The responses of the cardiovascular system to different stressors are not homogenous and vary depending on the nature of the effect sought. Although laboratories typically have expertise with one or two approaches, it is desirable to have experience with multiple…
Noninvasive coronary artery imaging has become popular since it was first used to measure coronary flow velocity (CFV) of the proximal left anterior descending coronary artery (LAD) using transesophageal echocardiography in the early 1990s followed by CFV measurements in the…
Congenital coronary artery (CA) anomalies (CAAs) encompass a diverse spectrum of pathology. They include both benign variations in CA anatomy as well as patterns that predispose to sudden cardiac death (SCD). Broadly speaking, congenital CA anomalies include abnormalities in (…
End-stage coronary artery disease (CAD) typically manifests as a dilated cardiomyopathy, commonly termed ischemic cardiomyopathy (ICM). The patient has known CAD combined with significant left ventricular (LV) systolic dysfunction with an ejection fraction of 35% or less. The most common…
Myocardial infarction (MI) is characterized by acute ischemia caused by occlusion of an epicardial coronary artery causing irreversible cardiomyocyte death and subsequent cell necrosis, which results in a localized inflammatory response with recruitment and migration of macrophages, monocytes, neutrophils, and…
Diagnosis Echocardiography can show a regional wall motion abnormality (WMA) that may indicate the presence of coronary artery disease (CAD). Even in patients without established CAD, a WMA is associated with a 2.4- to 3.4-fold increase in risk of cardiac…
Patients who have had an acute myocardial infarction (MI) are subject to a broad range of potential complications, some of which are life threatening. These complications range from cardiogenic shock caused by the loss of a critical mass of myocardium…
When patients present with chest pain, the clinician needs to be alert and thorough in trying to determine its cause. The patient’s demographic characteristics together with a careful history should provide the initial information for understanding the likely etiologies. The…
Acknowledgment The authors acknowledge the contributions of Dr. Shmuel S. Schwartzenberg, MD, who was a coauthor of this chapter in the previous edition. Acute Effects Of Myocardial Ischemia Significant coronary artery stenosis results in impaired blood flow and reduced myocardial…
New-onset, stable chest pain among patients without known coronary artery disease (CAD) is a common clinical problem that results in approximately 4 million stress tests annually in the United States. Significant variations in diagnostic strategies are well documented and may…