Unstable Coronary Artery Syndromes Pathophysiology, Diagnosis and Treatmentby Robert L. Wilensky
Cardiovascular disease affects 20% of all Americans and is the leading cause of death in the USA. Every year approximately 1,500.000 Americans suffer from an acute myocardial infarction, and over 25% of the total number of deaths in this country are attributable to coronary artery disease. Unstable angina causes over 650,000 hospital admissions, and in the absence
Cardiovascular disease affects 20% of all Americans and is the leading cause of death in the USA. Every year approximately 1,500.000 Americans suffer from an acute myocardial infarction, and over 25% of the total number of deaths in this country are attributable to coronary artery disease. Unstable angina causes over 650,000 hospital admissions, and in the absence of medical therapy, the rate of progression from unstable angina to infarction is 12-20%. Since plaque disruption, plaque erosion, and acute intracoronary thrombus formation play major roles in the pathophysiology of both unstable angina and acute myocardial infarction, and since the two disease entities represent a continuum of coronary ischemic syndromes, it is appropriate to discuss the two disease states in a single monograph.
Unstable Coronary Artery Syndromes, Pathophysiology, Diagnosis and Treatment will offer the clinician a reference book which coherently discusses the pathophysiology of acute ischemic syndromes as well as remarks diagnosis and treatment strategies. Geared toward internists and cardiologists, the book should allow the reader to understand the pathophysiology of unstable coronary artery syndromes and subsequently apply this knowledge to patient care.
Description: The spectrum of acute coronary syndromes are covered in this book in ten chapters, from pathophysiology to the potential of gene therapy.
Purpose: The purpose is to allow readers to understand the pathophysiologic mechanisms of coronary syndromes and apply that knowledge to patient care. This is indeed a worthy subject because acute coronary syndromes or unstable angina/non-Q wave myocardial infarction is a very common problem.
Audience: This book would be enjoyed by internists as well as cardiologists but may be best suited for clinician scientists and cardiology trainees because of the focus on cellular molecular mechanisms as well as future genetic potential mechanisms.
Features: The editor focuses on the pathophysiology of unstable angina and reviews some data that created controversies in this area. The ten chapters are divided into three sections: pathophysiology, acute coronary syndrome, and potential future treatments. There is an excellent review of the pathogenesis of atherosclerosis which is extremely well referenced. There is an emphasis on cellular molecular mechanisms with good discussions of the vulnerable plaque with sections on plaque inflammation triggering and the interaction of TPMPAI-I. The medical management of acute myocardial infarction is well covered and well referenced, as is coronary angioplasty in acute myocardial infarction. In the final chapters contributors deal with gene therapy and angiogenesis, including discussion of grafts of healthy myocytes to diseased hearts. Tables, graphs, and illustrations complement the text.
Assessment: This is a good addition to the medical literature. This same area is covered in two other texts with slightly different foci: Topol's Acute Coronary Syndromes (Marcel Dekker, 1998), and Cannon's Management of Acute Coronary Syndromes (Humana Press, 1999). Much of the same material is covered in these texts as the one reviewed here, but the focus of this text is more on pathophysiology and cellular molecular mechanisms. The focus in the other texts is more on treatment and diagnosis with electrocardiography, female implications, young patients, coronary presentations, cost effectiveness, and quality/outcomes of treatments . Acute coronary syndromes represent a very important area and a large patient population for medical practice.
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