Additional Information
Book Details
Abstract
From basic clinical facts to new advanced guidelines, Practical Cardiology, by Drs. Majid Maleki, Azin Alizadehasl, and Majid Haghjoo, is your new go-to resource for new developments in cardiology knowledge, imaging modalities, management techniques, and more. This step-by-step, practical reference is packed with tips and guidance ideal for residents, fellows, and clinicians in cardiology, as well as internal medicine, cardiac surgery, interventional cardiology, and pediatric cardiology.
- Features a wealth of information, including practical points from recently published guidelines, ECGs, hemodynamic traces of advanced imaging modalities in real patients, and much more.
- Offers a comprehensive review of cardiovascular medicine, from basic to advanced.
Table of Contents
| Section Title | Page | Action | Price |
|---|---|---|---|
| Front Cover | Cover | ||
| Practical Cardiology | i | ||
| Practical Cardiology | iii | ||
| Copyright | iv | ||
| List of Contributors | v | ||
| Preface: Practical Cardiology | ix | ||
| Acknowledgments | xi | ||
| Contents | xiii | ||
| 1 - Evidence-Based Cardiology Practice\r | 1 | ||
| INTRODUCTION\r | 1 | ||
| EVIDENCE-BASED MEDICINE RESOURCES | 1 | ||
| CLINICAL PRACTICE GUIDELINES | 3 | ||
| EVIDENCE IS NOT ENOUGH | 5 | ||
| REFERENCES | 5 | ||
| 2 - Evaluation of Patients with Cardiovascular Problems\r | 7 | ||
| HISTORY | 7 | ||
| General Questions | 7 | ||
| Congestive Heart Failure | 7 | ||
| Ischemic Heart Disease | 7 | ||
| Congenital Heart Disease | 7 | ||
| Rheumatic Heart Disease and Endocarditis | 7 | ||
| Dyspnea | 8 | ||
| Syncope | 8 | ||
| Chest Pain | 8 | ||
| PHYSICAL EXAMINATION | 8 | ||
| Patient Observation | 8 | ||
| Arterial Pulse Examination | 9 | ||
| Arterial Pulse | 9 | ||
| Venous Pulse Examination | 9 | ||
| Normal Jugular Venous Pulse | 9 | ||
| Increased a Wave | 10 | ||
| X Descent | 10 | ||
| V Wave | 10 | ||
| Y Wave (Diastolic Collapse) | 10 | ||
| Palpation and Observation of the Chest | 10 | ||
| Auscultation | 10 | ||
| First Heart Sounds (S1) | 13 | ||
| Second Heart Sounds (S2) | 13 | ||
| Third and Fourth Heart Sounds (S3 and S4) | 13 | ||
| Clicks | 13 | ||
| Murmur | 14 | ||
| Systolic Murmurs. These murmurs may be normal or abnormal. They can be heard at different parts of the systolic cycle as early, ... | 15 | ||
| Ejection Murmurs. These murmurs are produced by the turbulent flow across stenotic pulmonary or aortic valves. Systolic ejection... | 15 | ||
| Regurgitation Murmurs. These murmurs are produced because of abnormal flow through insufficient mitral or tricuspid valves or VS... | 15 | ||
| Diastolic Murmurs. These murmurs are always abnormal. They can be early, mid, or late diastolic. Diastolic rumble is usually cau... | 15 | ||
| Continuous Murmurs. These murmurs occur during all the systolic and diastolic cycles. They are usually abnormal. Patent ductus a... | 15 | ||
| Differential Diagnosis of Murmurs by Maneuvers. As discussed earlier, maneuvers such as respiration, Valsalva maneuver, squattin... | 15 | ||
| CONCLUSION | 15 | ||
| REFERENCES\r | 15 | ||
| 3 - Electrocardiography\r | 17 | ||
| INTRODUCTION | 17 | ||
| NORMAL ELECTROCARDIOGRAMS | 17 | ||
| The Pattern of Normal Waves and Intervals | 17 | ||
| Normal Variants on Electrocardiograms | 19 | ||
| Benign Early Repolarization | 23 | ||
| ABNORMAL ELECTROCARDIOGRAMS | 23 | ||
| Malignant Early Repolarization | 23 | ||
| Atrial Abnormality | 23 | ||
| Ventricular Hypertrophy | 23 | ||
| Intraventricular Conduction Delays | 27 | ||
| Alternans Patterns on Electrocardiograms | 30 | ||
| Technical Errors and Artifacts | 33 | ||
| REFERENCES | 59 | ||
| 4 - Exercise Stress Testing\r | 61 | ||
| INDICATIONS | 61 | ||
| CONTRAINDICATIONS3 | 61 | ||
| Absolute | 61 | ||
| Relative Contraindications | 61 | ||
| EXERCISE STRESS TEST PROTOCOLS | 61 | ||
| EVALUATION OF FUNCTIONAL CAPACITY | 62 | ||
| HEART RATE RESPONSE | 62 | ||
| BLOOD PRESSURE RESPONSE | 62 | ||
| Hypertensive Response | 62 | ||
| Hypotensive Response | 63 | ||
| ELECTROCARDIOGRAM CHANGES | 63 | ||
| Normal Response | 63 | ||
| Rapid Upsloping Response | 63 | ||
| Slow Upsloping ST Changes | 63 | ||
| Horizontal ST-Segment Depression | 63 | ||
| Minor ST-Segment Changes | 63 | ||
| Downsloping ST-Segment Depression | 64 | ||
| ST-Segment Elevation | 64 | ||
| ST-Segment Elevation in Leads with Previous Q Wave | 64 | ||
| ARRHYTHMIAS | 65 | ||
| RECOVERY | 65 | ||
| INDICATIONS FOR TERMINATION OF EXERCISE STRESS TESTING3 | 65 | ||
| REFERENCES | 66 | ||
| 5 - Echocardiography\r | 67 | ||
| TRANSTHORACIC STUDY | 67 | ||
| Standard Windows | 67 | ||
| Left Parasternal Window | 67 | ||
| Apical Views | 68 | ||
| Subcostal View | 68 | ||
| Suprasternal View | 68 | ||
| Right Parasternal Views | 68 | ||
| DOPPLER ECHOCARDIOGRAPHY | 68 | ||
| Doppler Study in Standard Views | 74 | ||
| Parasternal Short Axis View | 74 | ||
| Apical Views | 74 | ||
| Right Ventricular Inflow View | 74 | ||
| Other Views and Doppler Flow | 75 | ||
| MYOCARDIAL TISSUE DOPPLER IMAGING | 75 | ||
| TRANSESOPHAGEAL ECHOCARDIOGRAPHY | 75 | ||
| CONTRAST ECHOCARDIOGRAPHY | 76 | ||
| STRESS ECHOCARDIOGRAPHY | 76 | ||
| STUDY OF MYOCARDIAL VIABILITY | 78 | ||
| THREE-DIMENSIONAL ECHOCARDIOGRAPHY | 78 | ||
| TWO-DIMENSIONAL (SPECKLED) STRAIN ECHOCARDIOGRAPHY | 78 | ||
| STUDY OF THE CARDIAC CHAMBERS | 78 | ||
| Left Ventricular Volume | 79 | ||
| Left Ventricular Systolic Function | 80 | ||
| Left Ventricular Diastolic Function | 81 | ||
| Left Atrium | 81 | ||
| Right Ventricle | 82 | ||
| Right Atrium | 82 | ||
| STUDY OF VALVULAR HEART DISEASE | 83 | ||
| Mitral Valve Disease | 83 | ||
| Mitral Stenosis | 83 | ||
| Mitral Regurgitation | 84 | ||
| Rheumatic Mitral Regurgitation | 84 | ||
| Myxomatous Mitral Valve Prolapse | 84 | ||
| Flail Mitral Leaflet | 85 | ||
| Mitral Annular Calcification | 85 | ||
| Functional Mitral Regurgitation | 85 | ||
| Evaluation of Mitral Regurgitation | 85 | ||
| Low-Gradient Severe Aortic Stenosis | 88 | ||
| Subvalvular Aortic Stenosis | 88 | ||
| Aortic Regurgitation | 89 | ||
| Tricuspid Valve Disease | 89 | ||
| Pulmonary Valve Disease | 89 | ||
| Prosthetic Heart Valves | 91 | ||
| Infective Endocarditis | 92 | ||
| Ischemic Heart Disease | 93 | ||
| Regional Wall Motion Abnormalities | 93 | ||
| Acute Complications of Myocardial Infarction | 94 | ||
| Cardiomyopathies—Dilated Cardiomyopathy | 94 | ||
| Hypertrophic Cardiomyopathy | 95 | ||
| Restrictive Cardiomyopathy | 95 | ||
| Endomyocardial Fibrosis | 97 | ||
| Noncompaction Cardiomyopathy | 97 | ||
| Arrhythmogenic Right Ventricular Dysplasia | 97 | ||
| Pericardial Disease | 97 | ||
| Pericardial Effusion and Tamponade | 99 | ||
