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.

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.

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."

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.

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.

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.

In this issue of Heart Failure Clinics, guest editors Drs. Alberto M. Marra, Pietro Ameri, and Alexander E. Sherman bring their considerable expertise to Challenges in Pulmonary Hypertension. Top experts in the field cover key topics such as gender aspects in pulmonary hypertension; PAH in connective tissue diseases beyond systemic sclerosis; genetic background of high altitude pulmonary edema; oxygen therapy in pulmonary vascular disease; and more. Contains 13 relevant, practice-oriented topics including rare forms of pulmonary hypertension; management of SARS-CoV-2 infection and COVID-19 in patients with pulmonary arterial hypertension; anabolic deficiency in pulmonary arterial hypertension; anticoagulation in pulmonary hypertension; and more. Provides in-depth clinical reviews on challenges in pulmonary hypertension, 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.

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."

Venous Ulcers, Second Edition, provides a comprehensive synthesis of evidence-based recommendations and the highest level of expertise from a leading group of doctors, which is a fundamental constituent for the appropriate management of nonhealing venous wounds in everyday practice. This book offers a fertile environment for a complete understanding of genetics and molecular and biochemical mechanisms that lead to the development and progression of venous ulcers, which is essential for elucidating the underlying pathophysiology and can be utilized for developing novel therapies and accessing previously inaccessible areas of research. Socioeconomic impact, impact on health-related quality of life, the clinical course of the disease, and diagnostic algorithms are elaborated in detail. All currently available treatment modalities are explained in a clinically applicable approach with particular emphasis on operative technique, technical feasibility, success rates (both clinical and technical), and side effects. Lastly, this book elaborates on special diagnostic considerations and management of the most complex patients, often requiring the highest level of expertise for successful treatment.

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.

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.

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.

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.

From the Proceedings of the Meeting of the American Section of the International Society for Heart Research (ISHR) at Hilton Head, South Carolina, September 21-24, 1983

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.

The importance of left ventricular hypertrophy (LVH) in cardiovascular disease has gained wide recognition. LVH is a highly important risk factor associated with major cardiovascular events, including symptomatic heart failure, particularly in patients with systemic hypertension. In recent years much has been learned about the genetics, molecular background, prevalence, incidence and prognosis of LVH. A variety of noninvasive methods has emerged for detecting LVH and the assessment of reversal of hypertrophy, yet a lot of controversy remains about the connotations and clinical implications of LVH. For instance, in the athlete's heart LVH may constitute a physiological adaptation to pressure overload, which normalizes following discontinuation of strenuous physical activity. On the other hand, in particular in patients with hypertension, LVH denotes a serious prognosis in the course of hypertension. In these patients LVH should be regarded as a grave prognostic sign rather than an innocent compensatory phenomenon. The distinction between physiologic and pathophysiologic LVH is the basis for this book. Left Ventricular Hypertrophy - Physiology versus Pathology is a bibliographical reflection of a Boerhaave Symposium held on April 9, 1999, in Leiden, The Netherlands. At this symposium the major issues in dealing with LVH were discussed, including etiology, genetics, detection, and therapy. In particular, the book includes novel detection methods for LVH such as magnetic resonance imaging and spectroscopy. Furthermore, much attention was paid to the molecular and genetic approach of LVH. This book will assist clinical cardiologists, fellows in cardiology, general internists, radiologists, cardiothoracic surgeons, biochemists, physiologists, pharmacologists, and basic research fellows in understanding the most recent insights in the background of physiologic versus pathologic LVH.

