BOOK
Braunwald's Heart Disease E-Book
Douglas L. Mann | Douglas P. Zipes | Peter Libby | Robert O. Bonow
(2014)
Additional Information
Book Details
Abstract
Ideal for cardiologists who need to keep abreast of rapidly changing scientific foundations, clinical research results, and evidence-based medicine, Braunwald’s Heart Disease is your indispensable source for definitive, state-of-the-art answers on every aspect of contemporary cardiology, helping you apply the most recent knowledge in personalized medicine, imaging techniques, pharmacology, interventional cardiology, electrophysiology, and much more!
- Practice with confidence and overcome your toughest challenges with advice from the top minds in cardiology today, who synthesize the entire state of current knowledge and summarize all of the most recent ACC/AHA practice guidelines.
- Locate the answers you need fast thanks to a user-friendly, full-color design with more than 1,200 color illustrations.
- Learn from leading international experts, including 53 new authors. Explore brand-new chapters, such as Principles of Cardiovascular Genetics and Biomarkers, Proteomics, Metabolomics, and Personalized Medicine.
- Access new and updated guidelines covering Diseases of the Aorta, Peripheral Artery Diseases, Diabetes and the Cardiovascular System, Heart Failure, and Valvular Heart Disease.
- Stay abreast of the latest diagnostic and imaging techniques and modalities, such as three-dimensional echocardiography, speckle tracking, tissue Doppler, computed tomography, and cardiac magnetic resonance imaging.
- Consult this title on your favorite e-reader, conduct rapid searches, and adjust font sizes for optimal readability.
Table of Contents
| Section Title | Page | Action | Price |
|---|---|---|---|
| Front Cover | cover | ||
| Inside Front Cover | ifc1 | ||
| Braunwald's Heart Disease, 10/e | i | ||
| Copyright Page | iv | ||
| Dedication | v | ||
| Acknowledgments | vi | ||
| Contributors | vii | ||
| Preface to the Tenth Edition | xv | ||
| Preface—Adapted from the First Edition | xvii | ||
| Table Of Contents | xix | ||
| Video Contents | xxiii | ||
| Look for these other titles in the Braunwald’s Heart Disease Family | xxvii | ||
| I Fundamentals of Cardiovascular Disease | 1 | ||
| 1 Global Burden of Cardiovascular Disease | 1 | ||
| Shifting Burden of Cardiovascular Disease | 1 | ||
| Epidemiologic Transition in Predominant Causes of Death | 1 | ||
| Sequence of Stages | 1 | ||
| Is There a Fifth Phase: The Age of Inactivity and Obesity? | 3 | ||
| Different Patterns of Epidemiologic Transition | 3 | ||
| Current Variations in the Global Burden of Cardiovascular Disease | 4 | ||
| High-Income Countries | 5 | ||
| Demographic and Social Indices | 5 | ||
| Burden of Disease | 5 | ||
| East Asia and Pacific | 6 | ||
| Demographic and Social Indices | 6 | ||
| Burden of Disease | 6 | ||
| Central and Eastern Europe and Central Asia | 7 | ||
| Demographic and Social Indices | 7 | ||
| Burden of Disease | 7 | ||
| Latin America and the Caribbean | 8 | ||
| II Genetics and Personalized Medicine | 57 | ||
| 7 Personalized and Precision Cardiovascular Medicine | 57 | ||
| Assessment of Disease Risk: Family Health History and Health Risk Assessments | 57 | ||
| A Genomic Toolbox for Personalized and Precision Medicine | 58 | ||
| DNA Variation | 58 | ||
| Whole-Genome Sequencing | 58 | ||
| Gene Expression | 58 | ||
| Proteomics | 58 | ||
| Metabolomics | 58 | ||
| Personalized and Precision Cardiovascular Medicine: Clinical Potential | 59 | ||
| Hypertension | 59 | ||
| Coronary Artery Disease and Myocardial Infarction | 59 | ||
| Heart Failure | 59 | ||
| Arrhythmias | 59 | ||
| Cardiac Transplant Rejection | 59 | ||
| Pharmacogenetics | 60 | ||
| Barriers and Solutions to the Integration of Genomics Into Cardiovascular Medicine | 62 | ||
| Future Perspective: Toward Personalized and Precision Cardiovascular Medicine | 62 | ||
| References | 62 | ||
| Family History and Risk Assessment | 62 | ||
| Genomic Approaches to Personalized Medicine | 62 | ||
| Clinical Applications of Personalized Medicine | 62 | ||
| Pharmacogenetics in Personalized Medicine | 62 | ||
| Implementation of Personalized Medicine | 63 | ||
| 8 Principles of Cardiovascular Genetics | 64 | ||
| Inherited Basis for the Variation in Risk for Cardiovascular Disease | 64 | ||
| Patient Case, Part I. | 64 | ||
| A Brief Primer on Molecular Biology | 64 | ||
| Modes of Inheritance | 65 | ||
| Approaches to Discovering the Inherited Basis for Cardiovascular Disease | 66 | ||
| Human Genetic Variation | 66 | ||
| Characterizing Human Genetic Variation: Genotyping and Sequencing | 67 | ||
| Study Designs to Correlate Genotype with Phenotype | 67 | ||
| Family-Based Studies | 67 | ||
| Patient Case, Part II. | 67 | ||
| Extreme-Phenotype Studies | 69 | ||
| Population-Based Studies | 69 | ||
| Illustrative Examples | 70 | ||
| Mendelian Disease Using Classic Linkage | 70 | ||
| Mendelian Disease Using Direct DNA Sequencing | 70 | ||
| Complex Trait Using Extremes in a Population | 70 | ||
| Complex Trait Using Genome-Wide Association | 71 | ||
| Clinical Application of Genetic Findings | 71 | ||
| Risk Prediction | 71 | ||
| Patient Case, Part III. | 71 | ||
| Distinguishing Causal from Reactive Biomarkers | 72 | ||
| Patient Case, Part IV. | 72 | ||
| Personalized Medicine | 73 | ||
| Patient Case, Part V. | 73 | ||
| Therapeutic Targets: From Gene to Drug in a Decade | 73 | ||
| Future Directions | 73 | ||
| Acknowledgment | 74 | ||
| References | 74 | ||
| Approaches to Genetic Studies | 74 | ||
| Applications of Genetics to Lipid Disorders | 74 | ||
| Risk Prediction Using Genetic Markers | 74 | ||
| Genetic Approaches to Assessing the Causality of Risk Factors | 74 | ||
| Personalized Medicine | 74 | ||
| 9 Drug Therapeutics and Personalized Medicine | 75 | ||
| Importance of Correct Drug Use | 75 | ||
| The Key Decision in Drug Therapy: Risk Versus Benefit | 75 | ||
| Mechanisms Underlying Variability in Drug Action | 76 | ||
| Pharmacodynamic Principles | 77 | ||
| Time Course of Drug Effects | 77 | ||
| Molecular and Genetic Basis for Variable Drug Response | 79 | ||
| Optimizing Drug Doses | 80 | ||
| Plasma Concentration Monitoring | 81 | ||
| Dose Adjustments | 82 | ||
| Disease and Concomitant Drugs | 82 | ||
| Drug Interactions | 82 | ||
| Incorporating Pharmacogenetic Information into Prescribing | 82 | ||
| Future Challenges | 83 | ||
| References | 83 | ||
| 10 Biomarkers, Proteomics, Metabolomics, and Personalized Medicine | 84 | ||
| What is a Biomarker? | 84 | ||
| Clinical Applications of Cardiovascular Biomarkers | 85 | ||
| Novel Technologies in the Identification of Biomarkers | 86 | ||
| Introduction to Proteomics and Metabolomics | 86 | ||
| Analytic Challenges for Proteomics and Metabolomics | 87 | ||
| Overview of the Discovery Process | 88 | ||
| Applications of Mass Spectrometry–Based Discovery to Cardiometabolic Disease | 89 | ||
| Future Directions in Biomarker Discovery | 90 | ||
| Clinical Measures of Biomarker Performance | 90 | ||
| Sensitivity, Specificity, and Positive and Negative Predictive Value | 90 | ||
| Discrimination, C-Statistics, and the Receiver Operative Characteristic Curve | 91 | ||
| Accuracy and Calibration | 91 | ||
| Risk Reclassification | 91 | ||
| External Validation and Impact Studies | 92 | ||
| A Practical Example: High-Sensitivity C-Reactive Protein, Lipids, and the Reynolds Risk Score | 92 | ||
| Conclusion | 92 | ||
| References | 92 | ||
| What Is a Biomarker? | 92 | ||
| Biomarker Discovery | 93 | ||
| Evaluation of the Clinical Performance of Biomarkers | 93 | ||
| III Evaluation of the Patient | 95 | ||
| 11 The History and Physical Examination: | 95 | ||
| The History | 95 | ||
| The General Physical Examination | 96 | ||
| General Appearance | 96 | ||
| Skin | 97 | ||
| Head and Neck | 97 | ||
| Extremities | 97 | ||
| Chest and Abdomen | 97 | ||
| The Cardiovascular Examination | 98 | ||
| Jugular Venous Pressure and Waveform | 98 | ||
| Measuring the Blood Pressure | 99 | ||
| Assessing the Pulses | 100 | ||
| Inspection and Palpation of the Heart | 102 | ||
| Auscultation of the Heart | 102 | ||
| Heart Sounds | 102 | ||
| First Heart Sound (S1) | 102 | ||
| Second Heart Sound (S2) | 103 | ||
| Systolic Sounds | 103 | ||
| Diastolic Sounds | 103 | ||
| Cardiac Murmurs | 104 | ||
| Systolic Murmurs | 104 | ||
| Diastolic Murmurs | 104 | ||
| Continuous Murmurs | 104 | ||
| Dynamic Auscultation | 106 | ||
| Indications for Echocardiography | 106 | ||
| Integrated, Evidence-Based Approach to Specific Cardiac Disorders | 107 | ||
| Heart Failure | 107 | ||
| History | 107 | ||
| Physical Examination | 107 | ||
| Jugular Venous Pressure | 107 | ||
| Third and Fourth Heart Sounds | 108 | ||
| Rales and Edema | 109 | ||
| Valsalva Maneuver | 109 | ||
| Other Findings | 109 | ||
| Valvular Heart Disease | 110 | ||
| Mitral Stenosis | 110 | ||
| Mitral Regurgitation | 110 | ||
| Aortic Stenosis | 111 | ||
| Aortic Regurgitation | 111 | ||
| Tricuspid Valve Disease | 111 | ||
| Pulmonic Valve Disease | 111 | ||
| Prosthetic Heart Valves | 111 | ||
| Pericardial Disease | 112 | ||
| Pericarditis | 112 | ||
| Pericardial Tamponade | 112 | ||
| Constrictive Pericarditis | 112 | ||
| Future Directions | 112 | ||
| Acknowledgments | 112 | ||
| References | 112 | ||
| The General Physical Examination | 112 | ||
| The Cardiovascular Examination | 112 | ||
| Integrated, Evidence-Based Approach to Specific Cardiac Disorders | 113 | ||
| Future Directions | 113 | ||
| 12 Electrocardiography | 114 | ||
| The Normal Electrocardiogram | 120 | ||
| Atrial Activation and the P Wave | 121 | ||
| The Normal P Wave | 121 | ||
| Atrial Repolarization | 121 | ||
| Heart Rate Variability | 121 | ||
| Atrioventricular Node Conduction and the PR Segment | 121 | ||
| Ventricular Activation and the QRS Complex | 122 | ||
| Ventricular Activation | 122 | ||
| Normal QRS Complex | 122 | ||
| QRS Duration | 123 | ||
| The Normal ST-T Wave | 123 | ||
| The J Wave | 124 | ||
| The U Wave | 124 | ||
| The QT Interval | 124 | ||
| Other Measures of Ventricular Recovery | 124 | ||
| QT Dispersion | 124 | ||
| Normal Variants | 125 | ||
| The Abnormal Electrocardiogram | 125 | ||
| Atrial Abnormalities | 125 | ||
| Ventricular Hypertrophy | 127 | ||
| Left Ventricular Hypertrophy | 127 | ||
