Heart Perfusion, Energetics, and Ischemia

The principal purpose of a NATO (North Atlantic Treaty Organization) Advanced Research Workshop, a part of the NATO Advanced Study Institutes Programme, is to: (a) exchange thoughts at the frontiers of knowledge or at the frontiers of two (or more) fields or sectors; (b) review and assess the state of the art; (c) formulate recommendations for future research directions; (d) formulate plans for large international scientific experiments. The aim of the ARW on "Microvascular, rheological, metabolic and heat-transfer aspects of the heart: relation to ischaemia and thrombosis", convened in Chateau de Bonas, July 4-11, 1982, was to describe functions and performance of the heart in an interdisciplin ary effort, involving cardiologists, pathologists, biochemists, haemorheologists, physiologists, pharmacologists and bioengineers; to explore interactions between such subfields as blood rheology, micro circulation and ischaemia of the myocardium, heat transfer, heat work and performance as a pump, effect of -metabolites and ion transfer, mechanism of sudden death, protein synthesis and protein molecular transformations. One of the purposes of the Convenor was to relate clinical haemorheology to the heart energetics and heart metabolism. This was only partly established, as difficulties of communications between different fields, difficulties of semantics and of specialized out looks could not be overcome within a -few days. Nevertheless, a gate was opened for communications interchange in the future. There was even a problem within each specialty, and as is rather common, quite diverse views have been expressed. This, of course, is quite normal in the progress of science.

Inhalt
1: Keynote Lectures on Multidisciplinary Approach to Heart Failure, Ischemia, and Infarction.- Different Factors in Death from Coronary Disease.- Blood Hyperviscosity in Heart Performance and Ischaemia: Heat Transfer and Stress.- Discussion Comments and Responses.- 2: Heart as the Pump: Work Output.- The Human Heart as a Pump.- The Heart as a Muscle and a Pump: Ventricular Function of the Heart in Ischemic Heart Disease.- Control of Cardiac Output in Sustained Essential Hypertension: A Biomathematical Approach.- Discussion The Heart as a Muscle and a Pump.- 3: Microcirculation and Myocardial Perfusion.- The Coronary Arteries.- The Coronary Microcirculation.- Microcirculation in Myocardium and Cerebral Cortex.- Subendocardial Ischemia in the Absence of Coronary Artery Disease.- Pharmacological Approach to Perfusion.- Ischemia in the Heart due to Atherosclerotic Mechanisms, Flow Anomalies and Vascular Spasm.- Discussion Comments and Responses.- 4: Ischemia and Infarction: Cellular, Humoral and Viscosity Aspects.- Mechanism of Cell Death in Myocardial Ischaemia.- Role of Platelets and Biophysical Factors in Thrombosis and Atherosclerosis.- Blood Viscosity in Myocardial Infarction.- Whole Blood Viscosity and Ischemic Heart Disease.- Calcium and Erythrocyte Microrheology: Pharmacological Applications.- Discussion A Potential Role for Plasma Proteins in Hyper-Viscosity and Capillary Sludging with Special Reference to Myocardial Ischaemia.- Comments on Blood Rheology in Coronary Heart Disease.- A Clinical Perception of the Role of Blood Viscosity.- 5: Myocardial Metabolism: Proteins, Metabolites and Ion Exchange.- Cardiac Protein Synthesis in Stress: Overload, Ethanol, and Anoxia.- Molecular Biology of Intercellular Matrix Macromolecules in Relation to the Cardiovascular System.- Thermal Transitions in Collagenous Tissues as Sensors of the Environment.- Cardiac Metabolites: The Importance of Supply and Demand.- Metabolites in Shock.- Calcium Exchange in the Heart.- Appendix to the Calcium Exchange in the Heart.- Calcium in Ischaemic Heart.- Discussion Proteoglycans and Glycosaminoglycans in Heart Valves.- Calcium Exchange I.- Calcium Exchange II: Sarcolemmal Fluxes Associated with Contraction of Heart Muscle.- Calcium Exchange III.- Comments and Responses.- 6: Thermodynamics and Heat Transfer.- The Cardiovascular System and Heat Transfer.- Energy Transfer in the Heart.- Thermodynamics and Cardiac Energetics.- Temperature Distribution and Transport of Heat in the Canine Myocardium.- Temperature Sensitivity Coefficients of Heat Transfer Processes in Myocardium, with Special Reference to the Determination of Tissue Perfusion.- Steady State Heat Transfer in the Left Ventricle.- Appendix to the Steady Heat Transfer in the Left Ventricle.- Discussion Comment on Myocardial Temperature and Blood Flow Distribution.- Comment on Existence of Hot Spots.- Comments and Responses.- 7: Summary, Conclusions and Perspectives.- Viewpoint on Heart Disease and Public Health.- Congestive Heart Failure is not Due to Low Cardiac Output per se.- Energy Transformation in the Heart.- Problems in Calcium Exchange.- Recommendations for Future Work on Metabolites.- Role of Microrheology of Blood (Hyperviscosaemia).- Viewpoint on Collagen Transition and Collagen as a Temperature Sensor.- Perspectives.- List of Participants.