Robert H. Cox - Böcker

The presentation of new, emerging concepts of the pathogenesis and management of acute Myocardial Infarction is the unprecedented objective of this book. Based upon the Symposium on Acute MI, this timely text presents the advances that have taken place on several fronts in the past five years, particularly in the area related to thrombolytic therapy. Separated into four sections, the book covers the mechanisms of acute MI; medical problems of detection, sizing, and damage; non-invasive medical management; and invasive management. Of particular interest is the section on non-invasion management which focuses on the results from the TIMI Clinical Trial and the successful use of tissue plasminogen activator (tPA). Focus is also placed on the long-term follow up of patients treated with thrombolytic therapy and the no-reflow phenomenon in the stunned myocardium. A collaboration of recognized experts in their fields, this text is of extreme value to the practicing cardiologist, radiologist, surgeon and emergency care physician.The text's first section explores the basic mechanisms of coronary artery contraction, coronary artery stenosis and vasopasm. Its second section develops the pathophysiology of acute MI including the reversibility of ischemic myocardial injury, and methods for detecting the size and extent of myocardial infarcts. The crucial role of cardiac muscle cell membrane damage is also discussed. The physiology and pharmacology of tPA are described in the third section as are the results from the initial phase 1 TIMI trial. The final section which concentrates on surgical procedures, also provides future directions for the diagnosis and treatment of acute Myocardial Infarctions.

Hypertension is recognized to be one of the major risk factors for the development of peripheral vascular disease. The last decade has witnessed several major advances in therapy for hypertension, including the development of angiotensin-converting enzyme inhibitors and calcium channel blockers. These compounds have greatly improved the ability to control blood pressure and to reduce the impact of this risk factor on morbidity and mortality. In spite of these advances, cardiovascular disease remains a major health problem in most modern industrialized countries with related deaths exceeding those from all other causes combined. In contrast to these advances in therapy, our understanding of the basic mechanisms responsible for the pathogenesis of hypertension remains incomplete. Recent studies have produced new insights into the nature of the regulation of muscle contraction in both heart and blood vessels as well as the changes in muscle function that occur in hypertension. However, the effects of antihypertensive therapy, both in terms of restoring normal function and in producing reversal of hypertension-associated changes, has not been as thoroughly studied, especially in the vasculature. Studies in the heart suggest that the efficacy of different therapeutic agents in restoring normal function and reversing hypertensive changes vary substantially with the mechanism of action of the therapeutic agent. It has also been recently determined that some therapeutic agents produce adverse effects on plasma lipid profiles, which could lead to the secondary acceleration of the atherosclerotic process, while at the same time normalizing blood pressure.