| Diagnostic Criteria | 128 | ||
| IV Heart Failure | 429 | ||
| 21 Mechanisms of Cardiac Contraction and Relaxation | 429 | ||
| Microanatomy of Contractile Cells and Proteins | 429 | ||
| Ultrastructure of Contractile Cells | 429 | ||
| Subcellular Microarchitecture | 430 | ||
| Mitochondrial Morphology and Function | 430 | ||
| Contractile Proteins | 432 | ||
| Titin and Length Sensing | 433 | ||
| Strong and Weak Binding States | 433 | ||
| Actin and Troponin Complex | 433 | ||
| Myosin and the Molecular Basis of Muscular Contraction | 433 | ||
| Graded Effects of [Ca2+]i on the Cross-Bridge Cycle | 435 | ||
| Length-Dependent Activation and the Frank-Starling Effect | 435 | ||
| Cross-Bridge Cycling Differs from the Cardiac Contraction-Relaxation Cycle | 435 | ||
| Force Transmission | 435 | ||
| Contractile Protein Defects and Cardiomyopathy | 435 | ||
| Calcium Ion Fluxes in the Cardiac Contraction-Relaxation Cycle | 435 | ||
| Calcium Movements and Excitation-Contraction Coupling | 435 | ||
| Ca2+ Release and Uptake by the Sarcoplasmic Reticulum | 436 | ||
| Sarcoplasmic Reticulum Network and Ca2+ Movements | 436 | ||
| Junctional Sarcoplasmic Reticulum and Ryanodine Receptor | 436 | ||
| Turning off Ca2+ Release: Breaking Positive Feedback | 436 | ||
| Calmodulin: A Versatile Mediator of Ca2+ Signaling | 436 | ||
| Calcium Sparks and Waves | 438 | ||
| Calcium Uptake into the Sarcoplasmic Reticulum by SERCA | 438 | ||
| Sarcolemmal Control of Ca2+ and Na | 438 | ||
| Calcium and Sodium Channels | 438 | ||
| Molecular Structure of Ca2+ and Na+ Channels | 439 | ||
| T- Versus L-Type Ca2+ Channels | 439 | ||
| L-Type Ca2+ Channel Localization and Regulation | 439 | ||
| Sodium Channels | 439 | ||
| Ca2+/Calmodulin-Dependent Protein Kinase II Alters Gating of INa, ICa, and Other Channels | 439 | ||
| Ion Exchangers and Pumps | 439 | ||
| Sodium-Calcium Exchanger | 439 | ||
| Heart Rate and Na+/Ca2+ Exchange | 440 | ||
| Sodium Pump (Na+/K+-Adenosine Triphosphatase) | 440 | ||
| Adrenergic Signaling Systems | 440 | ||
| Physiologic Fight-or-Flight Response | 440 | ||
| Beta-Adrenergic Receptor Subtypes | 441 | ||
| Alpha-Adrenergic Receptor Subtypes | 441 | ||
| G proteins | 441 | ||
| The Stimulatory G Protein Gs | 441 | ||
| The Inhibitory G Protein Gi | 441 | ||
| A Third G Protein, Gq | 442 | ||
| Cyclic Adenosine Monophosphate and Protein Kinase A | 442 | ||
| Adenylyl Cyclase | 442 | ||
| Protein Kinase A | 442 | ||
| Beta1-Adrenergic and Protein Kinase A Signaling in Ventricular Myocytes | 443 | ||
| Beta-Adrenergic Receptor Desensitization | 444 | ||
| Calcium-Calmodulin–Dependent Kinase II | 444 | ||
| Cholinergic and Nitric Oxide Signaling | 444 | ||
| Cholinergic Signaling | 444 | ||
| Cyclic Guanosine Monophosphate Signaling in the Heart | 445 | ||
| Nitric Oxide | 445 | ||
| Reactive Oxygen Species As Signaling Molecules | 445 | ||
| Contractile Performance of Intact Hearts | 445 | ||
| The Cardiac Cycle | 446 | ||
| Left Ventricular Contraction | 446 | ||
| Left Ventricular Relaxation | 447 | ||
| Left Ventricular Filling Phases | 447 | ||
| Definitions of Systole and Diastole | 447 | ||
| Contractility Versus Loading Conditions | 447 | ||
| Contractility | 447 | ||
| Preload and Afterload | 447 | ||
| Starling’s Law of the Heart | 447 | ||
| Venous Filling Pressure and Heart Volume | 447 | ||
| Frank and Isovolumic Contraction | 448 | ||
| Afterload | 448 | ||
| Preload and Afterload Are Interlinked | 448 | ||
| Force-Length Relationships and Ca2+ Transients | 448 | ||
| Anrep Effect: Abrupt Increase in Afterload | 448 | ||
| Wall Stress | 448 | ||
| Wall Stress, Preload, and Afterload | 449 | ||
| Heart Rate and Force-Frequency Relationship | 449 | ||
| Treppe or Bowditch Effect | 449 | ||
| Physiologic Force-Frequency Relationship and Optimal Heart Rate | 450 | ||
| Myocardial Oxygen Uptake | 450 | ||
| Work of the Heart | 450 | ||
| Internal Work (Potential Energy) | 451 | ||
| Kinetic Work | 451 | ||
| Measurements of Contractile Function | 451 | ||
| Force-Velocity Relationship and Maximum Contractile Function in Muscle Models | 451 | ||
| Isometric Versus Isotonic Contraction | 451 | ||
| Pressure-Volume Loops | 451 | ||
| Power Production and Contractile Function | 452 | ||
| Limitations of the Concept of Contractility | 452 | ||
| Left Ventricular Relaxation and Diastolic Dysfunction | 452 | ||
| Right Ventricular Function | 452 | ||
| Atrial Function | 452 | ||
| Future Perspectives | 452 | ||
| References | 453 | ||
| Microanatomy of Contractile Cells and Proteins | 453 | ||
| Calcium Ion Fluxes in the Cardiac Contraction-Relaxation Cycle | 453 | ||
| Sarcolemmal Control of Ca2+ and Na | 453 | ||
| Adrenergic Signaling Systems | 453 | ||
| Cholinergic and Nitric Oxide Signaling | 453 | ||
| Contractile Performance of Intact Hearts | 453 | ||
| 22 Pathophysiology of Heart Failure | 454 | ||
| Overview | 454 | ||
| Pathogenesis | 454 | ||
| Heart Failure as a Progressive Model | 454 | ||
| Neurohormonal Mechanisms | 454 | ||
| Activation of the Sympathetic Nervous System | 454 | ||
| Activation of the Renin-Angiotensin System | 455 | ||
| Neurohormonal Alterations of Renal Function | 457 | ||
| Neurohormonal Alterations in the Peripheral Vasculature | 459 | ||
| Nitric Oxide | 460 | ||
| Left Ventricular Remodeling | 461 | ||
| Alterations in the Biology of the Cardiac Myocyte | 462 | ||
| Cardiac Myocyte Hypertrophy | 462 | ||
| Alterations in Excitation-Contraction Coupling | 463 | ||
| Increased Ca2+ Leak | 463 | ||
| Sarcoplasmic Reticulum Ca2+ Reuptake and Sarcolemmal Ca2+ Elimination | 464 | ||
| Action Potential Duration and Sodium Handling | 464 | ||
| Abnormalities in Contractile and Regulatory Proteins | 464 | ||
| Abnormalities in Cytoskeletal Proteins | 465 | ||
| Beta-Adrenergic Desensitization | 465 | ||
| Alterations in the Myocardium | 466 | ||
| Alterations in Left Ventricular Structure | 469 | ||
| Reversibility of Left Ventricular Remodeling | 471 | ||
| Future Perspectives | 471 | ||
| Matrix Metalloproteinases | 472.e1 | ||
| References | 472.e1 | ||
| Metabolic Modulation | 472.e2 | ||
| Trimetazadine | 472.e2 | ||
| Ranolazine | 472.e3 | ||
| Glucagon-like Peptide-1 | 472.e3 | ||
| Micronutrient Supplementation | 472.e3 | ||
| References | 472.e3 | ||
| References | 472 | ||
| Heart Failure as a Progressive Model: Neurohormonal Mechanisms | 472 | ||
| Heart Failure as a Progressive Model: Left Ventricular Remodeling | 472 | ||
| 23 Clinical Assessment of Heart Failure | 473 | ||
| Heart Failure Definitions | 473 | ||
| The Medical History and Physical Examination | 473 | ||
| Heart Failure Symptoms | 473 | ||
| Other Historical Information | 474 | ||
| The Physical Examination | 475 | ||
| Routine Assessment | 476 | ||
| Chest Radiography | 476 | ||
| The Electrocardiogram | 477 | ||
| Measurement of Blood Chemistry and Hematologic Variables | 477 | ||
| Biomarkers | 477 | ||
| Natriuretic Peptides | 478 | ||
| Other Biomarkers | 479 | ||
| Risk Scoring for Prognosis | 480 | ||
| Right-Heart Catheterization | 480 | ||
| Endomyocardial Biopsy | 480 | ||
| Detecting Comorbid Conditions | 480 | ||
| Assessment of Quality of Life | 481 | ||
| Cardiopulmonary Exercise Testing | 481 | ||
| Imaging Modalities Useful in Diagnosis and Management of Heart Failure | 481 | ||
| Summary and Future Perspectives | 483 | ||
| Comorbid Conditions and Heart Failure | 482.e1 | ||
| References | 482.e1 | ||
| References | 483 | ||
| Heart Failure Definitions | 483 | ||
| The Medical History and Physical Examination | 483 | ||
| Routine Assessment | 483 | ||
| Risk Scoring for Prognosis | 483 | ||
| Right-Heart Catheterization | 483 | ||
| Detecting Comorbid Conditions | 483 | ||
| Assessment of Quality of Life | 483 | ||
| Cardiopulmonary Exercise Testing | 483 | ||
| Imaging Modalities Useful in Diagnosis and Management of Heart Failure | 483 | ||
| 24 Diagnosis and Management of Acute Heart Failure | 484 | ||
| Epidemiology | 484 | ||
| Nomenclature and Definition | 484 | ||
| Scope of the Problem | 484 | ||
| Preserved Versus Reduced Ejection Fraction | 484 | ||
| Age, Race, and Sex | 485 | ||
| Comorbid Conditions | 485 | ||
| Pathophysiology | 486 | ||
| Congestion | 486 | ||
| Myocardial Function | 487 | ||
| Renal Mechanisms (see also Chapter 88) | 488 | ||
| Vascular Mechanisms | 488 | ||
| Neurohormonal and Inflammatory Mechanisms (see also Chapter 22) | 489 | ||
| Evaluation of the Patient with Acute Heart Failure | 489 | ||
| Classification | 489 | ||
| Symptoms | 490 | ||
| Physical Examination | 490 | ||
| Other Diagnostic Testing | 491 | ||
| Biomarkers | 491 | ||
| Other Laboratory Testing | 491 | ||
| Chest Radiography, Electrocardiogram, and Echocardiogram | 491 | ||
| Clinical Triggers | 491 | ||
| Risk Stratification | 491 | ||
| Predictive Models of In-Hospital Mortality | 491 | ||
| Predictive Models of Postdischarge Events | 492 | ||
| Management of the Patient with Acute Heart Failure | 493 | ||
| Phases of Management | 493 | ||
| Phase I: Urgent/Emergent Care | 493 | ||
| Phase II: Hospital Care | 494 | ||
| The Cardiorenal Syndrome in Hospitalized Patients | 495 | ||
| Phase III: Predischarge Planning | 495 | ||
| Phase IV: Postdischarge Management | 495 | ||
| General Approaches to Therapy of Acute Heart Failure | 495 | ||
| Targeting Congestion | 495 | ||
| Blood Pressure | 496 | ||
| Volume Status | 497 | ||
| Renal Function | 497 | ||
| Invasive Hemodynamic Strategy | 497 | ||
| Process of Care, Outcomes, and Quality Assessment | 497 | ||
| The Rehospitalization Problem | 497 | ||
| Specific Therapies for Acute Heart Failure | 498 | ||
| Diuretics | 498 | ||
| Vasodilators | 498 | ||
| Nitrates | 499 | ||
| Sodium Nitroprusside | 500 | ||
| Nesiritide | 501 | ||
| Inotropes and Inodilators | 501 | ||
| Dobutamine | 502 | ||
| Dopamine | 502 | ||
| Epinephrine | 502 | ||
| Phosphodiesterase Inhibitors | 502 | ||
| Vasopressors | 503 | ||
| Other Nonpharmacologic Therapies | 503 | ||
| Ultrafiltration | 503 | ||
| Hypertonic Saline | 504 | ||
| Potential New Therapies | 504 | ||
| Vasodilating Agents | 504 | ||
| Serelaxin | 504 | ||
| Other Natriuretic Peptides | 506 | ||
| Neurohormonal Antagonists | 506 | ||
| Soluble Guanylate Cyclase Activators | 507 | ||
| Inotropic Agents | 507 | ||
| Cardiac Myosin Activators | 507 | ||
| Istaroxime | 507 | ||
