End-of-life issues in cardiology are becoming increasingly important in the management of patients in the cardiac unit, but there is frequently a lack of understanding regarding their impact on cardiology practice. The cardiac unit is increasingly becoming the location whereby a number of key clinical decisions relating to end-of-life care are being made, such as the decision to remove medications, the appropriate removal of cardiac devices, the management of do not resuscitate orders and the requirement for other cardiac procedures in light of the management of the terminally ill cardiac patients. Those working in palliative care need input from the cardiovascular team as the cardiologist is frequently still managing these patients until they are moved to the hospice. That this move into a hospice is often delayed until the very last moment, there is considerable onus on the cardiovascular management of these patients to be much broader in scope and take account of some of the more palliative medical decisions needed in this group of patients. This concise reference will detail the practical issues open to cardiovascular physicians and those medical professionals who manage patients reaching the end of their life from a cardiology perspective. It will detail the full management options open to them to ensure that their practice is in line with the requirements of the patient nearing the end of their life whether the cause be cardiovascular in origin or who need appropriate management of secondary cardiovascular symptoms. It will also include the various ethical, cultural and geographical issues that need to be considered when managing these patients.

Whenever the heart is challenged with an increased work load for a prolonged period, it responds by increasing its muscle mass--a phenomenon known as cardiac hypertrophy. Although cardiac hypertrophy is commonly seen under physiological conditions such as development and exercise, a wide variety of pathological situa tions such as hypertension (pressure overload), valvular defects (volume overload), myocardial infarction (muscle loss), and cardiomyopathy (muscle disease) are also known to result in cardiac hypertrophy. Various hormones such as catecholamines, thyroid hormones, angiotensin II, endothelin, and growth factors have also been shown to induce cardiac hypertrophy. Although the exact mechanisms underlying or pathological forrns of cardiac hypertrophy are poorly under the physiological stood, an increase in the intraventricular pressure is believed to represent the major stimulus for the development of cardiac hypertrophy. In this regard, stretching of the cardiac muscle has been shown to induce the hypertrophic response, but the role of metabolic influences in this process cannot be ruled out. Furthermore, different hormones and other interventions in the absence of stretch have been observed to stimulate protein synthesis in both isolated cardiomyocyte and vascular myocyte preparations. Nonetheless, it is becoming dear that receptor as well as phospholipid linked signal transduction pathways are activated in some specific manner depend ing upon the initial hypertrophic stimulus, and these then result in an increase in the size and mass of cardiomyocytes.

Atrial Fibrillation from an Engineering Perspective provides an up-to-date overview of techniques developed for acquisition, modeling, and analysis of noninvasive, bioelectrical signals reflecting this common arrhythmia. Special emphasis is put on emerging technologies for monitoring of atrial fibrillation in connection with ischemic stroke, interventional ablation procedures, and pharmacological treatment, applications which all depend on the availability of techniques for detecting and characterizing episodes of paroxysmal atrial fibrillation. Detectors exploring both rhythm and morphology are described, as well as detectors confined to rhythm and better suited for low power implementation. A wide variety of approaches to modeling and characterization of atrial activity are described, emanating from a statistical and deterministic starting points. This book is suitable for graduate students, researchers, and engineers who want a comprehensive treatise of atrial fibrillation from an engineering perspective. It may be used for self-study, as a supplement to courses in signal processing, or as a modern monograph by researchers in the field of atrial fibrillation.

In this issue, guest editors bring their considerable expertise to this important topic. Provides in-depth reviews on the latest updates in the field, providing actionable insights for clinical practice. Presents the latest information on this timely, focused topic under the leadership of experienced editors in the field. Authors synthesize and distill the latest research and practice guidelines to create these timely topic-based reviews.

Cardiac Ischemia: From Injury to Protection has been divided into six parts. The first part describes the differences between hypoxia and ischemia, animal models, the effects of ischemia on myocardial function and metabolism, and the electrophysiological consequences of ischemia. The second part deals with the mechanisms of cardiomyocyte death in ischemia, structural aspects of irreversible ischemic injury, necrosis and apoptosis of cardiac cells, the role of calcium, and the concept of calcium antagonism. The third chapter is a brief description of reperfusion injury, its clinical relevance, and possible prevention. The fourth part summarizes changes in myocardial vasculature during ischemia and reperfusion. The fifth part is the survey of two main possibilities for increasing cardiac resistance to ischemia and hypoxia, i.e. long-lasting adaptation to chronic hypoxia and short-lasting preconditioning. The last part of the book deals with comparative and ontogenetic aspects of cardiac sensitivity to oxygen deprivation; this chapter also summarizes the ontogenetic differences and limitations in endogenous and exogenous protection of the ischemic/hypoxic heart.

