The importance of heart and artery disease as a cause of death and disability is difficult to exaggerate: it causes over half of all deaths in the western world and now accounts for one-quarter of deaths in the entire world. This appalling incidence persists in spite of commendable progress in treatment and prevention, particularly in the last two or three decades. Deaths from coronary disease have decreased by a third in the past twenty years and stroke has decreased by a half in the same period. This remarkable improvement, saving thousands of lives per year, has come about due to changes in life style (low fat diet, control of high blood pressure, less smoking and more exercise) and progress in treatment (more effective drugs, coronary care units, pacemakers, and cardiac surgery). Progress in understanding the pathophysiologic and pharn, acologic mechanisms operative in heart disease have been paramount in the development of more rational and more effective therapy. Dramatic and spectacular surgical treatments have fired the public imagination. Bypass surgery is commonplace and results in complete or considerable relief of symptoms in the majority of patients operated upon

It has been almost 15 years since the fIrst reports appeared indicating that adenosine exerted a .protective effect in ischemic and reperfused myocardium. Numerous experimental studies have shown that adenosine (both exogenous and endogenous adenosine) delays the onset of ischemic contracture, modulates myocardial metabolism during ischemia, attenuates reversible postischemic ventricular dysfunction (myocardial stunning), and reduces myocardial infarct size. Initial studies on adenosine's cardioprotective effect were based on its ability to stimulate postischemic ATP resynthesis, increase coronary blood flow, and reduce heart rate. Although these actions of adenosine are undoubtedly benefIcial to the ischemic/reperfused heart, it now appears that adenosine's cardioprotective effect may be exclusive of these properties. The immense growth in the number of articles on adenosine cardioprotection in the last several years has been related in large part to the hypothesis that adenosine plays a role in ischemic preconditioning. Ischemic preconditioning is the phenomenon in which a brief period of ischemia (and reperfusion) prior to a more prolonged occlusion reduces myocardial infarct size. This form of myocardial protection has received much interest because ischemic preconditioning has been shown to be the most potent means of reducing infarct size in all animal models thus far tested. In fact prior to studies implicating adenosine's role in ischemic preconditioning, adenosine's infarct reducing effect was not well recognized.

In Heart Cell Communication in Health and Disease an extensive review of different aspects of heart cell communication is presented. The book starts with the fundamental concept that cardiac cells are communicated, and then proceeds to the role of gap junctions in heart development, the molecular biology of gap junctions, the biophysics of the intercellular channels, the control of junctional conductance and the influence of gap junctions on impulse propagation. This is the first time that a single volume has described cell communication in the normal heart and under different pathological conditions such as heart failure, coronary disease, myocardial ischemia and cardiac arrhythmias. In this way the process of cell communication is analyzed at different levels of complexity, providing the reader with a wide view of this field and its relevance to cardiology.

This is an important and timely volume. The history of research in homocysteine metabolism can be divided into three periods. The first phase was the exploration of the individual reactions and metabolites that characterize the transmethylation and transsulfuration sequences. The former originated with his description of the biosynthesis of methylpyridine and culminated in the work of Cantoni and Axelrod. Similarly the finding that insulin contained cystine was a potent catalyst for the metabolic and nutritional studies of Rose and du Vigneaud. The description and the definition of homocystinuria, a rare inherited meta bolic disorder, marked the beginning of the second historical period. Where previously there had been few laboratories located largely in the United States soon there were numerous research groups representing many nationalities. The more intense focus led to major advances, both in the laboratory and in the clinics. Studies of afflicted individuals, when combined with investigations in experimental animals, provided the basis for a concept of methionine metabo lism that encompassed both transmethylation and transsulfuration. The central role of homocysteine was apparent."

Especially the past two decades have seen renewed interest in the vasculitides. In this volume an international expert group presents the current state of knowledge and concentrates on principles of immune modulating therapy. Drawing from their work in rheumatology, nephrology, internal medicine, connective tissue disease and clinical immunology, they present new concepts in classificiation, diagnosis and pathophysiology of the vasculitides. Evidence from experimental and clinical trials is reviewed, as well as the outlook for further research.

