The Surgical Treatment of Acute Myocardial Ischemia

Robert J. Flemma, MD
JAMA. 1974;228(13):1688. doi:10.1001/jama.1974.03230380056034.
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This five-chapter monograph on the surgical therapy of acute myocardial ischemia rightfully concentrates on an area of great controversy. The introduction delineates the set goals of this book—to develop the current indications for surgical therapy—while stating "that what is true today may only be of historical interest tomorrow." Unfortunately, the manuscript does list today's indications for surgical therapy without paying attention to the critical analysis that might predict which of these indications will be more than passing fancy.

Chapter 2, "Pathophysiology of Myocardial Ischemia," is an excellent summary of myocardial metabolism worthy of review by student, resident, internist, or surgeon, and is by far the highlight of the entire book. This chapter alone makes the book worthwhile. This chapter documents the time sequence from myocardial ischemia to irreversible damage, but the excellent data presented here are neglected or forgotten in the anecdotal discussions of the later chapter on acute myocardial


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