Cardiology Rounds
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Published

Volume-Issue

Title

Total: 79

12/2006

10-10

Acute Stress Cardiomyopathy and Reversible Left Ventricular Dysfunction
By GERARD P. AURIGEMMA, MD
Over the past three decades, in addition to permitting insight into common diseases (eg, valvular or ischemic heart disease), echocardiography has greatly improved the understanding of systolic and diastolic function.

CME questionnaire available

11/2006

10-9

Fish Intake, Contaminants, and Human Health:
Evaluating the Risks and the Benefits
Part 2 – Health Risks and Optimal Intakes

By DARIUSH MOZAFFARIAN, MD, DRPH
This two-part report summarizes findings from a recent publication in the Journal of the American Medical Association. Part 1, in the October issue of Cardiology Rounds, discussed the potential health benefits of fish and fish oil intake. Part 2, in this issue, discusses the potential health risks and describes optimal intakes for different populations.

CME questionnaire available

10/2006

10-8

Fish Intake, Contaminants, and Human Health:
Evaluating the Risks and the Benefits
Part 1 – Health Benefits

By DARIUSH MOZAFFARIAN, MD, DRPH
This two-part report summarizes findings from a recent publication in the Journal of the American Medical Association. Part 1 discusses the potential health benefits of fish and fish oil intake. Part 2 discusses the potential health risks and describes optimal intakes for different populations.

CME questionnaire available

09/2006

10-7

The Role of Arterial Stiffness in the Pathogenesis
of Hypertension and Cardiovascular Disease

By GARY F. MITCHELL, MD
Aortic stiffening is a common but highly variable disorder that is associated with advancing age and exacerbated by many known cardiovascular disease (CVD) risk factors, including genetic factors. Increased aortic stiffness and the mismatch between aortic diameter and flow contribute to the widening of pulse pressure (PP) and development of systolic hypertension.

CME questionnaire available

06/2006

10-6

Do statins protect the kidney as well as the heart?
By MARCELLO TONELLI, MD, SM, FRCPC
Statins are widely prescribed for the primary and secondary prevention of cardiovascular disease, based on evidence indicating that they reduce mortality and the risk of vascular events in a variety of populations.

CME questionnaire available

05/2006

10-5

The Road to Wasting is Paved with Lost Minerals
By KARL T. WEBER, MD
Congestive heart failure (CHF), with its characteristic signs and symptoms, is a major health problem of epidemic proportions, particularly amongst the elderly. It is now recognized that this clinical syndrome involves more than a failing heart and salt-avid kidneys.

CME questionnaire available

04/2006

10-4

The Role of Salt in Hypertension: Its Effects are Far More than to Increase Arterial Pressure
By EDWARD D. FROHLICH, MD, FACC, MACP
The term “salt sensitivity” has been used for decades to suggest that increased ingestion of ascular Division (Clinical) salt results in an elevated arterial pressure. This concept is supported by a tremendous body of epidemiological, experimental, and clinical literature demonstrating that increased arterial pressure is associated with dietary salt excess resulting in hypertensive disease.

CME questionnaire available

03/2006

10-3

Catheter Interventions in Massive Pulmonary Embolism
By NILS KUCHER, M.D.
Most patients with an acute pulmonary embolism (PE) will have an uncomplicated clinical course once effective levels of anticoagulation are obtained.

CME questionnaire available

02/2006

10-2

Progress in Stroke Prevention and Treatment
By JAMES D. MARSH, MD
Stroke is a major cause of death and disability for Americans and, among older citizens, it is often an event more greatly feared than myocardial infarction (MI) or cancer. This is because a state of dependency is often a permanent consequence of a major stroke.

CME questionnaire available

01/2006

10-1

Pathophysiology of Intermittent Claudication in Peripheral Arterial Disease
By WILLIAM R. HIATT, M.D.
Peripheral arterial disease (PAD) is associated with an increased risk of cardiovascular mortality and substantial functional limitation. Patients with claudication have exerciseinduced ischemia in the muscles of the leg that limits walking distance and exercise capacity.

