The treatment of end-stage heart failure with advanced surgical therapies has evolved significantly over the last several years and is a dynamic subspecialty within cardiac surgery. "Surgical Treatmentfor Advanced Heart Failure "describes the surgical management of advanced heart failure, including coronary artery revascularization, mitral valve repair, aortic valve replacement, ventricular remodeling, cardiac resynchronization, mechanical circulatory support with short-term devices for acute stabilization, long-term mechanical support as a bridge to transplant and for destination therapy, left ventricular assist devices, complete cardiac replacement with the total artificial heart, and cardiac transplantation. With contributions from a distinguished group of heart failure cardiologists and transplant surgeons, it is an authoritative resource for cardiac surgeons, cardiologists, and surgeons.

Non-Invasive Imaging of Atherosclerosis is a primer, reference and review of some of the key features of current activities in the field of atherosclerosis. The Editors' goal is to provide material and stimulating ideas to basic scientists and clinical researchers in order to extend the application of vascular imaging and to further develop methods suitable for investigation of the arterial wall. The first section presents current knowledge about pathology, vascular mechanics and compensatory mechanisms active during atherogenesis. It explores the early lesion, complications of plaques and early detection of plaques. Section II reviews several key methodological issues of B-mode ultrasound imaging and some of the most current data. Quantitative B-mode ultrasound is an established non-invasive tool widely used in large epidemiologic studies and interventional clinical trials of atherosclerosis. The last section addresses the most promising areas of development in vascular imaging. This involves new techniques to evaluate the atherosclerotic bed, to follow atheroma progression/regression and to evaluate vascular mechanics in atherosclerotic arteries. The last chapter places the application of non-invasive imaging in perspective.

On 15 November 1997, the first international symposium "Neural and Chemical Control of Breathing: Pharmacological and Clinical Aspects" was held at Leiden University Medical Center on the occasion of the retirement of one of the members of the Control of Breathing Research Group of the Departments of Physiology and Anesthesiology, Dr. Aad Berkenbosch. Among others, Dr. Berkenbosch, played an important role in this research group, which made a large and significant contribution to scientific research on the regulation of breathing. This book presents the proceedings of that meeting together with papers of several authors who have strong bonds with the Leiden Departments of Physiology and Anesthesiology. All studies represent state of the art work on the subject of respiratory control and cardiovascular medicine, with emphasis on the physiological, pharmacological and anesthesiological aspects of both fields. The book is divided in several sections: Oxygen Physiology. Prof. John Severinghaus presents among other things his ideas on oxygen sensing and high altitude related diseases. Prof. Honda gives results from studies in a unique set of subjects without carotid bodies. The findings of Honda's group support the idea that an intact hypoxic drive from the carotid bodies is necessary for the generation of central hypoxic depression. Dr. Hans van Beek discusses the effects of hypoxia and hypercapnia on cardiac contractility in animal models. Prof. Oeseburg demonstrates the feasibility of Near Infra Red Oximetry for monitoring tissue oxygenation in patients. Central Chemoreception.

In this second edition of his highly acclaimed book, Christopher P. Cannon, MD, and a team of preeminent clinical investigators have thoroughly revised and expanded every chapter to reflect the recent explosion of clinical trials on the management of acute coronary syndromes (ACS). This includes: the newer tests, such as C reactive protein; a multimarker approach to diagnosis and risk stratification; new antiplatelet agents; and combinations of thrombolytic-antithrombotic regimens. Also discussed are the latest developments in interventional cardiology, the use of cost-effectiveness in clinical trials to choose appropriate therapies, and the employment of critical pathways analysis to improve compliance with evidence-based medicine and guideline recommendations.

After yet another decade of leaming, experimenting, and inves tigating since my first book, Arterial System Dynamics, the many new medical breakthroughs and technological advances have inspired me to write this book to bridge the gap between basic research and clinical applications. The application of physical principles and quantitative approaches to the understanding of the arterial circulation and its interactions with the heart in normal and diseased conditions form the basis of The Arterial Circulation. Knowledge of the physiology and rheology of arteries, as well as all of their structural-functional corre lates, is a necessary prerequisite to the proper hemodynamic interpretatiqn of pressure-flow relations and the pulsatile transmis sion characteristics in different arteries. The natural coupling and interactions of the heart, the coronary circulation, and the arterial system necessitate analysis of alterations to global functioning. Modeling provides a tool for isolating and predicting parameter changes and is employed throughout the book. Experimental data are provided for model validations, and also for more realistic interpretations. Techniques and new methods for clinical hemo dynamic measurement and diagnosis are included to help the reader un derstand the physical principles underlying such abnormal cardiovascular functions as hypertension, stenosis, and myocardial ischemia. The progressive changes in vascular properties during aging are also discussed. Modem approaches utilizing computer mode ling and allomery are presented with selected examples, such as combined hypertension and aortic valve stenosis, and ventricular hypertrophy."