| Other Inotropic Agents | 507 | ||
| Renoprotective Agents | 507 | ||
| Future Perspectives | 507 | ||
| References | 507 | ||
| Epidemiology | 507 | ||
| Pathophysiology | 507 | ||
| Evaluation of the Patient with Acute Heart Failure | 508 | ||
| Management of the Patient with Acute Heart Failure | 508 | ||
| 25 Management of Patients with Heart Failure with Reduced Ejection Fraction | 512 | ||
| Epidemiology | 512 | ||
| Etiology | 512 | ||
| Prognosis | 514 | ||
| Biomarkers and Prognosis | 514 | ||
| Renal Insufficiency | 515 | ||
| Approach to the Patient | 516 | ||
| Patients at High Risk for Developing Heart Failure | 516 | ||
| Management of Patients with Symptomatic and Asymptomatic Heart Failure | 516 | ||
| Transient Left Ventricular Dysfunction | 516 | ||
| Defining the Appropriate Strategy | 518 | ||
| General Measures | 519 | ||
| Activity | 520 | ||
| Diet | 520 | ||
| Management of Fluid Retention | 520 | ||
| Diuretic Classes | 520 | ||
| Loop Diuretics | 521 | ||
| Thiazide and Thiazide-like Diuretics | 522 | ||
| Mineralocorticoid Receptor Antagonists | 522 | ||
| Potassium-Sparing Diuretics | 523 | ||
| Carbonic Anhydrase Inhibitors | 523 | ||
| Vasopressin Antagonists | 523 | ||
| Diuretic Treatment of Heart Failure | 524 | ||
| Complications of Diuretic Use | 524 | ||
| Electrolyte and Metabolic Disturbances | 525 | ||
| Hypotension and Azotemia | 525 | ||
| Neurohormonal Activation | 525 | ||
| Ototoxicity | 525 | ||
| Diuretic Resistance and Its Management | 525 | ||
| Device-Based Therapies for Management of Fluid Status | 527 | ||
| Prevention of Disease Progression | 527 | ||
| Angiotensin-Converting Enzyme Inhibitors | 527 | ||
| Complications of Angiotensin-Converting Enzyme Inhibitor Use | 528 | ||
| Angiotensin Receptor Blockers | 530 | ||
| Complications of Angiotensin Receptor Blocker Use | 530 | ||
| Beta Blockers | 530 | ||
| Side Effects of Beta Blockers | 532 | ||
| Aldosterone Antagonists | 532 | ||
| Side Effects of Aldosterone Antagonists | 532 | ||
| Ivabradine | 533 | ||
| Renin Inhibitors | 533 | ||
| Pharmacogenomics | 533 | ||
| Management of Patients Who Remain Symptomatic | 533 | ||
| Background Therapy | 533 | ||
| Cardiac Glycosides | 534 | ||
| Complications of Digoxin Use | 534 | ||
| n-3 Polyunsaturated Fatty Acids | 535 | ||
| Management of Atherosclerotic Disease | 535 | ||
| Special Populations | 535 | ||
| Women | 535 | ||
| Race/Ethnicity | 535 | ||
| Elderly Persons | 535 | ||
| Patients with Cancer | 536 | ||
| Anticoagulation and Antiplatelet Therapy | 536 | ||
| Management of Cardiac Arrhythmias | 536 | ||
| Device Therapy | 536 | ||
| Cardiac Resynchronization | 536 | ||
| Implantable Cardioverter Defibrillators | 537 | ||
| Sleep-Disordered Breathing | 537 | ||
| Disease Management Approach | 538 | ||
| Patients with Refractory End-Stage Heart Failure | 538 | ||
| Future Perspectives | 539 | ||
| Pharmacogenetics | 546.e1 | ||
| References | 546.e2 | ||
| Cardiac Glycosides | 546.e3 | ||
| Mechanisms of Action | 546.e3 | ||
| Positive Inotropic Effect | 546.e3 | ||
| Antiadrenergic Properties | 546.e3 | ||
| Electrophysiologic Actions | 546.e3 | ||
| Pharmacokinetics and Dosing | 546.e3 | ||
| Drug Interactions with Digoxin | 546.e4 | ||
| Therapeutic Drug Monitoring | 546.e4 | ||
| Digitalis Toxicity | 546.e4 | ||
| Management | 546.e4 | ||
| Antidigoxin Immunotherapy | 546.e4 | ||
| References | 546.e4 | ||
| References | 539 | ||
| Epidemiology and Prognosis | 539 | ||
| Management of Heart Failure | 539 | ||
| 26 Devices for Monitoring and Managing Heart Failure | 547 | ||
| Ventricular Dyssynchrony: the Target of Cardiac Resynchronization Therapy | 547 | ||
| Randomized Controlled Trials of Cardiac Resynchronization Therapy in Patients with New York Heart Association Class III and IV Heart Failure | 547 | ||
| Multisite Stimulation in Cardiomyopathy Trials | 548 | ||
| Multicenter InSync Randomized Clinical Evaluation | 548 | ||
| Multicenter InSync Implantable Cardioverter Defibrillator Randomized Clinical Evaluation | 548 | ||
| CONTAK CD | 549 | ||
| Cardiac Resynchronization in Heart Failure Trial | 549 | ||
| Comparison of Medical Therapy, Pacing, and Defibrillation for Heart Failure | 549 | ||
| Randomized Controlled Trials of Cardiac Resynchronization Therapy in Patients with New York Heart Association Class I and II Heart Failure | 550 | ||
| Resynchronization Reverses Remodeling in Systolic Left Ventricular Dysfunction Trial | 550 | ||
| Multicenter Automatic Defibrillator Implantation Trial with Cardiac Resynchronization Therapy | 550 | ||
| Resynchronization/defibrillation for Ambulatory Heart Failure Trial | 550 | ||
| Indications for Cardiac Resynchronization Therapy in Patients with Heart Failure | 550 | ||
| Limitations of Cardiac Resynchronization Therapy | 551 | ||
| Future Directions in Cardiac Resynchronization Therapy | 551 | ||
| Sudden Cardiac Death in Patients with Heart Failure | 551 | ||
| Randomized Controlled Trials of Implantable Cardioverter-Defibrillators for Heart Failure | 551 | ||
| Multicenter Automatic Defibrillator Implantation Trial II | 551 | ||
| Prophylactic Defibrillator Implantation in Patients with Nonischemic Dilated Cardiomyopathy Trial | 551 | ||
| Sudden Cardiac Death–Heart Failure Trial | 552 | ||
| Indications for Prophylactic Implantation of Implantable Cardioverter-Defibrillators in Patients with Heart Failure | 552 | ||
| Implantable Devices to Monitor Heart Failure | 553 | ||
| Device-Based Heart Failure Diagnostics | 553 | ||
| Implantable Hemodynamic Monitors | 553 | ||
| Summary and Future Directions | 554 | ||
| References | 554 | ||
| Ventricular Dyssynchrony | 554 | ||
| Randomized Controlled Trials of Cardiac Resynchronization Therapy | 554 | ||
| Indications for Cardiac Resynchronization Therapy | 554 | ||
| Primary Prevention of Sudden Cardiac Death in Patients with Heart Failure | 554 | ||
| Implantable Devices to Monitor Heart Failure | 554 | ||
| 27 Heart Failure with a Preserved Ejection Fraction | 557 | ||
| Overview | 557 | ||
| Terminology | 557 | ||
| Epidemiology | 557 | ||
| Natural History | 558 | ||
| Mortality | 558 | ||
| Mode of Death | 558 | ||
| Morbidity | 558 | ||
| Pathophysiology | 560 | ||
| Normal Diastolic Properties | 560 | ||
| Left Ventricular Relaxation | 560 | ||
| Determinants of Left Ventricular Relaxation | 561 | ||
| Hemodynamic Load | 561 | ||
| Heterogeneity | 561 | ||
| Cellular Mechanisms | 561 | ||
| Prevalence and Prognosis for Abnormal Relaxation | 561 | ||
| Left Ventricular Diastolic Stiffness, Compliance, and Distensibility | 561 | ||
| Methods of Measurement | 561 | ||
| Determinants of Left Ventricular Pressure- versus-Volume Relationship | 562 | ||
| Extracellular Matrix | 563 | ||
| Myofilament and Extramyofilament Proteins | 563 | ||
| Prevalence and Prognosis for Decreased Diastolic Distensibility | 563 | ||
| Clinical Features | 563 | ||
| Diagnostic Criteria | 563 | ||
| Demographic Features | 564 | ||
| Comorbid Conditions | 564 | ||
| Rarer Causes of Heart Failure with Preserved Ejection Fraction | 565 | ||
| Acute Decompensated Heart Failure in Patients with HFpEF (See also Chapter 24) | 565 | ||
| Clinical Assessment of Cardiovascular Structure and Function | 566 | ||
| Left Ventricular Structure | 566 | ||
| Left Ventricular Volume | 566 | ||
| Left Ventricular Mass | 566 | ||
| Left Ventricular Geometry | 566 | ||
| Left Ventricular Function | 566 | ||
| Diastolic Properties | 566 | ||
| Noninvasive Estimation of Left Ventricular Diastolic Filling Pressure. | 567 | ||
| Prevalence and Prognosis for Diastolic Dysfunction in HFpEF. | 567 | ||
| Systolic Properties | 568 | ||
| Therapy | 568 | ||
| Summary of Randomized Controlled Trials | 569 | ||
| Management of Heart Failure with Preserved Ejection Fraction | 570 | ||
| Nonpharmacologic Therapy | 570 | ||
| Treatment of Comorbid Conditions | 570 | ||
| Pharmacologic and Device-Based Strategies | 571 | ||
| Remote Monitoring Systems to Help Tailor Management | 571 | ||
| Neurohormonal Modulation | 571 | ||
| Future Perspectives | 571 | ||
| Cellular Mechanisms of Myocardial Relaxation | 561.e1 | ||
| References | 561.e1 | ||
| Limitations in Use of E/e | 567.e1 | ||
| References | 567.e1 | ||
| Assessment of Exercise Capacity in Heart Failure with Preserved Ejection Fraction | 568.e1 | ||
| Reference | 568.e1 | ||
| References | 572 | ||
| Overview and Terminology | 572 | ||
| Epidemiology | 572 | ||
| Natural History | 572 | ||
| Pathophysiology | 572 | ||
| Clinical Features | 572 | ||
| Therapy | 573 | ||
| 28 Surgical Management of Heart Failure | 575 | ||
| Coronary Artery Revascularization | 575 | ||
| Ischemic Cardiomyopathy | 575 | ||
| Selection of Patients for Coronary Artery Revascularization | 575 | ||
| Risks of Coronary Artery Bypass Grafting | 575 | ||
| Benefits of Coronary Artery Bypass Grafting | 576 | ||
| Improvement in Left Ventricular Function | 576 | ||
| Symptomatic Improvement | 577 | ||
| Valve Surgery in Patients with Left Ventricular Dysfunction | 578 | ||
| Mitral Valve | 578 | ||
| Aortic Valve | 580 | ||
| Left Ventricular Reconstruction | 581 | ||
| Passive Cardiac Support Devices | 581 | ||
| Cardiac Transplantation | 582 | ||
| Donor Allocation System | 582 | ||
| Evaluation of the Potential Recipient | 582 | ||
| The Cardiac Donor | 583 | ||
| Surgical Considerations | 584 | ||
| Immunosuppression | 584 | ||
| Rejection | 585 | ||
| Infection | 586 | ||
| Medical Complications and Comorbid Conditions | 586 | ||
| Malignant Neoplasia | 586 | ||
| Diabetes | 586 | ||
| Hypertension | 587 | ||
| Renal Insufficiency | 587 | ||
| Hyperlipidemia | 587 | ||
| Cardiac Allograft Vasculopathy | 587 | ||
| Outcomes after Heart Transplantation | 588 | ||
| Survival | 588 | ||
| Functional Outcomes | 588 | ||
| Future Perspectives | 588 | ||
| References | 588 | ||
| Coronary Artery Revascularization | 588 | ||
| Valve Surgery in Patients with Left Ventricular Dysfunction | 589 | ||
| Left Ventricular Reconstruction | 589 | ||
| Cardiac Transplantation | 589 | ||
| 29 Mechanical Circulatory Support | 590 | ||
| Indications for Mechanical Circulatory Support and Device Selection | 590 | ||
| Bridge to Recovery | 590 | ||
| Bridge to Transplantation | 590 | ||
| Destination Therapy | 590 | ||
| Overview of Engineering Designs of Ventricular Assist Devices | 592 | ||