| Pericardial Constriction | 99 | ||
| Pericardial Cysts | 100 | ||
| Intracardiac Masses and Tumors | 100 | ||
| Intracardiac Thrombi | 103 | ||
| Aortic Disease | 103 | ||
| Proximal Aorta Disease | 103 | ||
| CONGENITAL HEART DISEASE | 104 | ||
| Atrial Septal Defects | 104 | ||
| Ventricular Septal Defects | 106 | ||
| Patent Ductus Arteriosus | 107 | ||
| Tetralogy of Fallot | 108 | ||
| Complete Transposition of the Great Arteries | 108 | ||
| Truncus Arteriosus | 108 | ||
| Double-Outlet Right Ventricle | 108 | ||
| Cardiac Resynchronization Therapy | 109 | ||
| Ventricular Assist Devices | 109 | ||
| Cardiac Interventional Procedures | 109 | ||
| REFERENCES | 109 | ||
| 6 - Chest Radiography in Cardiovascular Disease | 113 | ||
| NORMAL CHEST RADIOGRAPHS | 113 | ||
| Lungs and Pulmonary Vasculature | 113 | ||
| THE CHEST RADIOGRAPH IN HEART DISEASE | 114 | ||
| Overview | 114 | ||
| Thoracic Musculoskeletal Structures | 114 | ||
| Pulmonary Vascularity | 114 | ||
| Determining the Vascular Pattern | 114 | ||
| Segmental Analysis\r | 114 | ||
| Pattern Recognition | 115 | ||
| Diminished Vasculature. In the frontal view, a concave main pulmonary artery segment is the most reliable indicator of small mai... | 115 | ||
| Left-to-Right Shunt. In patients with left-to-right shunt, the size of all pulmonary segments, including the central, hilar, and... | 115 | ||
| Pulmonary Artery Hypertension. Pulmonary hypertension occurs when there is increased resistance in any part of the pulmonary cir... | 115 | ||
| Eisenmenger Syndrome | 116 | ||
| Pulmonary Venous Hypertension | 116 | ||
| Cardiac Chambers and Great Vessels | 117 | ||
| Specific Chamber Enlargement | 117 | ||
| Left Atrial Enlargement (Fig. 6.8) | 117 | ||
| Right Atrial Enlargement (Fig. 6.9) | 117 | ||
| Left Ventricular Enlargement (Fig. 6.10) | 119 | ||
| Right Ventricular Enlargement (Fig. 6.11) | 119 | ||
| MITRAL VALVE DISEASE | 119 | ||
| Mitral Valve Stenosis (Fig. 6.12) | 119 | ||
| Chest Radiography | 121 | ||
| Mitral Regurgitation | 121 | ||
| Radiography (Fig. 6.13) | 121 | ||
| AORTIC VALVE DISEASE | 121 | ||
| Aortic Stenosis | 121 | ||
| Radiography (Fig. 6.14). Aortic stenosis is a pressure overload lesion that causes concentric LV hypertrophy. Consequently, AS, ... | 122 | ||
| AORTIC REGURGITATION | 122 | ||
| Radiography (Fig. 6.15) | 123 | ||
| PULMONARY STENOSIS | 123 | ||
| Valvular Pulmonary Stenosis | 123 | ||
| Radiography | 123 | ||
| PULMONARY REGURGITATION | 123 | ||
| Radiography (Fig. 6.17) | 123 | ||
| TRICUSPID VALVE DISEASE | 123 | ||
| Tricuspid Stenosis | 124 | ||
| Tricuspid Valve Regurgitation | 124 | ||
| Radiography (Fig. 6.18) | 125 | ||
| CONGENITAL HEART DISEASE | 125 | ||
| Radiography of Congenital Heart Disease | 125 | ||
| Clinical-Radiographic Classification of Congenital Heart Disease | 125 | ||
| Group I | 126 | ||
| Group II | 127 | ||
| Group III | 127 | ||
| Group IV | 129 | ||
| Coarctation of the Aorta | 129 | ||
| REFERENCES | 130 | ||
| 7 - Cardiac Computed Tomography\r | 131 | ||
| MULTIDETECTOR COMPUTED TOMOGRAPHY TERMINOLOGY | 131 | ||
| Isotropic Data Acquisition | 131 | ||
| Spatial Resolution | 131 | ||
| Speed and Temporal Resolution | 132 | ||
| SCAN MODES | 132 | ||
| RADIATION EXPOSURE | 134 | ||
| PATIENT PREPARATION | 134 | ||
| CARDIAC COMPUTED TOMOGRAPHY ANATOMY1,10-12 | 135 | ||
| Cardiac Chambers | 136 | ||
| Image Reconstruction | 137 | ||
| CALCIUM SCORING | 139 | ||
| CLINICAL INDICATIONS | 142 | ||
| Diagnosis of Coronary Artery Disease | 142 | ||
| Imaging of Coronary Stents | 144 | ||
| Computed Tomography in the Emergency Department | 146 | ||
| RANDOMIZED CONTROLLED TRIALS EVALUATING CLINICAL OUTCOMES WITH USE OF CORONARY COMPUTED TOMOGRAPHY | 147 | ||
| Angiography in the Emergency Department for Evaluation of Patients with Possible Acute Coronary Syndromes | 147 | ||
| Coronary Computed Tomography Angiography in Patients with Prior Coronary ArteryBypass Graft | 147 | ||
| Detection of Noncalcified Plaque | 147 | ||
| Anomalous Coronary Arteries | 149 | ||
| Computed Tomography Perfusion, Computed Tomography Fractional Flow Reserve (FFR), and Myocardial Scar | 155 | ||
| REFERENCES | 156 | ||
| 8 - Cardiac Magnetic Resonance Imaging\r | 159 | ||
| BASIC PHYSICS, TECHNICAL CONSIDERATIONS, AND IMAGING TOOLS | 159 | ||
| HARDWARE AND TECHNICAL REQUIREMENTS | 161 | ||
| CLINICAL APPLICATIONS | 161 | ||
| Anatomic Visualization | 162 | ||
| Functional Evaluation | 162 | ||
| Tissue Characterization | 164 | ||
| PATIENT SELECTION AND PREPARATION | 164 | ||
| SPECIFIC INDICATIONS AND MAGNETIC RESONANCE TECHNIQUES | 166 | ||
| REFERENCES | 166 | ||
| 9 - Nuclear Cardiology\r | 167 | ||
| INTRODUCTION | 167 | ||
| RADIOPHARMACEUTICALS | 167 | ||
| DETECTION OF CORONARY ARTERY DISEASE AND STRESS TESTS | 167 | ||
| ELECTROCARDIOGRAPHY-GATED SPECT | 168 | ||
| IMAGE INTERPRETATION | 168 | ||
| SEMIQUANTITATIVE VISUAL ANALYSIS | 168 | ||
| NORMAL VARIATIONS, ARTIFACTS, AND PITFALLS | 169 | ||
| ASSESSMENT OF VIABILITY | 169 | ||
| RADIONUCLIDE ANGIOGRAPHY | 170 | ||
| POSITRON EMISSION TOMOGRAPHY | 170 | ||
| REFERENCES | 171 | ||
| 10 - Catheterization and Angiography\r | 173 | ||
| INTRODUCTION | 173 | ||
| RADIATION SAFETY | 173 | ||
| PRECATHETERIZATION PREPARATIONS1 | 173 | ||
| ACCESS | 174 | ||
| Radial Access | 175 | ||
| SHEATHS AND CATHETERS | 175 | ||
| Coronary Angiography Catheters | 175 | ||
| GUIDEWIRES | 175 | ||
| LEFT HEART CATHETERIZATION | 176 | ||
| RIGHT HEART CATHETERIZATION | 176 | ||
| CORONARY ANGIOGRAPHY INDICATIONS | 177 | ||
| CORONARY CATHETER MANIPULATION | 177 | ||
| Left Judkins Catheter | 177 | ||
| Right Judkins Catheter | 177 | ||
| CORONARY ANATOMY | 177 | ||
| ANGIOGRAPHIC PROJECTIONS | 178 | ||
| CORONARY FINDINGS AND INTERPRETATION | 178 | ||
| Calcification | 178 | ||
| Thrombus | 178 | ||
| Stenosis | 178 | ||
| Lesion Complexity for Intervention | 178 | ||
| Ectasia | 178 | ||
| Coronary Spasm | 179 | ||
| CORONARY ANOMALIES AND VARIATIONS | 179 | ||
| Absent Left Main Artery | 179 | ||
| Anomalous Origin of the Left Circumflex Artery from the Right Coronary Artery | 179 | ||
| Anomalous Origin of the Right Coronary Artery from the Left Cusp | 179 | ||
| Coronary Fistula | 180 | ||
| Muscle Bridge | 180 | ||
| CATHETERIZATION COMPLICATIONS | 180 | ||
| Pseudoaneurysm | 180 | ||
| Arteriovenous Fistula | 180 | ||
| Retroperitoneal Hematoma | 180 | ||
| REFERENCES | 180 | ||
| 11 - Hemodynamic Study\r | 183 | ||
| INTRODUCTION | 183 | ||
| PRESSURE MEASUREMENT | 183 | ||
| OXIMETRY MEASUREMENTS | 183 | ||
| TEMPERATURE MEASUREMENTS | 183 | ||
| CARDIAC PERFORMANCE | 183 | ||
| Cardiac Index | 183 | ||
| Thermodilution Cardiac Output | 184 | ||
