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It was a great pleasure for us to welcome so many experts from all over the world to our symposium in Aachen. We are also pleased - and you can attribute this to my own vanity - with the success and acceptance of the concept of myocardial reperfusion and revascularization - specifically selective intracoronary lysis followed either by PTCA or bypass surgery - which we have been pursuing since 1979. But after the dramatic immediate effects of the first attempts, which you have to experience yourself, we did not expect it to be any different. We decided against performing a randomized study in which every patient is catheterized, and thrombolytic therapy only given to some of the patients, for which we have been criticized at times. At the previous symposium in Aachen in 1983 on the topic of thrombolysis for acute myocardial infarction, in the final session several speakers were asked directly about this topic, and replied that if they were patients they would not want to be randomized into the placebo group. In the meantime positive results from large, randomized studies have been recorded, which are presented in this volume. I mention in particular the Western Washington Study from Dr. Kennedy and the Interuniversity Study in Holland. Aachen, a relatively small city with 250,000 inhabitants, provided the opportunity to treat a relatively large patient population with acute myocardial infarction.
Therapy in cardiology has advanced enormously in recent years. This has resulted in the organization of many meetings and the publication of numerous books dedicated to examining the latest aspects of, for instance, pharmacolog ic, electrical and surgical treatment. However, only a few of these meetings and publications have attempted to present an overall review of all advances that have taken place in the field of therapy. In the last years the Spanish Society of Cardiology has shown a great interest in the continuous medical education in cardiology. The Society has organized various meetings and has published several books on the above-mentioned topics. Consequently, the Society has decided to publish this book, an update of the therapeutics in cardiology, of which a Spanish version is also available. World renowned experts and outstanding Spanish cardiologists were invited to review all aspects of therapy in cardiology. We would like to thank the Spanish Society of Cardiology and the Catalan Cardiac Society for the generous assistance they have given us during all stages of book preparation. We also would like to express our appreciation to all the authors for their valuable contributions. Their combined efforts enable us to put this volume in the hands of the reader.
"Silent Ischemia, Current Concepts and Management" contains the proceedings of a conference held in Rottach-Egern, West Germany, March 5 to 7, 1987. We are most grateful to the authors for the effort to provide manuscripts before the meeting, to the sponsor, Bayer AG, for their generous support and to the publishers for their efficient collaboration, all of which have made the appearance of this book possible. When discussing silent myocardial ischemia, the first question is: "why is it silent?". To approach this question, a deeper look has to be taken into the pathophysiology of cardiac pain and the excitatory and inhibitory mechanisms involved. It has to be borne in mind that - in contradiction to what the poets have told us so beautifully for many centuries - the heart is a visceral and not a sensitive organ. If asymptomatic ischemia did not carry prognostic significance comparable to the symp tomatic manifestations of ischemia, then the problem of silent ischemia would be very academic and without consequences for treatment. Therefore studies on prognosis of silent ischemia are of great importance, as their results should indicate how aggressively patients are to be managed.
First multi-year cumulation covers six years: 1965-70.
First multi-year cumulation covers six years: 1965-70.
Ischemie heart disease is still the most frequent cause of death in the western world. There have been significant achievements in diagnostic procedures as well as in the medical, invasive, and surgiealtreatment ofischemieheart disease inrecent years. A variety ofdrugs are availablefor the pharmacotherapyofischemieheart disease, par ticularly nitrates, ß-blockers, and calcium-antagonists which are used as mono therapy or in various combinations. However, the selection of patients for a certain treatment, as weIl as the optimization of an individual treatment are still largely empirical. On the other hand, the recent advances in experimental cardiology emphasize the extremely complex and dynamie scenario of ischemic heart disease, involving endothelial damage, coagulation processes, metabolie and morphologie derangements, coronary constrictor mechanisms, blood flow redistribution, arrhythmogenesis, contraetile dysfunction during ischemia and reperfusion, and finally lack or presence of pain perception. Therefore, it appears desirable to close the gap between experimental and clinical cardiology and, thus, to provide a pathophysiologieal basis for rational cliniealdecisions with respect to diagnostic and therapeutic procedures. The idea for this book arose during the preparation of a seminar series on experi mental cardiology, when I found it diffieultto collect the pertinentinformation from textbooks of cardiology, physiology, pathology, and pharmacology, as well as from numerous review and original artieies on specifictopies. I am now very grateful that expert cliniealand experimental colleagues from around the world have joined me in the effort to provide a comprehensive textbook on the pathophysiology of myocar dial ischemia and its rational pharmacotherapy.
Coronary Microvascular Obstruction in Acute Myocardial Infarction: From Mechanisms to Treatment provides a comprehensive understanding of the phenomenon of coronary microvascular obstruction (CMVO) that is the main limitation of reperfusion therapies in ST-elevation myocardial infarction. It provides in-depth coverage of the phenomenon of CMVO which heavily affects prognosis by increasing the risk of death and heart failure at follow-up. A first of its kind reference dedicated solely to this topic, it is appropriate for a wide audience, from researchers, to those who aid in the management, prevention and treatment of CMVO. Provides in-depth coverage of coronary microvascular obstruction (CMVO), spanning research, management, prevention and treatment Includes the most up-to-date information on CMVO as presented from top experts around the word Provides access to a companion website with extra material, including tables, additional references and instructional videos Gives extensive coverage on how to measure CMVO, including in-depth indexes that can be used to detect and quantify the phenomenon