Myocardial Infarction: Measurement and Intervention

ISBN-13: 9789400974548 / Angielski / Miękka / 2011 / 564 str.

G.S. Wagner

Opis

Patients currently experiencing acute myocardial infarcts are the beneficiaries of information gathered during the 80 years since this clinical phenomenon was described and the 20 years since treatment in coronary care units was introduced. Physicians have gained the ability to minimize inhospital mortality from rhythm disturbances and have gained insight into the importance of optimizing both left ventricular fIlling pressure and outflow resistance in the management of myocar dial failure. Understanding of the pathophysiology of acute myocardial infarcts has matured sufficiently so that now it is possible to consider whether an infarct must evolve to a predetermined size or whether the size could be limited by implementing one or more clinically feasible strategies. Concurrently, it has become evident that patients with acute infarcts are not as 'fragile' as previously supposed, and that they may undergo procedures such as coronary angiography and coronary bypass surgery with acceptable risks. Clinical trials are currently in progress to assess the possible benefit of various interventions for limiting myocardial infarct size. The outcome of these studies may be used to formulate strategies for clinical care of future patients. If the results are positive, community hospitals may undergo changes even more exten sive than those required when they established coronary care units. If the inter ventions are not proven to provide significant advantages over the course of nature, the current concepts of coronary care may be retained. However, such conclusions will be only as valid as the techniques used to measure infarct size."

Spis treści

I. Pathophysiology.- 1. Time course of infarct and healing.- II. Methods for Determining Infract Size.- 2. The ECG: QRS change.- 3. The ECG: the spatial and nonspatial determinants of the extracellularly recorded potential with emphasis on the TQ-ST segment.- 4. Enzymatic estimation: creatine kinase.- 5. Enzymatic estimation: confounding effects of blood flow to infarcted myocardium.- 6. Hemodynamic measurements.- 7. Contrast ventriculography.- 8. Radionuclide ventriculography.- 9. Ultrasound.- 10. Computerized tomography.- 11. Regional myocardial blood flow: a model for assessing intervention therapy in the conscious animal.- 12. Radionuclide perfusion techniques.- 13. Infarct-avid imaging techniques.- 14. Postmortem: anatomic quantitation.- 15. Postmortem: histochemical techniques.- III. Interventions for Limiting Infract Size.- 16. Overview of potential mechanisms.- 17. Decreasing myocardial energy utilization.- 18. Increasing coronary blood flow.- 19. Alterations in the coagulation system.- 20. Alterations of the metabolic and cellular responses.- 21. The relationship between coronary angiographic patterns and the effects of infarct limiting interventions.- IV. An Overview.- 22. Current status of measurements and efforts to reduce myocardial infarct size in man.