How is the heartbeat generated? What controls the strength of contraction of heart muscle? What are the links between cardiac structure and function? How does our understanding of skeletal and smooth muscle and non-muscle cells influence our thinking about force development in the heart? Are there important species differences in how contraction is regulated in the heart? How do the new molecular data fit together in understanding the heart beat? What goes wrong in ischemia, hypertrophy, and heart failure? This book paints a modern portrait' of how the heart works and in this picture the author shows a close-up of the structural, biochemical, and physiological links between excitation and contraction. The author takes the reader through a series of important, interrelated topics with great clarity and continuity and also includes many useful illustrations and tables. The book starts by considering the cellular structures involved in excitation-contraction coupling and then described the characteristics of the myofilaments as the end effector of excitation-contraction coupling. A general scheme of calcium regulation is described and the possible sources and sinks of calcium are discussed in simple, but quantitative terms. The cardiac action potential and its many underlying currents are reviewed. Then the characteristics of some key calcium transport systems (calcium channels, sodium/calcium exchange and SR calcium uptake and release) are discussed in detail. This is then built into a more integrated picture of calcium regulation in succeeding chapters by detailed discussions of excitation-calcium coupling mechanisms (in skeletal, cardiac, and smooth muscle), the interplay betweencalcium regulatory processes, and finally mechanisms of cardiac inotropy, calcium overload, and dysfunction (e.g., ischemia, hypertrophy, and heart failure). Excitation-Contraction Coupling and Cardiac Contractile Force &endash; Second Edition is an invaluable source of information for anyone who is interested in how the heart beat is controlled and especially suited for students of the cardiovascular system at all levels from medical/graduate students through senior investigators in related fields.

Although some investigators have questioned the importance and even the existence of silent myocardial ischemia, documentation presented at this two day symposium leaves little doubt about its existence and importance. It has been estimated that about 3 million of the estimated 4 million angina sufferers in the United states have frequent episodes of silent myocardial ischemia. Although it is not possible to define how many Americans die due to silent ischemia, it has been suggested that the mortality rate may exceed hundreds of thousands of victims annually. Unfortunately, there still remains a lack of definitive information as to why some ischemic events are painless. Some suggest the concept that the location and size of the myocardium at jeopardy relates to pain, that the pain threshold varies from patient to patient or that there are neurological deficits in the myocardium of some patients with silent ischemia. Abnormalities in myocardial perfusion and function can occur without pain. An interesting observation presented by several investigators has been that when a coronary artery is occluded in man, no ischemic pain is perceived for the first 30 seconds. Only after a 30 second period or so of occlusion does angina occur. An even more confusing observation is that some 30 second periods of occlusion of the same vessel in the same patient results in angina while the next occlusion can be a totally silent event.

Some 25 years ago, the coronary care unit concentrated high technology and the acutely ill patients who might benefit from it in a single, recognizable space. Since then, that space and its technical equipment have changed, as has part of its population. Acute ischemia, silent and manifest, occurs within and outside of the coronary care unit as pain, arrhythmia, or pump failure. Its detection and treatment require the utilization of many diagnostic techniques and skills, not the least of which is two-dimensional Doppler echocardio graphy, which is gaining importance. Future developments, in tandem with computer technology, may add to this importance by enabling tissue identification, spatial representation, and Doppler flow mapping. This book describes the state of the art for the practicing clinician using Doppler echocardi?graphy at the bedside of patients with acute ischemic manifestations of coronary heart disease. The first requirement is to move from the echo laboratory to the coronary care unit, emergency department, operating room, or catheterization laboratory, using equipment suited for that purpose. The second, more trying imperative is to secure good cooper Ition between those treating the acutely ill patient and the investigator who interferes with his probes. If successful ceeding in both, rewarding results can be obtained, since echocardiography is a very sensitive and specific tool for recognizing and quantifying early ischemia.

Pathophysiology of Cardiovascular Disease has been divided into four sections that focus on heart dysfunction and its associated characteristics (hypertrophy, cardiomyopathy and failure); vascular dysfunction and disease; ischemic heart disease; and novel therapeutic interventions.
This volume is a compendium of different approaches to understanding cardiovascular disease and identifying the proteins, pathways and processes that impact it.

