Cardiac output has always been a subject of interest to both clinicians and researchers in different branches of medicine and surgery. In the last decade more attention has also been paid to its application in pediatrics, neonatology, fetal medicine and pregnancy. Better understanding of the peripheral circulation has provided more insight into the patholophysiology of different diseases. Many cardiac and non-cardiac disorders affect cardiac outputs. Monitoring of the changes in cardiac output is also important in the acutely ill patient. There are several methods to measure cardiac output, each with advantages and pitfalls. This book deals with all relevant aspects of cardiac output in eight parts: part one describes the methods of measuring cardiac output and a comparison between the catheterisation based and the noninvasive techniques, while part two describes the changes in cardiac output due to physiological causes. Part three describes cardiac output in cardiac diseases and systemic hypertension. Cardiac output in acutely ill patients is discussed in part four. Effect of cardiac medications, temporary atrial pacing, permanent pacing, pharmacologic stress testing and anesthesia are covered in detail in part six, while changes in cardiac output in noncardiac diseases are described in part seven. Finally great attention has been paid in part eight to the regional circulation including cerebral, coronary, skeletal and splanchnic circulations. A separate chapter discusses in detail the dynamics of blood flow. This book will be useful both to the cardiologists as well as to physicians in other fields of surgery and medicine and to their trainees. Readers will find this book an interesting and a useful reference on the topic of cardiac output.

Although cardiac output is measured as the flow of blood from the left ventricle into the aorta, the system that controls cardiac output includes many other components besides the heart itself. The heart’s rate of output cannot exceed the rate of venous return to it, and therefore, the factors governing venous return are primarily responsible for control of output from the heart. Venous return is affected by its pressure gradient and resistance to flow throughout the vascular system. The pressure gradient for venous return is a function of several factors including the blood volume flowing through the system, the unstressed vascular volume of the circulatory system, its capacitance, mean systemic pressure, and right atrial pressure. Resistance to venous return is the sum of total vascular resistance from the aortic valve to the right atrium. The sympathetic nervous system and vasoactive circulating hormones affect short-term resistance, whereas local tissue blood flow autoregulatory mechanisms are the dominant determinants of long-term resistance to venous return. The strength of contraction of the heart responds to changes in atrial pressure driven by changes in venous return, with small changes in atrial pressure eliciting large changes in strength of contraction, as described by the Frank–Starling mechanism. In addition, the autonomic nervous system input to the heart alters myocardial pumping ability in response to cardiovascular challenges. The function of the cardiovascular system is strongly affected by the operation of the renal sodium excretion–body fluid volume–arterial pressure negative feedback system that maintains arterial blood pressure at a controlled value over long periods. The intent of this volume is to integrate the basic knowledge of these cardiovascular system components into an understanding of cardiac output regulation. Table of Contents: Introduction / Venous Return / Cardiac Function / Integrated Analysis of Cardiac Output Control / Analysis of Cardiac Output Regulation by Computer Simulation / Analysis of Cardiac Output Control in Response to Challenges / Conclusion / References / Author Biography

This presentation describes various aspects of the regulation of tissue oxygenation, including the roles of the circulatory system, respiratory system, and blood, the carrier of oxygen within these components of the cardiorespiratory system. The respiratory system takes oxygen from the atmosphere and transports it by diffusion from the air in the alveoli to the blood flowing through the pulmonary capillaries. The cardiovascular system then moves the oxygenated blood from the heart to the microcirculation of the various organs by convection, where oxygen is released from hemoglobin in the red blood cells and moves to the parenchymal cells of each tissue by diffusion. Oxygen that has diffused into cells is then utilized in the mitochondria to produce adenosine triphosphate (ATP), the energy currency of all cells. The mitochondria are able to produce ATP until the oxygen tension or PO2 on the cell surface falls to a critical level of about 4–5 mm Hg. Thus, in order to meet the energetic needs of cells, it is important to maintain a continuous supply of oxygen to the mitochondria at or above the critical PO2 . In order to accomplish this desired outcome, the cardiorespiratory system, including the blood, must be capable of regulation to ensure survival of all tissues under a wide range of circumstances. The purpose of this presentation is to provide basic information about the operation and regulation of the cardiovascular and respiratory systems, as well as the properties of the blood and parenchymal cells, so that a fundamental understanding of the regulation of tissue oxygenation is achieved.

