Coronary Microcirculation In The Clinical Context

The increasing awareness of coronary microvascular dysfunction through the broad spectrum of car-diovascular disease makes this pathophysiological feature an important aspect to study in clinical practice. A multimodality approach, including echocardiography, cardiovascular magnetic resonance, PET and cardiac catheterization, allows a holistic view into microcirculation in each entity, and contri-butes for a better understanding of the pathophysiology.The search for coronary microvascular dysfunction may potentially change the management of the patient and treatment approach, with recognized prognostic impact. This book aims to review the principal aspects of coronary microvascu-lar dysfunction, from the pathophysiology, to imaging, clinical relevance and treatment.

In the past two decades a number of studies have shown that abnormalities in the function and structure of coronary microcirculation can be detected in several cardiovascular diseases. On the basis of the clinical setting in which it occurs, coronary microvascular dysfunction (CMD) can be classified into four types: CMD in the absence of any other cardiac disease; CMD in myocardial diseases; CMD in obstructive epicardial coronary artery disease; and iatrogenic CMD. In some instances CMD represents an epiphenomenon, whereas in others it represents an important marker of risk or may contribute to the pathogenesis of myocardial ischemia, thus becoming a possible therapeutic target. This book provides an update on coronary physiology and a systematic assessment of microvascular abnormalities in cardiovascular diseases, in the hope that it will assist clinicians in prevention, detection and management of CMD in their everyday activity.

Coronary Microvascular Obstruction in Acute Myocardial Infarction: From Mechanisms to Treatment provides a comprehensive understanding of the phenomenon of coronary microvascular obstruction (CMVO) that is the main limitation of reperfusion therapies in ST-elevation myocardial infarction. It provides in-depth coverage of the phenomenon of CMVO which heavily affects prognosis by increasing the risk of death and heart failure at follow-up. A first of its kind reference dedicated solely to this topic, it is appropriate for a wide audience, from researchers, to those who aid in the management, prevention and treatment of CMVO. Provides in-depth coverage of coronary microvascular obstruction (CMVO), spanning research, management, prevention and treatment Includes the most up-to-date information on CMVO as presented from top experts around the word Provides access to a companion website with extra material, including tables, additional references and instructional videos Gives extensive coverage on how to measure CMVO, including in-depth indexes that can be used to detect and quantify the phenomenon

This book is open access under a CC BY 4.0 license. This quick-reference handbook offers a concise and practical review of key aspects of the treatment of ST-segment elevation myocardial infarction (STEMI) in the era of primary percutaneous coronary intervention (PPCI). In the context of STEMI, PPCI is the preferred mode of emergency revascularization. Access to PPCI is rapidly increasing and is now routinely practiced in both general and specialist hospitals and there has been a recent emphasis on developing STEMI networks to enhance and expedite the referral pathway. This coupled with concurrent developments to enhance the safety and efficacy of the PPCI procedure has heralded an era where STEMI interventions are increasingly considered an important subspecialty within interventional cardiology. Written by leading cardiologists who have been instrumental in the adoption of PPCI in their respective institutions, the book provides junior and senior cardiologists alike with insightful and thought-provoking tips and tricks to enhance the success of PPCI procedures, which may in turn translate into direct improvements in outcomes. The book is also relevant for healthcare providers and emergency department physicians.

This presentation describes various aspects of the regulation of tissue oxygenation, including the roles of the circulatory system, respiratory system, and blood, the carrier of oxygen within these components of the cardiorespiratory system. The respiratory system takes oxygen from the atmosphere and transports it by diffusion from the air in the alveoli to the blood flowing through the pulmonary capillaries. The cardiovascular system then moves the oxygenated blood from the heart to the microcirculation of the various organs by convection, where oxygen is released from hemoglobin in the red blood cells and moves to the parenchymal cells of each tissue by diffusion. Oxygen that has diffused into cells is then utilized in the mitochondria to produce adenosine triphosphate (ATP), the energy currency of all cells. The mitochondria are able to produce ATP until the oxygen tension or PO2 on the cell surface falls to a critical level of about 4–5 mm Hg. Thus, in order to meet the energetic needs of cells, it is important to maintain a continuous supply of oxygen to the mitochondria at or above the critical PO2 . In order to accomplish this desired outcome, the cardiorespiratory system, including the blood, must be capable of regulation to ensure survival of all tissues under a wide range of circumstances. The purpose of this presentation is to provide basic information about the operation and regulation of the cardiovascular and respiratory systems, as well as the properties of the blood and parenchymal cells, so that a fundamental understanding of the regulation of tissue oxygenation is achieved.

Research centering on blood flow in the heart continues to hold an important position, especially since a better understanding of the subject may help reduce the incidence of coronary arterial disease and heart attacks. This book summarizes recent advances in the field; it is the product of fruitful cooperation among international scientists who met in Japan in May, 1990 to discuss the regulation of coronary blood flow.

A complete guide to non-invasive imaging techniques in cardiology Today's imaging technologies offer cardiologists more ways than ever to diagnose conditions of the heart without the need of endoscopies and other invasive procedures. Now in its third edition,Cardiac CT, PET and MRI continues to provide an in-depth explanation of these tools and their correct applications, while also exploring cardiac imaging's most recent and groundbreaking developments. This wide-ranging guide places CT, PET and MRI in a practical context, illustrating clearly their respective functions as they apply to specific cardiological disorders and clinical situations. With the addition of seven new chapters, it also offers an expanded insight into PET – an increasingly popular and affordable diagnostic utility, hitherto underexplored in texts devoted to imaging. Cardiac CT, PET and MRI includes: Clinically focused examinations of CT, PET and MRI – the three most popular non-invasive imaging modalities Illustrative full-color photos and images Access to a companion website featuring additional content Cardiologists, radiologists, nuclear medicine physicians, physicists, and imaging technologists alike will find the third edition of Cardiac CT, PET and MRI an informative and accessible resource with a direct use in their day-to-day practice.

Microcirculation is a rather new field which has been of predominant interest to basic scientists, linking togeth~r technical, hemodynamic, and biochemical aspects. The fmdings elaborated, however, are not only of theoretical interest, but bear in addition great clinical implications. In clinical cardiology this became quite evident by the use of tracers in order to study myocardial perfuSion and by the deSCription of certain clinical entities - such as angina with normal coro nary arteries - which are best explained by "disturbed microcirculation". With respect to this new developing theoretical and clinical field of cardiac microcirculation it was the aim of the Microcirculation Working Group of the European Society of Cardiology to have a symposium on which all different but clinically relevant aspects of cardiac microcirculation will be covered. This symposium, held in Heidelberg in January 1980, was planned not only for the exchange of concepts and ideas, but was expected to be in addition partially a teaching session; the basic scientists should be directed toward a better under standing of the clinical problems, and the clinicians should learn more about the basic mechanisms regulating substrate and ion exchange in such an impor tant organ as the heart, and furthermore the theoretical limitations of some of the diagnostic and therapeutical procedures should be taught. Without a lot of help we would never have succeeded in organizing the sym posium and editing its results.