| Patient Selection, Patient Comorbidity, and Timing of Mechanical Circulatory Support Intervention | 592 | ||
| Other Important Medical Considerations | 594 | ||
| Patient Outcomes with Mechanical Circulatory Support | 594 | ||
| Temporary Mechanical Circulatory Support | 594 | ||
| Extracorporeal Life Support/Extracorporeal Membrane Oxygenation | 594 | ||
| TandemHeart pVAD | 594 | ||
| Impella | 594 | ||
| Intra-aortic Balloon Pump | 595 | ||
| Devices Intended for Long-term Mechanical Circulatory Support | 595 | ||
| Ventricular Assist Devices | 595 | ||
| Thoratec HeartMate II | 595 | ||
| HVAD (HeartWare Ventricular Assist Device) | 596 | ||
| Total Artificial Heart | 596 | ||
| SynCardia CardioWest TAH-t | 596 | ||
| Interagency Registry of Mechanically Assisted Circulatory Support | 597 | ||
| Future Perspectives | 597 | ||
| Engineering Designs of Ventricular Assist Devices | 599.e1 | ||
| General Characteristics | 599.e1 | ||
| Pulsatile, Volume Displacement Pumps | 599.e1 | ||
| Continuous Flow Rotary Pumps | 599.e1 | ||
| References | 599.e3 | ||
| Important Medical Conditions in Instituting Mechanical Circulatory Support | 599.e4 | ||
| Valvular Heart Disease | 599.e4 | ||
| Coronary Artery Disease | 599.e4 | ||
| Arrhythmias | 599.e4 | ||
| Intracardiac Shunts | 599.e4 | ||
| References | 599.e4 | ||
| Clinical Trials with the Heartmate II Device | 599.e5 | ||
| References | 599.e5 | ||
| References | 599 | ||
| Indications for Mechanical Circulatory Support and Device Selection | 599 | ||
| Overview of Engineering Designs of Mechanical Circulatory Support Devices | 599 | ||
| Patient Selection, Patient Comorbidity, and Timing of Mechanical Circulatory Support Intervention | 599 | ||
| Patient Outcomes with Mechanical Circulatory Support | 599 | ||
| Interagency Registry of Mechanically Assisted Circulatory Support | 599 | ||
| Future Perspectives | 599 | ||
| 30 Cardiovascular Regeneration and Gene Therapy | 600 | ||
| Cell Therapy | 600 | ||
| Principles of Cell- and Gene-Based Cardiac Regenerative Therapies | 600 | ||
| Cell Types Used—Past, Present, and Future Strategies | 600 | ||
| First-Generation Cell Therapeutics | 600 | ||
| Autologous Whole Bone Marrow Cells | 600 | ||
| Mesenchymal Stem Cells | 601 | ||
| Skeletal Myoblasts | 601 | ||
| Endothelial Precursor Cells (CD34+ Cells) | 601 | ||
| Second-Generation Cell Therapeutics | 601 | ||
| Cardiac Stem Cells | 601 | ||
| Clinical Applications of Stem Cells | 604 | ||
| Ischemic Heart Disease | 604 | ||
| Nontraditional Clinical Indications | 604 | ||
| Idiopathic Dilated Cardiomyopathy | 604 | ||
| Disorders of Childhood/Congenital Heart Disease | 604 | ||
| Safety Profile of Cardiac Cell Therapy | 604 | ||
| A Role for Embryonic Stem Cells and Inducible Pluripotent Stem Cells? | 605 | ||
| Directed Differentiation | 605 | ||
| Summary and Future Perspectives for Cell Therapy | 605 | ||
| Tissue Engineering | 605 | ||
| Gene Therapy | 605 | ||
| Gene Therapy Vectors | 605 | ||
| Molecular Targets of Gene Therapy | 606 | ||
| Targeting the β-Adrenergic System | 606 | ||
| Homing of Stem Cells | 607 | ||
| Cell and Gene Delivery Systems | 608 | ||
| Clinical Trials in Gene Therapy | 608 | ||
| Summary and Future Perspectives for Gene Therapy | 609 | ||
| Acknowledgments | 609 | ||
| References | 609 | ||
| Cell Therapy | 609 | ||
| Tissue Engineering; Gene Therapy | 610 | ||
| 31 Care of Patients with End-Stage Heart Disease | 611 | ||
| Prognostication and Probable Course of Advanced Heart Failure | 611 | ||
| Medical Management of Advanced Heart Failure | 612 | ||
| Symptom Management | 613 | ||
| Pain | 613 | ||
| Dyspnea | 614 | ||
| Anxiety and Depression | 614 | ||
| Gastrointestinal Symptoms | 614 | ||
| Fatigue | 614 | ||
| End-of-Life Care | 614 | ||
| Hospice Care | 615 | ||
| Coping with Patients’ Deaths | 615 | ||
| References | 615 | ||
| V Arrhythmias, Sudden Death, and Syncope | 617 | ||
| 32 Genetics of Cardiac Arrhythmias | 617 | ||
| The QT-Opathies | 617 | ||
| Long-QT Syndrome | 617 | ||
| Clinical Description and Manifestations of Long-QT Syndrome | 617 | ||
| Genotype-Phenotype Correlates in Long-QT Syndrome | 620 | ||
| Andersen-Tawil Syndrome | 622 | ||
| Clinical Description and Manifestations of Andersen-Tawil Syndrome | 622 | ||
| Genotype-Phenotype Correlates in Andersen-Tawil Syndrome | 622 | ||
| Timothy Syndrome | 622 | ||
| Clinical Description and Manifestations of Timothy Syndrome | 622 | ||
| Short-QT Syndrome | 623 | ||
| Clinical Description and Manifestations of Short-QT Syndrome | 623 | ||
| Genotype-Phenotype Correlates in Short-QT Syndrome | 623 | ||
| Drug-Induced Torsades de Pointes | 623 | ||
| Clinical Description and Manifestations of Drug-Induced Torsades de Pointes | 623 | ||
| IKr Channel Blockers and the Repolarization Reserve | 623 | ||
| The Other Channelopathies | 624 | ||
| Catecholaminergic Polymorphic Ventricular Tachycardia | 624 | ||
| Clinical Description and Manifestations of Catecholaminergic Polymorphic Ventricular Tachycardia | 624 | ||
| Brugada Syndrome | 625 | ||
| Clinical Description and Manifestations of Brugada Syndrome | 625 | ||
| Genotype-Phenotype Correlates in Brugada Syndrome | 625 | ||
| Early Repolarization Syndrome | 626 | ||
| Clinical Description and Manifestations of Early Repolarization Syndrome | 626 | ||
| Progressive Cardiac Conduction Disease | 626 | ||
| Clinical Description and Manifestations of Progressive Cardiac Conduction Disease | 626 | ||
| Sick Sinus Syndrome | 626 | ||
| Clinical Description and Manifestations of Sick Sinus Syndrome | 626 | ||
| Conclusions | 627 | ||
| Future Perspectives | 627 | ||
| References | 627 | ||
| Long-QT Syndrome | 627 | ||
| Andersen-Tawil Syndrome | 628 | ||
| Timothy Syndrome | 628 | ||
| Short-QT Syndrome | 628 | ||
| Drug-Induced Torsades De Pointes | 628 | ||
| Catecholaminergic Polymorphic Ventricular Tachycardia | 628 | ||
| Brugada Syndrome | 628 | ||
| Early Repolarization Syndrome | 628 | ||
| Progressive Cardiac Conduction Disease and Sick Sinus Syndrome | 628 | ||
| 33 Genesis of Cardiac Arrhythmias: | 629 | ||
| Anatomy of the Cardiac Conduction System | 629 | ||
| Sinoatrial Node | 629 | ||
| Atrioventricular Junctional Area and Intraventricular Conduction System | 632 | ||
| Atrioventricular Node | 632 | ||
| Bundle of His (Penetrating Portion of the Atrioventricular Bundle) | 633 | ||
| Bundle Branches (Branching Portion of the Atrioventricular Bundle) | 633 | ||
| Terminal Purkinje Fibers | 633 | ||
| Innervation of the Atrioventricular Node, His Bundle, and Ventricular Myocardium | 633 | ||
| Arrhythmias and the Autonomic Nervous System | 635 | ||
| Basic Electrophysiologic Principles | 637 | ||
| Phases of the Cardiac Action Potential | 639 | ||
| Mechanisms of Arrhythmogenesis | 646 | ||
| Disorders of Impulse Formation | 646 | ||
| Triggered Activity | 648 | ||
| Early Afterdepolarizations | 650 | ||
| Long-QT Syndrome | 650 | ||
| Parasystole | 651 | ||
| Disorders of Impulse Conduction | 651 | ||
| Deceleration-Dependent Block | 651 | ||
| Tachycardia-Dependent Block | 651 | ||
| Decremental Conduction | 651 | ||
| Reentry | 651 | ||
| Entrainment | 651 | ||
| Anatomic Reentry | 652 | ||
| Conditions for Reentry | 652 | ||
| Functional Reentry | 653 | ||
| Tachycardias Caused by Reentry | 653 | ||
| Atrial Flutter | 653 | ||
| Atrial Fibrillation | 653 | ||
| Spatiotemporal Organization and Focal Discharge | 653 | ||
| Electrical Remodeling of the Atria | 655 | ||
| Sinus Reentry | 655 | ||
| Atrial Reentry | 655 | ||
| Atrioventricular Nodal Reentry | 655 | ||
| Preexcitation Syndrome | 655 | ||
| Ventricular Tachycardia Caused by Reentry | 656 | ||
| Brugada Syndrome | 657 | ||
| Catecholaminergic Polymorphic Ventricular Tachycardia | 658 | ||
| Arrhythmogenic Right Ventricular Cardiomyopathy | 658 | ||
| Ventricular Fibrillation: Initiation and Maintenance | 658 | ||
| Ventricular Tachycardias Caused by Nonreentrant Mechanisms | 659 | ||
| Triggered Activity | 659 | ||
| Automaticity | 660 | ||
| Molecular Composition of Ion Channels | 660.e1 | ||
| Voltage-Gated Na+ Channels | 660.e1 | ||
| Voltage-Gated Ca2+ Channels | 660.e1 | ||
| Voltage-Gated K+ Channels | 660.e1 | ||
| Inwardly Rectifying Cardiac K+ (Kir) Channels | 660.e1 | ||
| Cardiac Pacemaker Channel | 660.e1 | ||
| References | 661.e1 | ||
| References | 660 | ||
| Anatomy of the Cardiac Conduction System | 660 | ||
| Basic Electrophysiologic Principles | 660 | ||
| Mechanisms of Arrhythmogenesis | 661 | ||
| 34 Diagnosis of Cardiac Arrhythmias | 662 | ||
| History | 662 | ||
| Physical Examination | 662 | ||
| Electrocardiogram | 663 | ||
| The Ladder Diagram | 663 | ||
| Additional Tests | 664 | ||
| Exercise Testing | 666 | ||
| In-Hospital Electrocardiographic Recording | 666 | ||
| Long-Term Electrocardiographic Recording | 666 | ||
| Ambulatory Electrocardiographic (Holter) Recording | 666 | ||
| Event Recording | 667 | ||
| Implantable Loop Recorder | 668 | ||
| T Wave Alternans | 669 | ||
| Upright Tilt-Table Testing | 670 | ||
| Invasive Electrophysiologic Studies | 670 | ||
| Atrioventricular Block | 670 | ||
| Intraventricular Conduction Disturbance | 670 | ||
| Sinus Node Dysfunction | 671 | ||
| Tachycardia | 671 | ||
| Unexplained Syncope | 673 | ||
| Palpitations | 673 | ||
| Complications of Electrophysiologic Studies | 674 | ||
| Direct Cardiac Mapping: Recording Potentials Directly From the Heart | 674 | ||
| References | 676 | ||
| 35 Therapy for Cardiac Arrhythmias | 685 | ||
| Pharmacologic Therapy | 685 | ||
| General Considerations Regarding Antiarrhythmic Drugs | 685 | ||
| Drug Classification | 685 | ||
| Class IA | 685 | ||
| Class IB | 685 | ||
| Class IC | 685 | ||
| Class II | 685 | ||
| Class III | 685 | ||
| Class IV | 685 | ||
| Clinical Use | 688 | ||
| Side Effects | 688 | ||
| Proarrhythmia | 688 | ||
| Antiarrhythmic Agents | 690 | ||
| Class IA Agents | 690 | ||
| Quinidine | 690 | ||
| Dosage and Administration. | 690 | ||
| Indications. | 690 | ||
| Adverse Effects. | 690 | ||
| Procainamide | 690 | ||
| Dosage and Administration. | 691 | ||
| Indications. | 691 | ||
| VI Preventive Cardiology | 873 | ||
| 41 The Vascular Biology of Atherosclerosis | 873 | ||
| Overview and Background | 873 | ||
| Structure of the Normal Artery | 874 | ||
| Cell Types Composing the Normal Artery | 874 | ||
| Endothelial Cells | 874 | ||
