tailieunhanh - Cardiovascular Medicine Third Edition_2

he third edition of Cardiovascular Medicine is the product of our continuing effort to provide an authoritative and comprehensive review of important, clinically relevant cardiovascular disease topics. As compared to the second edition, this third edition contains 27 new chapters and a 30% expansion and update of mechanistic, diagnostic, and therapeutic approaches to cardiovascular medicine. Each chapter is written by one or more experts on the topic. We have also added two additional editors, Dr. Hein . Wellens, a leading worldwide authority on cardiac arrhythmias, their recognition and treatment, and Dr. David Holmes, Jr., a worldwide leader in interventional cardiovascular medicine. The continued rapid growth of new knowledge and. | 3 1 Silent Ischemia Matthew B. O Steen and Neal S. Kleiman Historical Perspective. 699 Mechanisms of Altered Pain Perception During Myocardial Ischemia. 699 Size of the Ischemic Area Ischemic Burden . 701 Hemodynamics and Left Ventricular Function. 702 Silent Ischemia in Patients with Diabetes Mellitus . . . 702 Detection and Documentation of Silent Ischemia. 703 Prognosis in Patients with Silent Ischemia . 705 Treatment of Silent Myocardial Ischemia . 707 Results of Suppressing Ischemia. 708 Summary . 708 Key Points Multiple mechanisms of silent ischemia have been proposed. The incidence and clinical significance of silent ischemia and the need for screening and therapy vary depending on the population being studied. Multiple methods for evaluating silent ischemia are available each has utility in different clinical settings. Historical Perspective Since Heberden s original description in 17721 of an exertional disorder of the breast and the subsequent recognition that angina pectoris was associated with obstructive narrowing of the coronary arteries clinicians caring for patients with coronary artery disease CAD have regarded angina as the benchmark by which to measure the prognosis and gauge the treatment of patients with coronary arterial atherosclerosis. However reports of coronary atherosclerosis occasionally severe in asymptomatic young soldiers killed in the First World War and the Korean War1 2 and in pilots 3 coupled with the increasing recognition that the electrocardiographic changes of infarction were often present in individuals with no history of chest pain 4-6 led to the uneasy acceptance that interruption of blood supply to the myocardium was not necessarily heralded by angina pectoris. As the ability to recognize myocardial ischemia increased so did the awareness that objective measures of detection were necessary in patients who were either asymptomatic or whose symptoms did not fulfill typical descriptions. It is now well accepted that a large .