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."

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.

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.

Diabetes is a major public health problem which is expected to affect 160 million people worldwide by the year 2000. Clearly an understanding of the effects of diabetes on the heart is an important step in the development of strategies to reduce the incidence of heart disease for diabetic patients, thus increasing their overall life-expectancy and quality of life. In this book, the editors bring together the different lines of evidence supportive of the idea of a diabetic cardiomyopathy. The first chapter provides an overview of the impact of cardiac dysfunction on the mortality and morbidity of the diabetic population in general, as well as a presentation of clinical aspects of heart disease in diabetes. This is followed by chapters concerned with the pathological and functional changes that occur in the heart as a result of diabetes and a description of the various therapeutic interventions that are available to reverse the effects of diabetes on the heart. Subsequent chapters focus on changes in protein synthesis, membrane function and intermediary metabolism that take place following the onset of diabetes. Since these alterations precede many of the functional and pathological changes, it may be that the processes responsible for the functional decline and tissue injury are initiated by diabetes-induced changes at the cellular and/or biochemical level.

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.

Implantable defibrillators as originally conceived by Michel Mirowski were limited to the detection and automatic termination of ventricular fibrillation. In the original "AID" device, the detection algoritlun sought to distinguish sinus rhytlun from ventricular fibrillation by identifying the "more sinusoidal waveform of ventricular fibrillation. " The therapeutic intervention was elicited only once deadly polymorphic rhythms had developed. It was rapidly learned, however, that ventricular fibrillation is usually preceded by ventricular tachycardia. Mirowski recognized the pivotal importance of developing algoritllms based on heart rate. Ventricular tachycardia detection allowed the successful development of interventions for the termination of ventricular tachyarrhythmias before they degenerated into ventricular fibrillation. Current device therapy no longer confines itself to tlle termination of chaotic rhythms but seeks to prevent them. Diagnostic algorithms moved upward along the chain of events leading to catastrophic rhytlulls. Rate smoothing algorithms were developed to prevent postextrasystolic pauses from triggering ventricular and atrial tachyarrhytlmlias. Beyond the renaissance of ectopy-centered strategies, long-term prevention received increasing attention. Multisite pacing therapies provided by "Arrhythmia Management Devices" were designed to reduce the "arrhytlunia burden" and optimize the synergy of cardiac contraction and relaxation. Clinical evidence now suggests that atrial fibrillation prevention by pacing is feasible and tllat biventricular pacing may be of benefit in selected patients with heart failure. However, these applications of device therapy that generally require ventricular defibrillation backup remain investigational and were not considered in this book.

The physiological genomics of the cardiovascular system studies the relationship between gene and physiological (dys)function. It is a rapidly developing area of research and distinguishes itself from other areas of molecular medicine by its highly integrative nature. In this multi disciplinarian area of the physiological sciences, there is interaction between gene structure and physiological cardiovascular function as well as interactions between the different organs and their physiological compartments. The mouse has played a central role in the study of genomics due to the detailed knowledge of the mouse genome and the wide availability of genetically modified mice. In the past, the mouse had mainly been used in the area of immunology and molecular biology, and physiological interest in the mouse was scarce. As more insight has come into the structural genomics of the mouse, however, it has become increasingly important to understand the relation between gene and physiological function. With this in mind we have been organizing the Amsterdam Mouse Symposia to bring together different disciplines interested in the molecular basis of cardiovascular function (see J. of Clinical and Exp. Pharmacology and rd Physiology (2002) 29: A69-AI02 for the proceedings of the 3 Amsterdam Mouse Symposium and Basic Research in Cardiology (2000) 95:492-535 for nd the proceedings of the 2 symposium)."

These Proceedings are from the Fifth Annual Meeting of the American Section of the International Society for Heart Research held at Hilton Head Island, South Carolina, September 21-24, 1983. The program and abstracts were published in the Journal of Molecular and Cellular Cardiology, Vol. 15, Supplement 4, September 1983, Academic Press. This Symposium Proceedings consists of three sections. Section I deals with the mechanical factors and their i'nfluence on coronary blood flow in the normal and failing heart. Section II is developed around the area of vascular smooth muscle and the factors that may control it which ultimately play such an important role in the regulation of coronary blood flow. Section III is primarily devoted to the mechanical aspects of the function of the heart in both hypertrophy and failure including the molecular changes in the myocyte, alterations in neural control, and in inotropic responsiveness of the hypertrophied and failing heart. The editors hope that these three areas encompass a significant body of new and ongoing information that will be helpful to those who work in these areas as well as those who treat patients with varying degrees of myocardial failure or with compromised coronary circulations. The editors express their appreciation to all the contributors and to Ms. Jeri B. McClain for assisting in the organization and compiling of this volume. Francis L. Abel, M. D. , Ph. D. Walter H. Newman, Ph. D.