In this issue, guest editors bring their considerable expertise to this important topic. Provides in-depth reviews on the latest updates in the field, providing actionable insights for clinical practice. Presents the latest information on this timely, focused topic under the leadership of experienced editors in the field. Authors synthesize and distill the latest research and practice guidelines to create these timely topic-based reviews.

In the 1980's a primary focus for intense cardiovascular research is in the treatment of patients with acute myocardial infarction. Although the prevalence of this syndrome has been decreasing in the United States, still over 1.5 million patients develop myocardial infarction per year. There is about a 20% chance of a North American male developing myocardial in farction before the age of 65. The in-hospital mortality still remains at ap proximately 10070-15070 and advances in pharmacologic and device therapy have allowed for the intensification of research in the treatment of patients with acute myocardial infarction. The following manuscripts represent the collective efforts of academic in vestigators in the United States and abroad as well as members of the phar maceutical industry, and the Food and Drug Administration to address the issues involved in interventions in the acute phase of myocardial infarction. State-of-the-art papers addressing important topics are followed by discus sion sections which have allowed participants to express their own viewpoints leading to a consensus opinion. The first part of this Symposium addresses the models of experimental myocardial infarction followed by the important issue of how one defines myocardial infarction size. The latter is extremely important to be certain that endpoints of therapeutic or device interventions are objective and reproducible. A detailed description of the pharmacological interventions to reduce myocardial infarction size as well as newer devices to effect mechanical and electrical disorders provide an up-to-date summary of current opinion."

Nitric oxide (NO) is one of the most remarkable biological molecules characterized at the turn of XX century. Small in size, but ubiquitous and complex in its network of molecular, cellular and organ inter- tions, NO plays an important role in mammalian and non-mammalian biology. The scope and versatility of NO actions on the biological systems range from neuromodulation and regulation of cardiovascular homeostasis to cell signaling and immunity. An impressive array of physiologic and pathologic reactions are controlled by or associated with changes in the biological specter of NO. The career of NO in science started from a handful of publications written before 1986 to more than 52,000 contributions at the end of 2002 (Pubmed, National Library of Medicine). More than 15,000 publications deal with the effects of NO in the cardiovascular system. The NO field has been recently knighted with the 1998 Nobel Prize in Medicine awarded to R.F. Furchgott, F. Murad and L.J. Ignarro."

In this issue of Cardiac Electrophysiology Clinics, guest editors Giuseppe Bagliani, Roberto De Ponti, and Fabio Leonelli bring their considerable expertise to the topic of the multifaced aspects of atrial flutter interpreted by precision electrocardiology. Top experts in the field teach readers to discriminate the different forms of atrial flutter based on surface electrocardiogram and intracavitary signals and to correctly approach this arrhythmia invasively by ablation. Readers will also learn the importance of the appropriate treatment in different patient populations. Contains 14 practice-oriented topics including normal and abnormal atrial anatomy relevant to atrial flutters: areas of physiological and acquired conduction blocks and delays predisposing to re-entry; electrocardiographic approach to atrial flutter: classifications and differential diagnosis; pathophysiology of typical and atypical atrial flutter; atrial flutters in adults with congenital heart disease; and more. Provides in-depth clinical reviews on atrial flutter as interpreted by precision electrocardiology, offering actionable insights for clinical practice. Presents the latest information on this timely, focused topic under the leadership of experienced editors in the field. Authors synthesize and distill the latest research and practice guidelines to create clinically significant, topic-based reviews.

This book describes mathematical models and numerical techniques for simulating the electrical activity in the heart. It gives an introduction to the most important models, followed by a detailed description of numerical techniques. Particular focus is on efficient numerical methods for large scale simulations on both scalar and parallel computers. The results presented in the book will be of particular interest to researchers in bioengineering and computational biology.

About 2. 5 million individuals have congestive heart fai lure in the United States with over 400,000 new cases expected annually. Congestive heart failure also is one of the commonest causes for hospital admissions accounting for over 5 million hospital days per year. Despite the early recognition of this condition and active medical research into both mechanisms and therapy, prognosis continues to remain dismal wi th less than a 50% expected five year survival. In the last decade we have seen many new medical and therapeutic options for patients with congestive heart failure which extend beyond the use of bed rest, sodium restriction, digitalis and diuretics. These include vasodilators of a variety of types including the angiotensin conventional enzyme (ACE) inhibitors. Also, many new inotropes are under active investigation both in oral and intravenous forms. In March of 1984 a survey of over 5000 physicians was performed under the auspices of the American Heart Association (reported in: JAOC 8:966, 1986). That survey showed that there was no universally accepted defini tion for congestive heart fai lure and that a wide spectrum of diagnostic cri teria for this common condi tion existed even among academic cardiologists. There was no clear standard as to even the mos t bas ic treatment of conges t i ve heart fai lure. For example, exercise restriction was recommended by 19% of physicians, 31% recommended no change in activity, and 50% either light exercise or an exercise conditioning program.

