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When I was asked some years ago by the editors of the Handbook of
Experimental Pharmacology to edit a new volume on Antianginal
Drugs, I agreed on the condition that, in accordance with my
scientific background, primary emphasis be given to clinical
pharmacology and therapeutics. It soon turned out that, due to
rapid developments in this field, nothing of the previous volume on
Antianginal Drugs by Charlier (Vol. 31, 1971) could be retained
apart from its basic idea of devoting considerable space to
methodology. Since editors must operate within certain limits, I
had to abstain from dealing with acute myocardial infarction in
detail despite the well-known overlap between unstable angina, the
preinfarction syndrome, and acute myocardial infarction. It was
only possible for acute myocardial infarction and the concept of
reduction of infarct size to be briefly discussed within the
chapter on pathophysiology of acute coronary insufficiency. The
chapter on invasive methods provided an opportunity to touch on new
approaches to early intervention in acute myocardial infarction.
Here, intracoronary streptokinase therapy and PTCA are considered,
again with attention to the overlap between mechanical and
pharmacological interventions.
This book comprises the essential records from a Boerhaave course
given in June 1971 for specialists in cardiology and other fields
of internal medicine interested in the subject of quantitation in
cardiology. It is evident that in the wide field of medicine, and
particularly in cardiology, there is a growing need for exact and
detailed information in conjunction with existing diag nostic
methods. This is apparent in the greater precision in anatomical
and haemodynamic details required by the thoracic surgeon as the
number of available heart operations gradually increases. In
retrospect it is hardly surprising that the high initial mortality
after the introduction of each operation depended to a large extent
upon the degree of accuracy with which the diagnosis was made.
Another urgent need for precise and quantitative information became
apparent when monitoring of high-risk patients, in order to
forestall compli cations and/or death, became routine. The same
applies for the diagnostic procedures used to estimate the
patient's chances of surviving an operation and/or rehabilitation
after a serious incident, such as myocardial infarction. In these
fields there is a vast amount of data to be handled and - in modern
diagnostic procedures - it must be processed so rapidly that the
human mind cannot suffice and computer equipment has
becomeindispensable."
Recent technological developments have brought long-term ambulatory
electro cardiography to the front of clinical cardiology. Its
application for solving clinical problems potentially related to
cardiac arrhythmias is rapidly increasing. In the meantime, the
method has found widespread use in the identification of patients
at risk for cardiac death as well as in the assessment of
therapeutic interventions. It was the purpose of this symposium to
bring together an international group of authorities in order both
to provide an overall view of the field and to discuss critically
the value of clinical, epidemiological and research applications of
long term ambulatory electrocardiography in the light of new
concepts and recent advances. The first section of this volume
discusses the methodology and the performance criteria of the
equipment and analysis systems. In the second section, the
potentials and problems encountered in the use of long-term
ambulatory electrocardiography for solving clinical questions and
for predicting the occurrence of clinically important arrhythmias
are extensively as continuous ST segment monitoring, blood dealt
with. New applications such pressure measurement and other
physiologic parameters are also included. Prevalence variability
and prognostic aspects of ventricular arrhythmias, both in normals
and in patients with cardiac disease, are the subject of section 3.
The last section provides a critical review of the use of the
method for the evaluation of therapeutic interventions with drugs.
The editors feel that this volume represents the 'state of the art'
in this newly important area of clinical cardiology."
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