Bernard G. Fish

Ischemic Heart Disease

Atherosclerosis of the coronary arteries is the most common cause of clinical ischemic heart disease. The Framingham heart study shows a marked increase in coronary artery disease and myocardial infarction after the age of 40 years.

Normal Heart and Great Vessels

The radiological appearance of the heart and great vessels has a wide variation. The configuration of the cardiovascular silhouette varies according to the body build (chest shape) or habitus, respiratory cycle, the age and sex of the individual, and position (effects of gravity) at the time of examination (supine, erect), changes in intrathoracic pressure (Valsalva and Mueller maneuvers), and the like.

Introduction to Echocardiography

The principle upon which ultrasound imaging is based is similar to that used in sonar depth finders. Sound waves are produced by a piezoelectric crystal that vibrates within a known frequency range when excited by an electric current. Such crystals also act as receivers, transforming acoustic energy back into electrical energy with extreme efficiency. Some naturally occurring crystals such as quartz and Rochelle salt have piezoelectric properties. Ultrasound transducers are usually made of ceramics such as barium titanate and lead zirconate.

Diseases of the Pericardium

The pericardium is a thin fibroserous sac that surrounds the heart and the proximal portions of the great vessels. It is composed of an external layer of dense fibrous tissue (fibrous pericardium) and an inner serous layer (serous pericardium).

Valvular Heart Disease

The clinical and hemodynamic manifestations of an abnormality of the semilunar or of the atrioventricular valves are secondary to obstruction or insufficiency of one or more valves.

Congenital Heart Disease

The classification of heart disease in children presents some practical difficulties. In general usage; the term congenital has come to mean those structural abnormalities of the heart due to faulty embryogenesis, regardless of etiology. Some congenital heart diseases thus designated may not be detectable until later in childhood; some may not be detected until adulthood; and some may not become clinically apparent at any time. Conversely, infective heart disorders may be acquired in utero and thus be present at birth. The traditional approach is to classify heart disease in children as congenital or acquired, regardless of the presence or absence of disease at birth. In general, that approach will be followed in this work.

Neoplasms of the Heart

Neoplasms of the heart may be divided into primary (benign or malignant) and secondary (metastatic). Primary cardiac neoplasms are rare, but may occur at any age. The majority are benign, the most common being the myxoma, which develops as a polypoid mass usually arising from the left atrium (LA). Sarcoma and rhabdomyoma are the second and third most common primary neoplasms of the heart. Other rare benign neoplasms (hamartoma, fibroma, fibromyxoma, lymphangioendothelioma) and malignant neoplasms (lymphosarcoma, fibrosarcoma, leiomyosarcoma and rhabdomyosarcoma) have been reported. Cardiac neoplasms are further classified by their location in and around the heart (e.g., intracavitary, myocardial or intramural, pericardial). The myxoma, the polypoid fibroma and the sarcoma arise from the endocardium (intracavitary tumors), whereas the rhabdomyoma and myocardial fibroma originate from the myocardium (intramural tumors). Neoplasms of pericardial origin are mesothelioma, lipoma, pericardial fibroma and angioma. Teratoma may also occur within the pericardium.