This book provides a detailed review of state of the art knowledge on critical care topics as well as the latest research findings. It covers the core aspects in excellent detail, but is not so comprehensive as to make its daily use unfeasible. For each condition considered, discussion of the pathophysiology is integrated with observations on diagnosis and treatment in order to allow a deeper understanding. The book is scientifically based, with extensive references to published research. This will allow readers to investigate their individual interests further and will enable physicians to justify measures by providing a coherent, evidence-based strategy and relevant citations where needed. Core Knowledge in Critical Care Medicine will appeal to experienced practitioners as an aide-mémoire, but will also be of great value to a wide range of more junior staff wishing to complement their background knowledge with important facts applicable to everyday practice.

Acute heart failure is a potentially life threatening situation where correct, rapid therapy can have a life saving impact. In this rapidly changing area of medicine this text aims to bring the latest understanding of the pathophysiology together with a practical guide to diagnosis and management using a thoroughly evidence based approach. This will appeal to a wide audience of health care professionals who will treat patients with acute heart failure, including doctors, medical students, nurses, and other professionals in the Emergency Department, General Internal Medicine, Anaesthetics, Cardiology (Medicine and Surgery) and Critical Care settings. It may be used as an evidence based guide for the junior practitioner or as an aide-memoire for the more senior. Always keeping the underlying pathophysiology at the forefront of the discussion, the reader is encouraged to understand the aetiology of the acute situation and how to direct management in order to correct the abnormal physiology. Each chapter is heavily referenced allowing the reader to easily refer to the original experimental studies and pursue topics in more detail if required. This text is a valuable addition to any practitioner who treats patients with acute heart failure and wants a deeper understanding of the condition.

Cardiovascular disease remains the leading cause of morbidity and mortality worldwide. Ischaemic heart disease contributes the largest burden and despite advances in revascularisation therapy significant morbidity and mortality exist in both the elective and emergency treatment setting. Short episodes of sub-lethal ischaemia and reperfusion applied before a period of prolonged ischaemia (preconditioning) and reperfusion stuttered with short episodes of ischaemia (postconditioning) are powerful, endogenous, cardioprotective phenomena which offer the potential to reduce myocardial injury and infarction by as much as 50%. Despite many years of research these mechanical, invasive techniques have not been adopted to routine practice. A pharmacological mimetic, targeting the same protective pathways as pre- and post- conditioning would have great potential in reducing myocardial injury in a number of clinical settings and could be easily administered and adopted to the clinical arena. Chapter 1 of this thesis summarises the research to date in this rapidly evolving field concentrating on two pharmacological conditioning mimetics, atorvastatin and erythropoietin and the clinical assessment of cardioprotection and myocardial salvage. Chapter 2 details the hypotheses to be investigated. Chapter 3 describes two studies undertaken in coronary artery bypass surgery with high dose atorvastatin as a potential cardioprotective agent. Chapter 4 describes a study testing the use of erythropoietin in patients presenting with acute myocardial infarction requiring emergency angioplasty and using cardiac magnetic resonance outcome measures. Chapter 5 highlights the difficulties in translating pre-clinical animal studies to the human clinical setting and discusses potential methods to improve this. In summary, this thesis examines the pre-existing research regarding atorvastatin and erythropoietin as cardioprotective agents. Novel clinical studies testing the use of these agents in the settings of coronary artery bypass surgery and acute myocardial infarction are presented. The findings are discussed and reviewed in the context of ongoing advances in the field of cardioprotection.