CME questionnaire available

12/2005

9-10

Diastolic and Systolic Heart Failure —
Similarities and Differences – Part 2

By KANU CHATTERJEE, MB, FRCP, FCCP, FACC, MACP
Diastolic and systolic heart failure are the two clinical subsets of the syndrome of heart failure (HF). There are considerable similarities, as well as differences, between the two entities.

CME questionnaire available

11/2005

9-9

Diastolic and Systolic Heart Failure — Similarities and Differences – Part I
By KANU CHATTERJEE, MB, FRCP, FCCP, FACC, MACP
Diastolic and systolic heart failure, the two clinical subsets of the syndrome of heart failure (HF), are frequently encountered in clinical practice. There are considerable similarities, as well as some important differences between the two entities in terms of their pathophysiology and clinical profile.

CME questionnaire available

10/2005

9-8

Metabolic Therapy for Heart Failure
By RONG TIAN, MD, PhD
Heart failure affects approximately 5 million Americans and more than a half million new cases are diagnosed each year. The steady rise in the prevalence of congestive heart failure (CHF) in recent years can be attributed to multi- factorial causes.

CME questionnaire available

09/2005

9-7

Contemporary Paradigms of Hypertrophic Cardiomyopathy
By CAROLYN Y. HO, MD
Cardiomyopathies are disorders of the myocardium that arise from a variety of etiologies and culminate in hypertrophic or dilated remodeling of the heart. Over the past two decades, there have been significant scientific advances in the study of primary cardiomyopathies: disorders of cardiac myocytes that remodel the myocardium in the absence of other underlying or contributing disease processes.

CME questionnaire available

06/2005

9-6

Proteomics and Cardiovascular Biomarker Discovery
By MARC S. SABATINE, MD, MPH, and ROBERT E. GERSZTEN, MD
Circulating biomarkers aid in determining both the diagnosis and prognosis of cardiovascular disease (CVD). Most of the currently used biomarkers were developed out of studies of known proteins.

CME questionnaire available

05/2005

9-5

Evaluation of Mitral Valve Regurgitation:
Implications for Percutaneous Mitral Valve Repair

By ELYSE FOSTER, MD
Isolated mitral valve repair surgery (MVRS) accounts for approximately 8,000 open-heart procedures that are performed each year in centers included in the Society for Thoracic Surgery (STS) database.

CME questionnaire available

04/2005

9-4

The Pleiotropic Effects of Statins: Fact or Fantasy?
By SCOTT KINLAY, MBBS, PhD
Statins have powerful effects on low-density lipoprotein (LDL) cholesterol and total cholesterol and reduce the risk of coronary artery disease and stroke.

CME questionnaire available

03/2005

9-3

Therapeutic Minimization of Ventricular Pacing to Prevent Atrial Fibrillation, Heart Failure, and Death
BY MICHAEL O. SWEENEY, MD
Abnormalities of cardiac impulse formation and propagation have been recognized as symptomatic and potentially lethal causes of cardiovascular illness for more than two centuries. Sinus node dysfunction (SND) is the dominant indication for cardiac pacing and refers to a broad array of abnormalities in sinus node and atrial impulse formation and propagation.

CME questionnaire available

02/2005

9-2

Cardiovascular Disease in the Developing World and its Cost-Effective Management
By THOMAS A. GAZIANO, MD,
At the beginning of the 20th century, cardiovascular disease (CVD) was responsible for < 10% of all deaths worldwide. Today, that figure is about 30% and CVD is the leading cause of death worldwide with about 80% of the burden now occurring in developing countries. This issue of Cardiology Rounds explains the epidemiological transition that has made CVD the leading cause of death in the world, assesses the status of the transition by region, and shows the regional differences in the burden of CVD.

CME questionnaire available

01/2005

9-1

The Act of Balancing Bleeding versus Thrombosis
By SAM SCHULMAN, MD, PhD
Patients with severe hemostatic defects are only partially protected from thrombosis. Conversely, those with thrombosis and the need for anticoagulant therapy may also suffer from bleeding.

