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La pregunta inevitable de la investigación surgió porque los segmentos musculares que conforman las cavidades ventriculares debían contar con un punto de apoyo para poder torsionarse, al igual que un músculo esquelético lo hace en una inserción firme, ¿había entonces un punto de apoyo en el corazón? Si existía, ¿cómo se insertaba el miocardio en dicha estructura? ¿Es posible que el corazón (un músculo continuo plegado en helicoide) se considere desde siempre péndulo en el mediastino, vertical, sin ataduras, cuando todo músculo se halla inserto en algún sitio para cumplir su papel con la fuerza necesaria? Esta situación anatómica sin duda obliga al corazón, del tamaño equivalente a un puño humano, a tener un punto de apoyo para poder cumplir con una función de bomba que impulsa un volumen de 4 a 6 litros/minuto a una velocidad de 200 cm/s contra la ley de gravedad; tener un consumo de solo 10 vatios, y que le permita trabajar en continuidad durante 80 años sin mantenimiento en una tarea ni siquiera alcanzada por máquinas construidas por el hombre. Era evidente que necesitaba de un soporte y esta era la pregunta que esperaba ser indagada.

This book delves into the various aspects of the renin-angiotensin-aldosterone system (RAAS) and its role in cardiovascular disorders. It explores the use of anti-hypertensive agents, with a focus on (ACE) angiotensin-converting enzyme inhibitors and angiotensin receptor blockers (ARBs). The chapters cover topics such as the preferred use of ACE inhibitors over ARBs in high-risk patients, the impact of these agents on insulin resistance, their role in acute heart failure and peripheral artery disease, and their immunomodulatory activity in hypertensive patients. Additionally, the book examines the role of ACE inhibitors and ARBs in COVID-19 patients and provides insights into recent trends in managing hypertension through RAAS inhibition. It serves as a valuable resource for researchers, clinicians, and healthcare professionals involved in the field of cardiovascular medicine.

This is the seventh edition of a long-selling book (first edition 1991) that was translated into Italian, French, Chinese, Portuguese, Spanish, English. In the last ten years, stress echocardiography has exploded in its breadth and variety of applications. From a one-fits-all approach (wall motion by 2D-echo in the patient with known or suspected coronary artery disease), the field has progressed to an omnivorous, next-generation laboratory employing a variety of technologies (from M-Mode to 2D, from pulsed, continuous, color and tissue Doppler to lung ultrasound) on patients covering the entire spectrum of severity (from elite athletes to patients with end-stage heart failure) and ages (from children with congenital heart disease to the elderly with aortic stenosis). This new edition is enriched with over 300 figures, 150 tables and video-clips. In a societal and economic climate of increasing pressure for appropriate, justified and optimized imaging, stress echocardiography offers the great advantages of being radiation-free, relatively low cost, with minimal environmental impact, and with a staggering versatility: we can get more (information) with less (cost and risk). The volume will be a tremendous aid to current best practices for all health operators who intend to use stress echocardiography and ultrasound for diagnosis and guidance of optimal management in their patients.

This book summarizes the broad and rapidly evolving field of geriatric pharmacotherapy, which is becoming increasingly relevant for practicing physicians who care and prescribe medications for older patients. Around the globe, ageing populations are associated with an increased prevalence of chronic diseases. Older adults are often affected by multimorbidity, i.e., suffer from more than one chronic disease. The main consequence of multimorbidity is polypharmacy, which is commonly defined as the regular use of five or more medicines. Polypharmacy has now reached epidemic proportions in our societies, and is associated with an increased risk of drug-drug interactions, drug-disease interactions and adverse drug reactions. The management of polypharmacy in older patients with complex multimorbidity poses several challenges and needs to be based on specific knowledge and prescribing expertise.The aim of this book is to provide a comprehensive update on thefield, and to share the expertise needed to optimize the management of pharmacotherapy in older patients.