| Limitations of the Thermodilution Technique | 184 | ||
| Fick Cardiac Output | 184 | ||
| Oxygen Consumption | 184 | ||
| Cardiac Output by Left Ventriculography | 184 | ||
| Filling Pressures (Preload) | 184 | ||
| Pulmonary Artery Catheter and Swan-Ganz Catheter | 184 | ||
| Central Venous Pressure Measurement and Interpretation | 184 | ||
| Central Venous Pressure Waveforms | 187 | ||
| Abnormal Central Venous Pressure Waveforms | 187 | ||
| Left Heart Filling Pressures | 187 | ||
| VENTRICULAR PRESSURE | 187 | ||
| Vascular Resistances | 188 | ||
| Systemic Vascular Resistance | 188 | ||
| Pulmonary Vascular Resistance | 188 | ||
| CLINICAL IMPLICATIONS OF RIGHT HEART CATHETERIZATION | 188 | ||
| Heart Failure Hemodynamics | 188 | ||
| Pulmonary Hypertension Hemodynamics | 189 | ||
| INTRAAORTIC BALLOON PUMP12 | 189 | ||
| REFERENCES | 191 | ||
| 12 - Heart Failure and Pulmonary Hypertension\r | 193 | ||
| HEART FAILURE DEFINITION | 193 | ||
| Key Points | 193 | ||
| DIAGNOSTIC WORKUP FOR HEART FAILURE | 193 | ||
| Key Points About Natriuretic Peptides | 193 | ||
| Electrocardiography | 194 | ||
| Echocardiography | 195 | ||
| Other Diagnostic Tests | 195 | ||
| Chest Radiography | 195 | ||
| Cardiac Magnetic Resonance Imaging | 195 | ||
| Coronary Angiography | 195 | ||
| ACUTE HEART FAILURE | 195 | ||
| Acute Heart Failure in the Emergency Department | 195 | ||
| Indications for Admission\r | 195 | ||
| Diagnosis and Prognosis | 197 | ||
| Diagnostic Investigations | 197 | ||
| Key Points About Diagnostic Investigations | 197 | ||
| Key Points About Laboratory Tests in Acute Heart Failure | 197 | ||
| Management | 198 | ||
| Management of the Early Phase | 199 | ||
| Key Points About Oxygen Therapy | 199 | ||
| Key Points About Noninvasive Positive-Pressure Ventilation and Intubation | 200 | ||
| Practical Points in Volume Management and Diuretic Therapy | 200 | ||
| Combination Diuretic Therapy. The potential risks and benefits of combination diuretic therapy are shown in Table 12.2. The most... | 201 | ||
| Key Points About Combination Diuretic Therapy | 201 | ||
| Practical Points in Intravenous Vasodilator Therapy | 201 | ||
| Choice of Vasodilator in Acute Heart Failure | 201 | ||
| Key Points About Vasodilator Therapy | 201 | ||
| Practical Points in Inotrope Therapy | 202 | ||
| Key Points About Inotrope Therapy | 202 | ||
| Indications for Invasive and Swan-Ganz Monitoring | 203 | ||
| First Scenario | 203 | ||
| Second Scenario | 203 | ||
| Key Points About Renal Replacement Therapy in Acute Heart Failure2,15 | 203 | ||
| Some Practical Point About Patients with Acute Heart Failure2 | 204 | ||
| Monitoring the Patient’s Status When Admitted for AHF2,4 | 204 | ||
| Discharge Plan | 204 | ||
| Key Points About Discharge Plans2,4 | 204 | ||
| THERAPEUTIC APPROACH TO CHRONIC HEART FAILURE | 204 | ||
| Therapeutic Approach to Patients with Heart Failure and Reduced Ejection Fraction | 204 | ||
| Novel Therapies | 205 | ||
| Diuretics | 205 | ||
| Practical Points About Diuretics | 205 | ||
| Angiotensin-Converting Enzyme Inhibitors and Angiotensin Receptor Antagonists1-3 | 208 | ||
| Key Points About Angiotensin-Converting Enzyme Inhibitors and Angiotensin Receptor Antagonists2,3 | 209 | ||
| Beta Blockers | 210 | ||
| Key Points on Beta Blockers2,3 | 210 | ||
| Mineralocorticoid Antagonists | 210 | ||
| Key Points on Mineralocorticoid Antagonists2,3 | 210 | ||
| Key Points About Ivabradine2,3 | 211 | ||
| Key Points About Angiotensin receptor antagonist/Neprilysin inhibitors2,3 | 211 | ||
| Some Practical Points on Other Treatments in HFrEF2,3 | 211 | ||
| Practical Points About the Frequency of Performing Laboratory Tests in Heart Failure Patients4 | 212 | ||
| Iron Therapy in Heart Failure | 212 | ||
| Definitions. Absolute ID is a ferritin level equal to or less than 100 μg/L. Functional ID is a ferritin level between 100 and 2... | 212 | ||
| Key Points About Iron Therapy in Heart Failure2,21 | 212 | ||
| Indications for Heart Transplantation and Left Ventricular Assist Device | 212 | ||
| Refractory Heart Failure Patients | 212 | ||
| Current Indications for Heart Transplantation | 212 | ||
| Listing for Heart Transplantation in Chronic Settings | 213 | ||
| Contraindications for Heart Transplantation | 213 | ||
| Assist Devices | 213 | ||
| Current Indications for Mechanical Circulatory Support in Acute and Chronic Heart Failure | 213 | ||
| Interagency Registry for Mechanically Assisted Circulatory Support (INTERMACS) Classification | 213 | ||
| Practical Points in Acute and Chronic Right Ventricular Failure | 214 | ||
| Management of Right Ventricular Failure | 214 | ||
| Key Points on Acute Right Ventricular Failure | 214 | ||
| Steps in Management of Acute Right Ventricular Failure | 214 | ||
| Key Points About Management of Acute Right Ventricular Failure | 216 | ||
| Key Points for Chronic Right Ventricular Failure | 216 | ||
| Practical Points in Heart Failure with Preserved Ejection Fraction2,25,26 | 216 | ||
| 13 - Tachyarrhythmias\r | 229 | ||
| INTRODUCTION | 229 | ||
| CLINICAL PRESENTATION | 229 | ||
| Classification | 230 | ||
| Atrioventricular Nodal Reentrant Tachycardia. Atrioventricular nodal reentrant tachycardia is the most common (60%) paroxysmal s... | 230 | ||
| Pathophysiology. The electrical substrate for AVNRT consists of dual atrioventricular (AV) nodal pathways.1 Whereas fast pathway... | 230 | ||
| Electrocardiographic Characteristics. Atrioventricular nodal reentrant tachycardia is characterized by a ventricular rate of 150... | 230 | ||
| Electrophysiologic Characteristics. In typical AVNRT (slow–fast), earliest retrograde atrial activation is recorded near the His... | 230 | ||
| Orthodromic Atrioventricular Reciprocating Tachycardia. Orthodromic AVRT is the second most common (30%) PSVT in adults.10 Ortho... | 230 | ||
| Pathophysiology. In orthodromic AVRT, the normal AV conduction system serves as the antegrade limb, and an AV accessory pathway ... | 230 | ||
| Electrocardiographic Characteristics. Orthodromic AVRT is characterized by a regular ventricular rate of 150 to 250 beats/min an... | 232 | ||
| Electrophysiologic Characteristics. In the presence of the manifest accessory pathway, incremental atrial pacing progressively i... | 232 | ||
| Focal Atrial Tachycardia. Focal AT (FAT) is the third most common SVT (≈10%).16 Men and women seem to be equally affected | 233 | ||
| Pathophysiology. Focal AT arises from a single atrial focus. Focal ATs have a characteristic distribution within right and left ... | 233 | ||
| Electrocardiographic Characteristics. The atrial rate during FAT is generally between 110 and 250 beats/min. AV conduction is us... | 233 | ||
