Over the last ten years, it has become increasingly obvious that sudden death represents the major challenge confronting cardiology in the last part of the XXth Century. Careful epidemiologic studies have established the magnitude of this overall important problem of public health. The frequent association of sudden death with coronary artery disease has been demonstrated. Some of the electrophysiologic mechanisms underlying lethal arrhythmias have been unveiled. In addition, clinical markers permitting identifica- tion of high risk individuals have emerged. Finally, different studies have...

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...

Hypertension is a major health problem and contrary to ischemic heart disease, which occurs only in Western countries, its distribution is almost universal. It is this universality that has prompted us to gather, in this book, data on arterial blood pressure obtained in different parts of the world. Moreover, cerebrovascular mortality, which is the commonest cause of death from hypertension, is decreasing in most Western countries and in Japan, and the reasons for this are still far from clear. A major problem in comparing blood pressure values from different centers is the standardization of...

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...

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...

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,...

In industrialized countries, ischemic heart disease is by far the most common organ-specific cause of death. The thrombotic occlusion of a coronary artery which had previously been severely altered by atherosclerosis, is the most frequent cause of ischemic deterioration of myocardial tissue, i. e. myocardial infarction. Death of the human individual occurs when myocardial ischemia causes a critical impairment of cardiac pump function. The failure of a heart with an ischemic area may be due to the amount and location of contractile tissue becoming paralyzed or even necrotic, or to arrhythmias...

For almost 40 years, a small but intense group of cardiovascular investigators have evaluated cardiac performance by measuring the mass, velocity, and acceleration of blood ejected from the left ventricle. These studies reveal that energy is transferred from ventricle to blood very early in systole, and that the left ventricle is charac terized as an impulse generator. Recent explosive developments in Doppler echocar diography have allowed study of the energetics of ventricular contraction through noninvasive acceleration, velocity, and volumetric flow measurements. Compared against reference...

In November 1986, I was invited to attend a symposium held in Barcelona on Diseases of the Pericardium. The course was directed by Dr. J. Soler-Soler, director of Cardiology at Hospital General Vall d'Hebron in Barcelona. During my brief but delightful visit to this institution, my appreciation of the depth and breadth of study into pericardial diseases, carried out by Dr. Soler and his group, grew into the conviction that these clinical investigators have accumulated a wealth of information concerning pericardial diseases, and that investigators and clinicians practicing in English speaking...

Sudden death is probably the greatest challenge facing modem cardiology today. This is mainly due to the impact of its brusque appearance and the socioeconomic implications. The incidende is presently decreasing somewhat, mainly due to the decline in new cases of ischemic heart disease on one hand, and to better preven tion in risk patients on the other. Nevertheless, the figures are still high and represent over 300.000 patients per year in the United States alone. This book is an updating of the problem of sudden death from a multifactorial standpoint. It includes not only...