Atherothrombosis and coronary artery disease by Valentin Fuster MD PhD, Eric J. Topol MD, Elizabeth G.

By Valentin Fuster MD PhD, Eric J. Topol MD, Elizabeth G. Nabel MD

Written by means of the world’s most appropriate specialists, this quantity offers complete insurance of present techniques to the prevention, analysis, and administration of atherothrombosis and its coronary and noncoronary issues. This version has been completely up-to-date, sharply concerned about medical info, and trimmed to at least one achievable volume.

Coverage starts off with a assessment of danger components and prevention, emphasizing lipid abnormalities, high blood pressure, smoking, diabetes, and weight problems. next sections study the pathogenesis of atherosclerosis, markers and imaging, acute coronary syndromes, persistent reliable angina, and noncoronary atherothrombosis. medical displays, scientific administration, and the most recent interventional thoughts are included.

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Example text

Coronary artery disease causes about 800,000 new heart attacks each year and 450,000 recurrent attacks (2). The incidence in women lags behind men by 10 years for total CHD and by 20 years for myocardial infarction and sudden death. The male sex predominance is least pronounced for uncomplicated angina pectoris. The inci- TABLE 2–3. 0) From Lloyd-Jones DM, Larson MG, Beiser A, et al. Lifetime risk of developing coronary heart disease. Lancet 1999;353: 89–92, with permission. dence of myocardial infarction increases more sharply with age than angina or sudden death (Table 2–4).

Boucek’s enthusiasm for the procedure was limited by his recognition that he could not prove that a coronary thrombus was present in any of the patients or whether it was lysed as a result of the administration of fibrinolysin. To understand these concerns, it is important to recognize that Boucek and his associates did not perform coronary arteriograms as part of their study. That procedure was rarely performed in 1960, and when it was used everyone but Mason Sones used a nonselective technique that generally provided inadequate visualization of the coronary circulation.

Although early deaths from arrhythmias resulting from acute myocardial infarction were reduced, many patients still died as a result of cardiogenic shock and other less dramatic consequences of extensive myocardial necrosis. The introduction of the flow-directed, balloon-tipped catheter in 1970 facilitated the assessment of the hemodynamic consequences of acute myocardial infarction. This new approach made it possible to evaluate left ventricular filling pressure and cardiac output at the bedside so that the physician could adjust therapy to treat specific hemodynamic abnormalities.

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