Despite numerous reports of cerebral damage in cardiac surgery, the subject has not been given the attention it requires. This book with a preface by Torkel Aberg, will remedy that situation. The causes and incidence of pre- and post-operative cerebral damage are considered in the first section. Cardiac surgery patients frequently have "preoperative" cerebral impairment, not surprising when one considers the impaired circulation from a damaged heart and the brain's prodigious need for blood. Moreover, several perioperative aspects of surgical procedures have been considered as possible causes of cerebral dysfunction, for example: microbubbles, toxic by-products, non-pulsatile blood flow. The second section describes how "imaging techniques" (CT scan, MRI, regional cerebral blood flow imaging), and "functional assessment" techniques, (Pet scan, EEG, BEAM and evoked potentials) can be used to measure cerebral damage. In the third section, psychometric and neuropsychological techniques are used to assess impaired mental abilities (abstract thinking, language, memory, visuo-spatial ability, mental flexibility, attention and concentration). The final section explores the relationship between cerebral dysfunction and psychopathology (several types of depression, anxiety, and aspects of organic brain syndrome, delirium and dementia).

Until recently, the renin-angiotensin-aldosterone system has been considered a systemic endocrine hormonal system exclusively. It is now known that each component of the renin-angiotensin system is produced, synthesized and indeed, present in many organisms including the heart and vessels. This volume presents the most recent clinical and laboratory experiences of the leading physicians and investigators in the field of the local cardiac renin-angiotensin aldosterone system.

Cardiovascular, renal and hypertension oriented physicians, investigators and scientists would find this book of interest.

Edward D. Frohlich, M.D., M.A.C.P, F.A.C.C., is the Alton Ochsner Distinguished Scientist at the Ochsner Clinic Foundation in New Orleans, Louisiana. He is also Professor of Medicine and of Physiology at Louisiana State University School of Medicine, New Orleans, and Clinical Professor of Medicine and Adjunct Professor of Pharmacology at Tulane University School of Medicine, New Orleans. He is past Editor-in-Chief of the American Heart Association journal HYPERTENSION.

Richard N. Re, M.D., is the Section Head, Hypertension at the Ochsner Clinic Foundation in New Orleans, Louisiana. He is also Ochsner's Scientific Director of Research.

In this greatly enlarged and thoroughly updated edition of his much praised Cardiac Markers, Alan Wu and his contributors focus on the use of markers in the practice of cardiology and-for the first time-on the use of natriuretic peptides for congestive heart failure. Here, leading international authorities in clinical chemistry and laboratory medicine, cardiology, emergency medicine, and the in vitro diagnostics industry describe the state-of-the-art uses of cardiac markers when treating coronary artery disease, and discuss in detail how they may be optimally used in a clinical setting. Comprehensive and cutting-edge, Cardiac Markers, Second Edition offers physicians a complete guide to the use of cardiac markers in clinical practice and clinical laboratorians a close-up view of the new markers now becoming standard.

The International Brain Hypothermia Symposium 2004was the second time I have had the honor of opening such a gathering on brain hypothermia treatment. It was a great pleasure to greet the participants in the hope that their valuablecontributions would make the Tokyo meeting memorable. Brainhypothermia has long been seen as a promising method that may overcome current limitations on brain resuscitation in patients with severe brain damage. However, although excellentresults have been obtained in experimental animal models, for some reason brain hypothermia has not alwaysbeen successful clinically, and resolving this problem has been a major challenge facing physicians specializing in brain therapies. The ICUmanagement of recent research has uncovered newmechanisms ofbrain damage not seen in animal models, including brain thermo-pooling at temperatures above 40 C in severe brain damage, masking neuronal hypoxia even with normal cerebral blood flow. Stress-related hyper glycemia with brain hypothermia was expected to generate useful results in patients with external injuries, cerebral occlusive stroke, and cardiac arrest. In recent clinical studies of brain hypothermia treatment, many excellent results began being reported on the manage ment of severe brain injury, ischemic stroke, and post-resuscitation after cardiac arrest. However, in clinical brain hypothermia treatment many questions remained about appro priate treatment targets, leu management technique, prevention of complications, control of brain tissue temperature, management of hypothermia insult, and mechanisms underly ing the onset of vegetative states."