CME questionnaire available

12/2004

8-10

Pathophysiology of Vascular Dysfunction in Diabetes
By JOSHUA A. BECKMAN, MD
Diabetes mellitus (DM) was likely first described about 3500 years ago and given its name about 2200 years ago by Demetrios of Apamaia. The word “diabetes” derives from the Greek “diabeinein” or “siphon,” a word that captures its association with excess urination.

CME questionnaire available

11/2004

8-9

Coronary Heart Disease in Women: Is There Any Role for Menopausal Hormone Therapy in Cardiac Protection?
By NANETTE K. WENGER, MD, FACC, FAHA, MACP
Coronary heart disease (CHD) is the leading cause of mortality in American women. Clinical outcomes for women following both myocardial infarction (MI) and coronary artery bypass graft surgery (CABG) are less favorable than for men.

CME questionnaire available

10/2004

8-8

Cardiac Remodeling and Recovery: Lessons from Mechanical Ventricular Assist Devices
By LESLIE W. MILLER, MD and KATHERINE LIETZ, MD
Cardiac injury, regardless of etiology, typically leads to an increase in wall stress, decreased compliance, reduced systolic function, and progressive chamber dilation. This process is termed “remodeling” and is associated with a worse prognosis in patients with heart failure.

CME questionnaire available

09/2004

8-7

Glucose-insulin-potassium (GIK) for acute myocardial infarction: Mechanisms of action and current status
CARL S. APSTEIN, M.D.
Recent basic and clinical evidence suggests that glucose-insulin-potassium (GIK) may reduce mortality after myocardial infarction (MI). This issue of Cardiology Rounds reviews the metabolic mechanisms responsible for the protective effects of GIK and its potential benefits in the management of acute MI (AMI).

CME questionnaire available

07/2004

8-6

Intracoronary vascular profiling of shear stress, lumen, and wall morphology to predict vascular behavior and atherosclerosis progression
Part 2: Clinical implications

By PETER H. STONE, M.D. and CHARLES L. FELDMAN, SC.D.
Although atherosclerosis is a pan-coronary disease, most of its important clinical sequelae are manifest focally and individual lesions evolve independently of one another.

CME questionnaire available

05/2004

8-5

Intracoronary vascular profiling of shear stress, lumen, and wall morphology to predict vascular behavior and atherosclerosis progression
Part 1: Rationale and methods

By PETER H. STONE, M.D. and CHARLES L. FELDMAN, SC.D.
Although atherosclerosis is a pan-coronary disease, most of the important clinical sequelae manifest focally, with individual lesions evolving independently of one another.

CME questionnaire available

04/2004

8-4

Update on Infective Endocarditis:
New Insights into an Old Disease

By CHRISTOPHER H. CABELL, MD, MHS, and THOMAS RYAN, MD
It is of use from time to time to take stock, so to speak, of our knowledge of a particular disease, to see exactly where we stand in regard to it, to inquire to what conclusions the accumulated facts seem to point, and to ascertain in what direction we may look for fruitful investigations in the future.

CME questionnaire available

03/2004

8-3

Obstructive Sleep Apnea and Heart Failure: Pathophysiologic and Therapeutic Implications
By T. DOUGLAS BRADLEY, M. D.
Heart failure (HF) is a common disorder afflicting approximately 4,000,000 Americans. Although the prevalence of HF is growing as more patients survive myocardial infarction (MI) and ischemic heart disease, a great deal of progress has been made in the treatment of this disorder over the past 20 years.

CME questionnaire available

02/2004

8-2

Prediction of Coronary Heart Disease Events
Part 2: The Contribution of Lifestyle Factors
and New Issues

By PETER W. F. WILSON, M.D.
Part 1 of this topic, in the last issue of Cardiology Rounds, presented traditional risk factors such as age, gender, cholesterol, blood pressure, smoking, and diabetes and the part they play in predicting coronary heart disease (CHD).