| Arterial Smooth Muscle Cells | 875 | ||
| Layers of the Normal Artery | 875 | ||
| Intima | 875 | ||
| Tunica Media | 876 | ||
| Adventitia | 876 | ||
| Atherosclerosis Initiation | 876 | ||
| Extracellular Lipid Accumulation | 876 | ||
| Leukocyte Recruitment and Retention | 877 | ||
| Focality of Lesion Formation | 879 | ||
| Intracellular Lipid Accumulation: Foam Cell Formation | 880 | ||
| Evolution of Atheroma | 881 | ||
| Innate and Adaptive Immunity: Mechanisms of Inflammation in Atherogenesis | 881 | ||
| Smooth Muscle Cell Migration and Proliferation | 882 | ||
| Smooth Muscle Cell Death During Atherogenesis | 882 | ||
| Arterial Extracellular Matrix | 882 | ||
| Angiogenesis in Plaques | 883 | ||
| Plaque Mineralization | 883 | ||
| Complication of Atherosclerosis | 883 | ||
| Arterial Stenoses and Their Clinical Implications | 883 | ||
| Thrombosis and Atheroma Complication | 884 | ||
| Plaque Rupture and Thrombosis | 884 | ||
| Thrombosis Due to Superficial Erosion of Plaques | 884 | ||
| Diffuse and Systemic Nature of Plaque Susceptibility to Rupture and Inflammation in Atherogenesis | 886 | ||
| Special Cases of Arteriosclerosis | 886 | ||
| Restenosis after Arterial Intervention | 886 | ||
| Accelerated Arteriosclerosis after Transplantation | 887 | ||
| Aneurysmal Disease | 887 | ||
| Infection and Atherosclerosis | 888 | ||
| References | 889 | ||
| Stucture of the Normal Artery | 889 | ||
| Atheroma Initiation | 889 | ||
| Evolution of Atheroma | 889 | ||
| Special Cases of Atherosclerosis | 889 | ||
| 42 Risk Markers and the Primary Prevention of Cardiovascular Disease | 891 | ||
| Rethinking Core Approaches to Primary Prevention | 891 | ||
| What Works and in Whom? a Simple Evidence-Based Alternative to the Prevention of Cardiovascular Disease | 892 | ||
| Merging Epidemiology and Randomized Trial Evidence: Why Measure Risk Factors? | 892 | ||
| Conventional Risk Markers and Their Interventions | 893 | ||
| Smoking | 893 | ||
| Interventions for Smoking Cessation | 894 | ||
| Hypertension | 895 | ||
| Interventions to Reduce Blood Pressure | 898 | ||
| Low-Density Lipoprotein (LDL) Cholesterol | 899 | ||
| Interventions to Lower LDL Cholesterol | 899 | ||
| High-Density Lipoprotein (HDL) Cholesterol | 900 | ||
| Interventions to Raise HDL Cholesterol | 901 | ||
| Alternative Lipid and Lipoprotein Measures | 901 | ||
| Triglycerides | 902 | ||
| Interventions to Reduce Triglyceride Levels | 902 | ||
| Metabolic Syndrome, Insulin Resistance, and Diabetes | 902 | ||
| Interventions to Reduce Cardiovascular Risk among Diabetic Patients | 904 | ||
| Aspirin for Primary Prevention | 904 | ||
| Conceptual Basis for the “Polypill” | 906 | ||
| Nonconventional Risk Markers and Associated Interventions | 906 | ||
| High-Sensitivity C-Reactive Protein | 906 | ||
| Interventions for Primary Prevention in Patients with Elevated High-Sensitivity C-Reactive Protein Levels | 908 | ||
| Other Biomarkers of Inflammation | 908 | ||
| Interventions to Reduce Alternative Markers of Inflammation | 910 | ||
| Lipoprotein(a) | 910 | ||
| Interventions to Reduce Lipoprotein(a) | 911 | ||
| Homocysteine | 911 | ||
| Interventions to Reduce Homocysteine | 911 | ||
| Direct Plaque Imaging | 912 | ||
| Interventions Based on Vascular Imaging | 913 | ||
| Genetic Markers for Cardiovascular Risk | 913 | ||
| Interventions for Prevention Based on Genotype | 914 | ||
| Environmental Exposures and Associated Interventions | 915 | ||
| Depression, Mental Stress, and Cardiovascular Risk | 915 | ||
| Interventions for Psychosocial Factors | 916 | ||
| Physical Activity | 917 | ||
| Interventions to Increase Physical Activity | 918 | ||
| Obesity and Weight Loss | 918 | ||
| Intervention Studies of Weight Loss | 920 | ||
| Diet, Moderate Alcohol Consumption, and Dietary Supplements | 920 | ||
| Diet | 920 | ||
| Moderate Alcohol Consumption | 922 | ||
| Dietary Supplements | 923 | ||
| Menopause and Postmenopausal Hormone Therapy | 924 | ||
| Interventions of Hormone Therapy for Cardioprotection | 925 | ||
| Community-Based and Multiple Risk Factor Intervention Programs | 926 | ||
| References | 927 | ||
| Rethinking Core Approaches to Primary Prevention | 927 | ||
| What Works and in Whom? A Simple Evidence-Based Alternative to the Prevention of Cardiovascular Disease | 928 | ||
| Merging Epidemiology and Randomized Trial Evidence: Why Measure Risk Factors? | 928 | ||
| Conventional Risk Markers and Their Interventions | 928 | ||
| Nonconventional Risk Markers and Associated Interventions | 929 | ||
| Environmental Exposures and Associated Interventions | 930 | ||
| 43 Systemic Hypertension: Mechanisms and Diagnosis | 934 | ||
| Definition, Prevalence, Variability, and Determinants of Hypertension | 934 | ||
| Definition | 934 | ||
| Prevalence | 934 | ||
| Blood Pressure Variability and Its Determinants | 934 | ||
| Behavioral Determinants | 934 | ||
| Genetic Determinants | 935 | ||
| Mechanisms of Primary (Essential) Hypertension | 936 | ||
| Hemodynamic Subtypes | 936 | ||
| Systolic Hypertension in Teenagers and Young Adults | 936 | ||
| Diastolic Hypertension in Middle Age | 936 | ||
| Isolated Systolic Hypertension in Older Adults | 936 | ||
| Neural Mechanisms | 937 | ||
| The Carotid Baroreceptor Pacemaker | 937 | ||
| Catheter-Based Renal Denervation | 937 | ||
| Obesity-Related Hypertension | 938 | ||
| Obstructive Sleep Apnea as a Cause of Neurogenic Hypertension | 938 | ||
| Renal Mechanisms | 939 | ||
| Resetting of Pressure-Natriuresis | 939 | ||
| Low Birth Weight | 939 | ||
| Genetic Contributions | 939 | ||
| Vascular Mechanisms | 939 | ||
| Endothelial Cell Dysfunction | 939 | ||
| Vascular Remodeling | 940 | ||
| Hormonal Mechanisms | 940 | ||
| Renin-Angiotensin-Aldosterone System | 940 | ||
| Aldosterone and Epithelial Sodium Channel Regulation | 941 | ||
| Receptor-Mediated Actions of Angiotensin II | 941 | ||
| Receptor-Mediated Actions of Renin and Prorenin | 942 | ||
| Vascular Inflammatory Cells and Hypertension | 942 | ||
| Pathogenesis of Hypertensive Heart Disease | 942 | ||
| Pressure Overload Hypertrophy | 942 | ||
| Impaired Coronary Vasodilator Reserve | 942 | ||
| Heart Failure | 942 | ||
| Diagnosis and Initial Evaluation of Hypertension | 942 | ||
| Initial Evaluation of the Hypertensive Patient | 943 | ||
| Measurement of Blood Pressure | 943 | ||
| Staging of Office Blood Pressure | 943 | ||
| Measurement Technique | 943 | ||
| Home and Ambulatory Monitoring | 943 | ||
| White Coat Hypertension | 944 | ||
| Masked Hypertension | 944 | ||
| Other Uses of Ambulatory Monitoring | 945 | ||
| Cardiovascular Risk Stratification | 945 | ||
| Emerging Methods to Improve Cardiovascular Risk Stratification in Hypertension | 945 | ||
| Blood Pressure Variability. | 945 | ||
| Heart Rate Variability. | 945 | ||
| Noninvasive Measurement of Central Aortic Pressure by Pulse Tonometry. | 945 | ||
| Erectile Dysfunction. | 945 | ||
| Evaluation of Target Organ Disease | 945 | ||
| Hypertensive Heart Disease | 945 | ||
| Large-Vessel Disease | 946 | ||
| Cerebrovascular Disease | 946 | ||
| Chronic Kidney Disease | 946 | ||
| Identifiable (Secondary) Forms of Hypertension | 946 | ||
| Renal Parenchymal Disease | 946 | ||
| Acute Renal Diseases | 946 | ||
| Chronic Renal Diseases | 947 | ||
| Hemodialysis Patients | 947 | ||
| Renal Transplantation | 947 | ||
| Renovascular Hypertension | 947 | ||
| Classification. | 947 | ||
| Mechanisms. | 948 | ||
| Diagnosis. | 948 | ||
| Management. | 948 | ||
| Renin-Secreting Tumors | 948 | ||
| Adrenal and Other Causes of Hypertension | 948 | ||
| Primary Aldosteronism and Other Forms of Mineralocorticoid-Induced Hypertension | 949 | ||
| Pathophysiology of Mineralocorticoid Excess | 949 | ||
| Diagnosis | 949 | ||
| Differential Diagnosis: Mendelian Forms of Hypertension | 949 | ||
| Therapy | 950 | ||
| Other Causes of Hypertension | 951 | ||
| Coarctation of the Aorta | 951 | ||
| Hormonal Disturbances | 951 | ||
| Future Perspectives | 951 | ||
| Acknowledgment | 951 | ||
| References | 951 | ||
| Definition, Prevalence, Variability, and Determinants of Hypertension | 951 | ||
| Mechanisms of Primary (Essential) Hypertension | 951 | ||
| Pathogenesis of Hypertensive Heart Disease | 952 | ||
| Diagnosis and Initial Evaluation of Hypertension | 952 | ||
| Adrenal and Other Causes of Hypertension | 952 | ||
| 44 Systemic Hypertension: Management | 953 | ||
| Lifestyle Modification | 953 | ||
| Dietary Interventions for Blood Pressure Control | 953 | ||
| The Mediterranean Diet Pattern | 953 | ||
| The DASH Diet Pattern | 954 | ||
| Sodium Consumption and Blood Pressure | 954 | ||
| Potassium Intake and Blood Pressure | 954 | ||
| Carbohydrate Consumption and Blood Pressure | 955 | ||
| Ethanol Intake and Blood Pressure | 955 | ||
| Sugar-Sweetened Beverages | 955 | ||
| Other Macronutrients and Micronutrients and Blood Pressure Control | 955 | ||
| Obesity/Body Weight | 955 | ||
| Physical Activity | 955 | ||
| Cigarette Smoking | 956 | ||
| Barriers to Adoption and Maintenance of Lifestyle Change and Possible Solutions | 956 | ||
| Antihypertensive Drugs | 956 | ||
| First-Line Drug Classes | 956 | ||
| Calcium Channel Blockers for Hypertension | 959 | ||
| Mechanism of Action | 959 | ||
| VII Atherosclerotic Cardiovascular Disease | 1029 | ||
| 49 Coronary Blood Flow and Myocardial Ischemia | 1029 | ||
| Control of Coronary Blood Flow | 1029 | ||
| Determinants of Myocardial Oxygen Consumption | 1029 | ||
| Coronary Autoregulation | 1030 | ||
| Determinants of Coronary Vascular Resistance | 1033 | ||
| Extravascular Compressive Resistance | 1033 | ||
| Transmural Variations in Minimum Coronary Resistance (R2) and Diastolic Driving Pressure | 1034 | ||
| Structure and Function of the Coronary Microcirculation | 1034 | ||
| Neural Control of Coronary Conduit and Resistance Arteries | 1036 | ||
| Cholinergic Innervation | 1037 | ||
| Sympathetic Innervation | 1037 | ||
| Paracrine Vasoactive Mediators and Coronary Vasospasm | 1037 | ||
| Coronary Vasospasm | 1038 | ||
| Right Coronary Artery Flow | 1038 | ||
| Physiologic Assessment of Coronary Artery Stenoses | 1039 | ||
| Stenosis Pressure-Flow Relation | 1039 | ||
| Interrelation of Distal Coronary Pressure, Flow, and Stenosis Severity | 1039 | ||
| Pathophysiologic States Affecting Microcirculatory Coronary Flow Reserve | 1043 | ||