That geriatric cardiology has become a science and clinical discipline in its own rights is beyond dispute. Most cardiac disorders present with different symptoms and signs, require a different diagnostic and therapeutic approach, and also have a different prognosis in the elderly as compared to younger patients. Cardiovascular Disease in the Elderly provides a comprehensive, up-to-date guide to the physician, representing a pioneering work in this increasingly complex area. For this third edition most of the chapters have been completely rewritten, some by different authors. Four new chapters have been added, dealing with cardiac transplantation, invasive cardiovascular procedures, dietary considerations and ethical considerations. It cannot be denied that invasive procedures and transplantation are highly controversial in this area, and the ethical dilemmas involved are ably discussed by Dr Davis and associates. All chapters are supplied with a thorough list of references, making this third edition of Cardiovascular Disease in the Elderly the most thorough, concise guide for the practicing physician.

Sir Dominic Corrigan's classic monograph "On Permanent Patency of the Mouth of the Aorta, or Inadequacy of the Aortic Valves" was published in 1832. Descriptions of aortic regurgitation had previously been published by others, but Corrigan's contribution was so comprehensive that his name is still closely associated with this disorder. He described the physical findings and the underlying gross pathologic anatomy of aortic regurgitation. He recognized that sudden death was not characteristic of aortic regurgitation, as it was in aortic stenosis, and his therapeutic approach was based on firm physiologic principles. In the past 150 years we have expanded Corrigan's work, and we have developed a detailed appreciation of the natural history, pathophysiology, diagnostic methods, and treatment of chronic aortic regurgitation. Fifteen years ago, cardiac catheterization and angiography had already achieved widespread application in the evaluation of aortic regurgitation, but cardiac ultrasound, especially Doppler echocardiography, was in its infancy, and the utility of radionuclide ventriculography was not widely appreciated.

Dyslipidemias: Pathophysiology, Evaluation and Management provides a wealth of general and detailed guidelines for the clinical evaluation and management of lipid disorders in adults and children. Covering the full range of common through rare lipid disorders, this timely resource offers targeted, practical information for all clinicians who care for patients with dyslipidemias, including general internists, pediatric and adult endocrinologists, pediatricians, lipidologists, cardiologists, internists, and geneticists. For the last twenty years, there has been a growing recognition worldwide of the importance of managing dyslipidemia for the primary and secondary prevention of atherosclerotic vascular disease, especially coronary heart disease. This has been mainly due to the publication of the guidelines of National Cholesterol Education Program's Adult Treatment Panel and Pediatric Panel from the United States. These guidelines have stimulated generation of similar recommendations from all over the world, particularly Europe, Canada, Australia and Asia. Developed by a renowned group of leading international experts, the book offers state-of-the-art chapters that are peer-reviewed and represent a comprehensive assessment of the field. A major addition to the literature, Dyslipidemias: Pathophysiology, Evaluation and Management is a gold-standard level reference for all clinicians who are challenged to provide the best care and new opportunities for patients with dyslipidemias.

Apoptosis or programmed cell death is increasingly considered to be a major factor in the development and progression of cardiovascular disease. In patients with heart failure the activation of apoptosis may result in the loss of irreplaceable cardiac myocytes promoting the clinical course of the syndrome. Moreover, in the coronary arteries inflammation and apoptosis may weaken critical structures of the vessel wall leading to plaque rupture and, subsequently, to myocardial infarction. Given these deleterious consequences, it seems almost paradoxical that programmed cell death is an active process that, if initiated under physiological circumstances, is essential for both coordinated tissue growth or destruction of malignant cells. Apoptosis in Cardiac Biology, written by a team of internationally renowned researchers, gives a timely synopsis of basic mechanisms, cellular and structural targets and, finally, clinical implications of programmed cell death in the heart. The expert authors of this volume give concise overviews on general and cell-specific aspects of programmed cell death in cardiac myocytes and fibroblasts, as well as in vascular smooth muscle and endothelial cells. Furthermore, novel therapeutic options arising from the outstanding pathophysiological significance of cardiac apoptosis are presented. This comprehensive review of Apoptosis in Cardiac Biology will be of interest to both clinicians and basic researchers who are active in the fields of cardiology and atherosclerosis.