The early detection of myocardial damage is one of the major challenges in contemporary cardiology. New biochemical markers have now emerged which appear to be highly sensitive and specific for the assessment not only of patients with myocardial infarction but also of those with unstable angina and prolonged chest pains. Some of these markers, such as the troponins, have been shown to have prognostic value in the context of acute chest pain. The incorporation of novel markers of myocardial damage to the routine diagnostic armamentarium is not without difficulty. The reasons for this include cost-benefit implications and the lack of definitive comprehensive publications dealing specifically with these issues. Technical difficulties with some of the novel markers are also a problem in some cases and this issue also needs to be carefully reviewed. A critical analysis of the biochemical characteristics, sensitivity and specificity as well as the potential clinical applications of the new markers is required. This monograph addresses these issues and also sets up the basis for a redefinition of myocardial damage and myocardial infarction. The book will be of particular interest to biochemists, pharmacologists, cardiologists, general physicians and clinical and basic researchers. The important issue of myocardial damage in relation to pharmacological agents has been specifically addressed in the book and this topic will be of particular interest to both clinical pharmacologists and those working in the pharmaceutical industry. International authorities, whose original work and expertise in the field are widely recognised, have contributed chapters to the book.

Pulmonary embolism is a common but vexing illness. This book provides a contemporary overview of the most important issues from a Western and a Japanese perspective, providing the reader with state-of-the-art knowledge of the epidemiology and molecular biology of the disease. In the Diagnosis section, the relationship between venous thrombosis and pulmonary embolism is explored, and exciting new findings are presented in the fields of echocardiography and magnetic resonance imaging. The Management section focuses on surgical intervention with acute embolectomy as well as updating thromboendarterectomy for chronic pulmonary embolism. The importance of primary and secondary prevention is emphasized in chapters addressing low molecular weight heparin and the inferior vena cava filter. This cutting-edge book is a valuable resource for practicing physicians, researchers, and students in internal medicine, hematology, pulmonary critical care, and vascular medicine.

sCongenital heart disease is the leading cause of infant death and affects approximately one in every 100 babies born in the United States. The study of cardiovascular development has acquired new momentum in last twenty years due to the advancement of modern molecular biology and new available equipments and techniques. In Cardiovascular Development: Methods and Protocols expert researchers in the field in the field detail many of the methods which are now commonly used in the field of cardiovascular development research. These include methods and technique for using different organisms for cardiovascular developmental research, using cell and molecular biology methods to study cardiovascular development, as well as other available techniques for cardiovascular development research. Written in the highly successful Methods in Molecular Biology (TM) series format, chapters include introductions to their respective topics, lists of the necessary materials and reagents, step-by-step, readily reproducible laboratory protocols, and key tips on troubleshooting and avoiding known pitfalls. Authoritative and practical, Cardiovascular Development: Methods and Protocols seeks to aid scientists in understanding new state-of-the-art techniques in the field of cardiovascular development research including in vivo imaging and Bioinformatics.

In this issue of Interventional Cardiology Clinics, guest editor Dr. Marvin H. Eng brings his considerable expertise to the topic of Special Topics in Interventional Cardiology. Top experts in the field cover key topics such as cath lab management in the setting of an infectious disease pandemic; acute neurointervention for ischemic stroke; percutaneous large thrombus and vegetation evacuation in the cath lab; and more. Contains 12 relevant, practice-oriented topics including intra-cardiac echocardiography for tricuspid valve intervention; alcohol septal ablation for hypertrophic obstructive cardiomyopathy; use of electrosurgery in interventional cardiology; and more. Provides in-depth clinical reviews on special topics in interventional cardiology, 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.

Cardiovascular diseases are the most important causes of death in the world today. In adults, the most frequent heart disease is acute myocardial infarction, which can lead to sudden death. To prevent these diseases we need to fight against their main risk factors, which include smoking, lipid disorders, hypertension, diabetes and a sedentary life-style, among others. It has been demonstrated that physical exercise or sports at any age provide notable benefits and can help to decrease other risk factors and reduce the incidence of cardio vascular diseases. Exercise can be simply walking or cycling. Aerobic exercise con tributes to weight loss and also helps to control blood pressure, cholesterol and diabetes. It therefore plays an important role in prevention of heart diseases. Sports for young people are of great value and advisable not only because they con tribute to physical fitness but also because they help in psychological well-being. Young people should be encouraged to include general exercise, and particularly sports, into their daily activities. The following points however, should be kept in mind: I. Although winning at a sport is important, this is only so if it is achieved in natural physical conditions and with the correct training. Therefore, it is advisable to keep well away from any type of activity which artificially increases physical performance, that is, drug taking."