| Left Ventricular Hypertrophy | 1043 | ||
| Coronary Microvascular Disease and Dysfunction | 1043 | ||
| Impaired Endothelium-Dependent Vasodilation in the Microcirculation | 1043 | ||
| Impact of Microcirculatory Abnormalities on Physiologic Measures of Stenosis Severity | 1045 | ||
| Coronary Collateral Circulation | 1045 | ||
| Metabolic and Functional Consequences of Ischemia | 1046 | ||
| Irreversible Injury and Myocyte Death | 1047 | ||
| Functional Consequences of Reversible Ischemia | 1048 | ||
| Myocardial Preconditioning and Postconditioning | 1048 | ||
| Stunned Myocardium | 1049 | ||
| Chronic Hibernating Myocardium | 1049 | ||
| Future Perspectives | 1055 | ||
| Classic Reading List | 1055 | ||
| References | 1055 | ||
| Control of Coronary Blood Flow | 1055 | ||
| Physiologic Assessment of Coronary Artery Stenosis | 1055 | ||
| Coronary Collateral Circulation | 1055 | ||
| Metabolic and Functional Consequences of Ischemia | 1055 | ||
| 50 Approach to the Patient with Chest Pain | 1057 | ||
| Causes of Acute Chest Pain | 1057 | ||
| Myocardial Ischemia or Infarction | 1057 | ||
| Pericardial Disease | 1057 | ||
| Vascular Disease | 1058 | ||
| Pulmonary Conditions | 1058 | ||
| Gastrointestinal Conditions | 1059 | ||
| Musculoskeletal and Other Causes | 1059 | ||
| Diagnostic Considerations | 1059 | ||
| Clinical Evaluation | 1059 | ||
| Initial Assessment | 1059 | ||
| History | 1059 | ||
| Physical Examination | 1059 | ||
| Electrocardiography | 1060 | ||
| Chest Radiography | 1060 | ||
| Biomarkers | 1060 | ||
| Diagnostic Performance | 1060 | ||
| Troponins. | 1061 | ||
| Creatine Kinase MB Isoenzyme. | 1061 | ||
| Other Markers. | 1061 | ||
| Prognostic Implications of Test Results. | 1061 | ||
| Testing Strategy | 1062 | ||
| Decision Aids | 1062 | ||
| Immediate Management | 1062 | ||
| Chest Pain Protocols and Units | 1062 | ||
| Early Noninvasive Testing | 1065 | ||
| Treadmill Electrocardiography | 1065 | ||
| Imaging Tests | 1065 | ||
| References | 1066 | ||
| Causes of Acute Chest Pain | 1066 | ||
| Diagnostic Considerations | 1066 | ||
| Immediate Management | 1067 | ||
| 51 ST-Elevation Myocardial Infarction: | 1068 | ||
| Changing Patterns in Incidence and Care | 1068 | ||
| Improvements in Outcome | 1068 | ||
| Limitations of Current Therapy | 1069 | ||
| Pathologic Findings | 1070 | ||
| Plaque (See also Chapter 41) | 1072 | ||
| Composition of Plaque | 1072 | ||
| Plaque Fissuring and Disruption | 1072 | ||
| Acute Coronary Syndromes | 1073 | ||
| Heart Muscle | 1073 | ||
| Current Concepts of the Cellular Events During Myocardial Infarction and Healing | 1075 | ||
| Modification of Pathologic Changes by Reperfusion | 1076 | ||
| Coronary Anatomy and Location of Infarction | 1077 | ||
| Right Ventricular Infarction | 1078 | ||
| Atrial Infarction | 1078 | ||
| Collateral Circulation in Acute Myocardial Infarction (See Chapter 49) | 1079 | ||
| Nonatherosclerotic Causes of Acute Myocardial Infarction | 1079 | ||
| Myocardial Infarction with Angiographically Normal Coronary Vessels | 1079 | ||
| Prognosis | 1080 | ||
| Pathophysiology | 1080 | ||
| Left Ventricular Function | 1080 | ||
| Systolic Function | 1080 | ||
| Diastolic Function | 1081 | ||
| Circulatory Regulation | 1081 | ||
| Ventricular Remodeling (See also Chapter 22) | 1081 | ||
| Infarct Expansion | 1081 | ||
| Ventricular Dilation | 1082 | ||
| Effects of Treatment | 1082 | ||
| Pathophysiology of Other Organ Systems | 1083 | ||
| Pulmonary Function | 1083 | ||
| Reduction of the Affinity of Hemoglobin for Oxygen | 1083 | ||
| Clinical Features | 1084 | ||
| Predisposing Factors | 1084 | ||
| Circadian Periodicity | 1084 | ||
| History (See also Chapters 11, 50, and 53) | 1084 | ||
| Prodromal Symptoms | 1084 | ||
| Nature of the Pain | 1085 | ||
| Other Symptoms | 1085 | ||
| Differential Diagnosis | 1085 | ||
| Silent ST-Elevation Myocardial Infarction with Atypical Features | 1085 | ||
| Physical Examination (See also Chapter 11) | 1085 | ||
| General Appearance | 1085 | ||
| Heart Rate | 1086 | ||
| Blood Pressure | 1086 | ||
| Temperature and Respiration | 1086 | ||
| Jugular Venous Pulse | 1086 | ||
| Carotid Pulse | 1086 | ||
| The Chest | 1086 | ||
| Cardiac Examination | 1086 | ||
| Palpation | 1086 | ||
| Auscultation | 1086 | ||
| Heart Sounds. | 1086 | ||
| Murmurs. | 1087 | ||
| Friction Rubs. | 1087 | ||
| Other Findings | 1087 | ||
| Fundi | 1087 | ||
| Abdomen | 1087 | ||
| Extremities | 1087 | ||
| Neuropsychiatric Findings | 1087 | ||
| Laboratory Findings | 1087 | ||
| Serum Markers of Cardiac Damage | 1087 | ||
| Cardiac-Specific Troponins | 1087 | ||
| Cutoff Values. | 1088 | ||
| High-Sensitivity Cardiac Troponin. | 1088 | ||
| Creatine Kinase-MB | 1088 | ||
| Recommendations for Measurement of Serum Markers | 1088 | ||
| Electrocardiography (See Chapter 12) | 1089 | ||
| Q-Wave and Non−Q-Wave Infarction | 1091 | ||
| Ischemia at a Distance | 1091 | ||
| Right Ventricular Infarction | 1091 | ||
| Imaging | 1091 | ||
| Roentgenography (See Chapter 15) | 1091 | ||
| Echocardiography (See Chapter 14) | 1091 | ||
| Magnetic Resonance Imaging (See Chapter 17) | 1092 | ||
| Nuclear Imaging (See Chapter 16) | 1092 | ||
| Computed Tomography (See Chapter 18) | 1092 | ||
| Estimation of Infarct Size | 1093 | ||
| Electrocardiography. | 1093 | ||
| Cardiac Markers. | 1093 | ||
| Noninvasive Imaging Techniques. | 1093 | ||
| Acknowledgment | 1093 | ||
| References | 1093 | ||
| Changing Patterns in Incidence and Improvements in Outcome | 1093 | ||
| Pathologic Findings | 1093 | ||
| Pathophysiology | 1093 | ||
| Clinical Features | 1094 | ||
| 52 ST-Elevation Myocardial Infarction: Management | 1095 | ||
| Prehospital Management | 1095 | ||
| Prehospital Care | 1095 | ||
| Emergency Medical Service Systems | 1095 | ||
| Prehospital Fibrinolysis | 1097 | ||
| Management in the Emergency Department | 1097 | ||
| General Treatment Measures | 1098 | ||
| Aspirin (See also Chapter 82) | 1098 | ||
| Control of Cardiac Pain | 1098 | ||
| Analgesics. | 1098 | ||
| Nitrates. | 1098 | ||
| Beta-Adrenergic Blocking Agents. | 1099 | ||
| Oxygen. | 1099 | ||
| Limitation of Infarct Size | 1099 | ||
| Dynamic Nature of Infarction | 1099 | ||
| Routine Measures for Limitation of Infarct Size | 1099 | ||
| Reperfusion Therapy | 1100 | ||
| General Concepts | 1100 | ||
| Pathophysiology of Myocardial Reperfusion | 1100 | ||
| Reperfusion Injury | 1100 | ||
| Protection Against Reperfusion Injury | 1101 | ||
| Reperfusion Arrhythmias | 1101 | ||
| Late Establishment of Patency of the Infarct Vessel | 1101 | ||
| Summary of the Effects of Myocardial Reperfusion | 1101 | ||
| Fibrinolysis | 1101 | ||
| Effect of Fibrinolytic Therapy on Mortality | 1102 | ||
| Comparison of Fibrinolytic Agents (See Chapter 82) | 1103 | ||
| Other Fibrinolytic Agents | 1103 | ||
| Effect on Left Ventricular Function | 1103 | ||
| Complications of Fibrinolytic Therapy | 1105 | ||
| Recommendations for Fibrinolytic Therapy | 1106 | ||
| Choice of Agent | 1106 | ||
| Late Therapy | 1106 | ||
| General Considerations | 1106 | ||
| Intracoronary Fibrinolysis | 1106 | ||
| Catheter-Based Reperfusion Strategies (See also Chapter 55) | 1106 | ||
| Surgical Reperfusion | 1106 | ||
| Selection of Reperfusion Strategy | 1106 | ||
| Referral for Angiography with the Intent of Revascularization after Initial Fibrinolysis | 1108 | ||
| Patients Not Eligible for Reperfusion Therapy | 1108 | ||
| Anticoagulant and Antiplatelet Therapy | 1109 | ||
| Anticoagulant Therapy | 1109 | ||
| Effect of Heparin on Mortality | 1109 | ||
| Other Effects of Heparin. | 1110 | ||
| Newer Antithrombotic Agents | 1110 | ||
| Hirudin and Bivalirudin. | 1110 | ||
| Low-Molecular-Weight Heparins. | 1110 | ||
| Parenteral Factor Xa Antagonists. | 1111 | ||
| Oral Factor IIa and Factor Xa Antagonists. | 1111 | ||
| Recommendations for Anticoagulant Therapy | 1111 | ||
| Anticoagulation with Fibrinolysis. | 1111 | ||
| Adjunctive Anticoagulation for Primary Percutaneous Coronary Intervention (See Chapter 55). | 1112 | ||
| Patients Treated Without Reperfusion Therapy. | 1112 | ||
| Antiplatelet Therapy | 1112 | ||
| Antiplatelet Therapy with Fibrinolysis | 1112 | ||
| Combination Pharmacologic Reperfusion | 1113 | ||
| Antiplatelet Therapy for Percutaneous Coronary Intervention in ST-Elevation Myocardial Infarction (See Chapter 55) | 1113 | ||
| Recommendations for Antiplatelet Therapy | 1113 | ||
| Hospital Management | 1114 | ||
| Coronary Care and Intermediate Care Units | 1114 | ||
| General Measures | 1115 | ||
| Physical Activity | 1115 | ||
| Pharmacologic Therapy | 1115 | ||
| Beta Blockers | 1115 | ||
| Recommendations | 1115 | ||
| Selection of Beta Blockers | 1117 | ||
| Inhibition of the Renin-Angiotensin-Aldosterone System | 1117 | ||
| VIII Diseases of the Heart, Pericardium, and Pulmonary Vasculature Bed | 1391 | ||
| 62 Congenital Heart Disease | 1391 | ||
| Anatomy | 1393 | ||
| Normal Cardiac Anatomy | 1393 | ||
| Cardiac Situs | 1393 | ||
| Atrioventricular Connections | 1393 | ||
| Ventriculoarterial Connections | 1393 | ||
| Atria | 1393 | ||
| Atrioventricular Valves | 1393 | ||
| Morphologic Right Ventricle | 1393 | ||
| Morphologic Left Ventricle | 1393 | ||
| Semilunar Valves | 1393 | ||
| Aortic Arch and Pulmonary Arteries | 1394 | ||
| Systemic Venous Connections | 1394 | ||
| Pulmonary Venous Drainage in a Normal Heart | 1394 | ||
| Pathologic Consequences of Congenital Cardiac Lesions | 1394 | ||
| Congestive Heart Failure (see Chapters 21 to 29) | 1394 | ||
| Cyanosis | 1395 | ||
| Definition | 1395 | ||
| Morphology | 1395 | ||
| Pathophysiology | 1395 | ||
| Clinical Features | 1395 | ||
| Hyperviscosity Syndrome | 1395 | ||
| Hematologic | 1395 | ||
| Central Nervous System | 1395 | ||
| Renal | 1395 | ||
| Arthritic | 1395 | ||
| Coronary Arteries | 1395 | ||
| Interventional Options and Outcomes | 1395 | ||
| Complete Repair | 1395 | ||
| Palliative Surgical Intervention | 1395 | ||
| Transplantation (see Chapter 28) | 1396 | ||
| Other Management of Cyanosis | 1396 | ||
| Phlebotomy | 1396 | ||
| Iron Replacement | 1396 | ||
| Bleeding Diathesis | 1396 | ||
| Gouty Arthritis | 1396 | ||
| Reproductive Issues | 1396 | ||
| Follow-Up | 1396 | ||
| Pulmonary Hypertension | 1396 | ||
| Eisenmenger Syndrome | 1397 | ||
| Definition | 1397 | ||
