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Book Details
Abstract
Coronary artery disease is the number one killer in the United States, affecting more than 13 million Americans each year. This issue of Cardiology Clinics comprehensively examines the epidemiology, traditional and novel risk factors, and management of coronary artery syndromes; invasive and noninvasive testing; CT angiography; medically refractory angina; diabetes and coronary artery disease, revascularization options, and Syndrome X.
Table of Contents
| Section Title | Page | Action | Price |
|---|---|---|---|
| Front Cover | Cover | ||
| Coronary Artery Disease | i | ||
| Copyright | ii | ||
| Contributors | iii | ||
| Contents | vii | ||
| Cardiology Clinics | x | ||
| Preface | xi | ||
| Epidemiology, Traditional and Novel Risk Factors in Coronary Artery Disease | 323 | ||
| Key points | 323 | ||
| Epidemiology of coronary artery disease | 323 | ||
| Introduction | 323 | ||
| Prevalence | 323 | ||
| Incidence | 324 | ||
| Clinical Presentation of CAD | 324 | ||
| Myocardial infarction | 324 | ||
| Silent myocardial ischemia and infarction | 325 | ||
| Sudden cardiac death | 325 | ||
| Risk Factors | 325 | ||
| CAD risk equivalents | 325 | ||
| Risk factors of CAD | 326 | ||
| Novel and emerging risk factors | 327 | ||
| Genetic testing | 327 | ||
| Summary | 327 | ||
| References | 328 | ||
| Stable Ischemic Heart Disease | 333 | ||
| Key points | 333 | ||
| Definition and clinical diagnosis | 333 | ||
| Silent Ischemia and Infarction Is Frequent | 334 | ||
| Goals of therapy, functional classification, and severity | 335 | ||
| Myocardial Energy (Oxygen) Imbalance and Ischemic Pain | 335 | ||
| Pretest Probability of Ischemia Graded According to Gender, Age, and Symptoms | 335 | ||
| Classifications that Include Additional Clinical and Baseline ECG Findings | 335 | ||
| Anti-ischemic therapy | 336 | ||
| Organic Nitrates | 336 | ||
| β-Blockers | 338 | ||
| Calcium Channel Blockers | 338 | ||
| Newer, nontraditional, unique, anti-ischemic agents | 341 | ||
| Nicorandil | 341 | ||
| Ivabradine | 341 | ||
| Trimetazidine | 341 | ||
| Fasudil | 344 | ||
| Ranolazine | 344 | ||
| Secondary prevention | 345 | ||
| Management of risk factors | 346 | ||
| References | 349 | ||
| Acute Coronary Syndromes | 353 | ||
| Key points | 353 | ||
| Pathophysiology | 354 | ||
| Diagnosis and risk stratification | 354 | ||
| Antiplatelet therapy | 354 | ||
| Aspirin | 354 | ||
| Clopidogrel | 354 | ||
| Prasugrel | 356 | ||
| Ticagrelor | 357 | ||
| Glycoprotein IIb/IIIa Inhibitors | 360 | ||
| Cangrelor | 360 | ||
| Anticoagulant therapy | 360 | ||
| Unfractionated Heparin | 360 | ||
| Enoxaparin | 360 | ||
| Fondaparinux | 360 | ||
| Bivalirudin | 361 | ||
| Novel Oral Anticoagulants | 361 | ||
| Anti-ischemic therapy | 361 | ||
| β-Blockers | 361 | ||
| Inhibitors of the Renin-Angiotensin-Aldosterone System | 361 | ||
| Calcium Channel Blockers | 361 | ||
| Nitrates | 361 | ||
| Ranolazine | 364 | ||
| Lipid-lowering therapy | 364 | ||
| Early invasive strategy versus initial conservative approach | 364 | ||
| Timing of invasive therapy | 364 | ||
| Additional considerations and patient subgroups | 365 | ||
| Diabetes Mellitus | 365 | ||
| Chronic Kidney Disease | 365 | ||
| Summary | 366 | ||
| References | 366 | ||
| Current State of ST-Segment Myocardial Infarction | 371 | ||
| Key points | 371 | ||
| Introduction | 371 | ||
| Early Evidence in STEMI Reperfusion | 372 | ||
| Coronary Stents and Contemporary Primary PCI | 373 | ||
| Surrogate Markers of Reperfusion in STEMI | 375 | ||
| Thrombectomy and Embolic Protection Devices | 375 | ||
| Novel Adjunctive Therapies | 376 | ||
| Antiplatelet and Antithrombotic Therapies in STEMI | 376 | ||
| New Challenges in STEMI | 378 | ||
| Cardiogenic Shock and Ventricular Assistive Devices in STEMI | 378 | ||
| Timely Reperfusion and Patient Outcomes | 379 | ||
| Treating STEMI in Regional Systems of Care | 380 | ||
| Summary | 382 | ||
| References | 382 | ||
| Noninvasive Stress Testing for Coronary Artery Disease | 387 | ||
| Key points | 387 | ||
| Introduction | 387 | ||
| Stress Testing for Diagnostic Purposes | 388 | ||
| Impact of Verification Bias on Diagnostic Accuracy | 388 | ||
| Stress Testing for Risk Stratification | 388 | ||
| Risk Stratification by Standard ETT | 389 | ||
| Risk Stratification by Treadmill Scores | 389 | ||