Written and edited by an outstanding team of experts in the field, Transcatheter Aortic Valve Implantation offers a multidisciplinary approach to this rapidly expanding procedure. Recent studies have shown transcatheter aortic valve implantation (TAVI) to be as effective as surgical aortic valve repair (SAVR), with demonstrably better outcomes for low, intermediate, and high-risk patients. Under the editorial leadership of Drs. Catherine M. Otto, Bernard D. Prendergast, and Simon Redwood, this practical reference incorporates recent research on patient selection, discusses current guidelines, and covers the new devices developed to address this fast-growing area. Follows the patient journey from indications, patient selection for TAVI, choice of valve, and pre-TAVI evaluation through the procedure itself, complications, and long-term outcomes-all with a multidisciplinary team approach. Features consistent headings and user-friendly content in every chapter: Checklists, Decision Pathways, Data/Evidence Summaries, and Essential Readings. Contains multidisciplinary TAVI Decision Pathways that provide a uniquely visual yet comprehensive approach for quick retrieval and application of all the latest clinical implications for TAVI. Includes the latest evidence-based data on TAVI vs. SAVR from the new AHA/ACC guidelines and implications for practice. Provides clear visual guidance with 150 pre-, intra-, and post-imaging illustrations, plus 50 TAVI procedural video clips. Enhanced eBook version included with purchase. Your enhanced eBook allows you to access all of the text, figures, and references from the book on a variety of devices.

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."

Quantitative coronary angiography has become an invaluable tool for the interventional cardiologist, providing objective and reproducible measurements of coronary artery dimensions, which can be used to study progression or regression of coronary atherosclerosis, as well as the immediate and long term effects of percutaneous interventions. Until recently, this powerful imaging technology was confined to a small number of so-called high level institutions. Fortunately, with the development of digital cardiac imaging equipment and adaptation of cine-angiographically based computer software for on-line use in the catheterization room, quantitative coronary angiography is now available to all interventionalists. This book is a timely guide for the impending QCA user, providing practical as well as theoretical and scientific information. A comprehensive evaluation of the clinical usefulness of QCA is covered, from the fundamental principles through experimental validation studies, application to clinical trials of a wide range of pharmacological and interventional therapies in the full spectrum of clinical presentation of coronary disease syndromes, evaluation of the therapeutic efficacy of various new devices for coronary intervention, together with extensive presentation of its physiological, functional and anatomical correlations, by comparison with other intracoronary measurement and imaging techniques. In addition, evolving theories and concepts in the ever topical restenosis phenomenon' after percutaneous intervention, based on serial QCA studies, are presented and discussed and a potentially unifying methodological approach to further study of this ubiquitous problem is offered. Thisbook, thanks to the collaboration of many experts in the field of intracoronary imaging and measurement, provides stimulating, interesting and practical information, both for the academic scientist and practising clinician.

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.

This book provides an update of recent advances in the basic and clinical applications of cell-based therapies for myocardial repair and regeneration in ischemic heart disease (IHD) and heart failure (HF). The first sections of the book illuminate basic aspects of stem cells such as definitions, isolation criteria and characterization of embryonic and adult stem cells, as well as pluripotent stem cells and tissue specific progenitor and stem cells. In the following section, the text examines the role of critical regulators of stem cell differentiation in myocardial regeneration, that include circadian rhythyms, microRNAs, epigenetics, microvescicles, and exosomes. The text concludes with a review of the use of stem/progenitor cells in cardiac regeneration and discuss current controversies, unresolved issues, challenges, and future directions. Stem Cells and Cardiac Regeneration is addressed to a wide audience consisting of cardiologists, clinicians, and research scientists, who will learn new concepts in cardiovascular regeneration and repair with special focus on molecular mechanisms and therapeutic potential for cardiovascular regeneration.

The Frontiers in Cardiovascular Health varies between and within nations, depend ing upon the level at which the battle is fought for better cardiovascular health. According to the 1997 World Health Report, 15 million deaths (i. e. 30% of the total number of deaths) were attributable to cardiovascular diseases and this number is on the rise. The projection for the year 2020 is quite alarming with an expected cardiovascular mortality reaching 50 million. Much of this burden is projected to occur in developing countries, more specifically in the most populous countries of the world, namely China and India. These countries are already burdened with infectious and parasitic diseases and are trying to eradicate such diseases. With increasing life expectancies people all over the world, especially in developing coun tries, are exposed to degenerative atherosclerosis resulting in increased cardiovascu lar mortality and morbidity. In developing countries, resources available for health care are very limited. For example many of the African countries spend less than $10 per person per year on his/her entire health care let alone cardiovascular health. The average health care budget for nearly two thirds of the global population is well below $100 per year, on a per capita basis. Therefore, in developing countries health promotion and primary prevention are the frontiers by necessity. Improving awareness and health education is not only a matter of choice but is an absolute necessity.

