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406 produkter
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Interstitial Fibrosis in Heart Failure, edited by Francisco J. Villarreal, M.D., Ph.D., provides a timely and integrative review of the basics of cardiac extracellular matrix structure. Topics covered include how cardiac remodeling influences its disposition, abundance and function; possible non-invasive techniques for diagnosis; and potential drug-based or molecular therapeutic strategies that may interrupt or even reverse the course of the development of cardiac fibrosis.This resource for both clinicians and scientists aims to cover state-of-the-art findings relevant to cellular and molecular processes underlying cardiac fibrosis including basic elements of structure, function, diagnosis and treatment.
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Drs. Xander Wehrens and Andrew Marks have gathered the collected wisdom of scientists that have devoted their working lives to the study of ryanodine receptors. In this series of brief, but informative, chapters, the contributions progress from the basic gene family and primary structure, through its 3D structure so far, to its regulation and physiology. The book ends with several chapters on mutations in the receptor that causes disease and their role in adaptation to disease. There are interesting new developments in the control of ryanodine receptors by accessory proteins, the latest of which is the proposed role of leaky RyR channels in causing delayed after depolarizations, a cause of lethal ventricular arrhythmias. The series of reviews in Ryanodine Receptors: Structure, Function and Dysfunction in Clinical Disease will bring anyone rapidly up to speed in current progress in the field, as well as highlight remaining questions.David E. Clapham, MD, PhDProfessor of Neurobiology and PediatricsHarvard Medical School
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MRI is used increasingly in cardiac and cardiovascular medicine - it is one of the most accurate tests in assessing the heart's structure and function, and unlike CT, it does not involve any radiation. Cardiovascular Magnetic Resonance assists cardiologists in determining when a CMR exam is useful for diagnosis and provides details on how to plan and read CMR studies.
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Mitochondria have been pivotal in the development of some of the most important ideas in modern biology. Since the discovery that the organelle has its own DNA and specific mutations were found in association with neuromuscular and cardiovascular diseases and with aging, an extraordi-nary number of publications have followed, and the term mitochondrial medicine was coined. Furthermore, our understanding of the multiple roles that mitochondria play in cardiac cell homeostasis opened the door for intensive experimentation to understand the pathogenesis and to find new treatments for cardiovascular diseases. Besides its role in adenosine triphosphate generation, mitochondria regu-late a complex network of cellular interactions, involving (1) generation and detoxification of reactive oxygen species, including superoxide anion, hy-drogen peroxide, and hydroxyl radical; (2) maintenance of the antioxidant glutathione in a reduced state and adequate level of mitochondrial matrix superoxide dismutase; (3) cytoplasmic calcium homeostasis, particularly under conditions of cellular calcium loading; (4) transport of metabolites between cytoplasm and matrix; (5) both programmed (apoptosis) and necrotic cell death; and (6) cell growth and development. It is therefore not surprising that this organelle has come to be the center stage in many current investigations of cardiovascular diseases, aging, and agi- related disease. Concomitant with these advances, an impressive effort is under- way for the development of new tools and methodologies to study mitochondrial structure and function, including powerful ways to visualize, monitor, and alter the organelle function to assess the genetic consequences of these perturbations.
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Chronic oxidative stress is associated with the aging process and often leads to the development of disorders such as cancer and arterial disease. Cardiovascular conditions in which oxidation damage has been strongly implicated include atherosclerosis, myocardial ischemia and reperfusion, coronary restenosis, diabetes mellitus, and congestive heart failure.Antioxidants and Cardiovascular Disease, Second Edition covers three major topics: 1) the first seven chapters review the oxidative modifcation hypothesis and its close relationship to lipid metabolism and to the pathogenesis of atherosclerosis; 2) the next four chapters describe the different compounds, nutrients and supplements with antioxidant properties and their mechanisms of action; 3) and finallly, the last ten chapters discuss the potential benefits of antioxidants in overall cardiovascular prevention, including hypertension, diabetes mellitus, dyslipidemias, and in the treatment and prevention of specific conditions such as chronic coronary artery disease, restenosis after percutaneous coronary intervention, and chronic heart failure.Antioxidants and Cardiovascular Disease, Second Edition is written by recognized experts in the fields of atherosclerosis, heart failure and antioxidants. It should be of interest to medical students and fellows, researchers, and practicing physicians.There has been rapid progress in our knowledge in this field during the last two to three years. Thus the current reedition appears timely. For instance, this second edition captures several recently reported and published clinical trials as welll as new information on diabetic and hypertensive cardiovascular disease.