CME questionnaire available

01/2004

8-1

Prediction of Coronary Heart Disease Events
Part 1: The role of traditional risk factors

By PETER W. F. WILSON, M.D.
Coronary heart disease (CHD) is largely attributable to arteriosclerosis, a disease process that develops insidiously in late adolescence and early adulthood, although the clinical sequelae are often not manifest until after age 45 years.

CME questionnaire available

12/2003

7-10

New therapies for pulmonary hypertension
By STUART R. RICH, MD
Pulmonary hypertension was once considered a progressive fatal disease for which there was no effective therapy. Over the past two decades, however, several new drugs have been developed that are effective in improving symptoms, exercise tolerance, and survival.

CME questionnaire available

11/2003

7-9

Oxidative stress and coronary heart disease
By JEAN-CLAUDE TARDIF, MD, FRCPC, FACC
Despite the fundamental biological role of oxygen as an efficient producer of energy, an altered form of oxygen – with modifications in key chemical bonds that may potentially result in alterations in cellular structure and function – contributes to disease progression.

CME questionnaire available

10/2003

7-8

Left Ventricular Remodeling and Synchronized Biventricular Pacing in Advanced Heart Failure
By MARTIN ST. JOHN SUTTON, FRCP
Ventricular remodeling describes the process of changes in heart size, geometry, and function that occur in response to a variety of stimuli.

CME questionnaire available

08/2003

7-7

Developing Drugs to Prevent and Treat Arterial Thrombosis
By ROBERT A . HARRINGTON, M.D.
Cardiovascular specialists and general internists spend the majority of their professional lives assessing the value of medical products (drugs/biologics/devices) and applying this knowledge to make treatment recommendations for their patients.

CME questionnaire available

06/2003

7-6

The Value of a Heart Biopsy
By KENNETH LEE BAUGHMAN, M.D.
Despite advances in the diagnosis and treatment of patients with cardiomyopathy, the prognosis remains poor.

CME questionnaire available

05/2003

7-5

Exercise intolerance and the role of exercise training in heart failure
By GARY J. BALADY, MD
Heart failure (HF) often leads to impaired exercise tolerance that incurs significant limitations in patients with this disability and, with the increased prevalence of HF, there are also important and widespread medical, social, and economic implications.

CME questionnaire available

04/2003

7-4

New guidelines for the management of unstable angina and non-ST-elevation myocardial infarction Part 2: An invasive versus a conservative strategy and long-term management
By CHRISTOPHER P. CANNON, MD
Every year, approximately 1.42 million patients are admitted to hospitals in the United States with unstable angina and non-ST-segment elevation myocardial infarction.

CME questionnaire available

03/2003

7-3

New guidelines for the management of unstable angina and non-ST-elevation myocardial infarction
Part I: Medical therapies

By CHRISTOPHER P. CANNON, MD
Every year, approximately 1.42 million patients are admitted to hospitals in the United States with unstable angina and non-ST-segment elevation myocardial infarction (UA/NSTEMI).

CME questionnaire available

02/2003

7-2

Minimally invasive cardiac valve surgery
By LAWRENCE H. COHN, MD
In 1996, the Brigham and Women’s Hospital, along with units at Loma Linda University and the Cleveland Clinic, introduced minimally invasive cardiac valve surgery for patients who had isolated valve pathology without coronary artery disease.

CME questionnaire available

01/2003

7-1

Alcohol septal ablation for hypertrophic obstructive cardiomyopathy
By MICHAEL A. FIFER, MD
Hypertrophic cardiomyopathy (HCM) is a disease characterized by idiopathic hypertrophy of the left (and sometimes right) ventricle. Clinical manifestations include angina (even in the absence of coronary artery disease), heart failure (due in large part to diastolic dysfunction), and arrhythmias.

CME questionnaire available

12/2002

6-10

High-density lipoprotein metabolism as a therapeutic target for atherosclerosis
By DANIEL J. RADER, M.D.
There is a strong inverse association between plasma HDL cholesterol (HDL-C) levels and incidence of coronary heart disease (CHD) that is independent of other known risk factors.

