Catecholamines And Heart Disease

A concise, in-depth analysis of the status of the sympathetic system in heart diseases This book summarizes the functional status of the sympathetic neural system in cardiological diseased states and highlights aspects of sympathetic neural activity that are important to an overall understanding of the pathophysiology process. Critical reviews of methods for evaluating sympathetic activity are discussed, existing data is closely scrutinized, and attempts are made to delineate the factors derived from increased sympathetic activity. The book provides a physiologically and clinically based approach to the investigation of the involvement of catecholamines in cardiovascular diseases, which makes it a valuable addition to the reference collections of researchers, clinical scientists, and graduate students.

An International Symposium "Catecholamines and the Heart" was held in Munich in May 1981, which was organized in cooperation with the Council on Cardiac Metabolism of the International Society and Federation of Cardiology and with the Microcirculation Working Group of the European Society of Cardiology. It was the aim of the organizers to evaluate in this Symposium the recent advances made in the field of sympathetic control of heart function. Particular attention was given to neural sympathetic pathways, to mechanisms and consequences of adrenoceptor stimulation and blockade as well as to clinically relevant implications mainly regarding the significance of catecholamines and of adrenoceptors in various heart diseases. The broad scope was covered in 34 papers presented by physiologists, pharmacologists and cardiologists during a two day meeting which was attended by an international audience. This book includes all papers as well as the discussions following each presentation. To accomplish rapid publication the manuscripts are published as submitted by the authors. The discussions were edited making use of the written questions and answers of the discussants. The Symposium was generously sponsored by Astra Chemicals GmbH, Wedell Holstein, Germany, which thus made possible a very fruitful exchange of information, ideas and concepts between specialists in various disciplines. The organizers gratefully acknowledge this support once again and would like to thank Dr. T. Kreuzer, the representative of Astra Chemicals, for his personal engagement.

A recent comprehensive study of stress and human health by the Institute of Medicine/National Academy of Sciences concludes that individuals who experience any of a wide range of stressful events or situations are at increased risk of developing a physical or mental disorder, including heart disease. Since cardiovascular disease continues to be a leading cause of illness and death, and since the etiology and pathogenesis of several of the commonest forms of heart disease are incompletely known, it is of fundamental impor tance to study the potential role of stress in the genesis of heart disease. Accordingly an International Symposium on Stress and Heart Disease was held in Winnipeg, Canada, June 26-29, 1984 and the proceedings form the basis of this book and its companion volume, "Stress and Heart Disease". The connection between stress (the behavioral sciences) and heart disease (the biomedical sciences) occurs in the mechanisms through which the brain affects or controls the endocrine and the autonomic nervous systems. Initially this linkage appeared to be relatively simple, mainly involving catecholamines and corticosteroids, and communication between nerve cells was thought to be electrical. Now knowledge has increased and concepts have change dramatic ally. Major advances have occurred in biochemical, anatomical, physiological, pharmacological, pathological and behavioral aspects of the neuroendocrine system. The over whelming significance of chemical communication in the nli xviii nervous system has become clear.

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.

The chapters of this book represent contributions by plenary lecturers and invited symposium speakers of the Fourth Annual Meet ing of the American Section of the International Society for Heart Research, held on May 26-29, 1982 in New Orleans, Louisiana. The aim of the Organizing Committee was to present an up-to-date picture of our knowledge of myocardial injury which would be equally useful to basic scientists and clinicians. The papers of this volume are divided into two groups: a) those dealing primarily with techniques to study myocardial injury, and b) those that discuss the different types of myocardial lnJury. The grouping of the papers within each of these headings roughly corresponds to the symposia presented at the meeting. I wish to acknowledge the financial support of the National Institutes of Health. Without grant HL 29149, the program could not have been financed. Contributions from the following companies were also gratefully received: Ayerst Laboratories, Ciba-Geigy, Merck Sharp and Dome, Pfizer Laboratories Division, A.H. Robbin Co., Smith-Kline Corporation, U.S.V. Pharmaceutical Co., and The Upjohn Co. My thanks are due to the members of The Organizing Committee (Drs. Gregory J. Bagby, Gerald S. Berenson, Alastair H. Burns, Harvey I. Miller, Robert Roskoski, Jr., and Judy A. Spitzer) for their help and support, and to the Secretary of the Meeting, Ms. L. Beatrice Abene for her excellent assistance. John J. Spitzer, M.D.

Cardiovascular disease (CVD) is the number one killer of men and women in industrialized countries. In older age groups, CVD is also the most important cause for hospitalization, and, in many countries, it is the basis of early retirement from work. Thus, CVD is associated with enormous costs for care and loss of productivity, as well as for disabilities, pensions, etc. All this has motivated clinicians and scientists to develop and implement new methodologies and technologies to better care for patients who are hospitalized for heart disease. Efforts to improve care in the acute phases of coronary heart disease (CHD) have been successful. During the last decade, the immediate mortality risk of a patient admitted to coronary care for a suspected myocardial infarction or other acute coronary syndrome has decreased to less than 10%. Despite these achievements, CVD continues to represent a major threat to the health of middle-aged and elderly men and women. This volume addresses myriad aspects of CHD prevention, including biobehavioral and psychosocial factors, behavioral epidemiology, behavioral intervention models, and policy. The first section of the text provides an introduction to CVD prevention and behavioral medicine. The second section introduces two theoretically different approaches to preventive action, high-risk and population-based strategies. The third section describes and discusses the important questions of how behavioral sciences can be conceptually integrated into traditional, medically based, preventive efforts. The fourth section presents both population and high-risk behavioral intervention approaches. In summary, this volume examines the social environment and its potentials for preventive actions, reviews the psychosocial and biobehavioral mechanisms involved in these effects, and describes concrete and practical implementations of behavioral medicine knowledge as they have been applied to CHD prevention.