Del 259 - Developments in Cardiovascular Medicine
Atlas of Non-Invasive Coronary Angiography by Multidetector Computed Tomography
Inbunden, Engelska, 2006
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Chapter 1: Basics and Performance of Cardiac Computed Tomography 3 Xavier Alomar-Serrallach, Ernesto Castillo-Gallo, Guillem Pons-Lladó 1. 1 Introduction 3 1. 2 Historical Perspective of Computed Tomography 3 1. 3 Basic Principles of Multidetector Computed Tomography in the Study of the Heart 4 1. 3. 1 Detectors 5 1. 3. 2 Image reconstruction 5 1. 3. 3 Temporal resolution 7 1. 3. 4 Spatial resolution 7 1. 3. 5 Control of radiation dose 8 1. 4 Performance of a Cardiac MDCT Study 9 1. 4. 1 Preparation of the patient 9 1. 4. 2 Image acquisition and contrast administration 9 1. 4. 3 Image reconstruction 11 Chapter 2: Normal Anatomy and Congenital Abnormalities of the Coronary Arteries 15 Rubén Leta-Petracca 2. 1 Introduction 15 2. 2 Left Coronary Artery 17 2. 2. 1 Left main (LM) artery 17 2. 2. 2 Left anterior descending (LAD) 18 2. 2. 3 Left circum?ex (LCx) 22 2. 2. 4 Intermediate coronary artery 23 2. 3 Right Coronary Artery (RCA) 26 2. 4 Pattern of Dominance of the Coronary Arteries 302. 5 Congenital Anomalies of the Coronary Arteries 33 2. 5. 1 Anomalies relatable to myocardial ischemia 35 2. 5. 2 Anomalies not leading to myocardial ischemia 37 Chapter 3: Detection and Quanti?cation of Coronary Artery Calcium by MDCT 43 Francesc Carreras 3. 1 Introduction 43 3. 2 CAC Quanti?cation: The Agatston Method 44 3.
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Aortic dissection affects approximately two in ten thousand individuals and can be fatal. This state-of the-art publication is a result of the combined efforts of participants from the International Registry of Aortic Dissection (IRAD). The book has been divided into sections. Each chapter provides a succinct overview of the current clinical literature and incorporates illustrations for further explanation.
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Our understanding of the pathophysiology of acute myocardial infarction has grown enormously in recent years. This has led to an increasingly aggressive approach to management, designed to blunt the extent of infarction by salvaging acutely ischemic myocardium. Alternatives now include throm bolysis, PTCA with and without prior thrombolysis, and emergency bypass surgery, as well as the more aggressive use of a variety of drugs. This book consists of a series of chapters by experienced cardiologists and cardiovascular surgeons that present today's state of the art in managing acute myocardial infarction. It is written with the purpose of presenting practical approaches of value to the clinician related to the more complex problems faced in dealing with patients undergoing myocardial infarction. xi EARLY INTERVENTIONS IN ACUTE MYOCARDIAL INFARCTION 1. MANAGEMENT OF ARRHYTHMIAS IN THE CORONARY CARE UNIT NORA GOLDSCHLAGER, RODERICK WOODS, AND NEAL BENOWITZ With the advent of coronary care units, mortality from cardiac arrhythmias occurring during acute myocardial infarction has been unquestionably and dramatically reduced. In addition, continuous electrocardiographic monitoring has resulted in the recognition of specific arrhythmias related to acute ischemic heart disease and thus to the development of appropriate strategies for their management. This chapter will review certain specific aspects of those bradyarrhythmias and atrial and ventricular tachyarrhythmias that are seen most commonly in acute myocardial infarction. Pharmacologic therapy, including the use of some of the newer antiarrhythmic agents, will be discussed, as will pacemaker ther apy of both bradyarrhythmias and tachyarrhythmias.