CME questionnaire available

11/2002

6-9

Rescuing the Failing Heart by Targeted Gene Transfer
By ROGER J. HAJJAR, M.D.
Congestive heart failure (CHF) represents an enormous clinical problem demanding effective therapeutic approaches. Despite advances in its treatment, including novel pharmacologic management, myocardial revascularization, mechanical assistance, and transplantation, CHF remains a leading cause of death in the United States and Europe.

CME questionnaire available

10/2002

6-8

Statistical Methods in Clinical Trials: Using Your Allocated Statistical Firepower
LEMUEL A. MOYÉ, M. D., Ph.D.
When designing a clinical trial, investigators commonly feel that they are fighting (or are caught in the middle of) a two-front war. One front is driven by the requirement that the research effort should be productive, the other by statistical concerns.

CME questionnaire available

08/2002

6-7

Atherosclerosis in Women: The Role of Gender
MARIE GERHARD-HERMAN, MD
Cardiovascular disease (CVD) accounts for over 40% of all deaths in women in the United States and is the leading killer of women in most developed countries.

CME questionnaire available

06/2002

6-6

Exercise Testing Part 2: The Value of Heart Rate Recovery
By MICHAEL S. LAUER, MD, FACC, FAHA
In the last issue of Cardiology Rounds, the value of exercise electrocardiography as a diagnostic tool for coronary artery disease was questioned because the results of this commonly performed test may be inaccurate due to verification bias.

05/2002

6-5

Exercise Testing Part 1: Looking Beyond the ST Segment
By MICHAEL S. LAUER, MD, FACC, FAHA
Although exercise electrocardiography is one of the most commonly performed, noninvasive diagnostic tests in the United States, it has fallen into relative disfavor in relation to other noninvasive modalities, including nuclear perfusion scintigraphy, PET scanning, and stress echocardiography.

04/2002

6-4

Non-reperfusion therapies for ST elevation MI patients who present late or are ineligible for reperfusion
MARC COHEN, MD, FACC
In the setting of acute ST segment elevation myocardial infarction (STEMI), myocardial necrosis begins within minutes, and is largely complete within a few hours.

03/2002

6-3

Clinical and genetic aspects of cardiac myxomas
CRAIG T. BASSON, MD, PhD
Primary cardiac tumors are rare and occur in 1 per 1000 to 1 per 100,000 individuals in unselected autopsy series at tertiary care centers.

02/2002

6-2

Chronic infection, Chlamydia and coronary heart disease – the story evolves
SANDEEP GUPTA, MD
The recognition of atherosclerosis as an inflammatory disease in its genesis, progression, and ultimate clinical manifestations, has created an intriguing area of vascular research.

01/2002

6-1

Therapeutic Angiogenesis: A Treatment for the New Millennium or Passing Fad?
BRIAN H. ANNEX, MD
Angiogenesis is defined as the growth and proliferation of blood vessels from existing vascular structures.

12/2001

5-10

Patent Foramen Ovale — Beauty Spot or Health Threat?
BERNHARD MEIER, MD
In 1877, Cohnheim first suggested a potential causal relationship of a patent foramen ovale (PFO) with significant disease when analyzing the case of a young woman with a stroke.

11/2001

5-9

Endothelial regulation of vascular tone:
From basic biology to clinical application

PETER GANZ, MD
At the cardiac catheterization laboratory at Brigham and Women’s Hospital, investigations of endothelial function were initiated nearly two decades ago in order to provide an explanation why atherosclerotic arteries paradoxically constrict in response to the same stimuli that lead to vasodilation of healthy arteries.

10/2001

5-8

Prevention of stroke
PHILIP A. WOLF, MD
In 1999, there were nearly 700,000 acute strokes in the United States.1 Of great concern, death rates from stroke, which had a remarkable decline of 62% between 1972 and 1990, had reached a plateau.

