Obstructive disease in the renal arteries can decrease blood flow to the kidneys, which can result in activation of the renin-angiotensin system, hypertension, ischemic nephropathy, and other pathological changes. Technological advances, including intraarterial stenting, have generated enthusiasm for revascularization as…
The pericardium is a two-layered sac that encircles the heart ( Fig. 56.1 ). The visceral pericardium is a mesothelial monolayer that adheres to the epicardium. It is reflected back on itself at the level of the great vessels, where…
Acquired disease of the right-sided cardiac valves is much less common than disease of the left-sided valves, possibly because of the relatively lower pressures and hemodynamic stress to which the right-sided valves are subjected. Indeed, right-sided valvular dysfunction most commonly…
Basic Principles of Coronary Blood Flow Myocardial cell contraction and relaxation are aerobic processes that require oxygen. Determinants of myocardial oxygen demands include preload, afterload, heart rate, contractility, and basal metabolic rate. Other than basal metabolic rate, these are factors…
Right and left heart catheterization is the introduction of a catheter into the right heart and left heart chambers, respectively. Right and left heart catheterization provide key hemodynamic data that can be used to diagnose various cardiac disorders. Left heart…
The ability to directly visualize arteries with an injection of a radiopaque contrast agent was a seminal advance in the history of modern medicine and led directly to the development of the concept of transluminal angioplasty (first performed in 1964),…
The ability to determine whether disease is present or absent—and how that patient should be treated—is the ultimate goal for clinicians who evaluate patients with suspected heart disease. Despite the number of diagnostic tests available, the importance of a careful…