Coronary Heart Disease. Clinical, Angiographic and Pathologic Profiles

Abstract

A comprehensive and real picture of the complexities of ischemic heart disease, both to the person who deals in day to day practice with its problems, as well as to the This book presents a comprehensive picture of is chemic heart disease to those who, either as practition student and resident who tries to develop firm concepts ers or students, deal with the varied facets of this com regarding the varied states observed in this common plex subject. It has meaning to the fields of clinical condition. cardiology, radiology, thoracic surgery, and pathology. After an introductory chapter on the anatomy of the coronary blood vessels, there follows a chapter on coro nary arteriography. The latter considers techniques, in dications, examples of normal and abnormal patterns, and complications of this procedure. Specific chapters deal with variations in the sites of origin and distribution of coronary arteries, both as seen angiographically and anatomically. Congenital anomalies of the coronary arteries which may engender states of ischemic heart disease are presented. The principal thrust of the work concerns the main arena of ischemic heart disease, namely, coronary ath erosclerosis. The pathology of coronary atherosclerosis is presented in conjunction with the results of anatomic and angiographic studies. Major chapters discuss the subjects of angina pecto ris, acute myocardial infarction, healed myocardial in farction, surgical "revascularization" with indications and the postoperative states, and the surgical treatment of myocardial infarction and its sequelae. 1 Anatomy of the Coronary Vessels -- The Right Arterial System -- The Left Arterial System -- The Atrial Arterial Supply -- The Conus Artery -- The Veins -- 2 Coronary Arteriography -- Techniques -- Complications -- Indications -- Angiographic Projections -- Angiographic Identifications during Systole and Diastole -- Measurements of the Coronary Arteries -- Angiographic Assessment of Coronary Artery Disease -- Nature of Obstructive Lesions -- Identification of Obstructive Lesions -- Collateral Circulation -- 3 Variations in Levels of Origin of the Coronary Arteries -- Normal -- Abnormal -- Illustrative Cases -- 4 Variations in Sites of Origin of the Coronary Arteries -- Origins of the Left Circumflex Coronary Artery from the Right Aortic Sinus -- Origin of the Left Circumflex Coronary Artery from the Right Coronary Artery -- Origin of the Anterior Descending Coronary Artery from the Right Coronary Artery -- Independent Origins of the Anterior Descending and Circumflex Coronary Arteries from the Left Aortic Sinus -- Origin of the Right Coronary Artery from the Posterior (Noncoronary) Sinus -- Origin of Both Coronary Arteries from the Right Aortic Sinus -- Origin of Both Coronary Arteries from the Left Aortic Sinus -- 5 Hypoplasia of the Coronary Arteries -- Right Coronary System -- Left Coronary System -- 6 Variations in the Length of the Left Coronary Artery -- Normal Left Coronary Artery -- Unusually Long Left Coronary Artery -- Short Left Coronary Artery -- 7 Single Coronary Ostium in the Aorta -- Single Coronary Artery -- Entire Coronary System Arising from the Aorta -- Origin of One of Two Coronary Arteries from the Pulmonary Trunk -- 8 Abnormal Communications of the Coronary Arteries -- Communication of the Right Coronary Artery with the Coronary Sinus -- Communication of the Left Circumflex Coronary Artery with the Coronary Sinus -- Communication of the Right Coronary Artery with the Right Ventricle -- Communication of a Single Left Coronary Artery with the Right Ventricle -- Coronary Angiomatous Malformations Communicating with the Right Ventricle -- Communication of the Conus Branch of the Anterior Descending Artery with the Pulmonary Trunk -- Communication of Conus Branch of the Right Coronary Artery with the Pulmonary Trunk -- 9 Pathology of Obstructive Coronary Disease -- Lesions of the Coronary Ostia -- Coronary Atherosclerosis -- Nonatheromatous Coronary Disease -- 10 Angiocardiographic-Pathologic Correlations -- Coronary Arteries -- Left Ventricle -- 11 Angina Pectoris -- Definition -- Stable Angina Pectoris -- Unstable Angina Pectoris -- 12 Intermediate Syndrome -- Definition -- Illustrative Cases -- 13 Acute Myocardial Infarction -- Definition -- Anatomic Locations -- Pathologic Features -- Clinical Manifestations -- Complications -- 14 Healed Myocardial Infarction -- Ventricular Scarring without Electrocardiographic Evidence of Previous Infarction -- Complications -- 15 Surgical 'Revascularization' -- General Considerations -- Bypass Grafting -- Intramyocardial Vascular Implant -- Endarterectomy -- 16 Surgical Therapy for Myocardial Infarction and Its Sequelae -- Acute Myocardial Infarction without Associated Lesions -- Rupture of the Ventricular Septum -- Mitral Valvular Insufficiency -- Left Ventricular Aneurysm.