Ptca An Investigational Tool And A Non Operative Treatment Of Acute Ischemia
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PTCA An Investigational Tool and a Non-Operative Treatment of Acute Ischemia
Author: P.W. Serruys
language: en
Publisher: Springer Science & Business Media
Release Date: 2012-12-06
Obstruction of coronary blood flow and the resultant consequences are the center stage pathophysiologic events in cardiology today. The speculations of Jenner, Burns, Heberdin, McKenzie, Prinzmetal and many others had until now been left to observations of isolated tissue and intact animal experimentation. Only with the advent of Gruentzig's technique, which allowed us to 'work safely inside the coronary arteries' are we able to observe the effects of coronary occlusion in living conscious man. PTCA provides not only a therapeutic modality for non-operatively opening coronary obstructions, but has also provided the best model for studying the effects of acute ischemia on the heart. The procedure also lead the way to all other interventional cardiology developments, including modern thrombolysis in the setting of acute myocardial infarction. In his previous works, Serruys has examined how PTCA can serve as a model for studying acute ischemia. In this book, he and his co-authors discuss the effects of balloon-induced ischemia on the electrocardiographic changes, coronary blood flow dynamics, cardiac muscle metabolism and left ventricular function, as well as measures to counter these effects and provide for reperfusion in unstable angina and acute myocardial infarction. Technology has expanded the 'eyes' of the observer of these events. The authors use many techniques including ECG recording from surface, endocardium, and intracoronary electrodes; angiographic assessment of coronary flow pattern using digital techniques, as well as doppler flow measurements; biochemical assessment of metabolic products stimulated by ischemia; and digital angiographic and echo doppler assessment of left ventricular function.
Drug Evaluation in Angina Pectoris
Author: Gianluigi Ardissino
language: en
Publisher: Springer Science & Business Media
Release Date: 2012-12-06
Although there are many books on angina, few are devoted to the important problem of how to evaluate drug efficacy in angina pectoris. Drug Evaluation in Angina Pectoris has two fundamental aims: the first is to review the methodological aspects of drug evaluation in stable and unstable angina pectoris; the second is to provide a logical and methodological background for future studies aimed at assessing the ability of medical treatment to improve prognosis. Part I updates the pathophysiology, clinical presentation and prognosis of angina pectoris. Part II aims to `put in numbers' the symptoms and signs of myocardial ischemia, starting from a revision of the currently used parameters. It is extremely important to quantify the variability of the disease for the correct design of clinical trial, a subject dealt with in Part III, which also discusses some clinico-pharmacological aspects of therapy. Part IV is a critical review of the drugs currently used for the treatment of stable and unstable angina, and particularly considers some important unresolved issues concerning their use. The current FDA and EC guidelines for the evaluation of antianginal drugs are briefly discussed in Part V, giving clinical investigators insight into how antianginal drugs are evaluated by regulatory agencies and what is considered as proof of a valid efficacy/tolerability ratio. Drug Evaluation in Angina Pectoris will assist discerning cardiologists, pharmacologists, and advanced students of cardiology as well as innovative pharmaceutical companies, all of whom need to understand what angina is, how to evaluate treatment, and how to judge the agents used in its treatment.
Ischemia-reperfusion in cardiac surgery
Author: Hans Michael Piper
language: en
Publisher: Springer Science & Business Media
Release Date: 2012-12-06
In open heart surgery, protection of the myocardium against injury by ischemia-reperfusion is an issue of utmost clinical interest. The knowledge on the causal mechanisms of myocardial injury in ischemia-reperfusion has greatly progressed in recent years, both to clinical and experimental research. This book provides a critical and comprehensive overview on the current discussion of myocardial protection in cardiac experimental research and surgery. Leading groups from Europe, the U.S. and Japan have contributed reviews of their special fields. On the basic science side, major topics discussed are the mechanisms of stunning and lethal reperfusion injury, the role of the endothelium and leukocyte activation in postischemic myocardial dysfunction, and the differences between the adult and neonatal myocardium. On the clinical side, the major concepts and procedures for cardioplegic myocardial protection, their rationales, application and respective merits are discussed. In a third part of the book, possible approaches for the monitoring of myocardial injury during ischemia and reperfusion are evaluated, with particular attention to their intraoperative use. This book brings together the scientific discussions on ischemia-reperfusion in experimental cardiology and cardiac surgery, a task needed for a long time. It is of general interest for clinicians as well as research workers and students in the cardiac field.