Del 99 - Developments in Cardiovascular Medicine
Myocardial Contrast Two-dimensional Echocardiography
Inbunden, Engelska, 1989
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To our knowledge, this is the first book dealing exclusively with myocardial contrast two-dimensional echocardiography (MC-2DE), a new and exciting diagnostic methodology for assessment of myocardial perfusion, which has seen rapid development and has now entered the clinical stage. The experi mental research and human applications have been described in technical papers published in a variety of journals, but our objective is to provide the reader with a comprehensive and concentrated overview of the field and of the current state of the art. To facilitate appreciation of the significant ad vances made and issues yet to be resolved, we are pleased to have several well known specialists contribute their own assessment of specific aspects of MC- 20E and illustrate the method's principles as well as applications. We were faced with inevitable overlaps and some repetitions in the discussion of quan titative potentials or limilations of the methodology. Rather than strictly 'streamlining' the text, we decided to accept some redundancy in the interest of presenting a diversity of points of views, reflecting the current evolutionary state of MC-20E. Following a brief reference to the established clinical contrast echocardiog raphy, recent developments and validations of the specialized MC-2DE tech nique are reviewed, bearing in mind that the field is in a flux and some of the ongoing activities have not as yet been formally reported. Mechanisms of the echo contrast and several new agents are decribed next, and an additional chapter illustrates current thoughts-on optimizing the echo contrast medium.
Risk/Benefit Analysis for the Use and Approval of Thrombolytic, Antiarrhythmic, and Hypolipidemic Agents
Proceedings of the Ninth Annual Symposium on New Drugs & Devices, October 27 & 28, 1988
Inbunden, Engelska, 1989
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The Symposium on New Drugs provides a forum for academic investigators, research and development personnel from the pharmaceutical industry and members of the Food and Drug Administration to discuss important clinical research issues. The Ninth Annual symposium on New Drugs addressed the problem of determining the risk versus benefit for use of three important classes of cardiovascular agents: thrombolytic, antiarrhythmic, and hypolipidemic agents. The use of thrombolytic agents has become one of the major advances in clinical intensive cardiologic care in the 1980s. While the lysis of clot(s) obstructing a major coronary artery should reverse or prevent the damage of acute myocardial ischemia and infarction, one must carefully consider the potential risks of such agents in regards to their potential benefits. The time when a thrombolytic agent should be administered to maximize benefit as well as how one defines a dose response relationship using intravenous critical care medicines were discussed as important clinical trial issues. The benefit versus risk data on currently available thrombolytic agents was reviewed and the potential roles for adjunctive agents addressed. Overall strategies regarding post- x thrombolytic care and relationships to sudden cardiac death were also detailed. The panel discussion sections provided a comprehensive view of the current thinking of the various participating groups in this symposium. Sudden cardiac death remains the number one cause of mortality in western industrialized societies.
