This book is an edited compilation of the scientific presentations given at a symposium on cardiovascular hemodynamics and the contemporary practice of cardiology which was organized in Malta, April 1989. The field of cardio­ vascular medicine has undergone an extraordinary explosion of knowledge regarding the basic biology of the heart and circulation in health and disease, as well as technologic innovations for probing and assessing cardiac geometry and physiology. This edition addresses such issues which are key problems in current management of patients with heart disease. For example, the classic notion that severe myocardial ischemia is invariably followd by either recovery of normal function or the progression to cell death has been challenged by experimental studies and clinical observations of patients undergoing throm­ bolysis and revascularization. This growing body of observations clearly indicates that the consequences of ischemia and reperfusion are much more complex and variable, and include several states of abnormal metabolism and contractile function which are distinct from either 'health' or 'death'. This book presents current issues of both consensus and controversy regarding the effects of myocardial ischemia and reperfusion, including irreversible cell loss (infarction), myocardial stunning, and myocardial hibernation. Particular attention is paid to the assessment and differentiation of such patients in the coronary care unit, catheterization suite, or following surgical revascula­ rization. Secondly, this book addresses the hemodynamic evaluation of the patient with valvular heart disease in today's cardiology practice.

Inhalt

1. From hemodynamic principles to clinical management.- 2. The clinical use and accuracy of echo-Doppler techniques for assessing severity of disease in valvular stenotic lesions.- 3. Proper timing of valve replacement in aortic stenosis.- 4. Optimal timing of surgery for volume overload hypertrophy in mitral and aortic regurgitation.- 5. Acute effects of myocardial ischemia on left ventricular function: How to differentiate myocardial infarction, stunned myocardium, and hibernating myocardium.- 6. Effects of coronary reperfusion on left ventricular function and survival: Some remaining problems.- 7. Effects of revascularization on left ventricular function in the stunned and hibernating myocardium.- 8. Heart failure: Newer concepts and origin of symptoms.- 9. Guidelines for the evaluation of treatment in congestive heart failure.- 10. Management of patients with hypertrophic cardiomyopathy.- 11. Antiarrhytmic therapy in heart failure.- 12. Non-invasive evaluation of cardiomyopathies.- 13. Can ultrasound reliably predict acute rejection in heart transplant recipients?.- 14. Cardiac transplantation.