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Fundamentals of Cardiac Pacing
The VIth World Symposium on Cardiac Pacing in Montreal 1979 opened with a course, meant to be an introduction for newcomers and an updating re fresher and link between the various fields of knowledge needed by experienced persons for cardiac pacing. Invited guest lecturers were selected for their world recognized expertise in the individual subjects. This book is a collection of the various presentations on historical, clinical, electrophysiological and technical aspects of cardiac pacing. Together they cover the fundamentals of cardiac stimulation. We hope that this book may become an introductory guide to the field of cardiac pacing and that it may contribute to a better understanding of t...
Maximal Myocardial Perfusion as a Measure of the Functional Significance of Coronary Artery Disease
Coronary flow reserve is a functional measure of stenosis severity re flecting the integrated effects of its geometry including percent stenosis, absolute lumen area, length and shape. Its clinical application has been primarily qualitative in non-invasive, perfusion imaging. Measurement of coronary flow reserve during routine coronary arte riography has been an elusive goal. Transit time and indicator dilution techniques for assessing coronary flow reserve at cardiac catheteriza tion are associated with marked variability compared to microspheres or flow meters, thereby making their use questionable in comparison to the precision of good quantitative arteriography. Coronary flow reserve mea...
Quality of Life after Open Heart Surgery
primary goal of all forms of therapy is not just prolonging life, but improving the quality of life, has forced analysis of what constitutes quality of life, a concept whose structure pervades all walks of life and eludes definition. Global well being, happiness, morale, vitality, fullness of social life, and satisfaction must be integrated and assessed for the effects of the disease and the therapy, in the context of specific personality traits, attitudes to life, family situation, and socio-economic and political freedom. A growing inter est in research on this subject has led to a clearer understanding of the components which come to determine quality of a patient's life, and how they can...
Occult Atherosclerotic Disease
Occult atherosclerotic diseases impose great challenges in the cardiovascular practice. Although their pathology is not much different from that of the overt group of diseases, the clinical approach to their diagnoses remains a puzzle. This has mainly emerged as a result of the problems faced in trying to pick up the vulnerable subjects from among the general public. More definitive candidates to be evaluated are those belonging to one of the high risk groups. There are no statistical figures available on the incidence of occult atherosclerotic disease in the "non risky" general public and this is definitely an area that needs further investigation. Atherosclerotic disease whether they are i...
Nuclear Cardiology in Everyday Practice
The most salient feature of the infor last four chapters of the book evaluate the mation provided by nuclear medicine is its information from an analytical and pathophysiological and functional charac statistical point of view. This approach is ter. For adequate experimental or clinical required for correct decision-making. interpretation, such information should This book is therefore the result of necessarily be interpreted alongside the accumulated experience in nuclear cardiology views of the clinical cardiologist, who is with the invaluable cooperation of medical able to apply it to the individual patient. statisticians. It is directed to physicians This approach, which is routine in ev...
Ischemia-reperfusion in cardiac surgery
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 leuko...
The Slow Inward Current and Cardiac Arrhythmias
Since Paul Cranefield published his monograph, The Conduction of the Cardiac Impulse, in 1975, much has been learned about the role of the slow inward current in cardiac electrophysiology. Because of this expanse in know ledge, both basic and clinical, it appeared reasonable to review in a mono graph once again what was known. When Martinus Nijhoff first approached us to undertake the task of updating this information, we were initially reluctant for several reasons. First, we did not feel that the subject could be adequately and thoroughly reviewed, from the cell to the bedside, by a single person. Second, time constraints on all of us precluded even attempting such a task. However, we were encouraged by several of our friends (' egged on' one might even say, since they wished the job done but did not want to do it themselves!) who promised faithfully to contribute chapters on time if we accepted the task. So we did, and most of them did also.
PTCA An Investigational Tool and a Non-Operative Treatment of Acute Ischemia
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 proce...
Thallium-201 and Technetium-99m-Pyrophospate Myocardial Imaging in the Coronary Care Unit
Noninvasive visualization of myocardial infarction using radionuclides dates back over eighteen years. Edward A. Carr and William H. Beierwaltes were first to report (1962) successful external imaging of myocardial infarcts in dogs and in man using an Anger scintillation camera. They demonstrated that after intravenous administration of 86Rb or l3ICS an infarct was visualized as a "cold spot", while 203Hg-labeled-chlormeridin resulted in a "hot-spot" image of the infarct. Since then, there have been major developmental improvements in avail able radionuclides, scintillation cameras and computer processing capabilities. In particular, the development of mobile gamma cameras opened the possi bility to obtain high quality images even at the bedside of critically ill patients. Since the development in 1974 of a new radiopharmaceutical, 20lTI and the application of 99mTc-pyrophosphate for myocardial imaging, these imaging agents are widely used for the detection of acute myocardial infarction. However, for practical application, frequently there appears to be uncertainty or even confusion concerning the relative merits of each method.