The ESC Textbook of Heart Failure is the latest addition to the European Society of Cardiology (ESC) publications portfolio and is fully supported by the European Heart Failure Association. The textbook brings together internationally renowned experts in the field of heart failure to present an up-to-date understanding of all aspects of this chronic condition that worsens with time. It is estimated that the worldwide population of patients suffering from heart failure is approximately 26 million. This clinically oriented work reflects contemporary European guidelines from the ESC and the European Heart Failure Association and summarizes the latest evidence from clinical trials. Made up of eighteen different sections the textbook covers the epidemiology, etiology, prevention, pathophysiology, and clinical phenotypes of heart failure. The assessment and management of chronic, acute, and advance heart failure are all discussed in detail. As well as chapters dedicated to self-care and patient education, the multidisciplinary approach to heart failure management, and clinical trial design and interpretation. The future direction of the field is discussed throughout with separate chapters on digital health, big data, and telemedicine/remote monitoring in heart failure also included. A must read for cardiovascular healthcare specialists in Europe and across the world it should also appeal to those in training, general physicians and those caring of the elderly, cardiothoracic surgeons, primary care doctors, and specialist nurses too.

'Los autores de este libro ya nos habían deleitado en un espléndido texto hace tres años. La lectura de esta nueva investigación es un disfrute que exige la atención continua. Concentración en la lectura para ir engarzando las piezas de ese rompecabezas, que al final del libro se muestra limpio, claro y demostrativo. En la primera proposición del libro se estudia la anatomía e histología del miocardio, que determinan un músculo continuo, espiralado, una pieza íntegra que para cumplir su función muscular necesita de un punto de apoyo, el fulcro cardíaco. El miocardio se inserta en sus extremos inicial y final en este núcleo con estructura tendinosa, cartilaginosa, incluso ósea, según la especie analizada, que se localiza por debajo y delante de la aorta. En esta parte, espléndidamente documentada, hay además una importante aportación como es la que dentro del mecanismo de contracción cardíaca existe una defricción entre las capas musculares. Luego, los autores analizan la difusión de los estímulos en el miocardio, la que tiene un patrón que corresponde a la disposición topográfica de los haces musculares, la dirección de sus fibras musculares y su mecánica de movimientos. Más adelante, desgranan una serie de estudios e investigaciones personales que definen y clarifican la mecánica cardíaca de tres tiempos con la conceptualización de la base científica de la fase de succión, proceso activo que explican como nunca se había hecho, siendo capaces de integrar la hidráulica y la física, disciplinas no siempre incorporadas adecuadamente para la evaluación de la mecánica cardíaca y la definición de la bomba mecánica de succión. Finalmente, se presentan los vertiginosos cambios producidos en las técnicas de imagen cardíaca que van a posibilitar la utilización de estas para la comprensión de la estructura tridimensional miocárdica y su acople con los nuevos conceptos fisiológicos de la mecánica cardíaca. Nos encontramos ante un texto único, diferente, provocador. Es una obra que exigirá de su atención al ciento por ciento, para ir sorteando los nuevos caminos que se abren ante nuestros ojos con investigaciones y propuestas originales en la frontera de lo desconocido'(Prof. Miguel Angel García Fernández, catedrático de Medicina-Imagen Cardiaca, Facultad de Medicina, Universidad Complutense de Madrid).

In this new book, Trainini and his team attempt a step forward and make a series of proposals that come to complete cardiac anatomy, physiology and mechanics. Reading this new investigation is a pleasure that demands continuous attention, so that our'neuronal boxes'do not rebel against the effort it means to sometimes destroy what we have firmly installed in them. The text should be read slowly, as it was never easy to tread in swamp-limited grounds and, as in the ascent to the summit of a difficult mountain, stop now and then to take a breath and enjoy the view as we get near the peak, where we will see the final landscape of the new vision. Then we will be conscious that the effort was worthwhile.