| Electrophysiologic Characteristics. Microreentrant and triggered-activity AT can be initiated by atrial extrastimulation or atri... | 234 | ||
| Atrial Flutter. Atrial flutter is uncommon in normal hearts (1.7%).19,20 AFL is 2.5 times more common in men.19 | 234 | ||
| Pathophysiology. Typical AFL uses the isthmus between the tricuspid annulus and inferior vena cava as necessary components of th... | 234 | ||
| Electrocardiographic Characteristics. Characteristic ECG features of the typical AFL include an atrial rate of 250 to 350 beats/... | 236 | ||
| Electrophysiologic Characteristics. In counterclockwise typical AFL, the impulse travels through the low septum, ascends superio... | 236 | ||
| Atrial Fibrillation. Atrial fibrillation is the most common cardiac arrhythmia in humankind. The prevalence of AF is higher in m... | 237 | ||
| Pathophysiology. The majority of AF episodes are initiated by ectopies from pulmonary veins. However, a minority of AF attacks a... | 237 | ||
| Electrocardiographic Characteristics. In AF, there is no organized atrial activity; therefore, no discrete P-waves are seen. Fib... | 237 | ||
| Electrophysiologic Characteristics. Intracardiac recordings clearly show beat-to-beat variability in the atrial electrogram (EGM... | 237 | ||
| Sinus Tachycardia (Including Inappropriate Sinus Tachycardia and Sinoatrial Nodal Reentrant Tachycardia). Sinus tachycardia is o... | 237 | ||
| Pathophysiology. Sinus tachycardia is a normal physiologic response to conditions in which there is enhanced catecholamine relea... | 238 | ||
| Electrocardiographic Characteristics. In sinus tachycardia, P-wave axis and morphology are similar or identical to sinus rhythm.... | 238 | ||
| Electrophysiologic Characteristics. Sinus tachycardia can be initiated by sympathomimetic agents in the electrophysiology labora... | 239 | ||
| Evaluation | 239 | ||
| Treatment | 239 | ||
| Regular Narrow Complex Tachycardia. In hemodynamically stable tachycardia, vagal maneuvers, IV adenosine, IV calcium antagonists... | 239 | ||
| Irregular Narrow Complex Tachycardia. In stable tachycardia, rate control and an antithrombotic are recommended to improve sympt... | 240 | ||
| Wide Complex Tachycardia | 240 | ||
| Etiology | 240 | ||
| Classification | 240 | ||
| Aberrant Supraventricular Tachycardia. All previously mentioned NCTs may present with WCT caused by baseline or rate-dependent a... | 241 | ||
| Pathophysiology. The supraventricular impulse can be delayed or blocked in the His-Purkinje system, giving rise to a wide QRS. T... | 241 | ||
| Electrocardiographic Characteristics. If available, a previous ECG when the patient was in normal sinus rhythm may be helpful. T... | 241 | ||
| Electrophysiologic Characteristics. Electrophysiologic characteristics of the aberrant SVT are similar to the SVT with narrow co... | 241 | ||
| Antidromic Atrioventricular Reciprocating Tachycardia. Antidromic AVRT is the least common arrhythmia associated with Wolff-Park... | 241 | ||
| Pathophysiology. In antidromic AVRT, antegrade conduction occurs over an accessory pathway, and retrograde conduction occurs ove... | 241 | ||
| Electrocardiographic Characteristics. Electrocardiog | 241 | ||
| Electrophysiologic Characteristics. The initial site of atrial activation in classic antidromic AVRT is consistent with retrogra... | 242 | ||
| Monomorphic Ventricular Tachycardia. Monomorphic VT is the most frequent cause of WCT (≤80%), especially in patients with struct... | 242 | ||
| Pathophysiology. Monomorphic VT may be idiopathic, but most of patients have underlying cardiac disease. VT usually originates f... | 242 | ||
| Electrocardiographic Characteristics. Monomorphic VT is characterized by three or more consecutive uniform ventricular ectopies ... | 242 | ||
| Electrophysiologic Characteristics. Ventricular tachycardia is characterized by AV dissociation and a negative HV interval or HV... | 244 | ||
| Pacemaker-Mediated Tachycardia. A variety of tachycardias may be encountered in which the pacing system is functioning normally.... | 244 | ||
| Pathophysiology. Regular WCT in patients with a pacemaker may be due to tracking of a native atrial tachyarrhythmia,35 ELT,36 or... | 244 | ||
| Electrocardiographic Characteristics. Most transvenous ventricular pacemakers pace the right ventricle, causing an LBBB pattern ... | 244 | ||
| Electrophysiologic Characteristics. Pacemaker-mediated tachycardia caused by sinus tachycardia or atrial tachyarrhythmias is eas... | 245 | ||
| Preexcited Atrial Fibrillation. Preexcited AF is one of the major causes of irregular WCT. AF with aberrant conduction is the mo... | 245 | ||
| Pathophysiology. The risk of AF or AFL is increased in patients with WPW.38,39 There is usually variable QRS morphology, dependi... | 245 | ||
| Electrocardiographic Characteristics. Preexcited AF is characterized by irregular tachycardia with variable QRS morphology. Ther... | 245 | ||
| Electrophysiologic Characteristics. The risk of AF is higher in the patients with a short antegrade effective refractory period ... | 245 | ||
| Artifactual Tachycardia. Sometimes ECG artifact may mimic WCT such as VT or VF. The presence of narrow-complex beats marching wi... | 245 | ||
| Polymorphic Ventricular Tachycardia. Polymorphic VT is a rare cause of irregular WCT | 245 | ||
| Pathophysiology. Polymorphic VT may occur in the setting of a normal or prolonged QT interval. For patients with polymorphic VT ... | 245 | ||
| Electrocardiographic Characteristics. Polymorphic VT is defined as an unstable rhythm with a continuously varying QRS complex mo... | 246 | ||
| Electrophysiologic Characteristics. Polymorphic VT is characterized by irregular WCT and AV dissociation. This type of VT can be... | 246 | ||
| Evaluation | 246 | ||
| Treatment | 247 | ||
| REFERENCES | 247 | ||
| 14 - Cardiac Implantable Electronic Devices\r | 251 | ||
| INTRODUCTION | 251 | ||
| NBG CODES FOR PACEMAKERS | 251 | ||
| NBD CODES FOR DEFIBRILLATORS | 252 | ||
| CLASSIFICATION OF CARDIAC IMPLANTABLE ELECTRONIC DEVICES | 253 | ||
| Transvenous Systems | 253 | ||
| Epicardial Systems | 253 | ||
| Novel Systems | 253 | ||
| COMPONENTS OF CARDIAC IMPLANTABLE ELECTRONIC DEVICES | 253 | ||
| Pulse Generator | 253 | ||
| Pacing or High-Voltage Leads (Electrodes) | 253 | ||
| PACING MODES | 253 | ||
| VOO/AOO Mode | 253 | ||
| VVI/AAI Mode | 254 | ||
| VVIR/AAIR | 254 | ||
| Hysteresis | 254 | ||
| Noise Reversion | 254 | ||
| VDD Mode | 254 | ||
| DOO Mode | 254 | ||
| DDI/DDIR Mode | 254 | ||
| DDD/DDDR Mode | 254 | ||
| TIMING CYCLE OF PACING | 254 | ||
| Single-Chamber Timing | 255 | ||
| Dual-Chamber Timing | 255 | ||
| Upper Rate Behavior | 256 | ||
| Wenckebach Pattern | 256 | ||
| 2:1 AV Block | 256 | ||