Following many years when a great deal of attention was directed towards the intracellular roles of purines, there is expanding interest in the field of extracellular purinergic signalling. In this book we focus on the actions of purines in cardiovascular biology, where it is clear that they play major roles in both normal and pathophysiological conditions. Activation of different purinoceptor subtypes by purines can regulate cardiac contractility and electrical activity, modulate catecholamine-mediated responses both pre- and post-junctionally, trigger and mediate ischaemic preconditioning, cause vasodilation and vasoconstriction and enhance endothelial proliferation and apoptosis as well as inhibit platelet and neutrophil function. This book covers the cardiovascular actions mediated by the major P1 and P2 subclasses of purinoceptors and emphasizes the interactions between these two signalling systems. Cardiovascular Biology of Purines covers topics ranging from molecular and cellular to systemic and clinical. It also aims to highlight how basic advances have led to the identification of novel targets for cardiovascular therapeutic developments. We hope that our book will prove to be timely and helpful.

In the four pages committed to a discussion of myocardial infarction in the first edition of Harrison's Principles of Internal Medicine, published in 1950, there was no mention of use of the laboratory for management of patients. Thirty years later, when the first edition of Braunwald's Heart Disease, A Textbook of Cardiovascular Medicine was published, 2 out of the 1943 pages in the text contained a discussion of the laboratory examinations in acute myocardial infarction. Our knowledge base of the multitude of ways that physicians can and should use the clinical chemistry laboratory has expanded dramatically since these classic texts were published. The nomenclature has changed: terms such as "cardiac enzymes" have given way to "cardiac biomarkers. " The number of assays has multiplied, and the operating characteristics of available assays are impr- ing at a gratifying but dizzying rate. We now use biomarkers to diagnose cardiovascular diseases and also to frame our treatment strategies. Thus, there is a clear need for a scholarly compilation of the state of the art of cardiac biomarkers. Dr. David Morrow has expertly edited an authoritative book that answers this need. The 34 chapters in Cardiovascular Biomarkers: Pathophysiology and Disease Mana- ment were written by a group of individuals who are internationally recognized thought leaders and experts in clinical and laboratory medicine.

Cardiac Markers is a comprehensive, up-to-date summary of clinical information on serum cardiac markers for coronary artery disease. This book reviews in detail the biochemistry, clinical significance, and analytical measurements for each marker, as well as the advantages and limitations of existing and proposed markers. Comprehensive descriptions of therapeutic approaches to manage patients are presented. Also included are up-to-date listings of primary references and commercial methodologies, the latest data on the pathophysiology of unstable angina, and a discussion of the new emergency-room chest pain centers. Anyone who needs to know how to examine, diagnose, treat, and manage patients with acute chest pain and heart attacks will find this book indispensable.

Much has been written about reperfusion injury in the past decade but unfortunately the information has been generally presented in the form of original specialist papers and little if any integral publication exists on the topic, summarising and analysing the clinical impact of the condition and its management. The pathophysiology and molecular mechanisms of reperfusion injury are complex and, regarding diagnosis, individual diagnostic techniques have been proposed but without a proper assessment of the relative values of these methods. A publication dealing with integral diagnostic strategies would be welcome by the managing physician. Management of the condition is also problematic, as strategies that appear to work in the experimental models do not translate into beneficial interventions in patients. There is a need for these issues to be addressed and discussed in a monographic fashion. Management of Myocardial Reperfusion Injury will tackle these issues in a modern and systematic way and the information will be delivered in a fashion that will be appealing to the reader.

The purpose of this book is to provide the outline for the "nuts and bolts" establishment and operation of a nuclear cardiology laboratory. In so doing, the authors have attempted to deal with the relevant issues that a laboratory director must address in either setting up the laboratory or maintaining its competitive edge and clinical competence over time. The authors primarily attempted to identify issues related to outpatient imaging facilities. However, where appropriate issues related to inpatients in hospital-based laboratories are also discussed.

In this new edition, the authors have kept the basic format established in the first edition. In addition to reviewing, modifying and updating each chapter in the first edition, they have added entirely new chapters on PET imaging, hybrid imaging and the clinical appropriateness of nuclear cardiology procedures.