This book covers the latest developments in the therapeutic implications of angiogenesis, ranging from angiogenesis in the brain, angiogenesis in cancer, angiogenesis' role in atherosclerosis and heart disease as well as metabolic disorders and peripheral vascular disease. The book is comprehensive in its coverage of angiogenesis in a diverse set of diseases and examines the role of cellular and subcellular structures during the development of angiogenesis. Well-organized and thorough, this is an ideal book for researchers and biomedical engineers working in the field of therapeutic implications of angiogenesis. This book also: Covers the basics of the physiology of angiogenesis, including VEGF pathways in angiogenesis, integr ins in angiogenesis, angiogenesis and exercise physiology, and more Details the role of angiogenesis in atherosclerosis and heart disease, including vascular endothelial growth factor and atherosclerotic plaque progression as well as angiogenesis and heart failure Illustrates in detail brain angiogenesis after stroke and the relationship between angiogenesis and Alzheimer's disease

This book covers aspects of new developments in the field of basic electrophysiology, cardiac pacing, implantable defibrillators and addresses socioeconomic aspects related to thse topics. The section on electrophysiology provides a comprehensive overview of basic hardware equipment, sudden death, heart rate variability, signal averaged ECG, RF catheter ablation and clinical decision making. The section on pacing includes overviews on new lead developments, pacing in cardiomyopathy, as well as VVIR & DDIR pacing and automatic mode switching. Finally the section on implantable defibrillator provides a detailed view of clinical and technical aspects of third generation devices. All chapters have been written by world experts in their fields and each chapter is fully illustrated with tables, ECG recordings and black and white photographs. The book should be of use to nurses, technicians, bioengineers, cardiologists, cardiovascular surgeons, health authorities and for all who are involved in the field of pacing and electrophysiology.

The management of patients who present with a myocardial i nfarcti on has altered radi ca lly over the past two decades. The expansion of knowledge relating to the epidemiology of the condition together with a greater understanding of the causes of the early mortality from it have resulted in major changes in the way these pati ents are treated duri ng the acute phase of the illness. The deve 1 opment of 'dedi cated' Coronary Care Units in hospitals and the recogni ti on of the need for ' Mobile Coronary Care Units' in the cOl1Ul1unity have made a major impact upon the early mortality from myocardial infarction. Over the past decade, a great deal of attention has been paid to strategies designed to limit the size of a myocardial infarct. As an extensi on of thi s approach, the 1980' s have seen the evo 1 uti on of techniques for revascularization of ischemic tissue. All these procedures while appearing to hold the promise of reducing the acute mortality from myocardial infarction, create the need for a planned approach to the long term management of these patients. While there are some modest i ndi cati ons that coronary atherosc 1 erosi s coul d be arrested or even reversed, for all practical purposes it remains a chroni c progressi ve di sease.

Antiplatelet therapy is the cornerstone of treatment of ischemic cardiovascular disease and over the last few years spectacular advancements in this field have been recorded. This is the first comprehensive handbook entirely dedicated to all the aspects of antiplatelet therapy. The book is divided into three main sections, pathophysiology, pharmacology and therapy, for a total of 23 chapters. A large group of leading experts from different European countries and from the USA, both from academia and industry, have contributed to the book. Besides a detailed overview on the pharmacology and clinical applications of all the currently used or of the novel antiplatelet agents, innovative approaches (e.g. intracellular signalling as an antiplatelet target, small RNAs as platelet therapeutics, etc.) or unconventional aspects (e.g. pharmacologic modulation of the inflammatory action of platelets are also treated. The book is oriented to both basic investigators and to clinicians involved with research on platelet inhibition or with the clinical use of antiplatelet therapies.

Remarkable progress has been made in understanding and treating heart failure. Among other developments, angiotensin-converting enzyme inhibitors and b blockers have been found to have beneficial therapeutic effects, reinforcing the view that heart failure may be both a hemodynamic and a neurohumoral disorder. The Japanese Heart Failure Society was established to curb the threat of heart failure through research, education, and clinical practice. At the Societys 2nd Annual Scientific Meeting in Sapporo, molecular biologists, physiologists, clinicians, surgeons, and researchers in related fields met to strengthen professional bonds for the ultimate goal of preventing death from heart failure. This book contains presentations from the Sapporo conference that provide new insights into heart failure in the areas of pathophysiology, cardiac sudden death, medical and surgical treatment, and promising new gene therapy.

In this issue of Cardiology Clinics, guest editors Drs. Timothy D. Henry and Santiago Garcia bring their considerable expertise to the topic of COVID-19. Top experts in the field cover key topics such as prothrombotic effects of COVID-19; impact of the COVID-19 pandemic on acute myocardial infarction care; impact of the COVID-19 pandemic on cardiac arrest and emergency care; vaccine-related cardiovascular effects; and more. Contains 11 relevant, practice-oriented topics including cardiovascular manifestations of COVID-19; use and prognostic implications of cardiac biomarkers (Troponin); COVID-19: Insights from cardiac pathology; ACS in COVID-19; STEMI in COVID-19; and more. Provides in-depth clinical reviews on COVID-19, offering actionable insights for clinical practice. Presents the latest information on this timely, focused topic under the leadership of experienced editors in the field. Authors synthesize and distill the latest research and practice guidelines to create clinically significant, topic-based reviews.