| PROGRAMMING CONSIDERATIONS FOR IMPLANTABLE CARDIOVERTER DEFIBRILLATORS | 256 | ||
| Minimizing Right Ventricular Pacing | 256 | ||
| Shock Reduction | 257 | ||
| OPTIMIZING CARDIAC RESYNCHRONIZATION THERAPY BY DEVICE PROGRAMMING | 257 | ||
| TROUBLESHOOTING | 257 | ||
| Undersensing | 257 | ||
| Oversensing | 258 | ||
| Loss of Capture | 258 | ||
| No Output | 258 | ||
| Pseudomalfunctions | 258 | ||
| REFERENCES | 259 | ||
| 15 - Bradyarrhythmias\r | 261 | ||
| INTRODUCTION | 261 | ||
| CLINICAL PRESENTATION | 261 | ||
| Sinus Node Dysfunction | 261 | ||
| Etiology | 261 | ||
| Classification | 262 | ||
| Diagnostic Modalities | 264 | ||
| Atrioventricular Block | 264 | ||
| Etiology | 264 | ||
| Classification | 264 | ||
| Diagnostic Modalities | 266 | ||
| Treatment | 266 | ||
| REFERENCES | 267 | ||
| 16 - Preventive Cardiology\r | 269 | ||
| HYPERTENSION | 269 | ||
| DYSLIPIDEMIA | 271 | ||
| SMOKING | 273 | ||
| DIABETES AND METABOLIC SYNDROME | 274 | ||
| Metabolic Syndrome (Syndrome X) | 275 | ||
| OBESITY | 276 | ||
| PHYSICAL ACTIVITY | 276 | ||
| DIET AND SUPPLEMENTS | 277 | ||
| Macronutrients | 277 | ||
| Carbohydrates and Dietary Fiber | 277 | ||
| Foods | 277 | ||
| Diet Patterns | 277 | ||
| Alcohol Consumption | 278 | ||
| Vitamin D | 278 | ||
| Coenzyme Q10 | 278 | ||
| INFLAMMATORY MARKERS | 278 | ||
| CARDIAC REHABILITATION | 279 | ||
| REFERENCES | 280 | ||
| 17 - Hypertension\r | 291 | ||
| INTRODUCTION | 291 | ||
| MECHANISMS OF HYPERTENSION | 291 | ||
| DIAGNOSIS OF HYPERTENSION | 292 | ||
| Initial Evaluation | 293 | ||
| Secondary Hypertension | 293 | ||
| HYPERTENSION MANAGEMENT | 293 | ||
| Lifestyle Modification | 293 | ||
| Drug Therapy | 294 | ||
| First Class Drugs | 294 | ||
| Calcium Channel Blockers. Nondihydropyridines such as diltiazem and verapamil are weak antihypertensive drugs (verapamil is weak... | 294 | ||
| RAS Inhibitors. Although many recent guidelines accept all three first class drugs to initiate hypertension therapy in patients ... | 297 | ||
| Thiazide-Type Diuretics. These are very effective drugs, especially when combined with the above-mentioned classes. As said befo... | 297 | ||
| Add-On Drugs | 297 | ||
| Aldosterone Antagonists. Spironolactone is one of the best add-on drugs, and it has shown much success in controlling resistant ... | 297 | ||
| Beta Blockers. This class of drugs can be used as add-on drugs in isolated hypertension cases, but CAD, heart failure, atrial fi... | 297 | ||
| Alpha Blockers. Drugs such as prazosin and terazosin, which are used for prostatism, are good add-on drugs for controlling hyper... | 298 | ||
| Central Sympatholytics. These are effective drugs as add-on drugs or oral agents used in hypertension urgencies. They can be hel... | 298 | ||
| Direct Vasodilators. Hydralazine is a good choice in pregnancy and is effective in patients with heart failure when combined wit... | 298 | ||
| RESISTANT HYPERTENSION | 298 | ||
| HYPERTENSION IN PREGNANCY | 298 | ||
| PERIOPERATIVE HYPERTENSION MANAGEMENT | 299 | ||
| THERAPEUTIC GOALS IN HYPERTENSION | 299 | ||
| ACUTE BLOOD PRESSURE ELEVATIONS | 299 | ||
| REFERENCES | 300 | ||
| 18 - Dyslipidemia\r | 303 | ||
| INTRODUCTION | 303 | ||
| BIOCHEMISTRY AND METABOLISM OF LIPIDS | 303 | ||
| Intestinal Pathway | 303 | ||
| Hepatic Pathway | 303 | ||
| Reverse Cholesterol Transport | 305 | ||
| LIPOPROTEIN DISORDERS | 305 | ||
| Primary Lipid Disorders | 305 | ||
| IMPACT OF LIPOPROTEIN DISORDERS ON CARDIOVASCULAR RISK | 306 | ||
| MANAGEMENT OF LIPOPROTEIN DISORDERS | 306 | ||
| TREATMENT GOALS IN LIPOPROTEIN DISORDERS | 308 | ||
| REFERENCES | 308 | ||
| 19 - ST-Segment Elevation Myocardial Infarction\r | 311 | ||
| DEFINITION | 311 | ||
| ST-Segment Elevation Myocardial Infarction in Special Groups | 312 | ||
| CLINICAL EVALUATION | 312 | ||
| Electrocardiography | 313 | ||
| Cardiac Biomarkers | 313 | ||
| TREATMENT | 314 | ||
| Coronary Artery Bypass Graft Surgery | 315 | ||
| Medications | 315 | ||
| Fibrinolysis for Acute ST-Segment Elevation Myocardial Infarction | 316 | ||
| Indications | 317 | ||
| Contraindications | 317 | ||
| COMPLICATIONS OF ST-SEGMENT ELEVATION MYOCARDIAL INFARCTION | 318 | ||
| Conduction Abnormalities After Myocardial Infarction | 318 | ||
| Management of Atrioventricular Block | 318 | ||
| Ventricular Arrhythmia During Acute Myocardial Infarction | 318 | ||
| Sustained Ventricular Tachycardia | 318 | ||
| Treatment. Patients with sustained polymorphic VT, very rapid VT, or pulseless monomorphic VT should be treated with unsynchroni... | 318 | ||
| Ventricular Fibrillation | 318 | ||
| Mechanical Complications of ST-Segment Elevation Myocardial Infarction | 319 | ||
| Left Ventricular Free Wall Rupture | 319 | ||
| Effect of Reperfusion | 319 | ||
| Late Reperfusion | 319 | ||
| Clinical Presentation. Perforation can present as unexpected death in a case of silent MI. With a known MI, complete or incomple... | 319 | ||
| Management. When fluid is visualized by echocardiography, pericardiocentesis is suggested. Immediate surgery is indicated if the... | 320 | ||
| Rupture of the Interventricular Septum | 320 | ||
| Mitral Regurgitation | 320 | ||
| Pericardial Complications of Myocardial Infarction | 321 | ||
| Peri-infarction Pericarditis | 321 | ||
| Pericardial Effusion (with or Without Tamponade) | 321 | ||
| Postcardiac Injury (Dressler) Syndrome | 322 | ||
| REFERENCES | 322 | ||
| 20 - Percutaneous Coronary Intervention\r | 329 | ||
| PLAIN OLD BALLOON ANGIOPLASTY | 329 | ||
| BARE METAL STENTS | 329 | ||
| DRUG-ELUTING STENTS | 329 | ||
| STENT THROMBOSIS | 329 | ||
| CHRONIC STABLE ANGINA | 330 | ||
| PERCUTANEOUS CORONARY INTERVENTION IN LEFT MAIN CORONARY ARTERY LESIONS | 330 | ||
| MULTIVESSEL DISEASE | 331 | ||
| PATIENTS WITH DIABETES MELLITUS | 331 | ||
| PERCUTANEOUS CORONARY INTERVENTION IN ACUTE CORONARY SYNDROME | 331 | ||
| INTRAVASCULAR ULTRASONOGRAPHY | 331 | ||
| FRACTIONAL FLOW RESERVE | 331 | ||
| ROTABLATOR (ROTATIONAL ATHERECTOMY) | 332 | ||
| POSTINTERVENTION CARE | 332 | ||
| REFERENCES | 334 | ||
| 21 - Transcatheter Therapies for Structural Heart Diseases\r | 337 | ||
| INTERVENTION IN STRUCTURAL HEART DISORDERS | 337 | ||
| OCCLUSION OF CARDIAC DEFECTS | 337 | ||
| Patent Foramen Ovale | 337 | ||
| Cryptogenic Stroke | 337 | ||
| Patent Foramen Ovale Closure | 337 | ||
| Other Possible Links | 338 | ||
| Atrial Septal Defect | 338 | ||
| Ventricular Septal Defect | 339 | ||
| Left Atrial Appendage Occlusion | 339 | ||
| Paravalvular Leak Closure | 340 | ||
| MITRAL VALVE INTERVENTIONS | 340 | ||
| Balloon Mitral Valvuloplasty | 340 | ||
| Indications | 341 | ||
| Percutaneous Mitral Valve Repair | 341 | ||
| AORTA AND AORTIC VALVE INTERVENTIONS | 342 | ||
