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Index American College of Cardiology, 180–81, 196–97, 206 American College of Chest Physicians, 150 American Heart Association, 38, 180–81, 196–97 American Medical Association, Council on Ethical and Judicial Affairs, 214 anesthesia, 122, 133, 152, 166, 194–95 anesthesiologists, 127, 138, 194–95, 206; and cardiopulmonary bypass, 139, 147, 162, 168; and oxygenators, 166–67 angina pectoris, 1–2, 6–7, 29, 31, 55, 81, 199, 225; and angioplasty, 93, 96, 192; and bypass surgery, 93, 96, 150, 180, 192; cause and symptoms of, 4; chronic stable, 6, 15, 61, 72, 73, 101; classic, 49; and coronary spasms, 49, 50; crescendo, 61; development and course of, 6; disease despite lack of, 30; and fibrous plaques, 72; as predictable, 104; preinfarction , 61; from progressive obstruction, 88; and prophylactic revascularization, 101; triggers for, 74; unstable, 6, 61, 73, 81, 95; variant, 49; and vasodilators, 65 angiography, 2, 9, 15, 32, 73, 82, 131, 203, 216; during acute coronary events, 62; and bypass surgery, 88; cerebral complications of, 151, 196; and Cleveland Clinic, 22; demands for time and attention to, 163–64; and financial interests, 17, 97, 211; and geographic variation, 205, 221; identification of high-risk plaques through, 90–96; limitations of, 53–56; and plaque rupture hypothesis , 105; and plaque types, 10; and progressive obstruction, 104; and racial variation, 208; rates of, 212; reliability of, 90; risks of, 61–62; and streptokinase, 68; and thrombolysis, 64; and thrombosis, 55–56, 57, 65 angioplasty, x, 2, 3, 27, 87, 180, 212; and angina, 93; and bypass surgery, 90, 190–96; cerebral complications of, 190, 191–92, 195–96; controversy over, 14–15; development of, 12–13, 64–65; earnings from, 17; elective, nonemergent, 96; in Europe, 213–14; expectations of, 28; and fear, 103; and geographic variation, 203, 205, 206–7; and global health, 219, 220–21, 223, 224; for inappropriate or uncertain indications, 14–15; and knowledge of attacks, 60; number of procedures performed, 12–13, 90, 97, 190; and plumbing analogy, 28, 88; and progressive obstruction, 18, 104; prophylactic, 89, 90–97; and race, 20, 208; and statins, 100–101; unnecessary, 98; unrealistic expectations for, 14 angioscopy, 73–74 angiotensin-converting enzyme inhibitors, 2 angiotensin inhibitors, 85 Anichkov, Nikolai, 34, 36–37 animal studies, 18, 36–37, 43, 57, 118, 128; and coronary thrombosis, 30; and heart-lung machines, 119, 121–22; imperfect knowledge from, 29, 33–35; personality in, 40–41; and plaque rupture, 40, 73 antibiotics, 66, 69 aorta, 9, 131, 163; and bypass grafts, 12, 157, 174; calcifications of, 186, 187; and emboli, 178, 192 appendectomy, 205, 213 Arkansas, 208, 210 arrhythmias, 5, 60, 61, 73, 150 arteriosclerosis, 5. See also atherosclerosis 312 Index aspirin, 3, 75, 80–82, 83–84, 195, 203, 221 atheromatous abscesses, 41, 43 atheromatous cysts, 36–37 atherosclerosis, 13, 41, 50, 94, 105, 131, 199; animal models of, 34, 40–41; causes of, 5; and definitional differences, 67–68; infection in, 68–69; and inflammation, 95; and Leary, 36–38; and lifestyle, 10, 100; process of, 31, 71–72; and progressive obstruction, 104; risk of, 21; variable trajectories of, 90–96. See also plaque; plaque rupture Australia, 219 autopsies, 18, 33, 38, 56, 57, 73, 91, 136; and angiography, 54; and clinical-pathological correlation, 35; and Constantinides, 41–42, 48; and Friedman, 43–44, 48; imperfect knowledge from, 29, 68; and thrombus as consequence vs. cause, 51–52; variant results from, 30–31; and visualization, 46 Bailey, Charles, 117, 126, 127, 131, 147 Banting, F. G., 37 Baroldi, Giorgio, 51, 56 Bernard, Claude, 33, 67 beta blockers, 2, 15, 75 Billroth, Theodor, 114–15 Blalock, Alfred, 116 blood clots. See thrombi blood clotting, 36, 41, 75, 76, 80, 81 bloodletting, 14, 84, 86, 99 blood pressure, 7, 41, 43, 50, 86, 186, 192, 221; and animal studies, 41, 43; control of, 13, 82, 197, 221; daily rhythms in, 75; intraoperative , 147–48; and risk factors, 104; and subendocardial infarction, 58 Blumenthal, David, 210 brain. See cerebral complications, of bypass surgery; cerebral complications, of cardiac surgery Braunwald, Eugene, 104, 151–52, 162 breast cancer, 94–95, 225 Breuer, Anthony, 152, 173–75 Bruch, Hilde, 160–61 Bunker, John, 212 Bypass Angioplasty Revascularization Investigation (BARI) Investigators, 195 bypass surgery, x, 13, 14, 27, 49, 103, 180–81, 203; during acute attack, 60–63; aggressive, 99; and angiography, 212; and angioplasty, 90, 190–96; beating-heart (off-pump), 116, 117, 122, 126, 156, 193–96, 199; and Clinton, 2, 225; development of...

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