Hemodynamics in Daily Practice

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.