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Main description:
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.
Contents:
One: An Investigational Tool.- From in-vitro to in-vivo model.- 1. Myocardial ischemia: Early adjustment and reversibility.- Instrumentation techniques for measurements of regional myocardial function in conscious animals.- Relationship between reduction in regional blood flow and myocardial function.- Adjustment to global LV ischemia.- Adjustment to regional myocardial ischemia.- Effects of reperfusion.- Coronary artery stenosis versus coronary artery occlusion.- Enzyme leakage from ischemic myocardium.- Reperfusion injury.- Summary.- References.- 2. Early changes in wall thickness and epicardial wall motion during percutaneous transluminal coronary angioplasty in man: Similarities with in-vitro and in-vivo model.- Echocardiographic changes in wall thickness.- Changes in epicardial wall motion.- Regional marker motion.- Analysis of pressure-derived indexes during systole and diastole.- Results.- Changes in regional epicardial wall motion.- Changes in global left ventricular function.- Discussion.- Early wall motion changes during acute ischemia.- Wall motion abnormalities in chronic ischemia.- References.- 3. Early mechanical changes associated with coronary artery Occlusion.- Materials and methods.- Results.- Regional function after 30 sec coronary occlusion.- Effects of longer and shorter occlusions.- Discussion.- References.- Electrocardiographic changes.- 4. Coronary angiographic and hemodynamic determinants of ST-segment response to acute coronary occlusion.- Patient selection.- Medications.- Angioplasty procedure and measurements.- Angiography.- Results.- Angiographic correlates.- Discussion.- Quantitation of ischemia: surface versus intracoronary ECG.- Use of the model in evaluating drug therapy.- Conclusion.- References.- 5. Dynamic appearance of collaterals during coronary occlusion and their impact on electrocardiographic changes and wall motion abnormalities.- Methods.- Study patients.- Cardiac catheterization and angioplasty protocol.- Results.- Discussion.- References.- Role of collaterals during PTCA.- 6. Collaterals and coronary wedge pressure.- Assessment of coronary collateral circulation.- Coronary wedge pressure: Definition and determinants.- Coronary wedge pressure and angiographic extent of collaterals.- Coronary wedge pressure and left ventricular function.- Coronary wedge pressure and restenosis after PTCA.- Conclusions.- References.- Coronary flow and flow reserve.- 7. Intracoronary blood flow velocity, reactive hyperemia and coronary blood flow reserve during and following PTCA.- Patients and methods.- Intracoronary blood flow velocity measurements.- Protocol.- Quantitative analysis of the coronary artery.- Protocol of the investigational procedure.- Coronary flow reserve measurements with digital subtraction cineangiography.- Results.- The first study group: Coronary blood flow velocity during PTCA as a guide line for assessment of the functional results.- Second study group: A comparison of two methods to measure coronary flow reserve in the setting of coronary angioplasty: intracoronary blood flow velocity measurements with a Doppler catheter, and digital subtraction cineangiography.- Discussion.- Intracoronary blood flow velocity: An on line assessement of the functional result of the dilatation?.- Peak reactive hyperemia a useful functional guide line during the procedure H2 Rationale for comparison of the two techniques to measure coronary flow reserve.- Maximal coronary blood flow after pharmacological vasodilation versus reactive hyperemia induced by coronary occlusion.- Limitations.- Coronary flow reserve immediately after PTCA.- Acknowledgements.- References.- Myocardial metabolism.- 8. Loss of hydrogen and potassium ions after short periods of myocardial ischaemia in man.- Measurement of arterio-venous differences.- Oxygen.- Potassium.- Hydrogen.- Other effects of angioplasty.- A unifying hypothesis.- References.- 9. Myocardial release of hypoxanthine and lactate during coronary angioplasty: A quickly reversible phenomenon, but for how long?.- Patients and methods.- PTCA technique.- Lactate measurements.- Hypoxanthine determination.- Flow measurements.- Statistical analysis.- Results.- Coronary hemodynamic measurements.- Lactate and hypoxanthine metabolism.- Discussion.- Use of purine release as a marker for ischemia during transluminal occlusion in man.- Metabolism during reperfusion.- Summary.- References.- 10. Myocardial release of hypoxanthine and urate during angioplasty: Potential mechanism for free radical generation.- Methods.- Patients.- Assays.- Results.- Discussion.- Acknowledgements.- References.- 11. Regional myocardial nitrogen-13-glutamate uptake following successful coronary angioplasty.- Patients and methods.- Results and discussion.- References.- Myocardial function.- 12. Left atrial function in acute transient ischemia on the left ventricle.- Patients and methods.- Results.- Discussion.- References.- 13. Left ventricular filling during acute ischemia.- Methods.- Results.- Left ventricular relaxation.- Left ventricular stiffness.- Left atrial contraction.- Discussion and conclusions.- References.- 14. Left ventricular function during acute coronary artery balloon occlusion in humans.- Methods.- Assessment of chamber and myocardial stiffness constants.- Assessment of time constants of relaxation.- Statistical analysis.- Results.- Left ventricular volumes and ejection fraction.- Time constants of relaxation (?W, ?M).- Chamber stiffness constant (?).- Myocardial stiffness constants k, ss, ?.- Discussion.