Open Access Medical Books



Edited by David Gaze .

286 pages . 
Open Access .

Cardiovascular disease is ranked as the leading cause of death world wide. According to the World Heart Federation, cardiovascular disease is responsible for 17.1 million deaths globally each year. Surprisingly, 82% of these deaths occur in the developing world. Such numbers are often difficult to comprehend. The gravity of the situation is enhanced when portrayed as the following: Heart disease kills one person every 34 seconds in the USA alone. 35 people under the age of 65 die prematurely in the UK every day due to cardiovascular disease (12,500 deaths per annum). Although the leading killer, the incidence of cardiovascular disease has declined in recent years due to a better understanding of the pathology, implementation of lipid lowering therapy new drug regimens including low molecular weight heparin and antiplatelet drugs such as glycoprotein IIb/IIIa receptor inhibitors and acute surgical intervention.
The disease burden has a great financial impact on global healthcare systems and major economic consequences for world economies. Cardiovascular disease cost the UK healthcare system £14.4 billion (€16.7 billion; $22.8 billion) in 2006. Hospital care for patients with cardiovascular disease accounts for approximately 70% of the cost with 20% spent on pharmacological agents. The total cost should include nonhealthcare costs such as production losses in the workforce and informal care of people with the disease. Production loss is estimated to cost the UK economy £8.2 billion in 2006 (55% due to death and 45% due to illness). Informal care cost the UK economy £8.0 billion in 2006. Overall cardiovascular disease is estimated to cost the UK economy £30.7 billion per annum.
This text aims to deliver the current understanding of coronary artery disease and is split into three main sections:
1. Epidemiology and pathophysiology of coronary artery disease where the spectrum of the disease will be described in relation to geographical location. Data from the industrialised countries on rates of myocardial infarction and angina are discussed in particular with reference to the wider healthcare and socioeconomic
status. In the second chapter gender differences in rates and type of cardiovascular diseases are discussed. Often women view cardiovascular disease as a lower disease category than breast or cervical cancer. The differences in atherosclerotic pathology between men and women are discussed as well as the different approaches to diagnostic regimens, treatment and mortality. Coronary blood flow is discussed with reference to the turbulence caused by atherosclerotic lesions and the clinical importance of Doppler Echocardiography in the evaluation of ischemic myocardium. In clinical practice, many patients present with angina and reduced coronary flow reserve despite normal coronary angiography of the large epicardial arteries. In this situation the vessels that limit flow to myocardium are the more distal epicardial prearterioles and intramyocardial arterioles typically too small to be visualized by conventional coronary angiography. Coronary microvascular dysfunction is poorly understood and difficult to manage. In addition, the presence of coronary microvascular 
dysfunction can be a confounding factor in the management of cardiac patients and is discussed in detail. The final chapter in this section deals with coronary artery disease during pregnancy. The incidence of pregnancy related acute coronary syndrome is 6 per 100,000 deliveries. One of the most important risk factors is maternal age. Pregnancy is a hypercoagulable state and has a major impact on hemodynamics. The presence of reduced left ventricular function increases the chance of an adverse maternal and fetal outcome. The underlying cause of an acute coronary syndrome may be different from outside pregnancy.
The aetiology, pathophysiology and associated mortality as well as treatment options are discussed.
2. Coronary artery disease diagnostics. The first chapter of this section deals with the laboratory based biomarkers used to detect coronary artery disease. The challenge has been the identification of a cardiospecific biomarker. The cardiovascular biomarkers essentially fall into three categories. Those that identify patients at risk atherosclerosis; those associated with plaque destabilisation and those which indicate rupture of the plaque, necrosis and cardiac insufficiency. The use of serum uric acid as a predictive biomarker in myocardial infarction is discussed in the second chapter. A plethora of non-clinical, clinical and epidemiological studies have accumulated over the decades that aimed to elucidate molecular and cellular  mechanisms of uric acid and its role as a diagnostic and prognostic aid or importantly, as a therapeutic target. This stems from its antioxidant potential. The
role of serum uric acid on the cardiovascular system with respect to hypertension, stroke, renal failure, heart failure and coronary heart disease are discussed. Being able to identify patients with coronary artery disease early will help lower hospital costs and decrease mortality and morbidity. Stress testing has emerged as the sole non-invasive method for risk stratifying patients. Apart from highlighting the advantages and disadvantages of various stress testing modalities, the chapter reviews which patients should undergo stress testing based on appropriateness criteria; managed separately based on their risk factors and identifying those who may be at increased risk of acute myocardial infarction or death. The final chapter of this section discusses the role of exercise electrocardiography in patients with stable chest pain. A UK National Institute for Health and Clinical Excellence (NICE) guideline on the diagnosis of discomfort of suspected cardiac origin published in 2010 proposes that Exercise ECG should not be used to diagnose or exclude angina for people without known coronary artery disease Historically exercise electrocardiography in the diagnosis of coronary artery disease has been questioned. However, the greater the ST segment changes on exercise electrocardiography, the greater the post-exercise probability of coronary artery disease. The chapter demonstrates the different impact the exercise electrocardiography has on subsequent management, depending on the method  employed to analyse the data .....

David C. Gaze
Dept of Chemical Pathology Clinical Blood Sciences,
St George’s Healthcare NHS Trust, London,


Part 1 Epidemiology and Pathophysiology of Coronary Artery Disease 

  1 Epidemiology of Coronary Artery Disease 3 John F. Beltrame, Rachel Dreyer and Rosanna Tavella

  2 Gender Differences in Coronary Artery Disease 31 Ryotaro Wake and Minoru Yoshiyama

  3 Coronary Flow: From Pathophysiology  to Clinical Noninvasive Evaluation 43 
Francesco Bartolomucci, Francesco Cipriani and Giovanni Deluca

  4 Coronary Microvascular Dysfunction in CAD: Consequences and Potential Therapeutic Applications 65 
Alan N. Beneze, Jeffrey M. Gold and Betsy B. Dokken

  5 Coronary Artery Disease and Pregnancy 81 Titia P.E. Ruys, Mark R. Johnson and Jolien W. Roos-Hesselink

Part 2 Coronary Artery Disease Diagnostics 

  6 Cardiovascular Biomarkers for the Detection of Cardiovascular Disease 103 
David C. Gaze

  7 Do We Need Another Look at Serum Uric Acid in Cardiovascular Disease? Serum Uric Acid as a Predictor of Outcomes in Acute Myocardial Infarction 123 
Siniša Car and Vladimir Trkulja

  8 Stress Testing and Its Role in Coronary Artery Disease 147 Rajkumar K. Sugumaran and Indu G. Poornima

  9 Reassessing the Value of the Exercise Electrocardiogram in the Diagnosis of Stable Chest Pain 171 
Peter Bourdillon

Part 3 Treatment Regimens for Coronary Artery Disease 

  10 Effectiveness and Efficiency of Drug Eluting Stents 185 José Moreu, José María Hernández, Juan M Ruiz-Nodar, Nicolás Vázquez, Ángel Cequier, 
Felipe Fernández-Vázquez and Carlos Crespo

  11 Coronary Revascularization in Diabetics: The Background for an Optimal Choice 213 
Giuseppe Tarantini and Davide Lanzellotti

  12 Diastolic Heart Failure After Cardiac Surgery 229 Ahmed A. Alsaddique, Colin F. Royse, Mohammed A. Fouda and Alistair G. Royse

  13 Spinal Cord Stimulation for Managing Angina from Coronary Artery Disease 257 
Billy Huh . 

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Published by: Unknown - Friday, February 1, 2013


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