| Natural History of Unoperated Patients | 1397 | ||
| Clinical Manifestations | 1397 | ||
| Indications for Intervention | 1397 | ||
| Interventional Options and Outcomes | 1398 | ||
| Oxygen | 1398 | ||
| Transplantation | 1398 | ||
| Medical Therapy | 1398 | ||
| Endothelin Receptor Antagonists. | 1398 | ||
| Phosphodiesterase Inhibitors. | 1398 | ||
| Follow-Up | 1398 | ||
| Cardiac Arrhythmias (see Chapters 34 to 39) | 1398 | ||
| Atrial Arrhythmias | 1398 | ||
| Ventricular Tachycardia | 1398 | ||
| Sudden Death (See Chapter 39) | 1398 | ||
| Atrioventricular Block | 1398 | ||
| Infective Endocarditis (see Chapter 64) | 1398 | ||
| Chest Pain (See Chapter 50) | 1399 | ||
| Evaluation of Patients with Congenital Heart Disease | 1399 | ||
| Physical Examination | 1399 | ||
| Physical Assessment | 1399 | ||
| Auscultation | 1400 | ||
| The Electrocardiogram | 1400 | ||
| The Chest Radiograph | 1400 | ||
| Cardiovascular Magnetic Resonance Imaging | 1400 | ||
| Echocardiography (See Chapter 14) | 1401 | ||
| Fetal Echocardiography | 1401 | ||
| General Considerations | 1401 | ||
| Impact of Fetal Echocardiography | 1401 | ||
| Direct Fetal Intervention | 1401 | ||
| Segmental Approach to Echocardiography in Congenital Heart Disease | 1401 | ||
| Other Echocardiographic Imaging Modalities | 1405 | ||
| Transesophageal and Three-Dimensional Echocardiography | 1405 | ||
| Cardiac Catheterization | 1406 | ||
| Therapeutic Catheterization | 1407 | ||
| Specific Cardiac Defects | 1407 | ||
| Left-to-Right Shunts | 1407 | ||
| Atrial Septal Defect | 1407 | ||
| Morphology | 1407 | ||
| Pathophysiology | 1407 | ||
| Natural History | 1408 | ||
| Clinical Features | 1408 | ||
| Indications for Intervention | 1409 | ||
| Device Closure. | 1409 | ||
| Surgery. | 1409 | ||
| Reproductive Issues | 1409 | ||
| Follow-Up | 1409 | ||
| Patent Foramen Ovale | 1409 | ||
| Anatomy | 1409 | ||
| Clinical Impact | 1410 | ||
| Therapeutic Options | 1410 | ||
| Atrioventricular Septal Defect | 1410 | ||
| Terminology | 1410 | ||
| Natural History | 1411 | ||
| Clinical Issues | 1411 | ||
| Down Syndrome. | 1411 | ||
| Non–Down Syndrome. | 1411 | ||
| Indications for Intervention | 1412 | ||
| Interventional Options and Outcomes | 1412 | ||
| Isolated Shunt at the Atrial Level (Primum Atrial Septal Defect). | 1412 | ||
| Complete Atrioventricular Septal Defect. | 1412 | ||
| Reproductive Issues | 1412 | ||
| Follow-Up Issues | 1412 | ||
| Isolated Ventricular Septal Defect | 1412 | ||
| Natural History | 1412 | ||
| Clinical Features | 1413 | ||
| Indications for Intervention | 1413 | ||
| Interventional Options and Outcomes | 1413 | ||
| Surgery. | 1413 | ||
| Device Closure. | 1413 | ||
| Reproductive Issues | 1413 | ||
| Follow-Up | 1413 | ||
| Patent Ductus Arteriosus | 1414 | ||
| Clinical Features | 1414 | ||
| Indications for Intervention | 1414 | ||
| Interventional Options and Outcomes | 1414 | ||
| Transcatheter Treatment (Fig. e62-1). | 1414 | ||
| Surgical Treatment. | 1414 | ||
| Reproductive Issues | 1414 | ||
| Follow-Up | 1414 | ||
| Persistent Truncus Arteriosus | 1414 | ||
| Natural History | 1415 | ||
| Clinical Features | 1415 | ||
| Indications for Intervention | 1415 | ||
| Interventional Options and Outcomes | 1415 | ||
| Reproductive Issues | 1415 | ||
| Follow-Up | 1415 | ||
| Cyanotic Heart Disease | 1415 | ||
| Tetralogy of Fallot (Including Tetralogy with Pulmonary Atresia) | 1415 | ||
| Natural History | 1416 | ||
| Clinical Features | 1416 | ||
| Unoperated Patients. | 1416 | ||
| After Palliative Surgery. | 1416 | ||
| After Reparative Surgery. | 1416 | ||
| Tetralogy of Fallot with Pulmonary Atresia and Major Aortopulmonary Collateral Arteries. | 1416 | ||
| Indications for Intervention | 1417 | ||
| Children. | 1417 | ||
| Adults, Unoperated. | 1417 | ||
| Palliated. | 1417 | ||
| Repaired. | 1417 | ||
| Interventional Options | 1417 | ||
| Surgery. | 1417 | ||
| Transcatheter. | 1417 | ||
| Implantable Cardioverter-Defibrillator. | 1417 | ||
| Interventional Outcomes | 1418 | ||
| Reproductive Issues | 1418 | ||
| Follow-Up | 1418 | ||
| Tricuspid Atresia (Absent Right Atrioventricular Connection) | 1418 | ||
| IX Cardiovascular Disease in Special Populations | 1711 | ||
| 76 Cardiovascular Disease in the Elderly | 1711 | ||
| Demographics and Epidemiology | 1711 | ||
| Pathophysiology | 1712 | ||
| Medication Therapy: Modifications for the Older Patient | 1713 | ||
| Loading Doses of Medications | 1713 | ||
| Hepatic (and Intestinal) Clearance | 1715 | ||
| Elimination Half-Life | 1716 | ||
| Adverse Drug Events and Drug Interactions | 1716 | ||
| Pharmacokinetic Interactions | 1716 | ||
| Adverse Pharmacodynamic Effects | 1717 | ||
| Inappropriate Prescribing in the Elderly | 1717 | ||
| Adherence | 1718 | ||
| Medicare Part D and the Patient Protection and Affordable Care Act | 1718 | ||
| Vascular Disease | 1718 | ||
| Hypertension | 1718 | ||
| Treatment | 1719 | ||
| Additional Considerations in the Older Patient with Hypertension | 1720 | ||
| Coronary Artery Disease | 1720 | ||
| Diagnosis | 1720 | ||
| Estimation of Risk | 1720 | ||
| History | 1722 | ||
| Testing for Ischemia | 1722 | ||
| Treatment | 1722 | ||
| Medical | 1722 | ||
| Lipid Lowering in the Elderly. | 1722 | ||
| Statins for Primary Prevention. | 1724 | ||
| Special Considerations with Pharmacologic Treatment in the Elderly Patient with Coronary Artery Disease | 1724 | ||
| Revascularization | 1724 | ||
| Percutaneous Intervention Versus Coronary Artery Bypass Grafting | 1724 | ||
| Clinical Perspective | 1725 | ||
| Acute Coronary Syndromes | 1726 | ||
| Diagnosis | 1726 | ||
| Treatment | 1726 | ||
| Acute Coronary Syndromes of Unstable Angina and Non–ST-Segment Elevation Myocardial Infarction | 1726 | ||
| ST-Segment Elevation Myocardial Infarction | 1726 | ||
| Additional Issues in the Elderly: Bleeding Risks | 1727 | ||
| Current Perspective | 1727 | ||
| Post–Myocardial Infarction | 1727 | ||
| Medications | 1727 | ||
| Rehabilitation Programs | 1727 | ||
| Carotid Artery Disease/Stroke | 1727 | ||
| Diagnosis | 1728 | ||
| Transient Ischemic Attack. | 1728 | ||
| Stroke. | 1728 | ||
| Treatment | 1728 | ||
| Acute Stroke Management | 1728 | ||
| Considerations and Contraindications with Recombinant Tissue Plasminogen Activator | 1728 | ||
| Prevention | 1728 | ||
| Medical Therapy | 1728 | ||
| Antiplatelet Drugs. | 1728 | ||
| Anticoagulant Drugs. | 1729 | ||
| Lipid-Lowering Drugs. | 1729 | ||
| Antihypertensive Drugs. | 1729 | ||
| Surgical and Endovascular Approaches | 1729 | ||
| Carotid Endarterectomy Compared with Carotid Artery Balloon Angioplasty and Stenting with Protection | 1729 | ||
| Clinical Perspective | 1729 | ||
| Peripheral Artery Disease | 1729 | ||
| Diagnosis | 1730 | ||
| Treatment | 1730 | ||
| Medical Therapy | 1730 | ||
| Additional Considerations in the Older Patient | 1730 | ||
| Revascularization | 1731 | ||
| Heart Failure | 1731 | ||
| Diagnosis | 1732 | ||
| Treatment | 1732 | ||
| Heart Failure with Reduced Ejection Fraction (Systolic Function) (Reduced Ejection Fraction Heart Failure) | 1733 | ||
| Nonpharmacologic Strategies. | 1734 | ||
| Heart Failure with Normal or Preserved Left Ventricular Ejection Fraction (HFpEF) | 1735 | ||
| Chemotherapy-Induced Heart Failure | 1735 | ||
| Clinical Perspective | 1735 | ||
| Arrhythmias | 1735 | ||
| Sinus Node Dysfunction | 1735 | ||
| Atrioventricular Node Dysfunction | 1736 | ||
| Atrial Arrhythmias | 1736 | ||
| Atrial Fibrillation | 1736 | ||
| Ventricular Arrhythmias | 1737 | ||
| Syncope | 1737 | ||
| Valvular Disease | 1738 | ||
| Aortic Valve Disease | 1738 | ||
| Aortic Stenosis | 1738 | ||
| Diagnosis | 1738 | ||
| Management | 1738 | ||
| Aortic Regurgitation | 1739 | ||
| Mitral Annular Calcification | 1740 | ||
| Mitral Stenosis | 1740 | ||
| Mitral Regurgitation | 1740 | ||
| Additional Considerations in the Elderly | 1740 | ||
| Future Directions | 1741 | ||
| References | 1741 | ||
| Demographics and Epidemiology/Pathophysiology | 1741 | ||
| Medication Therapy: Modifications for the Older Patient | 1741 | ||
| Vascular Disease | 1741 | ||
| Heart Failure | 1742 | ||
| Arrhythmias | 1743 | ||
| Valvular Disease | 1743 | ||
| 77 Cardiovascular Disease in Women | 1744 | ||
| Sex, Gender, and Genetic Differences in Cardiovascular Disease | 1744 | ||
| Cardiovascular Risk Factors in Women (see also Chapter 42) | 1744 | ||
| Established Risk Factors for Cardiovascular Disease | 1744 | ||
| Age | 1744 | ||
| Family History | 1744 | ||
| Hypertension | 1744 | ||
| Diabetes | 1745 | ||
| Dyslipidemia | 1745 | ||
| Smoking | 1745 | ||
| Physical Activity/Physical Fitness | 1745 | ||
| Emerging Risk Factors | 1745 | ||
| Metabolic Syndrome | 1745 | ||
| Obesity | 1745 | ||
| High-Sensitivity C-Reactive Protein | 1746 | ||
| Autoimmune Disease (see also Chapter 84) | 1746 | ||
| Polycystic Ovary Syndrome | 1746 | ||
| Functional Hypothalamic Amenorrhea | 1746 | ||
| Preeclampsia and Pregnancy-Associated Hypertension | 1746 | ||
| Gestational Diabetes | 1746 | ||
| Breast Cancer Therapy | 1746 | ||
| Reproductive Hormone Therapy | 1746 | ||
| Assessment of Risk for Cardiovascular Disease | 1747 | ||
| Ischemic Heart Disease in Women | 1747 | ||
| Symptoms of Ischemia | 1747 | ||
| Diagnosis of Obstructive Coronary Artery Disease in Women | 1748 | ||
| Beyond Obstructive Coronary Artery Disease: The Paradox of Ischemic Heart Disease in Women | 1749 | ||
| Acute Coronary Syndrome and Angina | 1749 | ||
| Nonobstructive Ischemic Heart Disease | 1749 | ||
| Cardiac Syndrome X and Microvascular Angina | 1750 | ||
| Takotsubo Cardiomyopathy | 1750 | ||
| Coronary Artery Bypass Grafting and Valve Surgery | 1750 | ||
| Peripheral Artery Disease | 1750 | ||
| Heart Failure | 1751 | ||
| Peripartum Cardiomyopathy | 1751 | ||
| Diagnosis of Heart Failure | 1751 | ||
| Treatment of Heart Failure | 1751 | ||
| Cardiac Transplantation | 1752 | ||
| Arrhythmia and Sudden Cardiac Death | 1752 | ||
| Prevention of Cardiovascular Disease | 1752 | ||
| Conclusion | 1754 | ||
| Acknowledgments | 1754 | ||
| References | 1754 | ||
| Epidemiology of Cardiovascular Disease in Women | 1754 | ||
| Risk Assessment in Women | 1754 | ||
| Sex Differences in Ischemic Heart Disease | 1754 | ||
| Sex Differences in Other Cardiovascular Diseases | 1754 | ||
| Prevention of Cardiovascular Disease in Women | 1754 | ||
