An important mission of the NIH Clinical Center is to perform research on the pathogenesis and treatment of diseases. However, clinical research often involves focus on specific diseases in select subgroups of patients. It is desirable, and consistent with Clinical Center policy, for clinical investigators and staff to maintain exposure to a broader spectrum of disease and disease presentations than are encompassed by research protocols in order to preserve clinical skills, ensure adequate training for research fellows, and stimulate ideas for future clinical research. This protocol permits inpatient and outpatient evaluation and treatment of patients with cardiovascular diseases who do not fulfill eligibility criteria for participation in existing Cardiovascular Branch clinical research protocols, but who are of medical interest for training Cardiovascular Branch staff.

• INCLUSION CRITERIA:

Patients with cardiovascular disease who are 18 years of age or older may participate in this training protocol The following is a representative list of the types of patient presentations and potential diagnoses eligible for this protocol:

Coronary artery disease with effort or rest angina or inducible myocardial ischemia as determined by noninvasive testing.

Valvular heart disease, including patients previously operated upon by Clinical Center heart surgeons prior to 1990.

Cardiomyopathies, including restrictive, congestive, and hypertrophic phenotypes.

Peripheral-artery disease with intermittent claudication or limb-threatening ischemia.

Renovascular disease with uncontrolled hypertension, intermittent pulmonary edema, or evidence of ischemic nephropathy.

Upper extremity peripheral artery disease.

Symptomatic supraventricular and ventricular arrhythmias occurring either as primary events or associated with structural or ischemic heart disease.

EXCLUSION CRITERIA:

Pregnancy, for those patients who require testing or treatment requiring dobutamine, gadolinium or contrast media or radiation exposure.

Inability of patient, parent or legal guardian to provide informed consent.