In the course of the last two decades, it has become increasingly evident that the sarcolemmal, sarcoplasmic reticular and mitochondrial membrane systems play an important role in determining the status of heart funotion in health and disease. These organelles have been shown to be intimately involved in the regulation of cation movements during the contraotion-relaxation cycle. Various proteins imbedded in the phospholipid 2+ + - + + bilayers of these membranes control Ca, Na, Cl, K and H concentrations within the oytoplasm by indirect or direct means. Cationic channels, Na+, + 2+ 2+ 2+ + 2+ + + K -ATPase, Ca IMg ATPase, Ca pump, Na -Ca exchanger, Na -II exchanger and adenylate cyclase affect myocardial funotion and viability through their role as regulators of specific ion movements. However, proteins are not the only important constituents of the membrane. Any disturbance in the interaction between proteins and phospholipids in the membrane has been suggested to alter the funotion of the organelles, upset ionic homeostasis and precipitate the development of abnormalities in oardiac performance. It is, therefore, orucial to understand the faotors whioh regulate membrane funotion in their totality if we are to oomprehend the nature of heart performanoe in healthy subjects. Similarly, the study of membrane dysfunotion in a wide variety of experimental models of heart disease at various stages of failure is essential if we are to fully understand the pathogenesis of heart dysfunotion and improve its treatment.

The Portfolio Diet for Cardiovascular Disease Risk Reduction: An Evidence Based Approach to Lower Cholesterol through Plant Food Consumption examines the science of this recommended dietary approach to reduce cholesterol in addition to other risk factors for cardiovascular disease. With a thorough examination into the scientific rationale for the use of this diet, discussions are included on the experimental findings both for the diet as a whole, and its four principle food components: nuts and seeds, plant based protein, viscous fibers, and plant-sterol-enriched foods. Environmental and ethical considerations of the diet are also discussed, showing the ramifications of food choice on health and beyond. Referenced with data from the latest relevant publications and enhanced with practical details (including tips, dishes, and menus), the reader is enabled to meet the goals of cholesterol lowering and cardiovascular disease risk reduction while also taking the health of the planet into consideration.

This 304 page full-color textbook is essentially two volumes in one. The first 92 pages present the basic principles of 12 lead ECG interpretation. The remainder of the book focuses on the evaluation of Acute Coronary Syndrome (ACS) patients. 13 ECG patterns associated with ACS are presented, including the most subtle ECG changes most often missed by clinicians and the ECG machine 's automated interpretation software. The curriculum provides an in-depth, balanced approach to patient assessment, combining advanced ECG interpretation skills with patient history, risk factor and cardiac marker evaluation. Correlation of ECG leads with the coronary arterial distributions which commonly supply each region of the heart are reinforced by use of 24 case studies of ST Segment Elevation Myocaridal Infarction (STEMI), Non ST Segment Elevation Myocardial Infarction (NSTEMI), Unstable Angina, and Brugada Syndrome. STEMI Case Studies emphasize the ECG identification of the infarct related artery, and complications to be expected based on failure of cardiac structures commonly supplied by the obstructed arterial distribution. Case studies begin with patients' initial assessment data obtained in the emergency department and continue into the cardiac catheterization lab where coronary artery angiography illustrates the location of arterial obstruction. Key learning objectives for each type of Myocardial Infarction (MI) are highlighted. 453 full color images, 135 review questions, and 114 ECGs reinforce the learning process. Target audience is all medical professionals whom are already competent in single-lead rhythm strip evaluation, and desire to become proficient in the 12 lead ECG evaluation of Acute Coronary Syndrome patients. This book was written and reviewed by veteran cardiac cath lab interventionalists. View this book 's Table of Contents on the publisher 's website: www.TriGenPress.com An instructor 's package with PowerPoint slides is also available from TriGen Publishing.