| Balloon Aortic Valvuloplasty | 342 | ||
| Transcatheter Aortic Valve Implantation | 342 | ||
| Coarctation of the Aorta | 343 | ||
| PULMONARY VALVE INTERVENTION | 343 | ||
| Pulmonary Valvuloplasty | 343 | ||
| Percutaneous Pulmonary Valve Implantation | 344 | ||
| REFERENCES | 346 | ||
| 22 - Aortic Disorders and Their Management\r | 349 | ||
| AORTIC DISEASES | 349 | ||
| Epidemiology and Screening Strategies of Aortic Aneurysms | 349 | ||
| Abdominal Aortic Aneurysms | 349 | ||
| Thoracic Aortic Aneurysms | 351 | ||
| PATHOLOGY AND PATHOPHYSIOLOGY OF AORTIC ANEURYSMS | 351 | ||
| Abdominal Aortic Aneurysm (Fig. 22.4) | 351 | ||
| Thoracic Aortic Aneurysm (Fig. 22.5) | 352 | ||
| Marfan Syndrome | 352 | ||
| Ehlers-Danlos Syndrome | 352 | ||
| Bicuspid Aortic Valve | 353 | ||
| MANAGEMENT (FIG. 22.8) | 354 | ||
| Medical Therapy | 354 | ||
| Thoracic Aortic Aneurysms | 354 | ||
| Abdominal Aortic Aneurysm | 354 | ||
| Open Surgery or Endovascular Therapy | 355 | ||
| ACUTE AORTIC SYNDROMES | 357 | ||
| Aortic Dissection and Its Variants | 357 | ||
| Aortic Dissection | 357 | ||
| Pathophysiology | 358 | ||
| Clinical Manifestations | 359 | ||
| Approach to Patients with Suspicious Aortic Dissection (Fig. 22.14) | 361 | ||
| Treatment (Fig. 22.15) | 364 | ||
| Aortic Dissection Variants | 364 | ||
| Ruptured Abdominal Aortic Aneurysm | 364 | ||
| REFERENCES | 366 | ||
| 23 - Peripheral Artery Disease\r | 367 | ||
| EPIDEMIOLOGY | 367 | ||
| CLINICAL MANIFESTATIONS | 367 | ||
| DIAGNOSIS | 368 | ||
| Imaging | 369 | ||
| Disease Severity Classification | 369 | ||
| Screening | 371 | ||
| TREATMENT | 371 | ||
| Antiplatelet and Anticoagulant Therapy | 371 | ||
| Statins | 371 | ||
| Glycemic Control | 371 | ||
| Smoking Cessation | 371 | ||
| Antihypertensive Therapy | 372 | ||
| Supervised Exercise Training | 372 | ||
| Specific Drugs for Treatment of Claudication | 372 | ||
| Cilostazol | 372 | ||
| Pentoxifylline | 372 | ||
| Naftidrofuryl | 372 | ||
| Endovascular or Surgical Intervention | 372 | ||
| Aortoiliac Disease | 373 | ||
| Femoropopliteal Disease | 373 | ||
| Tibioperoneal Disease | 373 | ||
| REFERENCES | 373 | ||
| 24 - Cardiomyopathies and Myocarditis\r | 377 | ||
| BACKGROUND | 377 | ||
| DILATED CARDIOMYOPATHY | 377 | ||
| Key Points About Peripartum Cardiomyopathy9,10,13 | 377 | ||
| Key Points and Recommendations for Cardiotoxicity Monitoring and Management4,5,14 | 377 | ||
| ARRHYTHMOGENIC RIGHT VENTRICULAR CARDIOMYOPATHY15-17 | 379 | ||
| RESTRICTIVE CARDIOMYOPATHY | 379 | ||
| Background | 379 | ||
| Key Points About Restrictive Cardiomyopathy | 379 | ||
| Idiopathic Primary Restrictive Cardiomyopathy | 379 | ||
| Infiltrative Restrictive Cardiomyopathy | 379 | ||
| Amyloidosis | 380 | ||
| Key Points About Amyloidosis25-28 | 380 | ||
| Hemochromatosis | 380 | ||
| Diagnosis | 381 | ||
| Key Points About Hemochromatosis29-31 | 381 | ||
| Cardiac Sarcoidosis | 382 | ||
| Key Points About Cardiac Sarcoidosis | 382 | ||
| Constrictive Versus Restrictive Physiology | 382 | ||
| HYPERTROPHIC CARDIOMYOPATHY | 384 | ||
| Background | 384 | ||
| Key Points About Hypertrophic Cardiomyopathy | 384 | ||
| Diagnostic Criteria | 384 | ||
| Key Points About Hypertrophic Cardiomyopathy | 385 | ||
| Treatment of Obstructive Hypertrophic Cardiomyopathy | 385 | ||
| Hemodynamic Study of Hypertrophic Cardiomyopathy | 386 | ||
| Key Points | 386 | ||
| Key Points About Myocarditis | 387 | ||
| Treatment of Myocarditis | 388 | ||
| REFERENCES | 392 | ||
| 25 - Valvular Heart Disease\r | 395 | ||
| AORTIC VALVE | 395 | ||
| Aortic Stenosis | 395 | ||
| Epidemiology | 395 | ||
| Causes and Pathology | 395 | ||
| Pathophysiology | 395 | ||
| Clinical Findings | 396 | ||
| Physical Examination | 399 | ||
| Diagnostic Testing | 400 | ||
| Electrocardiography | 400 | ||
| Chest radiography. A normal-sized heart and a dilated ascending aorta (poststenotic dilation) constitute the usual findings in a... | 400 | ||
| Echocardiography. Transthoracic echocardiography (TTE) is the gold-standard imaging modality for the initial evaluation and foll... | 400 | ||
| Transesophageal echocardiography. Transesophageal echocardiography (TEE) is not recommended for the routine evaluation of AS, bu... | 400 | ||
| Cardiac imaging. Cardiac CT is a useful method for the evaluation of the aortic root and ascending aorta dilatation in patients ... | 400 | ||
| Cardiac catheterization and angiography. In most patients, echocardiography can provide sufficient hemodynamic data for patient ... | 401 | ||
| Exercise stress testing. The use of the exercise test in patients with severe asymptomatic AS is reasonable (class IIa) in that ... | 401 | ||
| Hemodynamic progression. The progression rate is very variable. Older age, more calcification of the AV, hypertension, hyperlipi... | 401 | ||
| Low-Flow, Low-Gradient Aortic Stenosis | 401 | ||
| Low-Flow, Low-Gradient Aortic Stenosis with Normal Left Ventricular Systolic Function | 402 | ||
| 26 - Infective Endocarditis\r | 443 | ||
| EPIDEMIOLOGY | 443 | ||
| MICROBIOLOGY | 443 | ||
| Blood Culture–Positive Infective Endocarditis | 443 | ||
| Blood Culture–Negative Infective Endocarditis (Table 26.2) | 444 | ||
| Histologic Features of Infective Endocarditis | 444 | ||
| DIAGNOSIS | 446 | ||
| Clinical Presentation | 446 | ||
| Laboratory Findings | 448 | ||
| Imaging Techniques | 448 | ||
| Echocardiography | 449 | ||
| Multislice computed tomography | 449 | ||
| Magnetic resonance imaging | 449 | ||
| Nuclear imaging | 451 | ||
| Diagnostic Criteria | 451 | ||
| TREATMENT | 452 | ||
| Antimicrobial Therapy (Tables 26.8 To 26.11) | 452 | ||
| Indications and Timing of Surgery | 457 | ||
| Outpatient Management and Follow-Up Evaluation | 457 | ||
| Short-Term Follow-Up | 457 | ||
| Long-Term Prognosis | 457 | ||
| REFERENCES | 459 | ||
| 27 - Pericardial Disease | 461 | ||
| NORMAL PERICARDIUM, ANATOMY, AND FUNCTION | 461 | ||
| CAUSES, EPIDEMIOLOGY, AND PATHOPHYSIOLOGY OF ACUTE PERICARDITIS | 461 | ||
| Epidemiology | 461 | ||
| Clinical Presentation, History, and Physical Examination | 461 | ||
| Diagnosis | 463 | ||
| Electrocardiography | 463 | ||
| Laboratory Findings | 463 | ||
| Imaging: Echocardiography, Computed Tomography, and Magnetic Resonance Imaging | 463 | ||
| Natural History and Management | 463 | ||
| RELAPSING AND RECURRENT PERICARDITIS | 464 | ||
| PERICARDIAL EFFUSION | 464 | ||
| TAMPONADE | 464 | ||
| Pathophysiology and Hemodynamics | 465 | ||
| Specific Types of Tamponade | 465 | ||
| Clinical Features | 465 | ||
| Diagnostic Testing | 465 | ||
| Electrocardiography. The ECG shows tachycardia, low voltage, and electrical alternance caused by swinging heart | 465 | ||
