RSS Feeds
Update in Cardiology
- Joseph S. Alpert, MD; and
- Melvin D. Cheitlin, MD
- From Arizona Health Science Center, Tucson, Arizona, and San Francisco General Hospital, San Francisco, California. Current Author Addresses: Dr. Alpert: Arizona Health Science Center, 1501 North Campbell Avenue, Room 6334, Tucson, AZ 85724.
1996–97 Series
John Roberts, MD, Editor
Much of the recent research in cardiology has focused on the pathophysiology of coronary artery disease and the clinical implications that result from an understanding of that physiology, especially the implications surrounding the reduction of cholesterol levels. In addition, studies published in the past year have shown good evidence for the effectiveness of afterload reduction in patients with asymptomatic aortic regurgitation and of carefully monitored anticoagulation in patients with atrial fibrillation. Finally, a previously common practice in patients with myocarditis has been shown to have no effect on outcome.
Acute Coronary Artery Syndromes
Despite advances in both the prevention and the treatment of acute coronary artery syndromes—unstable angina and Q wave and non-Q wave myocardial infarction—the actual cause of atherosclerosis and thrombus formation in coronary arteries has not yet been fully elucidated. In the past 6 years, however, a new basic science called vascular biology has provided a much better understanding of the manner in which a coronary artery plaque becomes a life-threatening thrombus.
About 60% of the time, coronary artery disease manifests itself clinically as an acute coronary artery syndrome. Stable angina is the presenting condition in about 26% of cases, and the remaining cases present as sudden death.
Atherosclerosis Is Similar to Chronic Inflammation
Libby P. Molecular bases of the acute coronary syndromes. Circulation. 1995; 91:2844-50.
This review of recent laboratory findings helps explain some of the clinical and pathologic observations made during the past 10 years in patients with the acute coronary syndromes. Using molecular biological techniques, researchers have examined the presence of cytokines, immunologically activated cells, and changes in the extracellular matrix in vulnerable areas of atherosclerotic plaques.
Atherosclerosis shares many characteristics with chronic inflammatory processes. For example, oxidized lipoproteins probably contribute to smoldering inflammation within atherosclerotic plaques. Other agents that may help incite this inflammatory process include infectious agents …