Pathophysiology and Pharmacology of Heart Disease
Proceedings of the symposium held by the Indian section of the International Society for Heart Research, Chandigarh, India, February 1988
Inbunden, Engelska, 1989
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Research at the molecular and the cellular level has greatly enhanced our understanding of the pathogenesis and management of heart disease. Valuable contributions, towards this end, have been made by scientists from different dis ciplines including biochemistry, physiology, pathology, molecular biology and biophysics. We felt that it would be of interest and value to bring together ex perts from diverse specialities to present their work and to discuss the common problems encountered in their endeavours. In accordance, a symposium was organised in February 1988 at the Postgraduate Institute of Medical Education & Research, Chandigarh. It was held during the annual meeting of the Indian section of the International Society for Heart Research. This book is a compila tion of some of the papers presented at the symposium. The symposium was sponsored by the Council on Cardiac Metabolism of the International Society and Federation of Cardiology. A number of Indian or ganisations gave generous financial help. These included the National Academy of Medical Sciences, Indian Council of Medical Research, Council of Scientific and Industrial Research and Department of Science and Technology. Desktop publishing was used to prepare this volume. In doing so we came to appreciate the remarkable qualities, skills and help rendered by Professor Dharam Vir. For typing the manuscripts and for other secretarial assistance we gratefully acknowledge the help of Ravinder and Sawtantar. PATHOPHYSIOLOGY AND PHARMACOLOGY OF HEART DISEASE 1 THE NEWBORN PIG HEART, A SUPERIOR ANIMAL MODEL OF CARDIAC HYPERTROPHY Howard E.
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Following the advent of percutaneous balloon vel oped and are available for clinical use, as well angioplasty, interventional cardiovascular pro as those that are still in investigational phases. cedures have become of great interest to the Clinical case reports are presented by expert in cardiologist, radiologist, and cardiovascular vestigators on the use of various catheter systems surgeon. One of the most extensively explored in the coronary and peripheral circulation. alternatives to bypass surgery is laser-mediated Part V (Chapters 17-23) is the most up-to angioplasty. The fascination with laser radia date review of the clinical experience with vari tion has greatly contributed to its popularity, ous laser delivery systems. There is an emphasis but has also burdened it with unrealistic ex on patient selection, criteria for lesion choice, pectations. Many commercial laser systems are and follow-up data. A detailed description of available to the clinician and the researcher, laser recanalization techniques is presented for which often makes the choice of a laser system the various systems in the clinical setting.
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The dance along the artery The circulation on the lymph Are figured in the drift of stars. T. S. Eliot Die Methode ist alles. Carl Ludwig In physiology a spirit of finesse is required. Claude Bernard Armed with modern Doppler instrumentation, scientists can now quantify the red blood cell's "dance along the artery" as well as "the drift of stars. " In disciplines of science and medicine ranging from cardiology to astronomy, the Doppler principle now provides invaluable velo city measurements in the microcosm of capillary beds and in the cosmos. The newest appiication of the ubiquitous Doppler principle, laser-Doppler velocimetry, has been used to measure blood ftow in tissue for just a few years, but we perceived that, like most new techniques, the birth of laser-Doppler blood ftowmetry was not easy, nor was it likely to pass through infancy and reach maturity without difficulty. In physiology and medicine, better techniques for measur ing blood ftow are constantly in demand, but they often exhibit an unfortun ate boom-and-bust cyde: widespread acceptance and uncritical use are soon xiii xiv Preface followed by studies delineating the limits of the method's validity. The technique is then abandoned for the next more fashionable one, thus proving Ludwig's dictum that a given method is everything or nothing depending upon whether one can believe the data it yields.
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The Symposium on New Drugs provides for an annual forum for academic investigators, research and development personnel from the pharmaceutical and related health care industries, and members of the Food and Drug Administration to discuss important clinical research issues. The Tenth Annual Symposium on New Drugs addressed the problem of whether it was still appropriate to approve antihypertensive agents soley on the endpoint of lowering cuff blood pressure. The initial discussions at this symposium related to the approaches and methods to studying antihypertensive agents. Dr. William Frishman provided a detailed list of the new approaches to the treatment of hypertension and pointed out the many new concepts that are currently active in the development of many new antihypertensive agents. Dr. William White detailed the growing importance of ambulatory blood pressure monitoring to define hypertension and to determine the change in blood pressure due to pharmacologically active agents. Dr. Jay Cohn pointed out the flaws in using cuff blood pressure and detailed the potential virtues of using vascular compliance to identify patients requiring treatment for hypertension. Dr. Thomas Pickering also discussed the potential value of evaluating changes in left ventricular hypertrophy a finding which identifies high risk patients who need to be included in clinical trials. Dr. Michael Weber detailed the issues and suggested refinements in the approaches to clinical trial designs for antihypertensive agents and Dr. Raymond Lipicky discussed the definition of dose-duration and the role of non-Mem and Peak/Through measurements in defining an antihypertensive drug effect.