W. KUPPER Coronary artery vasoconstriction is not only the mechanism responsible for Prinzmetal's variant angina, but may also be involved in stable angina pectoris and myocardial infarction. However, the underlying patho-physiological mecha- nisms and the importance of coronary vasoconstriction in these syndromes is still largely unknown. Several hypotheses have been proposed. Sympathetic nervous activity plays a key role in the regulation of coronary blood flow, but mechanical or humoral constrictive factors may be active as well. a-adrenergic tone Adrenergic nerve fibers accompany coronary vessels of any size. The stimulation of cardiac sympathetic nerves causes an increase in coronary blood flow. If, however, chronotropic and inotropic effects of adrenergic stimulation are sup- pressed pharmacologically by beta-adrenoceptor blockade, a reduction in flow is observed. Thus, the primary effect of sympathetic stimulation on the coronary arteries is the alpha-adrenergic mediated vasoconstriction. Functionally inner- vated alpha-adrenoceptors have been documented both in large coronary con- ductance arteries and in the small resistance vessels. Animal studies and a human study have documented that a permanent constrictor tone is present on the coronary circulation both at rest and during exercise; this condition could be prevented with alpha-adrenoceptor blockade or was absent after heart transplan- tation. Therefore, alpha-adrenoceptor mediated coronary constriction is an at- tractive hypothesis as a possible pathophysiological mechanism of inappropriate coronary vasoconstriction and cororiary vasospasm.

Includes recommendations and clinical studies on ideal drugs to reduce blood pressure with fewest side effects and optimal efficacy. Presents a nutrition program for patients to manage high blood pressure and reduce weight which, if followed, helps lower the risk of heart attack, heart failure, stroke, kidney failure, and early death. Provides a comprehensive review of nutritional supplements to improve blood pressure control. Written by leading experts in hypertension and nutrition, this book presents a unique and optimal approach to reducing cardiovascular problems related to high blood pressure, it serves as a guide for both health practitioners and their patients.

Cardiovascular disease is the leading cause of death in the United States and is the focus of ongoing research. Consequently, treatment of cardiovascular disorders is among the most highly evidence-based area of medicine and pharmacy practice.

Quick Reference to Cardiovascular Pharmacotherapy provides important guidelines and standards of care in the pharmacological management of cardiovascular diseases. It begins with the management of cardiovascular risk factors and continues with important pharmacotherapeutics. In addition, the authors tackle crucial pharmacotherapeutic problems related to managing patients with cardiovascular diseases, such as drug-induced cardiovascular side effects and alternative pharmacotherapy for managing cardiovascular diseases. With numerous tables and charts utilized throughout, the pocketbook also contains important dosing information applicable specifically to cardiac patients.

Furthermore, based on their experience, the contributors offer important clinical pearls to help deal with commonly encountered clinical problems in daily practice. Quick Reference to Cardiovascular Pharmacotherapy provides health care professionals and students a concise, quick, and authoritative summary of how to utilize pharmacological agents for the management of cardiovascular disease.

Improving our insights into the genetic predisposition to cardiovascular disease is one of the most important challenges in our field in the next millennium, not only to unravel the cause of disease but also to improve the selection of patients for particular treatments. Nowadays, for example, subjects with a cholesterol above a particular plasma level are exposed to a cholesterol lowering regime based upon the beneficial outcome of epidemiological studies which include subjects not prone to the disease, despite a plasma cholesterol above the accepted level. Identification of the patients who are genetically predisposed to the consequences of this disorder will reduce the number of subjects unnecessarily treated and, hence, the costs of health care. Because in most cardiovascular diseases the genetic component is a consequence of more than one gene defect, only limited progress has as yet been made in identifying subjects genetically at risk. For example, in hypertension only in less than 10% of the patients the genetic defect has been identified. It has been known for quite some time that in heart and blood vessels fetal genes are as high blood pressure and upregulated or induced when they are exposed to such disorders ischemia. Little is known about the function of these genes in the cardiac and vascular adaptation to these disorders; only guesses can be made.

New Frontiers in Angiogenesis starts with a comprehensive overview of the field and continues with topics that have been minimally explored. The topics deal with dynamics of vasculogenesis using imaging techniques, bone marrow-derived endothelial cell precursors as potential therapeutic tools, regulation of post-angiogenic vessel regression, vascular mimicry, design and construction of artificial vessels, bioengineering of angiogenesis, and lymphangiogenesis recapitulating angiogenesis in health and disease states. Each chapter is written by leading experts of the subjects. It is hoped that this volume will challenge all of us interested in the field of angiogenesis and cardiovascular biology, in particular those in academia and industries, to think "outside the box" and explore angiogenesis from a fresh angle. It is hoped that New Frontiers in Angiogenesis is thought provoking and serve as a road map for discovering new findings to help betterments of human health.

Intravascular ultrasound imaging (IVUS) plays very important roles in clinical cardiology. This book describes the newest advances in vascular ultrasound imaging and the surrounding technologies for high frequency vascular ultrasound imaging. Most important topics of the book are technical applications of IVUS (elasticity imaging, chromaflow...) and the basic data (vibration, acoustic microscopy) that should provide very important information to understand clinical IVUS imaging.

