Contents



Chapter 2 **Myocardial Ischemia in Congenital Heart Disease: A Review 15** Fabio Carmona, Karina M. Mata, Marcela S. Oliveira and Simone G. Ramos

Chapter 3 **Significance of Arterial Endothelial Dysfunction and Possibilities of Its Correction in Silent Myocardial Ischemia and Diabetes Mellitus 41** I.P. Tatarchenko, N.V. Pozdnyakova, O.I. Morozova, A.G. Mordovina, S.A. Sekerko and I.A. Petrushin


Chapter 8 **Patient on ACS Pathway – Hypomagnesaemia a Contributory Factor to Myocardial Ischemia 133** Ghulam Naroo, Tanveer Ahmed Yadgir, Bina Nasim and Omer Skaf

#### Chapter 9 **Cell Autophagy and Myocardial Ischemia/Reperfusion Injury 143** Suli Zhang, Jin Wang, Yunhui Du, Jianyu Shang, Li Wang, Jie Wang, Ke Wang, Kehua Bai, Tingting Lv, Xiao Li and Huirong Liu

Preface

Cardiovascular disease is ranked as the leading cause of death world wide. According to the World Heart Federation, cardiovascular disease is responsible for 17.1 million deaths global‐ ly each year. A staggering 82% of these deaths actually occur in the developing world. Such numbers are often difficult to comprehend. The gravity of the situation is enhanced when portrayed as the following: A coronary even occurs every 25 seconds and CHD kills one person every 34 seconds in the United States of America alone. 35 people under the age of 65 die prematurely in the United Kingdom every day due to cardiovascular disease (12,500 deaths per annum). Although the leading killer, the incidence of cardiovascular disease has declined in recent years due to a better understanding of the pathological mechanisms in‐ volved and development of targeted therapeutics; along with the implementation of lipid lowering therapy such as statins and new drug regimens including low molecular weight heparin and antiplatelet drugs such as glycoprotein IIb/IIIa receptor inhibitors. Recent ad‐ vances in acute surgical intervention have also improved mortality, especially with the ad‐ vent of drug eluting stents and minimally invasive coronary artery bypass grafting, along

with improvements in cardioplegia and a systemic hypothermic environment.

is estimated to cost the UK economy £30.7 billion per annum.

The disease burden has a great financial impact on global healthcare systems and major eco‐ nomic consequences for world economies. Cardiovascular disease cost the UK healthcare system £14.4 billion (€16.7 billion; \$22.8 billion) in 2006. Hospital care for patients with car‐ diovascular disease accounts for approximately 70% of the cost with 20% spent on pharma‐ cological agents. The total cost should include non-healthcare costs such as production losses in the workforce and informal care of people with the disease. Production loss is esti‐ mated to cost the UK economy £8.2 billion in 2006 (55% due to death and 45% due to ill‐ ness). Informal care cost the UK economy £8.0 billion in 2006. Overall cardiovascular disease

This text firstly introduces the heart and circulation and the development and anatomy of the coronary arteries before introducing the all encompassing umbrella of cardiovascular disease and the Pathobiology of ischemic heart disease (IHD). The epidemiological burden of Ischemic heart disease is described on a global scale; followed by risk factors, diagnostic modalities and treatment regimens for IHD. The next chapter describes the deleterious ef‐ fects of congenital heart diseases and the role of myocardial ischemia in these conditions, detailing the pathogenesis, diagnosis and treatment options before tacking strategies for prevention. Chapter three demonstrates the gender disparity in sudden cardiac death (SCD). SCD occurs predominantly in women often without previous symptoms or history of CVD. The mechanisms surrounding SCD are detailed followed by identification of those at risk and potential treatment strategies such as implantable cardioverter-defibrillators for high risk subjects. Chapter four reports on the significance of endothelial function and its

