of beta-adrenergic blocking agents and surgical relief of left ventricular outflow tract obstruction. Although these approaches have led to great strides in the symptomatic control of the disease, many patients' symptoms have remained refactory to medical and surgical therapy. Most discouragingly, sudden death still occurs, even in patients on large doses of beta-blocking agents and in patients who have had surgical relief of left ventricular outflow tract obstruction.

This volume contains the proceedings of the Fourth International Symposium on Coronary Heart Disease, held in Frankfurt/Federal Republic of Germany. In 1970, when the fIrst symposium was held, the whole range of diagnostic and therapeutic measures was covered, but since then interest in coronary heart disease has increased so considerably that the fourth symposium was restricted to only two therapeutic aspects, angioplasty and intracoronary thrombolysis. It can be noted with pleasure that European cardiologists, namely Andreas Griintzig and Peter Rentrop, have made essential contributions to the applicability of these modes of treatment. When angioplasty was fIrst discussed at the Third International Symposium (Coronary Heart Disease, Stuttgart, 1978) a great deal of astonishment was expressed. Today the procedure has gained an important place in the treatment of angina pecto­ ris. The proportion of candidates for coronary surgery in whom angioplasty can be attempted instead of operation is around 10%, in certain subgroups even higher. The most remarkable fmding of our 5-year experience with angioplasty are the extre­ mely good long-term results. Recurrences happen in about 15%-20% of cases within the fIrst 3 months; after this period of time, recurrences are very unusual and mostly due to progression of the disease at other sites. Angioplasty has thus also contributed to our understanding of the dynamics of the atherosclerotic process.

This volume contains the proceedings of the Fourth International Symposium on Coronary Heart Disease, held in Frankfurt/Federal Republic of Germany. In 1970, when the fIrst symposium was held, the whole range of diagnostic and therapeutic measures was covered, but since then interest in coronary heart disease has increased so considerably that the fourth symposium was restricted to only two therapeutic aspects, angioplasty and intracoronary thrombolysis. It can be noted with pleasure that European cardiologists, namely Andreas Griintzig and Peter Rentrop, have made essential contributions to the applicability of these modes of treatment. When angioplasty was fIrst discussed at the Third International Symposium (Coronary Heart Disease, Stuttgart, 1978) a great deal of astonishment was expressed. Today the procedure has gained an important place in the treatment of angina pecto­ ris. The proportion of candidates for coronary surgery in whom angioplasty can be attempted instead of operation is around 10%, in certain subgroups even higher. The most remarkable fmding of our 5-year experience with angioplasty are the extre­ mely good long-term results. Recurrences happen in about 15%-20% of cases within the fIrst 3 months; after this period of time, recurrences are very unusual and mostly due to progression of the disease at other sites. Angioplasty has thus also contributed to our understanding of the dynamics of the atherosclerotic process.

Although nitroglycerin is one of the oldest drugs in cardiology the problem of tolerance is a scientific challenge of today. The proceedings of this symposium highlight the most re- cent questions related to this topic. Apparently, partial tolerance, or rather partial decrease in sensitivity, can arise during nitrate therapy. Probably this is the consequence of a partial readjustment of the vascular system. This readjustment refers particularly to the arterial system, i.e., to the hypoten- sive effect of nitrates in the standing position. A similar effect on the venous side is not present. On the other hand, the results assembled in this volume confirm the experience of many decades that long-term antianginal therapy with nitrates remains effective even when high doses are applied. Thus partial tolerance which also occurs after other vasodilators such as prazosin, does not imply tolerance against antianginal effectiveness. From the information available to- day it is reasonable to treat patients with angina pectoris acutely as well as chronically with nitrates in individually adjusted doses. Frankfurt, November 1982 M. Kaltenbach v Contents Foreword...VSession 1-Pharmacology Tolerance from the Pharmacokinetic and Pharmacodynamic Viewpoints N. Rietbrock, A. Lassmann, B. G. Woodcock ...3 Does Tolerance Develop During Long-Acting Nitrate Therapy? A Critical Review J. Abrams ...13 Pharmacokinetics of Isosorbide Dinitrate During Tolerance Development Ho-Leung Fung ...25 Discussion ...29 ...Session II - Hemodynamics Lack of Tolerance Development to the Hemodynamic Effects of Nitrates in Patients with Chronic Congestive Heart Failure Joseph A. Franciosa ...35 Discussion ...41 ...

This book aims to provide an easily read general account of clinical cardiology. It is primarily designed to meet the needs of medical students, but should be helpful to advanced students in nursing and paramedical fields, as well as providing a review text for medical interns and residents. The book may help to practice modern medicine in a humane way. This means utilizing all possibilities available, but, at the same time, recognizing their limitations. Since progress in the field of cardiology advances rapidly the physician can only keep up with it by understanding diagnostic and therapeutic measures rather than by memorizing mUltiple facts. The need for a book such as this one has already been proven by the wide acceptance in Europe of the first two German editions (authored by M. K.). Indeed, this success prompted the collaborative effort represented here. Along with the translation into English, the authors have tried to maintain an international perspective, in tune with the greater global awareness and cooperation of the 1990s.

This book aims to provide an easily read general account of clinical cardiology. It is primarily designed to meet the needs of medical students, but should be helpful to advanced students in nursing and paramedical fields, as well as providing a review text for medical interns and residents. The book may help to practice modern medicine in a humane way. This means utilizing all possibilities available, but, at the same time, recognizing their limitations. Since progress in the field of cardiology advances rapidly the physician can only keep up with it by understanding diagnostic and therapeutic measures rather than by memorizing mUltiple facts. The need for a book such as this one has already been proven by the wide acceptance in Europe of the first two German editions (authored by M. K.). Indeed, this success prompted the collaborative effort represented here. Along with the translation into English, the authors have tried to maintain an international perspective, in tune with the greater global awareness and cooperation of the 1990s.