| Risk Stratification with SPECT | 389 | ||
| Other SPECT Prognostic Variables | 392 | ||
| Stress PET for Risk Stratification | 392 | ||
| Stress Echocardiography for Risk Stratification | 393 | ||
| Comparison Between Standard ETT and Stress Imaging | 395 | ||
| Standard ETT Versus Stress Imaging in the Presence of a Normal Resting ECG | 395 | ||
| Choosing Between Standard ETT Versus Stress Imaging | 395 | ||
| Choosing Between SPECT and Echocardiography | 395 | ||
| Correct Interpretation of a Stress Imaging Study | 397 | ||
| Recent Randomized Trials of Stress Testing | 397 | ||
| Stress Imaging Substudies in Recent Randomized Trials | 398 | ||
| Future Directions | 400 | ||
| References | 400 | ||
| Invasive Testing for Coronary Artery Disease | 405 | ||
| Key points | 405 | ||
| Introduction | 405 | ||
| FFR | 406 | ||
| IVUS | 409 | ||
| OCT | 411 | ||
| NIRS | 412 | ||
| Summary | 414 | ||
| References | 414 | ||
| Calcium Scoring and Cardiac Computed Tomography in 2014 | 419 | ||
| Key points | 419 | ||
| Introduction | 419 | ||
| Background | 419 | ||
| Coronary computed tomographic angiography | 420 | ||
| Diagnostic Accuracy of CT Angiography | 420 | ||
| Beyond Coronary Imaging: The Triple Rule-Out Scan | 421 | ||
| Clinical application of CCTA in the ED for evaluation of chest pain: selection of patients | 422 | ||
| Evaluating for Vulnerable Plaque | 422 | ||
| Evaluating Incidentally Found Coronary Artery Calcification on CT Scans | 422 | ||
| Summary | 424 | ||
| References | 424 | ||
| Alternative Therapy for Medically Refractory Angina | 429 | ||
| Key points | 429 | ||
| Introduction | 429 | ||
| EECP therapy | 430 | ||
| EECP therapy in RAP management | 430 | ||
| Transmyocardial laser revascularization | 434 | ||
| Percutaneous transmyocardial laser revascularization | 435 | ||
| ACC/AHA and ESC guidelines | 435 | ||
| References | 436 | ||
| Coronary Artery Disease and Diabetes Mellitus | 439 | ||
| Key points | 439 | ||
| Introduction | 439 | ||
| Glycemic control and cardiovascular outcomes | 440 | ||
| Antidiabetic Drug Safety | 441 | ||
| Hypoglycemia and Mortality | 443 | ||
| Management of hyperlipidemia in patients with DM | 443 | ||
| Statin use and risk of diabetes | 444 | ||
| Coronary revascularization in patients with DM | 446 | ||
| Revascularization Versus Medical Therapy | 446 | ||
| Use of Drug-Eluting Stents in Patients with DM | 446 | ||
| Stent Thrombosis After DES Implantation | 446 | ||
| CABG Versus PCI in Multivessel CAD | 448 | ||
| Explaining the Mortality Benefit of CABG | 449 | ||
| Graft Selection and Patency in Patients with DM | 449 | ||
| Approach to coronary revascularization in patients with DM | 449 | ||
| References | 451 | ||
| Revascularization Options | 457 | ||
| Key points | 457 | ||
| Introduction | 457 | ||
| Clinical trials comparing CABG versus PCI | 458 | ||
| Multivessel disease | 458 | ||
| Left main disease | 459 | ||
| Summary | 460 | ||
| References | 460 | ||
| Cardiac Syndrome X | 463 | ||
| Key points | 463 | ||
| Introduction | 463 | ||
| Epidemiology | 464 | ||
| Prognosis | 464 | ||
| Diagnosis | 465 | ||
| Clinical Features | 465 | ||
| History | 465 | ||
| ECG | 465 | ||
| Coronary angiography | 465 | ||
| Differential Diagnosis | 465 | ||
| Pathogenesis overview | 466 | ||
| CMD | 466 | ||
| Normal Coronary Microvascular Function | 466 | ||
| Assessment of Coronary Microvascular Function | 467 | ||
| Impaired Coronary Microvascular Function | 467 | ||
| Risk Factors | 467 | ||
| Enhanced pain sensitivity | 467 | ||
| Origin of the Enhanced Pain Sensitivity Theory | 467 | ||
| Psychological and Behavioral Factors | 469 | ||
| Pathogenesis summary | 470 | ||
| Treatment overview | 470 | ||
| Anti-ischemic pharmacologic treatments | 470 | ||
| Nitrates | 470 | ||
| β-Adrenergic Receptor Blockers | 470 | ||
| Calcium Channel Antagonists | 471 | ||
| Ranolazine | 471 | ||
| Angiotensin-Converting Enzyme Inhibitors | 471 | ||
| Statins | 471 | ||
| Analgesic pharmacologic treatments | 472 | ||
| Xanthine Derivatives | 472 | ||
| Tricyclic Antidepressants | 472 | ||
| Nonpharmacologic treatment | 472 | ||
| Cognitive-Behavioral Therapy | 472 | ||
| Enhanced External Counterpulsation | 472 | ||
| Neurostimulation | 472 | ||
| Stellate Ganglionectomy | 473 | ||
| Lifestyle modifications | 473 | ||
| Treatment conclusion | 473 | ||
| Summary | 474 | ||
| References | 474 | ||
| Index | 479 |