Basic And Clinical Neurocardiology

The progression of heart disease is associated with changes in the neurohumoral mechanisms that control cardiac function. The degree to which this neurohumoral remodeling occurs, even before overt signs of cardiac disease become manifest, is important for prognosis. To determine why some patients experience sudden death while others sustain life in the presence of severely compromised cardiac function, the neuronal control of cardiac electrical and mechanical events must be considered. Starting at the level of individual neurons and building upwards, this book describes the synergistic interactions that occur among intrathoracic and CNS feedback loops to permit precise control of regional cardiac behavior. On this basic science foundation, subsequent clinical chapters explore the remodeling that occurs in this system with aging, with the evolution of specific cardiac pathologies, and with the psychological concomitants of heart disease. Most importantly, these chapters provide unique insights into how specific therapies like beta-andrenergic receptor blockade not only affect cardiomyocytes directly but also mitigate the adverse neurohumoral changes that accompany disease processes, such as heart failure and essential hypertension. The paradigm advanced in this volume is that heart disease is a multifaceted phenomenon involving the interplay of neurohumoral, cardiomyocyte and structural elements, each of which depends on the other. With our cumulative understanding of these interdependent processes, new avenues for time-appropriate, targeted methods of treating heart diseases can be developed.

Novel concepts about how neurons, from the level of the heart to the sensorium, exert dynamic control over cardiac electrical & mechanical events, are presented in this volume. A focus is on how various components of neural control of the heart remodel during the evolution of cardiac pathologies.

This valuable reference provides a wide range of practical, clinical information for physicians who care for patients with neurological and cardiac problems. Clinical Neurocardiology considers neurological complications arising from cardiac surgery and other cardiac interventions describes neurological findings in heart disease patients, including brain embolism, encephalopathies, and the effects of commonly prescribed drugs discusses the prognosis, diagnosis, and treatment of cardiac arrest details the management of coexistent coronary and cerebrovascular disease reviews the effects of various toxic and metabolic disorders causing neurologic symptoms in cardiac disease patients analyzes cardiac lesions as well as cardiac and neurological findings in patients with various diseases that effect the nervous system and heart and more! With over 1700 references, tables, drawings, photographs, and micrographs, Clinical Neurocardiology benefits cardiologists; neurologists; cardiac, cardiovascular, and vascular surgeons; neurosurgeons; internists; family and primary care physicians; physiologists; neuroscientists; and graduate and medical school students in these disciplines.

New ideas about intrinsic and extrinsic cardiac intrathoracic neurons, the role of spinal cord and medullary and higher center neurons are presented. The final chapters focus on the role that autonomic neurons play in the maintenance of cardiac function in the conscious state as well as in two major clinical conditions, dysrythimias and heart failure.

This valuable reference provides a wide range of practical, clinical information for physicians who care for patients with neurological and cardiac problems. Clinical Neurocardiology considers neurological complications arising from cardiac surgery and other cardiac interventions describes neurological findings in heart dise

Pheochromocytomas are rare, mostly benign tumors of the adrenal medulla whose symptoms are caused by a tumor-induced secretion of catecholamines. This book provides an overview of current knowledge on the clinical situation, diagnosis and therapy of the disease as well as an extensive discussion of novel aspects in the molecular basis of this disease such as the recognition of new tools in molecular biology. The endocrine diagnosis is based on precise knowledge of tumor metabolism of catecholamines and their metabolites and today comprises laboratory methods with a high sensitivity and specificity. As approximately one quarter of these tumors arise in the context of a familial disease, such as multiple endocrine neoplasia type 2, von Hippel-Lindau syndrome, neurofibromatosis type 1 or familial paragangliomas, the genetic diagnosis is becoming increasingly relevant. Equally indispensable are imaging methods such as 123I-MIBG scintigraphy or octreotide scintigraphy, which can be employed as a complementary approach in e.g. malignant tumors. The surgical therapy is clearly based on the nature of the disease; in sporadic unilateral as well as familial bilateral pheochromocytoma a lateral endoscopic approach is chosen. The treatment of malignant pheochromocytoma is mainly based on the use of nuclear medical techniques and selected chemotherapeutic approaches. This book is essential reading for clinicians and scientists in the fields of endocrinology as well as oncology, surgery and nuclear medicine.

The starting point for understanding the roles of stress and catecholamines in cardiovascular disorders is a theory defining stress. This book presents a new homeostatic theory of stress and distress and uses it to explain how systems using the endogenous catecholamines - norepinephrine, epinephrine, and dopamine - and other effector systems maintain the internal environment during stress. The theory proposes coordinated activation of the body's several stress systems in primitively specific patterns during exposure to various stressors. Comparator homeostats interpret afferent information about specific physiological or chemical variables and regulate operations of the effector systems. Via a hierarchical mosaic of central nerve cell clusters, the brain constantly redefines homeostasis by resetting homeostats, especially during stress.

This new analysis of reflex and hormonal control of the human cardiovascular system developed from questions raised in Human Circulation: During Physical Stress (Rowell, 1986) and from recent findings. The goal is to help students, physiologists and clinicians understand the control of pressure, vascular volume, and blood flow by examining the cardiovascular system during orthostasis and exercise, two stresses that most affect these variables. A discussion of the passive physical properties of the vascular system provides a basis for explaining how vascular control is modified by mechanical, neural, and humoral factors. Interactive effects of the vasculature on cardiac performance are emphasized; they reveal the importance of autonomic control, supplemented by muscle pumping, in maintaining adequate ventricular filling pressure. The author's detailed analysis of how total oxygen consumption is restricted focuses on limitations in cardiac pumping ability, oxygen diffusion from lungs to blood and from blood to active muscle, oxidative metabolism and neural control of organ blood flow. An unsolved mystery is the nature of the signals that govern the cardiovascular responses to exercise. This is discussed in a new and critical synthesis of ideas and evidence concerning the "error signals" that are sensed and then corrected by activation of the autonomic nervous system during exercise.