| Chest radiography. Moderate or more PE on chest radiography may be detected by flasklike cardiomegaly (Fig. 27.1) | 466 | ||
| Echocardiography. Echocardiography is the first-choice imaging modality for the diagnosis of PE. The accuracy of TTE to detect P... | 466 | ||
| Computed Tomography and Magnetic Resonance Imaging. Ordinarily, CT and MRI are not requested. However, they are used in loculate... | 467 | ||
| Management | 467 | ||
| Analysis of the Pericardial Fluid | 468 | ||
| CONSTRICTIVE PERICARDITIS | 468 | ||
| Pathophysiology | 468 | ||
| Clinical Findings | 468 | ||
| Physical Examination | 468 | ||
| Diagnostic Findings | 468 | ||
| Electrocardiography | 468 | ||
| Chest Radiography | 468 | ||
| Echocardiographic Features of Constrictive Pericarditis | 468 | ||
| Two-dimensional findings | 468 | ||
| M-mode findings | 469 | ||
| Doppler findings | 469 | ||
| Tissue doppler imaging | 469 | ||
| Cardiac Imaging | 469 | ||
| Cardiac Catheterization | 471 | ||
| DIFFERENTIATING CONSTRICTIVE PERICARDITIS FROM RESTRICTIVE CARDIOMYOPATHY | 471 | ||
| Management | 471 | ||
| EFFUSIVE–CONSTRICTIVE PERICARDITIS | 472 | ||
| Specific Causes of Pericardial Disease Infectious Disease | 472 | ||
| PERICARDIAL DISEASE IN HUMAN IMMUNODEFICIENCY VIRUS: CAUSES AND PATHOLOGY | 473 | ||
| TUBERCULOSIS | 473 | ||
| PERICARDITIS IN PATIENTS WITH RENAL DISEASE | 473 | ||
| DRESSLER SYNDROME AND POST–MYOCARDIAL INFARCTION PERICARDITIS | 473 | ||
| PERICARDITIS AFTER RADIATION | 473 | ||
| PERICARDIAL DISEASE IN CANCER | 474 | ||
| Primary Pericardial Tumor | 474 | ||
| INFLAMMATORY PERICARDIAL DISEASE | 474 | ||
| POST–CARDIAC SURGERY PERICARDITIS | 474 | ||
| Stress Cardiomyopathy | 474 | ||
| Hemopericardium | 474 | ||
| PERICARDIAL DISEASE IN SPECIAL POPULATIONS | 475 | ||
| Thyroid Disease | 475 | ||
| Pregnancy | 475 | ||
| Congenital Anomaly of the Pericardium | 475 | ||
| REFERENCES | 475 | ||
| 28 - Congenital Heart Disease | 477 | ||
| BASIC NOMENCLATURE AND SEGMENTAL APPROACH TO CONGENITAL HEART DISEASE | 477 | ||
| Sidedness (Situs) | 477 | ||
| Cardiac Orientation | 477 | ||
| Atrioventricular Connections | 477 | ||
| Ventriculoarterial Connections | 477 | ||
| CLINICAL ISSUES IN CONGENITAL HEART DISEASE | 478 | ||
| Cyanosis | 478 | ||
| Pathologic consequences | 478 | ||
| Pulmonary Arterial Hypertension and Eisenmenger Syndrome | 479 | ||
| CLINICAL EVALUATION OF CONGENITAL HEART DISEASE | 479 | ||
| Physical Examination | 479 | ||
| Electrocardiography | 479 | ||
| Chest Radiography | 479 | ||
| Echocardiography, Magnetic Resonance Imaging, and Computed Tomography | 479 | ||
| Cardiac Catheterization and Hemodynamic Study | 479 | ||
| Evaluation of circulatory shunts | 479 | ||
| Vascular resistance | 480 | ||
| Pulmonary vasoreactivity testing | 481 | ||
| SPECIFIC CONGENITAL CARDIAC DEFECTS | 481 | ||
| Investigations | 481 | ||
| Clinical examination. Findings include equalization of a and v waves in the jugular vein pulse, wide and fixed splitting of S2, ... | 481 | ||
| Electrocardiography. Right-axis deviation, incomplete right bundle branch block (RBBB) and “crochetage” sign or notching of the ... | 481 | ||
| Chest radiography. The RA and RV are enlarged, and there is evidence of pulmonary overflow or shunt vascularity. A small aortic ... | 482 | ||
| Echocardiography. The interatrial septal defect may be visualized by transthoracic echocardiography (TTE) in subcostal, apical f... | 482 | ||
| Cardiac catheterization. Catheterization is performed when other imaging modalities are inadequate, when evaluation of coronary ... | 482 | ||
| Closure of atrial septal defect. The following are indications for ASD closure | 482 | ||
| Patent Foramen Ovale | 482 | ||
| Ventricular Septal Defect | 482 | ||
| 29 - Venous Thromboembolism | 499 | ||
| INTRODUCTION | 499 | ||
| EPIDEMIOLOGY | 499 | ||
| CLINICAL RISK FACTORS | 499 | ||
| PATHOPHYSIOLOGY OF VENOUS THROMBOEMBOLISM | 500 | ||
| APPROACH TO PATIENTS WITH ACUTE DEEP VEIN THROMBOSIS | 503 | ||
| History and Physical Examination | 503 | ||
| Differential Diagnosis | 503 | ||
| D-dimer. D-dimer, or “the degradation product of cross-linked fibrin,” is the main laboratory test used in the diagnosis of DVT.... | 504 | ||
| Compression ultrasonography. Compression ultrasonography is now considered the noninvasive approach of choice in patients with s... | 504 | ||
| Magnetic resonance venography. Magnetic resonance venography (MRV) is among the most accurate diagnostic modalities for detectin... | 504 | ||
| Contrast venography. Contrast venography is still considered the gold standard for the diagnosis of DVT. Substituted by noninvas... | 505 | ||
| Practical Approach for Patients with Suspected Deep Vein Thrombosis | 505 | ||
| Approach to Patients with Acute Pulmonary Embolism | 505 | ||
| Clinical presentation | 505 | ||
| Differential diagnosis | 505 | ||
| D-dimer. See the earlier discussion | 506 | ||
| Electrocardiography. Signs of right ventricular strain such as S1Q3T3, S1S2S3, inverted T wave in right precordial leads, or new... | 506 | ||
| Imaging methods. Echocardiography: Depending on the severity of PE, from RV dilation and dysfunction together with pulmonary hyp... | 506 | ||
| Practical approach to patients with pulmonary emboli | 507 | ||
| ADDITIONAL TEST FOR PATIENTS WITH ESTABLISHED VENOUS THROMBOEMBOLISM | 508 | ||
| Screening for Hypercoagulable State | 508 | ||
| Screening for Malignancies | 508 | ||
| CLINICAL COURSE | 509 | ||
| Recurrent Venous Thromboembolism | 509 | ||
| Postthrombotic Syndrome | 510 | ||
| Chronic Thromboembolic Pulmonary Hypertension | 511 | ||
| Post-Pulmonary Thromboembolism Syndrome | 511 | ||
| TREATMENT | 511 | ||
| Anticoagulation | 511 | ||
| How to start anticoagulation therapy | 514 | ||
| How to continue anticoagulation therapy | 515 | ||
| When anticoagulation therapy should be discontinued | 516 | ||
| Bleeding risk and bleeding complications of anticoagulation therapies | 516 | ||
| Systemic Thrombolytic Therapy in Patients with Venous Thromboembolism | 517 | ||
| Deep vein thrombosis | 517 | ||
| Pulmonary thromboembolism | 517 | ||
| Pharmacomechanical Catheter-Directed Therapies | 517 | ||
| Surgical Management | 517 | ||
| SPECIAL THERAPEUTIC CONSIDERATION FOR PATIENTS WITH VENOUS THROMBOEMBOLISM | 518 | ||
| Ambulation in Patients with Deep Vein Thrombosis | 518 | ||
| Inferior Vena Cava Filters | 518 | ||
| Outpatient Management | 519 | ||
| Multidisciplinary Pulmonary Embolism Response Team | 519 | ||
| PREVENTION | 519 | ||
| In-Hospital Risk Factors for Venous Thromboembolism and Bleeding | 519 | ||
| In-Hospital Prophylaxis | 519 | ||
| Mechanical Prophylaxis | 519 | ||
| Prophylaxis in Major Orthopedic Surgery | 520 | ||
| REFERENCES | 520 | ||