Research centering on blood flow in the heart continues to hold an important position, especially since a better understanding of the subject may help reduce the incidence of coronary arterial disease and heart attacks. This book summarizes recent advances in the field; it is the product of fruitful cooperation among international scientists who met in Japan in May, 1990 to discuss the regulation of coronary blood flow.

First multi-year cumulation covers six years: 1965-70.

All physicians practicing medicine encounter patients suffering from cardiovascular disease. This book has been outlined in such a way that vascular surgeons, general internists, neurologists and cardiologists should be able to use it. The book covers the complete scope of cardiac diseases in addition to chapters on hypertension and atherosclerosis. In many patients there is a family history of cerebrovascular accidents, myocardial infarction or peripheral arterial disease. Also in patients reporting collaps, palpitations and arrhythmias the family is crucial and can provide clues to a genetic cause of the disease. This book is published to guide physicians in the process of determining whether a genetic component is likely to be present. Furthermore, information is provided what the possibilities and limitations of DNA diagnostic techniques are. Finally, the importance of newly identified categories of potential patients, i. e. gene carriers without symptoms or any inducible sign of disease, is highlighted. For some patients a genetic diagnosis is essential to determine appropriate therapy and for counseling? In some other diseases DNA diagnostic tools are available but the relevant for the patients may be less clear. In other families the search for a disease causing gene is ongoing and the possibilities to find genes and to unravel the pathophysiology of the disease is limited by the lack of patients. To give insight into the current state of genetic diagnostics, the authors have classified the cardiovascular diseases.

Arterial and venous diseases are major causes of morbidity and mortality in most of the world, especially in the western hemisphere. Not only of interest to angiologists, these illnesses are also of concern to most physicians in various fields ranging from cardiology, general medicine and cardiovascular surgery to physiology, pathology and clinical pharmacology. Specialists in diabetes, hypertension and epidemiology find these illnesses as challenging in their own fields of interest due to the gross interrelation of these diseases with their specialities. This book of 35 chapters contains an up-to-date discussion of various arterial and venous illnesses presenting major clinical applications ranging from basic pathology, haemodynamics and haemorheology to clinical features and management. Special attention has also been paid to epidemiology and prevention, discussing all the issues concerned. A special section on vascular emergency has also been included, thereby extending its usefulness to physicians and surgeons working in accident and emergency units.

The ATP-sensitive potassium channel (KATP) was discovered in 1983. Since then, an enormous amount of research has been undertaken to characterize it in detail. This volume consolidates both the current knowledge and most recent advances on the subject, and its relationship to myocardial protection. To this end, the editors have assembled investigators at the forefront of ongoing basic and clinical research to provide scholarly and candid comments concerning each of the pertinent issues, including: a comprehensive review of the biology of the channel with respect to the structure-activity relationship as well as overall chemistry of the channel; the role of opening this channel and its effect on smooth muscle (covering both the effects on myocardial stunning and its ability to protect against myocardial infarction); the relationship of KATP channel opening and the protection to the myocardium afforded by the phenomenon of ischemic preconditioning; the relationship between the KATP channel and electrophysiological consequences with specific reference to arrhythmogenicity; and the clinical implications of the use of agents that mimic the opening of this channel, with reference to its protective nature and its use in the treatment of angina. Audience: Clinicians and basic scientists who have a direct interest in the KATP channel as well as those groups who are interested in the entire concept of myocardial protection and its relationship to academic and clinical medicine.

The Social Security Administration (SSA) uses a screening tool called the Listing of Impairments to identify claimants who are so severely impaired that they cannot work at all and thus immediately qualify for benefits. In this report, the IOM makes several recommendations for improving SSA's capacity to determine disability benefits more quickly and efficiently using the Listings.

This unique book provides clinicians and administrators with a comprehensive understanding of perioperative hemodynamic monitoring and goal directed therapy, emphasizing practical guidance for implementation at the bedside. Successful hemodynamic monitoring and goal directed therapy require a wide range of skills. This book will enable readers to: • Detail the rationale for using perioperative hemodynamic monitoring systems and for applying goal directed therapy protocols at the bedside • Understand the physiological concepts underlying perioperative goal directed therapy for hemodynamic management • Evaluate hemodynamic monitoring systems in clinical practice • Learn about new techniques for achieving goal directed therapy • Apply goal directed therapy protocols in the perioperative environment (including emergency departments, operating rooms and intensive care units) • Demonstrate clinical utility of GDT and hemodynamic optimization using case presentations. Illustrated with diagrams and case examples, this is an important resource for anesthesiologists, emergency physicians, intensivists and pneumonologists as well as nurses and administrative officers.