Bøger i Developments in Cardiovascular Medicine serien

Since it was introduced less than 100 years ago, analysis of the circulatory response to exercise as a measure of cardiac function has undergone remarkable development. Most recently this approach has incorporated the burgeoning technology of the last half of the 20th century to meet the physiological and diagnostic needs of scientist and clinicians. The ease of administration, economy and abundant data that characterize exercise testing for its relative staying power as the most frequently utilized noninvasive method of cardiovascular evaluation. The basic modalities of exercise electrocardiography of treadmill and bicycle have been extended by noninvasive cardiac imaging techniques, including scintigraphy and echocardiography, that have provided new insights in myocardial function during exertion and pharmacologic stress. At the same time, traditional exercise electrocardiography has also been refined by innovations that have broadened its applications. Exercise Testing: Current Concepts and Recent Advances affords the reader a state-of-the-art presentation of the diverse and expanding methods of exercise testing and their roles in patient management. The contributors to this volume include individuals who have made seminal contributions to the field during the last several decades. Indeed, it is legitimate to designate this group as a `Who's Who of Exercise Testing'. It is our hope that this book will enhance the reader's understanding of contemporary methods of exercise testing, as well as provide a glimpse into future directions of this science, that this knowledge is applied to optimal diagnosis and management of our patients.

Despite recent advances in the diagnosis and treatment of various cardiac illnesses, including ischemic, valvular and cardiomyopathic disease, the most cost-effective means of employing laboratory testing and treatment modalities remains an issue in most practice settings. With the advent of managed care and vigilant third-party payer evaluation of the use of diagnostic tests and hospital length of stay, the most effective medical and economic method of managing everyday cardiac illness is a question that arises daily in practice. To this end, we have selected well-known and widely published experts in cardiac diagnosis and therapy to develop practical and informative approaches outlining the most cost-effective methods of patient management. The topics include the entire range of cardiac diseases and emphasize the economic impact on decision-making. We develop guidelines and present general strategies for the practicing cardiologist and general internist. Additionally, the editors, who have 10 years of experience in this area, discuss the methods necessary to bring critical pathways and practice guidelines into clinical use. Both hospital and out-patient phases of illness are considered. Special concerns of hospital, private practice managed care and group practice settings are specifically addressed.

In Heart Cell Communication in Health and Disease an extensive review of different aspects of heart cell communication is presented. The book starts with the fundamental concept that cardiac cells are communicated, and then proceeds to the role of gap junctions in heart development, the molecular biology of gap junctions, the biophysics of the intercellular channels, the control of junctional conductance and the influence of gap junctions on impulse propagation. This is the first time that a single volume has described cell communication in the normal heart and under different pathological conditions such as heart failure, coronary disease, myocardial ischemia and cardiac arrhythmias. In this way the process of cell communication is analyzed at different levels of complexity, providing the reader with a wide view of this field and its relevance to cardiology.

For over a quarter of a century, echocardiography has made an unparalleled contribution to clinical cardiology as a major tool for real-time imaging of cardiac dynamics. Echocardiography is widely used to assess cardiac function, and provides noninvasive information which is invaluable for the diagnosis of various disease states. In spite of its numerous advantages, in the clinical arena echocardiography has remained mostly qualitative and subjective. However, continued progress in our understanding of the interactions between ultrasound and tissue characteristics have brought about several new developments which allow quantitative analysis of ultrasound data. Among these new developments are endocardial boundary detection (frequently referred to as Acoustic Quantification), Color Kinesis and Doppler myocardial imaging. The purpose of this book is to provide the reader with the background necessary to understand and successfully utilize these methodologies. Chapters summarize in detail the studies that have validated these techniques thus far, and discuss their future applications.

Since the introduction of myocardial perfusion imaging and radionuclide angiography in the mid-seventies, cardiovascular nuclear medicine has undergone an explosive growth. The use of nuclear cardiology techniques has become one of the cornerstones of the noninvasive assessment of coronary artery disease. In the past 15 years major steps have been made from visual analysis to quantitative analysis, from planar imaging to tomographic imaging, from detection of disease to prognosis, and from separate evaluations of perfusion, metabolism, and function to an integrated assessment of myocardial viability. In recent years many more advances have been made in cardiovascular nuclear imaging, such as the development of new imaging agents, reevaluation of existing procedures, and new clinical applications. This book describes the most recent developments in nuclear cardiology and also addresses new contrast agents in MRI. What's New in Cardiac Imaging will assist the clinical cardiologist, the cardiology fellow, the nuclear medicine physician, and the radiologist in understanding the most recent achievements in clinical cardiovascular nuclear imaging.

Knowledge of cardiac ion channels and transporters has advanced remarkably in the last two decades with the development of patch-clamp and molecular biological techniques. This textbook offers a comprehensive overview of structures and functions of ion channels and transporters in the heart. Readers are first introduced to the molecular biology and electrophysiology of all the important ion channels. After discussing their developmental changes, the pharmacology and pathophysiology of clinically-relevant ion channels are reviewed. Molecular aspects of the cardiac excitation-contraction coupling and intracellular Ca2+ regulation by ion transporters are also described. The book will be useful to electrophysiologists, cardiac physiologists and pharmacologists, and molecular biologists interested in ion channels at all levels. For research specialists, the book will provide a perspective of the field. The book can be used as a reference source for working scientists in the fields of ion channels, biophysics, cardiac electrophysiology, and pharmacology. It is aimed at graduate and medical students, designed for use as a textbook for graduate and medical courses.

Pediatric cardiology is celebrating in the 1990s the 50th anniversary of the beginnings of the age of therapy. This informal `history' describes how the discipline grew from the era of pathologic anatomy to the dawn of therapy, the beginnings of closed heart surgery between 1939 and 1945. That dawn ushered in a remarkable half century of change and growth, leading from clinicophysiologic correlations through the start of open heart surgery in the 1950s. The text celebrates some of the achievements of this vivid and heroic age, and describes how, in the mid 1970s, new surgical and medical approaches, including prostaglandins and Doppler echocardiography, led to successful cardiac treatment in infancy, the `infant era'. Interventional cardiology and the study of childhood arrhythmias began. Now, in the 1990s, a new era emphasising molecular biology and cardiac development is growing from the tools and concepts of the past. The four eras have focused on pathologic anatomy, clinicophysiologic correlations and surgery, heart problems in infancy, and now the developing heart. In each era there have been advances in the four domains of pediatric cardiology, the heart before birth, the normal heart, heart disease and defects, and preventive cardiology. Growth in knowledge has been both episodic and dramatic, yet not a picture of unalloyed achievement. The later chapters discuss some of the problems beginning to be recognised in the new and current `developmental era'. The pioneers of pediatric cardiology, both men and women, are more than eponyms, for each used in new and original ways the tools and concepts available in their era. The interaction of tools and concepts is a theme in this book. Just as the tool of the stethoscope was vital in delineating the clinical profile of ventricular septal defect and patent ductus, the fluoroscope played a role in developing the concept of the Blalock Taussig shunt. Pioneers also includepatients and their families, and the book includes some discussion of what little is known of childhood and of the child with heart disease in the four different eras. This is a brief overview of the growth of knowledge of children's hearts from before William Harvey until our own time, and includes references to histories of cardiac surgery and to collections of classic cardiac papers. By its emphasis on the child as the central historic figure, and on the interaction of tools and concepts in the growth of knowledge, the text provides a celebratory approach to the 50th anniversary of modern pediatric cardiology.