"Essential Treatments in Cardiovascular Chinese Medicine" includes information on the basic medical sciences of blood lipids, clinical significance, diagnosis, and treatment methods. It also covers TCM differentiations, diagnosis, treatment principles, and methods.

In recent years, TCM practitioners have not been specifically trained in treating patients with hyperlipidemia. The book gives a detailed explanation of cholesterol problems and offers Chinese medicine as a solution.

This book is intended for US-based licensed TCM practitioners as well as cardiology researchers.
Gives a basic medical science and TCM theory background on cholesterol with clinical significance and diagnosisProvides treatment methods and advice, including nutritional therapy and Chinese medicine medicated dietary planPrepares the practitioner to sit for the Niambi Wellness Integrative anatomy and pathophysiology in cardiology final online exam

Interest in the ability of myocardium to adapt to ischaemic stress has continued to grow since the discovery of ischaemic preconditioning in 1986. In 1993, two reports heralded the recognition of a delayed preconditioning response in the heart, now commonly known as the second window' of protection. Since then, a number of studies have described the ability of delayed preconditioning and related adaptive phenomena to protect against a variety of pathologies in the ischaemic and reperfused myocardium. Our understanding of the cellular mechanisms of sub-acute adaptive cardioprotection has advanced considerably during this period. This compilation of state-of-the-art reviews by those who have made significant contributions to this field provides detailed and critical analysis of this research, from molecular basis to potential clinical relevance. The book aims to provide an authoritative, comprehensive and thoroughly up-to-date overview for scientists and clinicians engaged in, or observing, this rapidly-developing area of heart research. It will also be of interest to those engaged in research on other tissues where ischaemia-reperfusion pathology is of major concern.

In 1982, as chance would have it again, an opportunity appeared to Jom the Department of Physiology at Kuwait University. P. Braveny spend four years there, teaching, doing some research, recovering former international contacts. Coming back home, he faced the same gloomy, motionless disfavor as before. November 1989 turned P. Bravenfs career upside down. Immediately after the fall ofthe communist regime, he was elected vice-dean and later dean ofthe Faculty of Medicine, promoted full professor in physiology and appointed the head of the Department ofPhysiology. From 1992 to 1998 P. Braveny served as the vice-rector of Masaryk University. His professional career culminated in his presidency of the XIV World Congress of ISHR in Prague. Understandably, in the following years, he become interested (in his tutor's footsteps) in history of physiology and pub- lished two monoghaphs (E. Babak andV Kruta). This CV would be an incomplete one without mentioning his broad interests in natural sciences and in art, particu- larly music and painting. As a tutored amateur he has acquired certain success in the latter. When reviewing P. Bravenfs whole-life work, largely done under adverse cir- cumstances with minimum financial support, his almost two hundred papers, innu- merable essays and four monographs are a commensurate result. In appreciation, he was awarded honorary membership of the Czech Medical Society, Physiological Society and Cardiological Society, Gold Medal of Masaryk University, Ministry of Education Award etc. Bohuslav Ostadal Makoto Nagano Naranjan S.

In 1981 Dr Jean Lintermans published, with Dr van Dorp, a superb vol ume, 'Differential Diagnosis in Pediatric Echocardiography'. It was 'state of the art' with a unique organization, starting with M-mode echocardiograph ic findings rather than the disease category, and included a segmental approach to diagnosis, and concluded with an invaluable section on normal echocardiographic values. This volume was a great help to many of us in pediatric cardiology who were discovering the great clinical value of the noninvasive approach to diagnosis. This gave us a 'running start' for our own entry into the field. At that time, the 2 D or sector echocardiogram was finding increasing usefulness and there were several illustrations of this tech nique, integrated into that volume. Since 1980, the field of 2 D echocardiography has grown enormously in its usefulness, to the point that it has reduced the need for invasive studies, and has enhanced the precision of invasive studies when required. It is now time for a systematic and thorough approach to this field, and I am delighted that Jean Lintermans has provided us with this book. The pictures are uniformly superb and are very well labelled. The organization is cen tered around diagnostic categories, but the same attention to detail is pre sent that made the first volume so useful. I particularly value the extensive documentation of diagnostic findings, with numerous literature citations."