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This monograph contains 20 selected papers presented at the Symposium on Subcellular Basis of Contractile Failure which was held in Ottawa during May 11-13, 1989 and is designed for the benefit ofthose who were unable to attend this event. It is now increasingly becoming clear that an excessive amount of calcium is intimately involved in the pathogenesis of a wide variety of heart diseases. Accordingly, the investigations concerning the role of calcium chan nels and their regulatory mechanisms in heart function as well as of the intra cellular calcium overload in cardiac dysfunction are presented here. Since sodium is also considered to influence the cardiac contractile force by chang 2 ing the intracellular concentration of calcium through the Na +-Ca+ exchange 2 mechanism in the cell membrane, the role of Na +-Ca+ exchange in heart func tion as well as pathology of contractile failure is discussed. In view of the new ly discovered implications of the oxygen free radicals in cellular injury, papers concerning the role of these radicals in heart disease are included in this book. For the purpose of clarity, different chapters have been organized under three main headings: (I) Role of cations in heart function, (II) Cardiac hypertrophy and cardiomyopathies, and (III) Ischemic heart disease and cardiac failure.
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In June 1989, a third conference concentrating on the progress in quantita tive coronary angiography and related techniques was held in Rotterdam, again very successful as the two preceding events in 1985 and 1987.
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878 kr
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Drugs Looking for Diseases
Innovative Drug Research and the Development of the Beta Blockers and the Calcium Antagonists
Inbunden, Engelska, 1990
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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.
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by JULIEN IE HOFFMAN One of the earliest coronary physiologists was Scaramucci who, in 1695, postu lated that during systole the contracting myocardium inhibited coronary blood flow. Since then, the many contributions that have been made to our knowledge of the coronary circulation can be arbitrarily divided into three phases based on advances in technical methods. The early phase of research into the coronary circulation, done with great difficulty with crude methods, may be regarded as ending in the 1940s, and it included major discoveries made by such well known investigators as Georg von Anrep, Ernest Starling, Carl Wiggers, and Louis Katz, who formulated much of our basic understanding of the field. After 1940, the field of coronary physiology entered a new phase when instruments for high fidelity registration of coronary flow and pressure became available. This era was domi nated by Donald Gregg who combined careful attention to the function of these instruments (some of which he helped to develop) with an extraordinary ability to discern mechanisms from apparently minor changes in coronary flow and pressure patterns. His book 'The Coronary Circulation in Health and Disease' set a new standard in the field. After 1960, techniques for measuring regional myocardial blood flow became available, and enabled a large group of eminent investigators to make major advances in understanding the physiology and pathophysiology of myocardial blood flow.
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Antithrombotics
Pathophysiological Rationale for Pharmacological Interventions
Inbunden, Engelska, 1991
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Maximal Myocardial Perfusion as a Measure of the Functional Significance of Coronary Artery Disease
From a Pathoanatomic to a Pathophysiologic Interpretation of the Coronary Arteriogram
Inbunden, Engelska, 1991
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Coronary flow reserve is a functional measure of stenosis severity re flecting the integrated effects of its geometry including percent stenosis, absolute lumen area, length and shape. Its clinical application has been primarily qualitative in non-invasive, perfusion imaging. Measurement of coronary flow reserve during routine coronary arte riography has been an elusive goal. Transit time and indicator dilution techniques for assessing coronary flow reserve at cardiac catheteriza tion are associated with marked variability compared to microspheres or flow meters, thereby making their use questionable in comparison to the precision of good quantitative arteriography. Coronary flow reserve measured by special Doppler catheters as an adjunct to coronary arte riography shows in man the value of this integrated functional measure of stenosis severity and the limitations of percent diameter narrowing as a measure of its physiologic significance. However, Doppler catheters require additional instrumentation that is not yet an integral part of coronary arteriography and provide measures of absolute coronary flow reserve only. Relative maximum flow or relative flow reserve has been demon strated to be an important independent, complimentary descriptor of stenosis severity independent of fluctuating hemodynamic conditions. The method developed for DSA by Nico Pijls, described in this book is the first approach for assessing relative coronary flow reserve as a part of routine coronary arteriography by DSA. The theory and basic con cepts are well developed, experimental validation thorough and clinical applications timely.