| 30 - Cardiovascular Genetics | 525 | ||
| INTRODUCTION | 525 | ||
| GENETIC TESTING | 525 | ||
| CONGENITAL HEART DEFECTS | 526 | ||
| CARDIOMYOPATHIES | 530 | ||
| GENETICS OF CARDIAC ELECTROPHYSIOLOGY | 531 | ||
| COAGULATION AND FIBRINOLYSIS | 532 | ||
| REFERENCES | 532 | ||
| 31 - Renal Disorders and Cardiovascular Disease | 535 | ||
| HOMEOSTASIS | 535 | ||
| General Considerations | 535 | ||
| CLASSIFICATIONS AND DEFINITIONS | 535 | ||
| DIAGNOSIS | 535 | ||
| RESPIRATORY ACIDOSIS | 537 | ||
| RESPIRATORY ALKALOSIS | 537 | ||
| METABOLIC ACIDOSIS | 538 | ||
| METABOLIC ALKALOSIS | 539 | ||
| CARDIORENAL SYNDROME | 540 | ||
| Practical Points in Cardiorenal Syndrome Type 122-29 | 540 | ||
| Clinical Scenarios for Cardiorenal Syndrome Type 1 | 541 | ||
| First Scenario | 541 | ||
| Second Scenario | 541 | ||
| Third Scenario | 541 | ||
| Practical Points in Cardiorenal Syndrome Type 222-29 | 542 | ||
| Cardiorenal Syndrome Type 3: Acute Renocardiac Syndrome22,29 | 542 | ||
| Practical Points in Cardiorenal Syndrome Type 3 | 542 | ||
| Cardiorenal Syndrome Type 4: Chronic Renocardiac Syndrome22,29 | 542 | ||
| Practical Points in Cardiorenal Syndrome Type 4 | 542 | ||
| Cardiorenal Syndrome Type 5 (Secondary CRS)22,29 | 544 | ||
| REFERENCES | 544 | ||
| 32 - Endocrine Disorders and the Cardiovascular System | 545 | ||
| ANTERIOR PITUITARY | 545 | ||
| ADULT GROWTH HORMONE DEFICIENCY | 545 | ||
| GHD and cardiovascular risk factor8 | 545 | ||
| Diagnosis | 546 | ||
| ACROMEGALY | 546 | ||
| Cardiovascular System and Acromegaly | 546 | ||
| THYROID AND CARDIOVASCULAR SYSTEM | 546 | ||
| Thyrotoxicosis | 546 | ||
| Clinical and Hemodynamic Manifestations | 546 | ||
| HYPOTHYROIDISM | 547 | ||
| THYROID AND AMIODARONE | 547 | ||
| Amiodarone Induced Hypothyroidism | 547 | ||
| TREATMENT | 547 | ||
| Amiodarone-Induced Thyrotoxicosis | 547 | ||
| Diagnosis | 547 | ||
| ENDOCRINE HYPERTENSION | 548 | ||
| Primary aldosteronism | 548 | ||
| PHEOCHROMOCYTOMA | 548 | ||
| CUSHING SYNDROME | 548 | ||
| REFERENCES | 549 | ||
| 33 - The Heart and Pulmonary Diseases | 553 | ||
| INTRODUCTION | 553 | ||
| HEART DYSFUNCTION CAUSED BY CHRONIC RESPIRATORY DISEASE | 553 | ||
| INTERSTITIAL LUNG DISEASES OR DIFFUSE PARENCHYMAL LUNG DISEASES | 554 | ||
| SLEEP APNEA AND HYPOVENTILATION SYNDROME | 554 | ||
| PATHOPHYSIOLOGY | 555 | ||
| CLINICAL PRESENTATION AND DIAGNOSIS | 556 | ||
| TREATMENT | 557 | ||
| SYSTEMIC DISEASES WITH CONCOMITANT LUNG AND HEART INVOLVEMENT | 557 | ||
| MALIGNANT LUNG DISEASES AND THE HEART | 558 | ||
| 34 - Cardiovascular Drugs and Hemostasis | 561 | ||
| INTRODUCTION | 561 | ||
| Cardiovascular Reactions | 561 | ||
| Nephropathy | 561 | ||
| STRATEGY FOR PREVENTING RADIOCONTRAST-INDUCED NEPHROPATHY | 562 | ||
| HYPERSENSITIVITY REACTIONS TO RADIOGRAPHIC CONTRAST MEDIA | 562 | ||
| PREMEDICATION REGIMEN IN IMMEDIATE HYPERSENSITIVITY REACTION | 563 | ||
| INTRODUCTION | 563 | ||
| ASPIRIN THERAPY | 563 | ||
| THIENOPYRIDINE THERAPY | 564 | ||
| TICLOPIDINE | 564 | ||
| 35 - Stable Ischemic Heart Disease | 591 | ||
| INTRODUCTION | 591 | ||
| PATHOPHYSIOLOGY | 591 | ||
| CLINICAL MANIFESTATIONS | 593 | ||
| PHYSICAL EXAMINATION | 595 | ||
| DIFFERENTIAL DIAGNOSIS | 596 | ||
| DIAGNOSIS | 596 | ||
| Resting Electrocardiogram | 596 | ||
| Biochemical Tests | 596 | ||
| Echocardiography at Rest | 597 | ||
| Probability Estimate of CAD | 598 | ||
| Noninvasive Stress Testing | 599 | ||
| Invasive Testing | 602 | ||
| TREATMENT | 604 | ||
| Medical Management | 604 | ||
| Nonpharmacologic Treatment of Refractory Angina | 608 | ||
| Coronary Artery Disease Revascularization | 608 | ||
| Coronary Artery Bypass Grafting Versus Percutaneous Coronary Intervention | 609 | ||
| SPECIAL GROUPS | 612 | ||
| Women | 612 | ||
| Older Patients | 613 | ||
| Diabetes Mellitus | 613 | ||
| Renal Insufficiency | 613 | ||
| FOLLOW-UP OF PATIENTS WITH STABLE ISCHEMIC HEART DISEASE | 613 | ||
| DEFINITIONS | 619 | ||
| ETIOLOGY | 619 | ||
| DIAGNOSIS | 619 | ||
| Clinical Assessment | 619 | ||
| MANAGEMENT | 621 | ||
| Anti-ischemic Therapy | 621 | ||
| Nitrates | 621 | ||
| Beta-Blockers | 621 | ||
| Calcium Channel Blockers | 622 | ||
| Analgesics | 622 | ||
| Ranolazine | 623 | ||
| Antiplatelets | 623 | ||
| Aspirin | 623 | ||
| Clopidogrel | 623 | ||
| Prasugrel | 623 | ||
| Ticagrelor | 625 | ||
| Cangrelor | 625 | ||
| Duration of Dual Antiplatelet Therapy | 625 | ||
| Glycoprotein IIb/IIIa Inhibitors | 625 | ||
| Anticoagulation | 626 | ||
| Heparin | 626 | ||
| Low-Molecular-Weight Heparin | 626 | ||
| Fondaparinux | 627 | ||
| Bivalirudin | 627 | ||
| Ischemic-Guided or Early Invasive Strategy | 627 | ||
| Long-Term Therapy | 628 | ||
| REFERENCES | 628 | ||
| 36 - Anesthesia and Sedation in Cardiac Patients | 631 | ||
| INTRODUCTION | 631 | ||
| PREOPERATIVE ANESTHETIC ASSESSMENT OF PATIENTS FOR CARDIAC SURGERY | 632 | ||
| RISK ASSESSMENT OF PATIENTS FOR CARDIAC SURGERY | 632 | ||
| PRINCIPLES OF CARDIAC ANESTHESIA | 633 | ||
| CARDIAC ANESTHESIA DRUGS AND TECHNIQUES | 634 | ||
| NONCARDIAC SURGERY IN CARDIAC PATIENTS | 638 | ||
| SEDATION AND ANALGESIA FOR CARDIOVASCULAR PROCEDURES | 640 | ||
| DRUGS USED FOR PROCEDURAL SEDATION | 642 | ||
| Inhalational Anesthetics | 635 | ||
| Cardiopulmonary Bypass | 637 | ||
| MONITORING DURING PROCEDURAL SEDATION | 644 | ||
| SEDATION AND RESPIRATORY CARE IN CRITICALLY ILL CARDIAC CARE UNIT PATIENTS | 644 | ||
| REFERENCES | 645 | ||
| 37 - Principles of Cardiovascular Surgery | 647 | ||
| EXTRACORPOREAL CIRCULATION | 647 | ||
| DEEP HYPOTHERMIA AND CIRCULATORY ARREST | 648 | ||
| MYOCARDIAL PROTECTION | 649 | ||
| POSTOPERATIVE CARE | 649 | ||
| Insufficient Preload | 649 | ||
| Cardiac Causes | 650 | ||
| Increased Ventricular Afterload | 650 | ||
| APPROACH TO A LOW-OUTPUT STATE | 651 | ||
| ANTICOAGULATION | 651 | ||
| Mitral Valve Repair | 651 | ||
| Mitral Valve Replacement | 652 | ||
| Aortic Valve Replacement | 652 | ||
| Pulmonary and Tricuspid Valves | 652 | ||
| HEPARIN-INDUCED THROMBOCYTOPENIA | 652 | ||
| Mitral Valve Surgery | 653 | ||
| Aortic Valve Surgery | 654 | ||
| Tricuspid Valve Surgery | 657 | ||
| Atrial Fibrillation Surgery | 657 | ||
| Pericardium Surgery | 658 | ||
| CORONARY ARTERY BYPASS GRAFT | 658 | ||
| OFF-PUMP CORONARY ARTERY BYPASS GRAFT | 658 | ||
| REFERENCES | 659 | ||
| Index | 661 | ||
| A | 661 | ||
| B | 665 | ||
| C | 666 | ||
| D | 670 | ||
| E | 672 | ||
| F | 673 | ||
| G | 674 | ||
| H | 674 | ||
| I | 676 | ||
| J | 677 | ||
| K | 677 | ||
| L | 677 | ||
| M | 679 | ||
| N | 680 | ||
| O | 682 | ||
| P | 682 | ||
| Q | 686 | ||
| R | 686 | ||
| S | 687 | ||
| T | 689 | ||
| U | 691 | ||
| V | 691 | ||
| W | 693 | ||
| X | 693 | ||
| Y | 693 |