In the last ten years, major strides have been made in defining the presence and role of inflammation in atherosclerosis as well as in injury to the tissues that occurs after episodes of ischemia and reperfusion. In sixteen chapters, written by world-renowned individuals from different countries, the role of inflammation and different mediators in the pathogenesis of atherosclerosis is presented. The significance of inflammation and possible therapeutic implications is also described in depth. This book is of great interest for a wide range of physicians, researchers, and scientists who may want to study more and develop the concept of inflammation and atherosclerosis.

The multidetector CT scanner speeds diagnosis and treatment of patients. One of its many uses is to perform CT coronary angiography. Multidetector CT has generated excitement within the cardiology and radiology community as it provides clear pictures and takes less time than other non-invasive techniques, including conventional spiral and electron-beam CT which can take up to an hour or more. 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.

Over two centuries ago, oxygen was discovered as "air vital" the component of the earth's atmosphere necessary for life. Less than five years after this discovery, it was found that oxygen was both a life-sustaining and life threatening inhalant as it plays a role in the two extremes of the animal kingdom: life and death. In the subse quent years, we have made major strides in understanding the role of oxygen in maintaining life and volumes of information are now available on this topic. Our knowledge of the contribution of oxygen in cellular dysfunction and cell death which for the most part had lagged behind has begun to catch up. The deleterious ef fects of oxygen radicals and activated oxygen species on a variety of biological systems have now been described. Recently attention has also been focused on the toxic effects of oxygen on the cardiovascular system. The major aim of the present treatise is to offer an integrated view of the pathophysiological aspects of oxygen toxicity in the heart and blood vessels coupled with a review of therapeutic approaches (hopes?) with free radical scavengers and antioxidants. Internationally known expert investigators provide a concise and critical review on the topic of their expertise which also contains data from their own research."

The motivation for this book was the recognition by two of us (RL and TL) that, despite our training as cardiologists, we had a limited understand ing of many aspects of the surgical management of our patients. Conversa tions with other cardiologists at our own institution and at other medical centers around the country convinced us that many of our colleagues shared our uncertainty about the details of surgical procedures and the factors that determine decisions in the perioperative period. As surgical techniques continue to evolve, this knowledge gap can become only more severe. We therefore compiled information about cardiac surgery that might be useful for cardiologists and other nonsurgeons. We asked cardiologists what questions they would like to ask their surgical colleagues and provided these questions to the authors of the chapters. Thus, the goal of these chapters is to help nonsurgeons answer their own questions about common cardiac procedures, and to help prepare these physicians to address the questions raised by their patients. In addition, we hope that insight into these issues will improve communication between surgeons and their col leagues-and, ultimately, lead to better patient care. Contents Preface . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . vii Contributors . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . xi 1 Chapter 1. Anesthesia for Cardiac Surgery JONATHAN B. MARK Chapter 2. Cardiopulmonary Bypass . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18 DANIEL FITZGERALD Chapter 3. Myocardial Protection in Cardiac Surgery . . . . . . . . . . . . . . . . . . 23 JEFFREY SELL Chapter 4. Coronary Artery Bypass Grafting . . . . . . . . . . . . . . . . . . . . . . . . . . . . 32 HENDRICK B. BARNER Chapter 5. Surgery for Left Ventricular Outflow Obstruction: Aortic Valve Replacement and Myomectomy . . . . . . . . . . . . . ."

Defining and understanding cellular and molecular mechanisms that are relevant to women's health has become a critical area of scientific pursuit. Until recently, very little effort has been place on defining or understanding critical differences between women and men that may be critical to the overall health of the woman. In 1990, the National Institutes of Health recognized this gap in knowledge resulting in the creation of the Office of Research on Women's Health. One of the purposes of this office was to advance the understanding of health issues from the women's perspective from both a basic and clinical scientific perspective. From a scientific evolution of understanding, the existence of this office is new and thus there has not been enough time for new information to integrate itself in our current scientific thought process. This book will seek to capture and disseminate our current understanding of scientific advancements relevant to women's health and provide the information to a broad audience. The purpose of this work is to discuss recent advancements in basic science across three areas of concern for women's health. In addition, the book will provide "translational" chapters that attempt to place the basic science work in context within our current understanding of the human. Although it is well acknowledge that gender differences exist across organ function which translates into differences in whole body function, until recently little effort has been made to define basic mechanisms within various tissues within the woman. This work will focus on recent scientific findings that are relevant to women's health and to provide novel and relevant information to interested scientists and clinicians.