This compact guide on the practical management of the hypertensive individual first saw light in 1990. The underlying concept was, and still is, to produce an easily accessible 'leaf-through' type of mini-textbook on the hypertensive individual's condition and the many dilemmas that surround diagnosis, surveillance and intention to treat or not treat. Our primary aim has been to promote a utilitarian train of thought in the decision-making process in practice, whether general or specialistic. In pursuing this policy, we felt, however, that the terms of practical orientation and advice should be matched, in a concise form, to scientific arguments whenever possible. This cannot always be achieved in reality, so that some chapters unavoidably have a more scientifically-oriented flavour than others. For the 'eager reader' in search of more scientific facts, selected references have been provided. One may rightfully wonder whether such a concept would not turn into a hybrid kind of hypertension guide. And, yes, this booklet has become something of a hybrid, a compromise between an ultra lean and superbly pictorial compendium like the Clinician's Manual on Hypertension (Hansson, 1990) and the ABC of Hypertension (O'Brien et aI., 1995) on the one hand, and full-blown textbooks (e. g. Laragh and Brenner, 1995; Swales, 1995) and even the Handbook of Hypertension Series, Birken hager and Reid (1983 onwards) on the other."

Secondary forms of hypertension are not uncommon in clinical prac tice, but they are often overlooked or forgotten by clinicians in many fields of medicine. Dr. George Mansoor' s volume on Secondary Hyper tension is an important contribution to the field of clinical hypertension and vascular diseases, since it brings up to date the numerous diagnostic and therapeutic advances in the evaluation for secondary types of hyper tension. In the past, textbooks usually stated that an etiology could be determined in less than 5% of patients presenting with newly diagnosed hypertension. We now know this is far too low a proportion (e.g., pri mary hyperaldosteronism alone may account for hypertension in 5% of patients presenting with chronic elevations in blood pressure). Secondary Hypertension has been thoughtfully organized into chap ters evaluating screening and diagnosis, as well as medical and/or sur gical intervention of the well-known etiologies of secondary hypertension in adults and children. Additional coverage is given to such exogenous or lesser appreciated causes of secondary hypertension as obstructive sleep apnea and drugs. These sections make this book novel because in the past little attention has been paid to the effects of noncar diac drugs that interfere with antihypertensive therapy or to exogenous substances that might induce refractory hypertension."

Recent advances in technology have opened up new possibilities in the diagnosis and treatment of cerebrospinal vascular diseases. It is now possible to use magnetic resonance imaging to map brain function and metabolism as an aid to diagnosis. Novel applications of magnetic resonance angiography allow three-dimensional imaging, and the magnetization transfer contrast technique gives us a new window on cerebral vascular function. This volume presents work in all these fields as well as previewing the techniques of endovascular surgery for cerebrospinal vascular diseases. These include modern stereotactic radiosurgery for arteriovenous malformations and for angiographically occult vascular malformations of the brain. This book presents an overview of the latest applications of technology to this rapidly developing and challenging field.

It is indeed ironical that in the absence of a complete knowledge of Pathophysiology, clinical cardiologists are left with no choice but to do the best they can to help the patient with the armamentarium of drugs at their disposal. But nothing could be further from truth than to treat the diagnosed end point of a disease process without a full understanding of its patho physiology. This point was eloquently made by Dr. Arnold Katz in his Presidential Address (Chapter 1) at the 8th Annual Meeting of the American Section of the International Society for Heart Research held in Winnipeg, Canada, July 8-11, 1986. This volume represents a part of the scientific proceedings of this Meeting. From a reading of this treatise it will become evident that discoveries of newer scientific facts as well as a better understanding of pathophysiology are continuously influencing/ improving our therapeutic approaches in modern medicine. In this book, latest biochemical, physiological and pharmacological findings on different experimental models such as Myocaridal hypertrophy, Hypertension and heart failure, Diabetes, Cardio myopathies and Cardiac function in shock are described by internationally recognised experts. Hopefully information presented here will provide another building block to the edifice of Science of Cardiology which we all are trying to create. Acknowledgements We are grateful to the following Agencies and Foundations for their generous financial support of the Symposium, which formed the basis of this book. A. Major Contributors: 1. Manitoba Heart Foundation 2. Sterling-Winthrop Research Institute 3. Squibb Canada, Inc."