This publication is intended as a guide to common diagnostic, operative and percutaneous techniques used in creating and maintaining vascular access for hemodialysis. When writing the text, the authors have focused on surgeons in training, fellows, interventional radiologists and clinically active nephrologists. Dialysis nurses and other clinicians involved in the care of end stage renal disease and dialysis patients will also greatly benefit from this handbook. This 2nd edition of the text contains expanded sections on ESRD, access surveillance and surgical and diagnostic devices, as well as new sections on peritoneal and dual lumen catheter placement, commonly used drugs and dialysis, hemo- and peritoneal dialysis techniques and CPT and ICD coding for statistical and billing purposes. These changes reflect the highly technical nature of clinical management in this evolving specialty.

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.

Akin to nitric oxide, carbon monoxide (CO) was initially viewed as a pure toxic gas, yet it has been recently demonstrated to be an important endogenous molecule of gas that has profound physiological and pathophysiological effects on the cardiovascular system. In spite of the growing understanding achieved in this field, until now a comprehensive book summarizing the extraordinary advances in the research of the cardiovascular effects of CO has not been available. Carbon Monoxide and Cardiovascular Functions responds to the vexing challenges and exciting opportunities that confront researchers and clinicians studying the biological roles of CO in the cardiovascular system. This book presents many never-before-published results including the first case of human CO deficiency. It also discusses disorders where the cardiovascular effects of CO might have been altered, including hypertension, diabetes, stroke, and ischemic heart damage. A product of the collected knowledge of internationally respected scientists, this book serves as a standard reference summarizing recent developments, scientific controversies, and future directions in the study of the biological actions of CO on the cardiovascular system. By covering both ancient and state-of-the-art methodologies in great detail, Carbon Monoxide and Cardiovascular Functions, affords a rapid mastery of the powerful new advances in CO study.

This book discusses the benefits of application of different psychotherapy techniques, in addition to optimal medical approaches, in patients with ischemic heart disease. It explains the theoretical basis for use of these techniques, discusses the scientific evidence for their efficacy, and identifies important practical issues. Detailed attention is devoted to both well-established and recently developed approaches of proven value, as well as to future applications. In addition, practical insights are provided into the most effective ways of integrating psychotherapy with medical activities in hospitals, outpatient clinics, and rehabilitation centers. The authors are world experts in the fields of psychotherapy, pharmacology, and cardiology, who collectively provide a sound foundation for an interdisciplinary approach to patients with ischemic heart disease. Psychotherapy for Ischemic Heart Disease is both a textbook and a practical manual aimed particularly at cardiologists, psychologists, psychotherapists, and psychiatrists, but also internal medicine specialists, cardiac surgeons, general practitioners, rehabilitation doctors, students, nurses, and patients.

This volume represents a part of the scientific proceedings of the Sixth Annual Meeting of the American Section of the International Society for Heart Research that was held in Oklahoma City from September 13-15, 1984. The chapters have been grouped according to the content of invited symposia on cardiovascular topics ranging from electrophysiology, autonomic control of the circulation, aging of the myocardium, mechanisms of cardiovascular injury, cultured heart cell studies, etc. Abstracts of all the papers presented at this meeting are included in Volume 16 (Supp. 1) of the Journal of Molecular and Cellular Cardiology. Since our understanding of the pathobiology of cardiovascular injury requires integrating knowledge from both basic and clinical sciences, the information presented in this volume extends from fundamental biochemical processes to pharmacological agents required to treat complex cardiac arrhythmias. At the molecular level, the structural lipids of the sarcolemma may be altered during myocardial ischemia; the role of free radicals in this process is one emerging area of active study. At the subcellular level, plasma membranes provide the anatomical basis for maintenance of optimal potentials of excitable cells; the anatomy and physiology of the sarcolemma ultimately determines the response to drugs and metabolic perturbants. At the cellular level, much progress has been made in our understanding of cultured and adult myocytes during ischemia and hypoxia; in particular, the electrophysiology of these model systems is well understood and several chapters address this approach.

During the 25 years since acute coronary care was focused into Coronary Care Units there have been three major Phases: I. prevention of death caused by arrhythmias; II. prevention of death due to myocardial failure; and III. limitation of infarct size. In the latter two Phases, there has been infringement upon the time honored concept of a prolonged period of rest for the patient in general and the heart in particular to minimize myocardial metabolic demands. During the second Phase of coronary care, patients with myocardial failure received aggressive measures to increase cardiac work via increase in preload, decrease in afterload, and direct increase in inotropy. It was believed that true cardiogenic shock was so irreversible that it should be prevented by vigorous efforts to improve the cardiac output despite the risk of extending the area of ischemic myocardium. However, Phase II produced minimal overall reduction in mortality. In the initial part of Phase III, myocardial infarct (MI) size limitation was attempted by reducing myocardial metabolic demands via either beta adrenergic or calcium channel blocking agents. We are currently several years into the second part of Phase III of coronary care where the principle means of limiting MI size is restoration of coronary blood flow.