Written by leading authorities in the field, Chest Pain with Normal Coronary Arteries comprehensively reviews the clinical presentation and the pathogenesis of the condition, as well as its management. This book provides a practical tool for the clinician and a bank of information and new ideas for research scientists and clinical researchers interested in understanding the causes and mechanisms of chest pain with normal coronary arteries. Whether the pain be of gastroenterologic, cardiac or endocrine in origin, the book focuses on effective diagnosis, treatment and management of different pathologies in patients. Chest Pain with Normal Coronary Arteries is an essential read for all clinicians involved in managing patients with chest pain, and those that should be aware of non-cardiac chest pain.

Much has been written about reperfusion injury in the past decade but unfortunately the information has been generally presented in the form of original specialist papers and little if any integral publication exists on the topic, summarising and analysing the clinical impact of the condition and its management. The pathophysiology and molecular mechanisms of reperfusion injury are complex and, regarding diagnosis, individual diagnostic techniques have been proposed but without a proper assessment of the relative values of these methods. A publication dealing with integral diagnostic strategies would be welcome by the managing physician. Management of the condition is also problematic, as strategies that appear to work in the experimental models do not translate into beneficial interventions in patients. There is a need for these issues to be addressed and discussed in a monographic fashion. Management of Myocardial Reperfusion Injury will tackle these issues in a modern and systematic way and the information will be delivered in a fashion that will be appealing to the reader.

This book is timely and challenging. Within its pages are commentaries and opinions on the scientific background and explanatory ideas for a complex of symptoms and investigations known as syndrome X. The commonest cause by far of angina pectoris is coronary artery obstruction due to atheromatous lesions both within the wall of the artery and intruding into the lumen; in such patients it is expected that there maybe ST segment depression on atrial pacing or on an exercise test indicating myocardial ischemia. Syndrome X was a term first used in an editorial written by Kemp in 1973. He was referring to patients in group X in a paper from Arbogast and Bourassa. Patients in group X had three features, namely angina as judged on a clinical history, alterations of the ST segment on the electrocardiogram during atrial pacing and smooth unobstructed coronary arteries (presumed normal) as assessed by the technique of coronary angiography. The changes on the electrocardiogram, conventionally indicative of myocardial ischemia, could not be explained on the basis of any abnormality of the coronary arteries and Kemp named the complex of fmdings syndrome X because of this seeming paradox and the lack of a single explanation. In the last thirty-one years there has been substantial scientific interest in this syndrome giving rise to a large number of publications. The name syndrome X has led to considerable confusion. Physicians are familiar with the X chromosome and with X linked congenital disorders.

Angina pectoris with normal coronary arteriograms is a common entity which has puzzled cardiologists almost since the advent of coronary arteriography. Despite major advances in the understanding of the pathophysiology of angina in recent years and a multitude of studies on the subject, the cause and mechanisms underlying the syndrome of angina with normal coronary arteries remain unknown. Indeed, results of investigations are controversial and speculation still prevails regarding the nature of the so called 'Syndrome X'. Almost every important aspect of Syndrome X has been tackled in the book and the reader is exposed not only to the cardiologists' opinion, but also to the authoritative views of the gastroenterologists, gynaecologists and psychiatrists, extremely well represented in this monograph. The book deals with 'cardiologists' Syndrome X' and not the metabolic entity termed 'Syndrome X'. The possible connection between the two, however, is discussed. Angina with Normal Coronary Arteries: Syndrome X contributes to the understanding of Syndrome X and helps clinicians manage their Syndrome X-patients better and investigators to open new avenues for research.

Much has been written about reperfusion injury in the past decade but unfortunately the information has been generally presented in the form of original specialist papers and little if any integral publication exists on the topic, summarising and analysing the clinical impact of the condition and its management. The pathophysiology and molecular mechanisms of reperfusion injury are complex and, regarding diagnosis, individual diagnostic techniques have been proposed but without a proper assessment of the relative values of these methods. A publication dealing with integral diagnostic strategies would be welcome by the managing physician. Management of the condition is also problematic, as strategies that appear to work in the experimental models do not translate into beneficial interventions in patients. There is a need for these issues to be addressed and discussed in a monographic fashion. Management of Myocardial Reperfusion Injury will tackle these issues in a modern and systematic way and the information will be delivered in a fashion that will be appealing to the reader.