Cardiac ultrasound has rapidly developed into one of the most important clinical methods for diagnosis and follow-up of patients with heart disease and has changed the practice of cardiology permanently. In addition to improving image quality, most of the progress relies on digital image acquisition, storage, and quantitative analysis equipment. Automatic endocardial detection and three- dimensional reconstruction are now being developed. The progress with contrast echocardiography for myocardial perfusion imaging and results with tissue characterization is slow, but ever increasing, illustrating that the full potential of the method has not yet been explored. All of these digital techniques are extensively dealt with in this volume. Computerized tools will help the clinical cardiologists in their daily practice and stimulate further development to gen- uinely improve patient care in the coming years. We wish to thank the authors to this volume for their excellent contribution and Mrs. T. van der Kolk for secretarial assistance. IX Contributors F. J. ten Cate Thorax Center, Erasmus University, P. O. Box 1738, 3000 DR Rotterdam, The Netherlands R. Erbel II Medical Clinic, Johannes Gutenberg University, Langenbeckstr. 1, P. O. Box 3960, D-6500 Mainz, FRG Co-authors: R. Zotz, B. Henkel, G. Schreiner, C. Steuernagel, R. Zahn, H. Kopp, W. Clas, R. Brennecke, P. Schweizer, J. Meyer S. B. Feinstein Division of Cardiology, Box 44, University of Chicago, 950 East 59th Street, Chicago, IL 60637, USA D. G. Gibson Department of Cardiology, Brompton Hospital, Fulham Road, London SW3 6HP, UK Co-author: R. B. Logan Sinclair E.

Leading practitioners from the University of Pennsylvania review all aspects of heart failure diagnosis and management, with a particular emphasis on office-based/ambulatory care. Following the problem-solving steps used in an office-based practice, the authors provide extensive coverage of the presenting signs and symptoms of heart failure, as well as the tools with which to evaluate left-ventricular function, hemodynamics, and exercise performance. They also discuss the complex, evidenc-based therapeutic options for treating patients with dyspnea, fatigue, or edema, following the new ACC/AHA heart failure guidelines that are specifically and directed at targeted symptoms.

Cardiac Cellular Electrophysiology is intended for the clinical cardiologist who wishes to refresh or deepen his understanding of the cellular basis of cardiac electrophysiology, for researchers interested in the basis of the electrical activity of the heart, such as clinical investigators, physiologists or pharmacologists, for teachers in physiology, pharmacology and other biomedical studies, and for medical students from graduate to postgraduate level. Cardiac Cellular Electrophysiology starts with a primer of basic electrophysiology, the cardiac action potential and the physiological basis of the electrocardiogram. Our second aim after having introduced the basic concepts was to continue with giving an overview of the properties of the most important ionic currents in the heart, and to treat their modulation, in order to deal with the mechanisms underlying cardiac ischaemia, arrhythmias and remodelling. Edward Carmeliet and Johan Vereecke, Katholieke University Leuven, Belgium, have collaborated for over 30 years in cardiac electrophysiology research. Their studies include the genesis of the normal action potential, its changes in ischaemia, the effect of drugs, and the mechanism of arrhythmias, using techniques from the classic potential registration with intracellular microelectrodes to whole cell clamp and single channel measurements.

New Horizons for Failing Heart Syndrome brings together the latest knowledge on heart failure syndrome and the status of research on heart failure in Japan, compiling the results of the Japanese Circulation Society's second research series. Contents include the molecular mechanism of heart failure, mechanics of contraction of the failing heart, energetics of the failing heart, exercise physiology, and new aspects of management of heart failure. The Japanese Circulation Society's 3-year project for research on heart failure was conducted in two series, the first from 1988 to 1991 and the second from 1992 to the spring of 1995. The present volume embodies the most up-to-date overview of current research being carried out in Japan today, and will be of special interest to cardiologists, researchers, and other practitioners in the field.