- Appendix 1: Rationale for the development of simple indices of chamber and myocardial stiffness.- Appendix 2: Alternative evaluation of myocardial stiffness constants.- Appendix 3: Evaluation of the time constant ?M.- References.- 15. Use of intravenous DSA in the assessment of LV performance during PTCA.- Patients.- Methods.- Results.- Discussion.- Acknowledgement.- References.- 16. Two dimensional echocardiography during PTCA.- Incidence and time course of asynergy during PTCA.- Global left ventricular function and myocardial risk area.- Left ventricular size changes.- Sequence of ischemic symptoms.- References.- 17. Doppler echocardiographic assessment of left ventricular function during PTCA.- Methods.- Results.- Systolic function.- Diastolic function.- Clinical variables.- Effects of collateral circulation.- Diastolic filling later after balloon occlusion.- Effect of diltiazem on Doppler-echocardiographic measurements.- Discussion.- Temporal sequence of ventricular dysfunction.- Comparison with previous studies.- Acknowledgements.- References.- 18. Ejection filling and diastasis during transluminal occlusion in man: Consideration on global and regional left ventricular function.- Study population and protocol.- Methods.- Analysis of pressure derived indices during systole and diastole.- Analysis of regional and global left ventricular function.- Results.- Global left ventricular function during systole and diastole.- Regional indexes of left ventricular ejection and filling and region: pressure-radius length relations.- Regional pressure-radius length relation.- Discussion.- Myocardial ischemia, transient asynergy and altered relaxation.- Uncoordinated segmental contraction as a cause of impaired filling dynamics.- Effect of coronary occlusion on left ventricular chamber stiffness and regional diastolic pressure-radius relations.- Significance of the upward shift in pressure-volume and pressure-radius relations.- Comparison with animal models of acute low-flow ischemia.- Conclusion: PTCA as an ischemic model?.- Early wall motion during acute ischemia: how to interpret?.- Are there clinical implications in chronic ischemia?.- Are there clinical implications for the PTCA procedure?.- Acknowledgement.- References.- Therapeutic effects.- 19. Myocardial ischemia during PTCA: Consequences and treatment strategies.- Consequences of balloon induced coronary occlusion.- Electrocardiographic changes.- Left ventricular functional changes.- Pharmacologic agents designed to protect the ischemic myocardium.- Nitroglycerin.- Beta adrenergic blocking agents.- Calcium channel antagonists.- Oxygenated fluorocarbons.- Mechanical devices used to limit ischemia during balloon angioplasty.- Intraaortic balloon counterpulsation.- Coronary sinus retroperfusion.- Distal hemoperfusion catheter devices.- Percutaneous cardiopulmonary bypass support.- References.- 20. Does Diltiazem protect the ischemic myocardium during PTCA?.- Methods and material.- Results.- Discussion.- References.- 21. Influence of anti-ischemic drug treatment on the ischemic response to acute coronary occlusion in man.- Patients and methods.- Results.- Nitroglycerin, hemodynamics and electrocardiogram.- Calciumantagonists, hemodynamics and electrocardiogram.- Digital angiograms.- Discussion.- Clinical implications.- References.- 22. Cardioprotective effects of coronary sinus retroperfusion during LAD angioplasty.- Methods.- Patients' selection.- Retroperfusion systein.- Protocol.- Electrocardiographic recording.- Echocardiography.- Statistics.- Results.- Discussion.- Conclusion.- Acknowledgements.- References.- Two: Non-Operative Treatment of Acute Ischemia.- 23. Coronary angioplasty for unstable angina pectoris.- Classification of patients with unstable angina pectoris.- Pathophysiology of unstable angina and the impact of coronary angioplasty.- Coronary angioplasty in patients with 'stabilized' unstable angina.- Coronary angioplasty for refractory unstable angina.- Coronary angioplasty for early postinfarction angina.- Coronary angioplasty for variant angina.- Coronary angioplasty of only the culprit lesion in patients with unstable angina and multivessel disease.- Thrombolytics in the treatment of unstable angina.- Restenosis after coronary angioplasty in patients with unstable angina.- Proposed management of patients with unstable angina.- References.- 24. Coronary angioplasty in patients with non-Q wave myocardial infarction.- Natural history.- Pathogenesis.- Angiographic findings.- Therapeutic implications.- Conclusion.- References.- 25. Thrombolytic therapy and PTCA in acute myocardial thrombosis.- Coronary patency after thrombolysis and PTCA.- Infarct size and left ventricular function after thrombolysis and PTCA.- Clinical course and survival after thrombolysis and PTCA.- Immediate PTCA: a reappraisal.- Systematic delayed PTCA.- The treatment strategy in acute myocardial infarction.- References.- 26. The United States thrombolysis and angioplasty trials for acute myocardial infarction.- Pilot study.- Thrombolysis and angioplasty in myocardial infarction (TAMI).- Thrombolysis resistant group.- Randomized patients.- Patients unsuitable for randomization.- TIMI phase II.- The Johns Hopkins trial.- TAMI phase-II.- The role of angioplasty in myocardial infarction.- Direct angioplasty.- Immediate angioplasty.- Influence of the thrombolytic agent.- Early angiography and rescue angioplasty.- Conclusions drawn from the clinical trials.- References.
PRODUCT DETAILS
Publisher: Springer
Publication date: September, 2011
Pages: 400
Weight: 664g
Availability: Available
Subcategories: Cardiovascular Medicine
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