Bøger af Richard S. Meltzer

Some 25 years ago, the coronary care unit concentrated high technology and the acutely ill patients who might benefit from it in a single, recognizable space. Since then, that space and its technical equipment have changed, as has part of its population. Acute ischemia, silent and manifest, occurs within and outside of the coronary care unit as pain, arrhythmia, or pump failure. Its detection and treatment require the utilization of many diagnostic techniques and skills, not the least of which is two-dimensional Doppler echocardio- graphy, which is gaining importance. Future developments, in tandem with computer technology, may add to this importance by enabling tissue identification, spatial representation, and Doppler flow mapping. This book describes the state of the art for the practicing clinician using Doppler echocardi?graphy at the bedside of patients with acute ischemic manifestations of coronary heart disease. The first requirement is to move from the echo laboratory to the coronary care unit, emergency department, operating room, or catheterization laboratory, using equipment suited for that purpose. The second, more trying imperative is to secure good cooper- Ition between those treating the acutely ill patient and the investigator who interferes with his probes. If successful ceeding in both, rewarding results can be obtained, since echocardiography is a very sensitive and specific tool for recognizing and quantifying early ischemia.

To our knowledge, this is the first book dealing exclusively with myocardial contrast two-dimensional echocardiography (MC-2DE), a new and exciting diagnostic methodology for assessment of myocardial perfusion, which has seen rapid development and has now entered the clinical stage. The experi- mental research and human applications have been described in technical papers published in a variety of journals, but our objective is to provide the reader with a comprehensive and concentrated overview of the field and of the current state of the art. To facilitate appreciation of the significant ad- vances made and issues yet to be resolved, we are pleased to have several well known specialists contribute their own assessment of specific aspects of MC- 20E and illustrate the method's principles as well as applications. We were faced with inevitable overlaps and some repetitions in the discussion of quan- titative potentials or limilations of the methodology. Rather than strictly 'streamlining' the text, we decided to accept some redundancy in the interest of presenting a diversity of points of views, reflecting the current evolutionary state of MC-20E. Following a brief reference to the established clinical contrast echocardiog- raphy, recent developments and validations of the specialized MC-2DE tech- nique are reviewed, bearing in mind that the field is in a flux and some of the ongoing activities have not as yet been formally reported. Mechanisms of the echo contrast and several new agents are decribed next, and an additional chapter illustrates current thoughts-on optimizing the echo contrast medium.