Review Articles

Although a number of therapies have been able to reduce infarct size as part of reperfusion therapy in experimental studies, the clinical results after acute myocardial infarction have not been as satisfactory. Current understanding of the mechanisms and consequences of reperfusion injury and the pharmacologic options are discussed here.

Sinus tachycardia is frequently encountered in clinical practice but is often overlooked. It comprises four distinct rhythm disturbances namely normal sinus tachycardia, inappropriate sinus tachycardia, postural orthostatic tachycardia syndrome and sinus node re-entry tachycardia. The important differences in clinical features, basic underlying etiologic mechanisms and treatment strategies of these arrhythmias are discussed here.

Despite the various available methods of detection and risk assessment, an unsatisfactory proportion of cardiovascular disease cases are still missed. New approaches are, therefore, constantly being sought. This review discusses the potential applications of C-reactive protein, which has emerged as a powerful predictor of heart disease risk.

Many patients who die from coronary heart disease have ST-segment-elevation myocardial infarction. The optimum timing and method of reperfusion therapy, however, still need clarification. This review discusses the use of fibrinolytic drugs and primary coronary angioplasty and how to achieve the goals of door-to-balloon or door-to-needle times purported in the AHA/ACC guidelines.

Cells derived from bone marrow, blood, skeletal muscle and other tissues could have regenerative capacity in the human heart and vasculature. Should clinical practice become a reality, however, the indications for which cells, which disease, and which patients are less clear. Noel Caplice and colleagues discuss how such decisions might be made.

Brief episodes of ischemia before total coronary occlusion can protect the heart in animals; a similar preconditioning effect might be seen in humans. Preinfarction angina, already an important part of cardiac assessment, might be a corollary of preconditioning before myocardial infarction. Rezkalla and Kloner discuss the impact of preinfarction angina in the clinical setting.

Heart failure is increasingly thought to be a myocyte deficiency disease. Therapeutic strategies to increase the number of cardiac muscle cells by direct transplantation are being met with a mixture of enthusiasm and caution. While conceptually attractive, however, the success of this approach remains unproven. The evidence to date is discussed.

An inverse correlation exists between the plasma concentration of HDLs and the incidence of cardiovascular disease. The harnessing of this beneficial effect has been explored as a new approach for treatment. In this review, the range of beneficial effects and the methods being developed for the delivery of therapy are explored.

Chronic delayed cerebral vasospasm has a major impact on morbidity and mortality related to aneurysmal subarachnoid hemorrhage. Reduced concentrations of endothelium-derived NO, an important vasodilator, and increased levels of endothelin-1, one of the most potent vasoconstrictors, are important contributory factors. This review discusses the relevant mechanisms in cerebral vasospasm.

Despite treatment being available for angina in the form of β-blockers and calcium-channel blockers, these drugs are contraindicated in some patients. PharmacologicalI_finhibition could prove a promising alternative for protection from angina through heart-rate slowing. This review discusses the early mechanisms and early clinical use of ivabradine as a specific bradycardic agent.

Interruption or blocking of renin-angiotensin-aldosterone systems can reverse cardiac fibrosis and hypertensive vascular remodeling, and improve hypertensive left-ventricular hypertrophy. Local, possibly cellular, renin-angiotensin-aldosterone systems are thought to participate in the pathogenesis of vascular disease, but their roles are not yet fully explained. This review explores the evidence of such actions.

In Marfan's syndrome, connective-tissue alterations promote aortic aneurysm and dissection. Despite advances in understanding the causes, treatments are still based on old protocols. The pathophysiology of aneurysm formation and progression is, however, being elucidated by new genetic data, discussed here, which might aid the advancement of therapy for Marfan-related aneurysm.

The underlying electrophysiological mechanisms of cardiac arrhythmias remain unclear. Consequently, therapy is difficult, and for the worst arrhythmias is frequently ineffective. This review looks at the accumulating evidence for various emerging mechanisms of cardiac arrhythmias, with focus on selected ionic currents, stretch-activated phenomena and connexins.

Given the high risk of sudden death or myocardial infarction associated with atherosclerosis, frequently with no previous symptoms, techniques to better identify high-risk plaques might help lower morbidity and mortality. In this review, various biological markers are suggested as targets for imaging to aid risk assessment.

A positive relationship between salt and hypertension is well documented. Salt seems also to adversely affect cardiac structure and function independently from its influence on arterial pressure. This review discusses clinical and experimental evidence for an association between increased sodium consumption and cardiac structural and functional changes and raised cardiovascular risk.