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'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.

0 d Technische Weiterentwicklungen haben die Grundlage dazu geschaffen, daß heute im Langzeit-EKG neben Rhythmusstörungen auch passagere Myokardischämien erfaßt werden können. Damit ist es möglich, die Ischämiebelastung eines Koronarkranken unter Alltagsbedingungen zu objektivieren. In dieser Monographie werden aktuelle Ergebnisse der Heidelberger Arbeitsgruppe zur ST-Streckenanalyse im Langzeit-EKG dargestellt. Schwerpunkte sind die Validierung einer für die Routinediagnostik geeigneten Form der Auswertung sowie Untersuchungen zur diagnostischen und prognostischen Bedeutung dieser noch jungen Methode. Vergleiche mit den Ergebnissen von Belastungs-EKG-Untersuchungen beleuchten den möglichen Stellenwert des Langzeit-EKG's für die Routinediagnostik der koronaren Herzkrankheit. Als wesentlicher Vorteil der ST-Streckenanalyse im Langzeit-EKG gilt die Möglichkeit zur Erfassung unprovozierter, stummer Myokardischämien bei Patienten mit der gemischten Form der Angina pectoris. Diesem Thema ist ein eigenes Kapitel gewidmet. Die vorgestellten Untersuchungsergebnisse werden unter Berücksichtigung der aktuellen wissenschaftlichen Literatur diskutiert, wobei das Hauptaugenmerk auf die Anwendung der Methode im Rahmen der klinischen Routinediagnostik gerichtet ist.

In der vorliegenden dritten, aktualisierten Auflage dieses Buches werden die Entwicklung und die Leistungsfähigkeit der Langzeit-Elektrokardiographie dargestellt. Beide haben sich als insbesondere für den Patienten wenig belastende Standardverfahren in Diagnostik und Therapie bewährt. Die mit diesen Techniken sowohl qualitativ als auch quantitativ erzielbaren Ergebnisse werden im klinischen Zusammenhang mit weiteren Krankheitsbildern diskutiert und daraus die therapeutischen Konzepte entwickelt.

Cardiovascular nuclear medicine emerged 15 years ago as a new noninvasive technique for the detection of human cardiac disease. It arised from the fields of nuclear medicine and cardiology and the cooperation of both specialties has been very productive. At present, nuclear cardiology techniques belong to the routine armamentarium of the clinical cardiologist. Results obtained by perfusion markers, metabolic tracers, and radionuclide angiography have shown to have important impact on patient management. Although exercise electrocardiography and echocar­ diography yield the large bulk of necessary data in the cardiac patient, nuclear cardiology provides important data that go far beyond the results obtained by the standard procedures. Magnetic resonance imaging is a relative newcomer in cardio­ logy and has still to prove its value in clinical cardiology. Yet, initial results have been encouraging both in congenital heart disease and in coronary artery disease. This book is based on 16 review publications that have been written throughout the period of 1985 till present time. Most chapters have been published in the period 1989 until 1991; the preceding review papers have been updated as much as possible. Furthermore, Chapter 15 entitled'What's new in cardiac imaging'has been espe­ cially written for this book. The Chapters 9, 11 and 13 have been recently written and have not been published yet.

In recent years, intensive care and emergency medicine have emerged as new medical specialties. Better understanding of acute illness and continuous advances in technology have fostered rapid development of new forms of therapy. This volume provides updates in this rapidly expanding field and includes various topics presented by recognized experts in the field.

A critical phase in coronary heart disease, unstable angina, is thoroughly discussed in contributions by well-known experts. Since myocardial infarction still belongs to the main causes of death, this topic is highly relevant for the present research and possible future treatment of coronary heart disease. The major recent advances made in the pathophysiology, diagnosis and therapy of unstable angina are reported in depth.

With detailed contributions from 45 renowned international authorities, this Third Edition stands alone as the most comprehensive, contemporary view of the biology, physiology, and management of acute coronary syndromes (ACS)-offering 32 chapters that span the state-of-the science in the field and provide intriguing discussions on CRP and other dis

This reference collects the latest scientific evidence illustrating the increasing importance of pharmacoinvasive therapy in the treatment of ST elevation acute myocardial infarction-tracking the origins, evolution, and limitations of current treatment methods and highlighting new clinical trial data showcasing the potential of the combined treatme