"Predisposing conditions for acute ischemic syndromes" contains the proceedings of a conference held in Garmisch-Partenkirchcn, West Germany, October 14 and 15, 1988. The editors of this volume arc most grateful to the authors for their effort to provide manuscripts before the meeting, to the sponsor, Bayer AG, for their gen erous support, and to the publishers for the efficient collaboration, all of which have made the appearance of this book possible. All authors contributed their manu scripts in advance and they arc combined with an edited version orlhe discussions to allow rapid publication. In coronary heart disease the prognosis for patients is largely determined by the occurrence of irreversible ischemic damage to the myocardium. Irreversible eveniS are certainly preceded by a destabilization of a former stable situation. This desta bilization may occur with increasing symptomatology or without apparent warning signs to patient and physician; it may occur over a longer time period or very sud denly. The statemenl, however, holds true that no patient has ever died from stable angina pectoris. Thus, if the prognosis for patients with ischemic heart disease is to be improved, the focus has to be set on recognition and treatment of unstable ischemic syndromes. It was the goal of the conference to gather scientists and clinicans from different fields of research, to get an up-to-date view of the different aspects of unstable ischemic syndromes and to foster interdisciplinary discussions.

"Silent Ischemia, Current Concepts and Management" contains the proceedings of a conference held in Rottach-Egern, West Germany, March 5 to 7, 1987. We are most grateful to the authors for the effort to provide manuscripts before the meeting, to the sponsor, Bayer AG, for their generous support and to the publishers for their efficient collaboration, all of which have made the appearance of this book possible. When discussing silent myocardial ischemia, the first question is: "why is it silent?". To approach this question, a deeper look has to be taken into the pathophysiology of cardiac pain and the excitatory and inhibitory mechanisms involved. It has to be borne in mind that - in contradiction to what the poets have told us so beautifully for many centuries - the heart is a visceral and not a sensitive organ. If asymptomatic ischemia did not carry prognostic significance comparable to the symp tomatic manifestations of ischemia, then the problem of silent ischemia would be very academic and without consequences for treatment. Therefore studies on prognosis of silent ischemia are of great importance, as their results should indicate how aggressively patients are to be managed.

2 Diagnostic Use of Radiographic Methods in Coronary Disease. . . . . . . . . . . . . . . . . . . . . . . . . . 56 3 Material. . . . . . . . . . . . . . . . . . . . . . . . . 58 4 Mode of Operation . . . . . . . . . . . . . 62 5 Radiological Projections. . . . . . . . . . . . . . . . . 63 6 Monitoring of Cardiac Parameters . . . . . . . . . . . . 64 7 Pharmacological Tests . . . . . . . . . . . . . . . . 66 7. 1 Coronary Arteries . . . . . . . . . . . . . . . . . . . . . 66 7. 2 Left Ventricle. . . . . . . . . . . . . . . . . . . . . . . . 67 8 Accidents and Risks of Coronary Arteriography . . . . . 67 References . . . . . . . . . . . . . . . . . . . . . . . . . 68 III Angiographic Explorations: Normal Results . . . 71 1 Left Ventricle and Left Ventricular Function 71 1. 1 Radiological Anatomy. . . . . . . . . . . . 71 1. 2 Normal Kinetics. . . . . . . . . . . . . . . 77 1. 3 Analysis of Wall Contraction . . . . . . 78 1. 4 Volumes and Function Indexes. . . . . . . 81 2 Coronary Arteries and Veins . . . . . . . . 84 2. 1 Origin, Calibre and Preponderance of the Coronary Arteries . . . . . . . . . . . . . . . . . . . . . . . . 84 2. 2 Nomenclature and Segmentation of the Coronary Arteries . . . . . . . . . . . . . . . . . . . . . . 87 2. 3 A Reminder About the Physiology of Coronary Circulation . . . . . . . . . . . 93 2. 4 Angiographic Anatomy . . . . . . . . . . 94 2. 4. 1 Left Coronary Artery . . . . . . . . . . . 94 2. 4. 2 Right Coronary Artery. . . . . . . . . . . . . 95 2. 4. 3 Vascularization of Nodes and the Conduction System . . 96 2. 4. 4 Interconnecting Anastomoses . . . . . . . . . . . . . . . 97 2. 5 Coronary Veins . . . . . . . . . . . . . . . . . . . 97 References . . . . . . . . . . . . . . . . . . . . . . . . . 98 IV Angiographic Explorations: Congenital Anomalies of the Coronary Arteries. . . . . . . . . . . . . . . . . . . . . . . . 100 1 Anomalies of the Origin, Course and Distribution of Coronary Arteries Arising from the Aorta . . . . . . . . 100 2 Abnormal Origin of a Coronary Artery from the Pulmonary Artery . . . . . . . . . . . . . . . . . . . . . 101 3 Anomalies in the Diameter of Coronary Arteries . . . . . 104 4 Coronary Fistulae . . . . . . . . . . . 109 References . . . . . . . . . . . . . . . . . . . . . . . . . 113 VII V Angiographic Explorations: Coronary Atheroma. . . . . . . . 114 1 Left Ventricle . . . . . . . . . . . . . . . . . . . . . . . . 114 1. 1 Morphological Anomalies: Bulging and Lacuna-Like Aspects . . . . . . . . . . . . . . . . . . . . . . . . . . .