09/2001

5-7

Dietary Treatment to prevent cardiovascular disease PART II: Effects on hyperlipidemia
FRANK M. SACKS, M.D.
Patterns of cardiovascular disease (CVD) worldwide, epidemiology in the US, and clinical studies of diet, leave no doubt that high rates of coronary heart disease (CHD) and stroke are caused by poor nutrition (ie, too much food and too many harmful foods), as well as the erosion of an active lifestyle.

08/2001

5-6

Dietary treatment to prevent cardiovascular disease Part I: Lowering blood pressure
FRANK M. SACKS, M.D.
During my 18 years of clinical practice in hyperlipidemia at Brigham and Women?s Hospital and my teaching in this field, I have heard various views from practicing physicians on dietary treatment.

07/2001

5-5

Restenosis: Is the cure finally here?
DANIEL I. SIMON, MD and ALEXANDRE ZAGO, MD
More than 1 million percutaneous coronary intervention (PCI) procedures are performed annually worldwide to relieve the symptoms of coronary artery disease.

04/2001

5-4

Contractile failure during ischemia and
congestive heart failure: role of defective
excitation-contraction coupling

JOSHUA I. GOLDHABER M.D.
Contractile dysfunction is a hallmark of major cardiac disorders, including acute ischemia, reperfusion, hypertrophy, and failure.

01/2001

5-1

Impact of the Prediabetic State for the Treatment of Cardiovascular Disease in Prediabetic Patients
STEVEN M. HAFFNER, M.D.
Patients with both type 1 and type 2 diabetes are at increased risk for coronary heart disease (CHD) and stroke.

12/2000

4-10

The time-dependent open vasculature hypothesis
C. MICHAEL GIBSON, M.S., M.D.
In both experimental animal models and in clinical trials of acute myocardial infarction, it has been observed that more rapid restoration of flow in the infarct artery results in improved clinical outcomes, leading to a paradigm known as the “time-dependent open artery hypothesis.”

11/2000

4-9

Cardiac transplantation
GILBERT H. MUDGE, J R ., M.D.
Cardiac transplantation is an important therapeutic modality for the treatment of the mor-bidity and reduced survival associated with end-stage congestive heart failure.

05/2000

4-5

Endovascular treatment of atherosclerotic extracranial cerebrovascular disease: reasonable or irresponsible?
ANDREW C. EISENHAUER, MD
In recent years, endovascular therapy has expanded from the treatment of coronary and peripheral vascular disease into the more specialized treatment of cerebrovascular (CBV) disease.

04/2000

4-4

Minimally invasive cardiac valve surgery
LAWRENCE H. COHN, MD
Cardiac surgery is the last area of clinical surgery to adopt and embrace minimally invasive surgical techniques.

03/2000

4-3

Assessing and reducing cardiac risk in noncardiac surgery
THOMAS H. LEE, MD
The preoperative assessment of patients scheduled for noncardiac surgery is one of the most common clinical chal lenges facing internists and cardiologists.

02/2000

4-2

Inflammation and infection as risk factors of coronary artery disease: What is the evidence?
JOSEPH B. MUHLESTEIN, MD
Over the past several decades, atherosclerosis and its complications has become the major health problem in the Western world with more than 50% of deaths attributed to its complications.

01/2000

4-1

Transmyocardial laser revascularization: Subjective success, objective controversy
SARY F. ARANKI, MD
Low powered lasers were first used in the early 1980s to produce transventricular channels as an adjunct to coronary artery bypass graft surgery (CABG).

12/1999

3-4

Atrial fibrillation: current epidemiology, noninvasive imaging, and pharmacologic therapy
SHARON C. REIMOLD, MD
Atrial fibrillation (AF) is an increasingly common supraventricular arrhythmia. In this review, we will discuss the changing epidemiology of AF, the impact of noninvasive imaging on the evaluation of patients with AF, and the role of pharmacologic therapy in the treatment of this condition.

11/1999

3-3

Diastolic heart failure: Diagnosis, mechanisms, and treatment
MICHEAL R. ZILE, MD
Congestive heart failure (CHF) may be caused by a primary abnormality in systolic function, diastolic function or both.