| 78 Pregnancy and Heart Disease | 1755 | ||
| Pre-Pregnancy Counseling | 1755 | ||
| Hemodynamic Changes | 1755 | ||
| Evaluation | 1756 | ||
| Physical Examination | 1756 | ||
| Laboratory Evaluation | 1757 | ||
| Imaging | 1757 | ||
| Chest Radiography | 1757 | ||
| Transthoracic Echocardiography | 1757 | ||
| Transesophageal Echocardiography | 1757 | ||
| Fetal Echocardiography | 1757 | ||
| Magnetic Resonance Imaging and Computed Tomography | 1757 | ||
| Management during Pregnancy | 1757 | ||
| Medical Therapy | 1757 | ||
| Surgical Management | 1757 | ||
| High-Risk Pregnancies | 1757 | ||
| Cardiovascular Diseases | 1758 | ||
| Congenital Heart Disease | 1758 | ||
| Atrial Septal Defect | 1758 | ||
| Ventricular Septal Defect | 1758 | ||
| Patent Ductus Arteriosus | 1758 | ||
| Congenital Aortic Stenosis | 1758 | ||
| Coarctation of the Aorta | 1759 | ||
| Pulmonary Stenosis | 1759 | ||
| Cyanotic Heart Disease | 1759 | ||
| Ebstein’s Anomaly | 1759 | ||
| Congenitally Corrected Transposition (L-Transposition) | 1759 | ||
| Repaired Congenital Heart Disease | 1759 | ||
| Tetralogy of Fallot | 1759 | ||
| Transposition of the Great Arteries (D-Transposition) | 1760 | ||
| Coarctation | 1760 | ||
| Univentricular Heart and Fontan Operations | 1760 | ||
| Pulmonary Hypertension | 1760 | ||
| Valvular Heart Disease | 1760 | ||
| Prosthetic Valves | 1761 | ||
| Tissue Prostheses | 1761 | ||
| Mechanical Prostheses and Anticoagulant Treatment | 1761 | ||
| Unfractionated Heparin | 1761 | ||
| Low-Molecular-Weight Heparin | 1761 | ||
| Warfarin | 1762 | ||
| Connective Tissue Disorders | 1762 | ||
| Cardiomyopathies | 1762 | ||
| Dilated Cardiomyopathy | 1762 | ||
| Peripartum Cardiomyopathy | 1762 | ||
| Hypertrophic Cardiomyopathy | 1763 | ||
| Coronary Artery Disease | 1763 | ||
| Hypertension | 1763 | ||
| Arrhythmias | 1764 | ||
| Cardiovascular Drug Therapy | 1765 | ||
| Aspirin | 1765 | ||
| Amiodarone | 1765 | ||
| Angiotensin-Converting Enzyme Inhibitors | 1765 | ||
| Beta-Adrenergic Receptor Blockers | 1765 | ||
| Calcium Channel Blockers | 1765 | ||
| Digoxin | 1765 | ||
| Diuretics | 1765 | ||
| Warfarin | 1765 | ||
| Contraception | 1765 | ||
| Barrier Contraception | 1766 | ||
| Intrauterine Devices | 1766 | ||
| Oral Contraceptives | 1766 | ||
| Alternative Combined Hormonal Preparations | 1766 | ||
| Depot Progesterone | 1766 | ||
| Emergency Contraception | 1766 | ||
| Tubal Sterilization | 1766 | ||
| Future Perspectives | 1766 | ||
| References | 1766 | ||
| 79 Exercise and Sports Cardiology | 1771 | ||
| Introduction and Historical Perspective | 1771 | ||
| Definition of Terms | 1771 | ||
| The Cardiovascular Response to Exercise and Exercise Training | 1771 | ||
| The Effects of Habitual Physical Activity on Cardiovascular Risk (See also Chapter 42) | 1772 | ||
| The Cardiovascular Risks of Exercise | 1774 | ||
| The Approach to Common Clinical Problems in Sports Cardiology | 1775 | ||
| Decreased Exercise Capacity | 1775 | ||
| Abnormalities Found on Screening | 1775 | ||
| Cardiovascular Complaints in Athletes | 1776 | ||
| Determining Athletic Eligibility | 1776 | ||
| Advising Adult Athletes with Atherosclerotic Cardiovascular Disease | 1776 | ||
| Valve Disease in Athletes | 1777 | ||
| Elevated “Cardiac Enzymes” in Athletes | 1777 | ||
| Possible Myocardial Fibrosis in Athletes | 1777 | ||
| Conclusion | 1777 | ||
| References | 1778 | ||
| The Cardiovascular Response to Exercise and Training | 1778 | ||
| Physical Activity and Cardiovascular Risk | 1778 | ||
| The Cardiovascular Risks of Exercise | 1778 | ||
| Determination of Eligibility for Athletic Activity | 1778 | ||
| Cardiovascular Management in Athletes | 1778 | ||
| 80 Anesthesia and Noncardiac Surgery in Patients with Heart Disease | 1779 | ||
| Assessment of Risk | 1779 | ||
| Ischemic Heart Disease | 1779 | ||
| Hypertension | 1780 | ||
| Heart Failure | 1780 | ||
| Valvular Heart Disease (See also Chapter 63) | 1781 | ||
| Congenital Heart Disease in Adults (See also Chapter 62) | 1781 | ||
| Arrhythmias (See Chapters 34 Through 39) | 1781 | ||
| The Decision to Undergo Diagnostic Testing | 1782 | ||
| Tests to Improve Identification and Definition of Cardiovascular Disease | 1784 | ||
| Overview of Anesthesia for Cardiac Patients Undergoing Noncardiac Surgery | 1785 | ||
| Spinal and Epidural Anesthesia | 1786 | ||
| Monitored Anesthesia Care | 1786 | ||
| Intraoperative Hemodynamics and Myocardial Ischemia | 1786 | ||
| Postoperative Management | 1786 | ||
| Overview of the Postoperative Response to Surgery | 1786 | ||
| Postoperative Intensive Care | 1786 | ||
| Postoperative Pain Management | 1787 | ||
| Surveillance and Implications of Perioperative Cardiac Complications | 1787 | ||
| Strategies to Reduce the Cardiac Risk Associated with Noncardiac Surgery | 1788 | ||
| Surgical Revascularization | 1788 | ||
| Coronary Stenting and Noncardiac Surgery | 1788 | ||
| Pharmacologic Interventions | 1789 | ||
| Beta-Adrenergic–Blocking Agents | 1789 | ||
| Statin Therapy | 1790 | ||
| Nitroglycerin | 1790 | ||
| Other Medications | 1791 | ||
| Nonpharmacologic Interventions | 1791 | ||
| Temperature | 1791 | ||
| Electrocardiographic, Hemodynamic, and Echocardiographic Monitoring | 1791 | ||
| Transfusion Threshold | 1791 | ||
| References* | 1791 | ||
| Risk Assessment | 1791 | ||
| Preoperative Testing | 1791 | ||
| Anesthesia, Postoperative Management, and Surveillance | 1792 | ||
| Strategies to Reduce Cardiac Risk | 1792 | ||
| X Cardiovascular Disease and Disorders of Other Organs | 1793 | ||
| 81 Endocrine Disorders and Cardiovascular Disease | 1793 | ||
| Pituitary Gland | 1793 | ||
| Growth Hormone | 1793 | ||
| Cardiovascular Manifestations of Acromegaly | 1794 | ||
| Diagnosis | 1794 | ||
| Therapy | 1795 | ||
| Growth Hormone Deficiency | 1795 | ||
| Adrenal Gland | 1795 | ||
| Adrenocorticotropic Hormone and Cortisol | 1795 | ||
| Cushing Disease | 1795 | ||
| Diagnosis | 1796 | ||
| Treatment | 1796 | ||
| Hyperaldosteronism (See also Chapter 43) | 1796 | ||
| Addison Disease | 1796 | ||
| Diagnosis | 1797 | ||
| Treatment | 1797 | ||
| Prolactin Disease | 1797 | ||
| Parathyroid Disease | 1797 | ||
| Hyperparathyroidism | 1797 | ||
| Hypocalcemia | 1798 | ||
| Vitamin D | 1798 | ||
| Thyroid Gland | 1798 | ||
| Cellular Mechanisms of Thyroid Hormone Action on the Heart | 1798 | ||
| Thyroid Function Testing | 1800 | ||
| Thyroid Hormone–Catecholamine Interaction | 1800 | ||
| Hemodynamic Alterations in Thyroid Disease | 1800 | ||
| Hyperthyroidism | 1801 | ||
| Atrial Fibrillation (See also Chapter 38) | 1801 | ||
| Heart Failure in Thyroid Disease | 1802 | ||
| Treatment | 1802 | ||
| Hypothyroidism | 1802 | ||
| Diagnosis | 1803 | ||
| Treatment | 1803 | ||
| Subclinical Disease | 1804 | ||
| Subclinical Hypothyroidism | 1804 | ||
| Subclinical Hyperthyroidism | 1804 | ||
| Amiodarone and Thyroid Function (See Chapter 35) | 1804 | ||
| Changes in Thyroid Hormone Metabolism That Accompany Cardiac Disease | 1805 | ||
| Pheochromocytoma | 1805 | ||
| Diagnosis | 1806 | ||
| Treatment | 1806 | ||
| Future Perspectives | 1806 | ||
| References* | 1806 | ||
| Pituitary Function and Cardiovascular Disease | 1806 | ||
| Adrenal Function and Cardiovascular Disease | 1807 | ||
| Parathyroid Function, Calcium Metabolism, and Cardiovascular Disease | 1807 | ||
| Thyroid Involvement in Cardiovascular Disease | 1807 | ||
| Pheochromocytoma | 1808 | ||
| 82 Hemostasis, Thrombosis, Fibrinolysis, and Cardiovascular Disease | 1809 | ||
| Hemostatic System | 1809 | ||
| Vascular Endothelium (See Chapter 41) | 1810 | ||
| Platelet Inhibition | 1810 | ||
| Anticoagulant Activity | 1810 | ||
| Fibrinolytic Activity | 1810 | ||
| Platelets | 1810 | ||
| Adhesion | 1811 | ||
| Activation | 1811 | ||
| Aggregation | 1811 | ||
| Coagulation | 1812 | ||
| Extrinsic Tenase | 1812 | ||
| Intrinsic Tenase | 1812 | ||
| Prothrombinase | 1812 | ||
| Fibrin Formation | 1812 | ||
| Contact Pathway | 1813 | ||
| Fibrinolytic System | 1813 | ||
| Mechanism of Action of Tissue Plasminogen Activator | 1814 | ||
| Mechanism of Action of Urokinase Plasminogen Activator | 1814 | ||
| Mechanism of Action of Thrombin-Activated Fibrinolysis Inhibitor | 1814 | ||
| Thrombosis | 1815 | ||
| Arterial Thrombosis (See Chapter 41) | 1815 | ||
| Venous Thrombosis (Also see Chapter 73) | 1815 | ||
| Inherited Hypercoagulable States | 1815 | ||
| Factor V Leiden | 1815 | ||
| Prothrombin Gene Mutation | 1816 | ||
| Elevated Levels of Procoagulant Proteins | 1816 | ||
| Antithrombin Deficiency | 1816 | ||
| Protein C Deficiency | 1816 | ||
| Protein S Deficiency | 1816 | ||
| Other Hereditary Disorders | 1816 | ||
| Acquired Hypercoagulable States | 1817 | ||
| Surgery and Immobilization | 1817 | ||
| Advanced Age | 1817 | ||
| Obesity | 1817 | ||
| Cancer | 1817 | ||
| Pregnancy | 1817 | ||
| Sex Hormone Therapy (Also see Chapter 77) | 1817 | ||
| History of Previous Venous Thromboembolism | 1818 | ||
| Antiphospholipid Antibody Syndrome | 1818 | ||
| Hyperhomocysteinemia (See Also Chapter 42) | 1818 | ||
| Treatment of Thrombosis | 1819 | ||
| Antiplatelet Drugs | 1819 | ||
| Aspirin | 1819 | ||
| Mechanism of Action | 1819 | ||
| Indications | 1819 | ||
| Dosages | 1819 | ||
| Side Effects | 1819 | ||
| Aspirin Resistance | 1819 | ||
| Thienopyridines (See Also Chapters 52, 53, and 55) | 1819 | ||
| Disclosure Index | di1 | ||
| Relationship Codes | di1 | ||
| Institution and Company Codes | di1 | ||
| Contributors | di2 | ||
| Index | i1 | ||
| A | i1 | ||
| B | i9 | ||
| C | i10 | ||
| D | i19 | ||
| E | i21 | ||
| F | i25 | ||
| G | i26 | ||
| H | i28 | ||
| I | i33 | ||
| J | i34 | ||
| K | i34 | ||
| L | i34 | ||
| M | i36 | ||
| N | i42 | ||
| O | i42 | ||
| P | i43 | ||
| Q | i49 | ||
| R | i49 | ||
| S | i51 | ||
| T | i55 | ||
| U | i58 | ||
| V | i58 | ||
| W | i60 | ||
| X | i60 | ||
| Y | i60 | ||
| Z | i60 | ||
| Index | e1 | ||
| A | e1 | ||
| B | e9 | ||
| C | e10 | ||
| D | e19 | ||
| E | e21 | ||
| F | e25 | ||
| G | e26 | ||
| H | e28 | ||
| I | e33 | ||
| J | e34 | ||
| K | e35 | ||
| L | e35 | ||
| M | e36 | ||
| N | e42 | ||
| O | e43 | ||
| P | e43 | ||
| Q | e49 | ||
| R | e49 | ||
| S | e51 | ||
| T | e55 | ||
| U | e58 | ||
| V | e58 | ||
| W | e60 | ||
| X | e60 | ||
| Y | e60 | ||
| Z | e60 | ||
| Inside Back Cover | ibc1 |