The spectrum of unstable coronary syndromes has been the object of steadily increasing research particularly in respect of novel diagnostic and treatment modalities. Although the WHO criteria for the diagnosis of acute myocardial infarction have been known for decades, there is still much debate as to the proper use of these, especially the handling of biochemical markers. Traditional enzymes have limitations in diagnostic power and new markers have unclarified applicability with regard to standardisation of assays and decision limits. Furthermore, the growing understanding of the conception of minimal myocardial damage in the borderzone between unstable angina pectoris and myocardial infarction necessitates refinement in the definitions of the various entities within the kaleidoscope of acute myocardial ischaemia. There has been a strong impetus within the European Society of Cardiology to present this subject to a broad audience of cardiologists, and as a consequence the theme of biochemical markers has become an important constituent of the Education and Training Programmes of the Society. This book has fundamental implications for the overall comprehension of this complex area. This book on myocardial damage, compiled by international experts, will truly appeal to the basic scientist as well as the clinician searching for updated knowledge of the pathophysiology and risk stratification of unstable coronary syndromes.

This book is timely and challenging. Within its pages are commentaries and opinions on the scientific background and explanatory ideas for a complex of symptoms and investigations known as syndrome X. The commonest cause by far of angina pectoris is coronary artery obstruction due to atheromatous lesions both within the wall of the artery and intruding into the lumen; in such patients it is expected that there maybe ST segment depression on atrial pacing or on an exercise test indicating myocardial ischemia. Syndrome X was a term first used in an editorial written by Kemp in 1973. He was referring to patients in group X in a paper from Arbogast and Bourassa. Patients in group X had three features, namely angina as judged on a clinical history, alterations of the ST segment on the electrocardiogram during atrial pacing and smooth unobstructed coronary arteries (presumed normal) as assessed by the technique of coronary angiography. The changes on the electrocardiogram, conventionally indicative of myocardial ischemia, could not be explained on the basis of any abnormality of the coronary arteries and Kemp named the complex of fmdings syndrome X because of this seeming paradox and the lack of a single explanation. In the last thirty-one years there has been substantial scientific interest in this syndrome giving rise to a large number of publications. The name syndrome X has led to considerable confusion. Physicians are familiar with the X chromosome and with X linked congenital disorders.

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.

Angina pectoris with normal coronary arteriograms is a common entity which has puzzled cardiologists almost since the advent of coronary arteriography. Despite major advances in the understanding of the pathophysiology of angina in recent years and a multitude of studies on the subject, the cause and mechanisms underlying the syndrome of angina with normal coronary arteries remain unknown. Indeed, results of investigations are controversial and speculation still prevails regarding the nature of the so called `Syndrome X'. Almost every important aspect of Syndrome X has been tackled in the book and the reader is exposed not only to the cardiologists' opinion, but also to the authoritative views of the gastroenterologists, gynaecologists and psychiatrists, extremely well represented in this monograph. The book deals with `cardiologists' Syndrome X' and not the metabolic entity termed `Syndrome X'. The possible connection between the two, however, is discussed. Angina with Normal Coronary Arteries: Syndrome X contributes to the understanding of Syndrome X and helps clinicians manage their Syndrome X-patients better and investigators to open new avenues for research.

This book is intended for general cardiologists and other physicians involved in the care of patients with chronic stable angina (CSA). The goal of this book is to update clinicians on recent data on the medical management of patients with CSA. Ischemic heart disease remains a major public health problem. Chronic stable angina is the initial manifestation of ischemic heart disease in approximately one half of patients. Stable coronary artery disease is generally characterized by episodes of reversible myocardial demand/supply mismatch, related to ischaemia or hypoxia, which are usually inducible by exercise, emotion or other stress and reproducible-but, which may also be occurring spontaneously. Such episodes of ischaemia/hypoxia are commonly associated with transient chest discomfort (angina pectoris). The aim of the management of CSA is to reduce symptoms and improve prognosis. The management of these patients encompasses lifestyle modification, control of coronary artery disease risk factors, evidence-based pharmacological therapy and patient education. All patients with stable angina should be offered optimal medical treatment, defined as one or two anti-anginal drugs as necessary, plus drugs for secondary prevention of cardiovascular disease. Regarding the role of revascularization, randomised trials provide compelling evidence that myocardial revascularisation by coronary artery bypass grafting or by percutaneous coronary intervention improves symptoms of angina relative to continued medical treatment.