Cardiovascular Nuclear Medicine and MRI
Quantitation and Clinical Applications
Inbunden, Engelska, 1992
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In recent years there have been major advances in the fields of cardiovascular nuclear medicine and cardiac magnetic resonance imaging. In nuclear cardiology more adequate tomographic systems have been designed for routine cardiac use, as well as new or improved quatitative analytic software packages both for planar and tomographic studies implemented on modern state-of-the-art workstations. In addition, artificial intelligence techniques are being applied to these images in attempts to interpret the nuclear studies in a more objective and reproductive manner. Various new radiotracers have been developed, such as antimyosin, labelled isonitriles, metabolic compounds, etcetera. Furthermore, alternative stress testing with dipyridamole and dobutamine has received much attention in clinical cardiac practice. Magnetic resonance imaging is a relative newcomer in cardiology and has already shown its merits, not only for anatomical information but increasingly for the functional aspects of cardiac performance.
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In an attempt to clarify the situation regarding the diagnosis, pathogenesis and therapeutics of cardiovascular dysfunction in diabetes, an International Symposium on Diabetic Heart was held in Tokyo, Japan during October, 1989. 32 selected articles from the poster presentations, compiled in this book, have been grouped in four sections: evaluation of cardiovascular problems, interactions of diabetes and hypertension, pathophysiological aspects of cardiovascular dysfunction in diabetes and pharmacological and therapeutic aspects of diabetic heart. It is hoped that the contents of these chapters will provide adequate information regarding the current status of cardiovascular abnormalities in diabetes and this book should be of interest to both clinical and experimental cardiologists as well as endocrinologists interested in diabetes.
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In the past five years, interventional cardiology has entered a new era of evaluating percutaneous transcatheter technologies to treat coronary artery disease and prevent restenosis. Cardiologists attempting to follow this field may be confused by the growth and expansion of new devices, the technical details relevant to each device and enthusiastic claims of success. This monograph is a comprehensive assessment of restenosis from the perspective of these new technologies including stenting, atherectomy, rotational abrasion and lasers. The international breadth of experience is reflected in the summary from both sides of the Atlantic, at times with conflicting observations and results which can be in itself valuable, given the diverse experience to date. In addition to the summaries of the early and late results of these new devices, issues in the methodology of restenosis research are addressed, including limitations of quantitative coronary arteriography in evaluating the new devices and advances in alternatives to arteriography such as intrevascular imaging.This text aims to weave many of these concepts together, establishing the ground work for further development of mechanical approaches to limit restenosis. It is intended for use by interventional cardiologists interested in practical and research aspects of restenosis.
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The technical evolution of cardiac surgery in the last decades has been rewarded with long-term survival with few complications. A matching improvement in the quality of this survival as subjectively felt by the patient has now become the most important to assess the justification of surgery. This book is the summary of the proceedings of an international symposium which addressed the growing demand in this facet of cardiac surgery. Quality of life after valve replacement, coronary bypass, surgery for congenital heart disease and heart transplantation has been analyzed in terms of the physiological, intellectual functioning, emotional state, performance of social roles and general satisfaction. The patient's well-being has become the focus of a joint effort of cardiologists, surgeons, general practitioners, psychologists, sociologists and occupational physicians, for all of whom this book aims to be a guide to the improvement of a patient's "Quality of Life After Open Heart Surgery"