10/1999

3-2

How do generalists and specialists compare in cardiovascular care?
JOHN Z. AYANIAN, MD, MPP
The quality and outcomes of care provided by primary care physicians and specialists are increasingly important issues for the health-care system of the United States.

09/1999

3-1

Current perspectives in coronary intervention
JEFFREY J. POPMA, MD
Over the past several years, there has been a profound evolution in the techniques used for percutaneous coronary intervention (PCI).

12/1998

2-8

Primary and secondary prevention of coronary heart disease
J. MICHEAL GAZIANO, MD, MPH
Cardiovascular disease (CVD) remains the number one cause of death in the US, accounting for nearly half of all deaths among both men and women.

10/1998

2-7

Asymptomatic myocardial ischemia in stable angina, unstable angina, and myocardial infarction: Current status and future directions
PETER H. STONE, MD
Myocardial ischemia or infarction may occur in the absence of symptoms; however, more recently it has been appreciated that symptomatic manifestations are often extremely inconsistent and heterogeneous within a particular patient.

08/1998

2-6

The unique challenge of treating the adult patient with congenital heart disease
MICHEAL J. LANDZBERG, MD
For the most part, adult patients with congenital heart (ACH) disease are “products” of pediatric medical and surgical advances that took place in the second half of this century.

05/1998

2-5

Nitric oxide and vascular disease
JAMES K. LIAO, MD, FACP, FACC
Nitric oxide (NO),or a closely related molecule derived from NO, is now known to be the endogenous vasodilator initially described as endothelium-derived relaxing factor (EDRF).

04/1998

2-4

Platelet glycoprotein IIb/IIIa inhibition in acute coronary syndromes
CHRISTOPHER P. CANNON, MD
Every year more than four million patients are admitted to hospitals worldwide with the diagnosis of unstable angina or acute myocardial infarction (MI). In addition , over 900,000 patients annually worldwide undergo percutaneous transluminal coronary angioplasty (PTCA) with or without stenting.

03/1998

2-3

Circadian rhythm and the triggering of acute coronary syndromes
GEOFFREY H. TOFLER, MD
Despite the frequency of the acute coronary syndromes of myocardial infarction (MI), sudden cardiac death, and unstable angina, relatively little is known of the events that transform a patient with chronic, stable coronary atherosclerosis into a patient with an acute life-threatening illness.

02/1998

2-2

Pulmonary embolism
SAMUEL Z. GOLDHABER, MD, FACC
The clinical spectrum of pulmonary embolism (PE) ranges from small, incidental thrombosis to massive PE associated with sudden death due to cardiogenic shock. Pulmonary arterial obstruction and platelet secretion of vasoactive agents elevate pulmonary vascular resistance. Increased alveolar dead space impairs gas exchange, and stimulation of irritant receptors causes alveolar hyperventilation.

01/1998

2-1

Rationale for the Use of ß-Adrenergic Blockers in Patients with Systolic Heart Failure
ERIC J. EICHHORN, MD, FACC
Our concepts of chronic heart failure have changed dramatically in the last 30 years. We have gone from viewing heart failure as an edematous state, to a view of heart failure in terms of a mechanical or hemodynamic paradigm, to a view of heart failure as a neurohormonal illness.

12/1997

1-2

Antithrombin Therapy in Acute Coronary Syndromes
ELLIOTT M. ANTMAN, MD
Following rupture of a vulnerable plaque, the coagulation cascade is activated and fibrin strands are formed. The classic view of the coagulation cascade postulated that two independent pathways converged on the activation of factor X.

11/1997

1-1

Beyond Cholesterol: Novel Risk Factors for Atherosclerotic Disease
PAUL M. RIDKER, MD, MPH, FACC
Based upon data from the Framingham Heart Study,the American Heart Association has advocated a risk-factor prediction algorithm that takes into account age, total and high-density lipoprotein HDL)cholesterol, systolic blood pressure, smoking history, diabetes, and evidence of left ventricular hypertrophy.

Total: 79