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Doody's Review ServiceReviewer: Audris J. Bredikis, MD (Loyola University Stritch School of Medicine)
Description: An intimate relationship between CNS, the neurohumoral system, the autonomic nerve system, and regulation of the heart activity is described in this text.
Purpose: Although not clearly stated, I believe this book is written to cover in one book the large amount of new information about complex neurocardiac interactions.
Audience: This is an excellent resource for medical students, researchers, and clinicians (including neurologists, cardiologists, and psychiatrists).
Features: A wide area of complex interactions, starting from anatomy and organization of neural pathways both at CNS and peripheral levels and extending to humoral neuromodulation of the heart activities, are covered. Part I is an excellent, updated review of newer, non-classical neurotransmitters, emotional neurocircuitries, circadian regulation, and effects of neuropathology on cardiovascular regulation. The neuroanatomy section, in which the intracardiac nerve supply is described, could be enriched with human data regarding effects of surgical incisions and radio-frequency ablation in the areas rich with intracardiac ganglia on electrophysiological properties of sinus and atrioventricular nodes. Regarding the extracardiac nerve system, the role of stellate ganglion in mediating differential regional electrophysiological effects on sinus, atrioventricular node, and myocardium is clinically relevant and would be a nice addition to Part I as well. Part II is an excellent review of stress hormones and their effects on the heart. This chapter is a timely update on the complexity of physiological actions of stress hormones beyond ACTH. Cardiac pain is a subject of Part III, in which a detailed review of cardiac nociceptive system anatomy, pathophysioligy, clinical syndromes, and new insights into syndrome X is provided. The angiotensinogen II and vasopressin relationship and the role of angiotensinogen II receptor subtypes in the release of vasopressin are reviewed in a Part IV. Multi-level actions of renin-angiotensin system at peripheral and CNS levels in the regulation of cardiovascular homeostasis are described in Part IV as well. The role of mediators of inflammation in atherogenesis is also discussed. The relationship of neuropsychiatric disorders and cardiac disease and the association of depression with increased cardiovascular mortality are very interesting clinical topics and are well covered in the last chapter.
Assessment: This is a very timely and successful attempt to synthesize a huge amount of new information regarding complex neurocardiac interactions in one book. The clinical usefulness of this book would be enhanced by including a chapter on neural effects on cardiac arrhythmias as well as on important clinical syndromes, like long QT syndrome, carotid sinus syndrome, and neurocardiogenic syncope, which hopefully we will find in the next edition.