This volume provides comprehensive protocols that researchers can use to dissect out fundamental principles and molecular mechanisms of hypertension, extending from genetics of experimental hypertension to biomarkers in clinical hypertension. Hypertension: Methods and Protocols guides readers through chapters on genetics and mmics of hypertension; the Renin-Angiotensin-Aldosterone System; vasoactive agents and hypertension; signal transduction and reactive oxygen species; novel cell models and approaches to study molecular mechanisms of hypertension; vascular physiology; and new approaches to manipulate mouse models to study molecular mechanisms of hypertension. Written in the highly successful Methods in Molecular Biology series format, chapters include introductions to their respective topics, lists of the necessary materials and reagents, step-by-step, readily reproducible laboratory protocols, and tips on troubleshooting and avoiding known pitfalls. Authoritative and cutting-edge, Hypertension: Methods and Protocols aims to ensure successful results in the further study of this vital field.

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 second edition of this textbook builds on the success of the original version by incorporating the latest developments in the clinical evidence base for cardiac rehabilitation whilst also aligning with the wider agenda in terms of commissioning and other national guidance. This edition also recognises the importance of an integrated approach to the prevention and rehabilitation of cardiovascular disease forming the foundation of every cardiac rehabilitation programme. Seven specified standards together with seven core components are presented which aim to ensure programmes are clinically effective and achieve sustainable health outcomes. Edited and written by a multidisciplinary team of experts on behalf of the British Association for Cardiovascular Prevention and Rehabilitation, this book provides contemporary evidence-based guidelines for standards of good practice. Special features: * An evidence-based, practical how to of the subject * Edited and written by the writing group for the BACPR 2012 Standards * With contributions from nationally and internationally recognised experts in this field

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.

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.

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.

Essentials of Cardiovascular Examination highlights common mistakes made in cardiovascular examination. The book provides a solid foundation of clinical knowledge for the beginner, and an excellent reference guide for the experienced clinician. Divided into 53 chapters across four sections, the book begins with guidance on approach to the patient, including cardiac history, general examination, and the anatomy of the heart and coronary circulation. The second section covers the cardiovascular system in detail, with topics including pulse, blood pressure, and percussion of the heart. The third section covers diseases relating to the cardiovascular system, ranging from congenital heart disease to ischemic heart disease and arrhythmias. The final section covers different investigations of the cardiovascular system, including the electrocardiogram, non-invasive imaging, stress tests and cardiac catheterisation. With 70 images, illustrations and information tables, Essentials of the Cardiovascular System covers anatomy and physiology, physical diagnosis of all common cardiovascular diseases, their investigation and treatment, making this an ideal resource for students preparing for examinations. Key Points Concise guide to anatomy, physiology, physical diagnosis of diseases, investigation and treatment 70 illustrations, images and information tables Ideal for students preparing for examinations Excellent reference guide for experienced clinicians

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 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.

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 . . . . . . . . . . . . . ."

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.

Percutaneous cardiac and endovascular procedures performed by a variety of interventional physicians continue to evolve and expand. One of the most important steps in performing these procedures is vascular access and their Achilles heel is vascular access site complications. This volume is here to help the clinician, providing a practical overview of the techniques and technologies used in top catheterization laboratories to access the arterial and venous beds. Dr. Mazen Abu-Fadel and his contributors, part of the renowned cardiovascular team at the University of Oklahoma College of Medicine, carefully walk the reader through the various techniques used to obtain vascular access into most arterial and venous sites. They thoroughly describe current data, techniques, advantages, risks, and benefits of each vascular access site. Covering everything from anatomic landmarks to closures devices, Arterial and Venous Access in the Cardiac Catheterization Lab offers a complete overview of each procedure. In addition, it provides an up-to-date guide to the best medical technologies and equipment used when performing these procedures. Arterial and Venous Access in the Cardiac Catheterization Lab is an invaluable resource for a wide range of clinical personnel, from attending physicians and trainees to nursing staff and vascular technicians. Written by experienced leaders in the field, it demonstrates how to perform complex, risky procedures while providing patients with expert care.

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.

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.

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.

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.

In Harch of 1980, we organized the first symposium on how to evaluate new antiarrhythmic agents in which the participants included members of the Cardio-Renal Division of the Food and Drug Administration, academic investigators from the United States and Abroad and directors and imple mentors of pharmacological research representing the pharmaceutical industry. By bringing together all three elements, it was hoped that better communication and under standing would ensue to more rapidly bring new cardiac agents to the American public. This goal was important since a rather limited number of antiarrhythmic agents were and are currently available to treat patients with such disorders in the United States. These agents are needed not only for the treatment of patients with sustained ventricular tachyarrhythmias which produce life-threatening hemodynamic consequences but also and in fact more potentially important as a prophylactic measure in the high risk patient subject to sudden cardiac death. This book represents the proceedings of the third of these Symposiums whose purpose was to evaluate the clinical research methodology and models used in the evaluation of ne" antiarrhythmic agents for not only acute therapeutic inter vention but also for the prophylaxis of sudden cardiac death. In addition, new devices have evolved over the past few years that can detect and treat life-threatening cardiac arrhythmias and the evaluation of efficacy and safety of these devices is detailed."

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.

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

Coronary heart disease remains the leading cause of death for men and women in the United States and other industrialized nations. Acute myocardial infarction accounts for a majority of these deaths, approaching 750,000 yearly. Thrombolytic therapy has revolutionized the treatment of myocardial infarction, saving lives to a greater extent than any treatment developed to date. The identification of patients best suited for thrombolytic therapy has been a challenging task, as has the ideal adjuvant strategy. Further, the noninvasic diagnosis of treatment successes and failures, as well as the expeditious triaging of patients requiring mechanical/surgical revascularization have been difficult to define, but progress has been made recently. The emergence of information vital for patient care has appeared at an extraordinary pace, with hundreds of articles being published yearly. Unfortunately, a resource devoted to the area of thrombolysis does not exist, making the dissemination of information to physicians, scientists and health care providers problematic. The Modern Era of Coronary Thrombolysis is designed to bring the medical and scientific communities up to date. It will serve as a foundation for future investigation, as well as a resource which can be referred to for many years to come.

A review of our current understanding of the physical phenomena associated with the flow of blood through the brain, applying these concepts to the physiological and medical aspects of cerebrovascular disease so as to be useful to both the scientist and the clinician. Specifically the book discusses the physical bases for the development of cerebrovascular disease and for its clinical consequences; specific current and possible future therapies; experimental, clinical, and computational techniques used to investigate cerebrovascular disease; blood dynamics and its role; imaging methods used in the diagnosis and management of cerebrovascular disease. Intended as a one- or two-semester course in biophysics, biomedical engineering or medical physics, this is also of interest to medical students and interns in neurology and cardiology, and provides a useful overview of current practice for researchers and clinicians.