Biology of the Arterial Wall is intended as a general reference text concerned with the biology of the vascular cells and the blood vessel wall under physiological and pathological conditions. One of the major functions of the arteries is to maintain a continuous blood flow to the organs whatever the pressure conditions, thanks to the vasomotor tone of the smooth muscle cells. Great advances have been made over the last decade in the understanding of the endothelial cells as integrators and transducers of signals originating from the blood stream. The pluripotent control functions of the endothelial cells in the vessel wall are now well recognized. A review of endothelial functions and dysfunctions is presented. Cell biology and molecular genetic studies have now identified an array of molecules elaborated by endothelial cells and vascular smooth muscle cells and by the blood-borne elements which interact with artery cells, defending the artery against injury and modulating evolving abnormal processes. Molecules which induce or inhibit endothelial and/or smooth muscle cells are currently under great scrutiny. Angiogenesis, which plays a major role in tumor growth, but may also be beneficial as a healing process in muscle ischemia, is discussed. Apoptosis, or programmed cell death, has only recently been recognized as an essential process in blood vessel modeling and remodeling. An overview of apoptosis in the vascular system is presented. It is increasingly evident that the adjustments of the blood vessel wall are made in the presence of deforming disease processes such as hypertension and atherosclerosis. The second part of the book is concerned with the blood vessel wall in disease conditions. Several chapters review the role of the vessel and vascular cells in inflammation, and vascular remodeling during arterial hypertension and aging. One chapter is devoted to atherogenesis, atheroma and plaque instability, followed by the pathophysiology of post-angioplasty restenosis, which is a crucial issue in modern interventional cardiology.

The book will be written by the experts in the disease including imaging, interventional cardiology and surgical valve expertise. The book has five main sections: Aortic Valve Disease Mitral Valve Disease Tricuspid Valve Disease Pulmonic Valve Disease Multimodality Imaging The main objectives of the book are: 1- to provide the main guidelines to clinicians on how to identify and diagnose valvular heart disease 2- to provide an overview of what the near future will bring in the diagnosis, prevention and risk stratification of patients to catheter versus surgical approaches 3- to outline the possible implications for medical therapies in slowing progression of calcific aortic valve disease and myxomatous mitral valve disease

Taurine 9 contains original articles and critical reviews based on the oral and poster presentations of XIX International Taurine Meeting held in Krakow, Poland in May 2014. The purpose of the book is to present current ideas, new avenues and research regarding biological functions and clinical applications of taurine and taurine derivatives. It focuses on all aspects of taurine research including the cardiovascular system, the immune system, diabetes, the central nervous system, endocrine system and the role of taurine supplements in nutrition. It also includes presentations of novel animal experimental models using Cdo1 and CSAD knock-out mice.

Cardiac surgery is performed on hundreds of thousands of patients a year, and can have an important beneficial impact on the outcomes of patients with coronary and valvular heart diseases. Despite the favorable recovery of most patients, some will have their post-operative period interrupted by the development of atrial fibrillation, with a host of potential complications including stroke. High risk subgroups may develop atrial fibrillation in more than half of cases, and often despite aggressive prophylactic measures. Treatment of atrial fibrillation and its aftermath can also add days to the hospital stay of the cardiac surgical patient. In an era of aggressive cost cutting and optimization of utilization of health care resources, the financial impact of this arrhythmic complication may be enormous. Experimental studies have led to a greater understanding of the mechanism of atrial fibrillation and potential precipitating factors in the cardiac surgical patient. Prophylactic efforts with beta-blockers, antiarrhythmic drugs and atrial pacing are being used, or are being investigated in clinical trials. New methods of achieving prompt cardioversion with minimal disruption of patient care, and prevention of the thromboembolic complications of atrial fibrillation, are also important therapeutic initiatives. This text is designed to aid health care professionals in the treatment of their patients in the recovery period after cardiac surgery, and to instigate additional research efforts to limit the occurrence of, and the complications following, this tenacious postoperative arrhythmia.