Contrast agents for medical ultrasound imaging is a field of growing interest. A large amount of literature has been published on the medical applications of such contrast agents. However, there is no textbook giving a broad overview of the physics and acoustics of the agents. This monograph aims to fill this gap. The book is written by a physicist, from a physics point of view, and it tries to draw links from the physics and acoustics to the medical imaging methods, but medical applications are mainly included for background information. The book consists of nine chapters. The first three chapters give a broad overview of the acoustic theory for bubble-sound interaction, both linear and nonlinear. Most contrast agents are stabilized in a shell, and this shell can have a strong influence on the interaction between the bubbles and the ultrasound. The effect of the shell is given special attention, as this is not easily found in other bubble literature. The following chapters, 4, 5, 6, and 7, describe experimental and theoretical methods used to characterize the acoustic properties of the agents, and results of studies on some agents. Chapter 8 shows how the theory and the experimental results can be combined and used to model various phenomena by means of computer simulations. The main purpose of the simulations is to get insight into the mechanisms behind the described phenomena, not to get accurate predictions and values. The book is aimed at both newcomers into the field, as well as those who are more experienced but want better insight into the acoustics of the contrast bubbles.

Molecular Defects in Cardiovascular Diseaseprovides an in-depth discussion of the molecular mechanisms underlying the genesis of cardiovascular defects and the implications this has on current and emerging targeted therapeutics. Divided into three sections, this book covers the scientific foundations of our present understanding as well as the array of clinical manifestations and their treatment. The first section covers Molecular Mechanisms of Heart Disease, with discussion of the development of cardiovascular dysfunction. The remaining two sections provide a more clinical focus. The second, Cardiac Hypertrophy and Heart Failure deals with metabolic derangements, Ca2+ handling, and subcellular remodeling. It illustrates the wide variety of molecular defects which may serve as targets associated with the transition from cardiac hypertrophy to advanced heart failure. The third section, Hypertension and Diabetes, provides molecular rationale for the pathogenesis of hypertension and diabetic cardiomyopathy, as well as highlighting the importance of hormones toward this end.

A necessary resource for clinicians and researchers, this book elucidates the experimental basis of the practice of cardiology. It is the culmination of our advances in the understanding of cardiovascular molecular biology and a blueprint for the efficacious use of targeted therapies.

Cardiovascular disease continues to be the number ioral medicine" was developed and shaped into the one source of morbidity and mortality in our coun- following definition: try. Despite a 35% reduction since 1964, these Behavioral medicine is the interdisciplinary field con- diseases, particularly coronary heart disease cerned with the development and integration of behav- (CHD), claim nearly 1,000,000 lives each year in ioral and biomedical science knowledge and techniques the United States (Havlik & Feinleib, 1979). relevant to the understanding of health and illness and The Framingham study, among others, has iden- the application of this knowledge and these techniques to prevention, diagnosis, treatment and rehabilitation. tified three major risk factors implicated in the de- (Schwartz & Weiss, 1978) velopment of CHD: smoking, elevated serum cho- lesterol, and high blood pressure (Castelli et at., This concept of "biobehavioral" collaboration 1986). Given that these factors account for less challenged scientists and clinicians of many disci- than 50% of the variance associated with CHD plines to consider how they might more effectively (Jenkins, 1976), it has become obvious that addi- develop diagnostic, treatment, and prevention tional risk factors must be identified if further pro- strategies by merging their perspectives to address gress is to be made in disease prevention and simultaneously, among others, behavioral, psy- control.