Additional Information
Book Details
Abstract
This issue of Physician Assistant Clinics, guest edited by Daniel Thibodeau MHP, PA-C, DFAAPA, is devoted to Cardiology. Articles in this issue include: Hypertension: Evaluation, Management and Keeping Patients in the Safe Zone; Cardiovascular Risk and Assessment: Impact of Comorbidities to the Cardiovascular System; Arrhythmia Detection and Management; Anticoagulation: The Successes and Pitfalls of Long-term Management; Dyslipidemia: Long-term Management and Other Uses of Statins for Cardiac Disease; Acute Coronary Syndrome: Care After a Patient Event and Strategies to Improve Adherence; Evaluation of Chest Pain in the Primary Care Setting; Ischemic Heart Disease; Heart Failure and Cardiomyopathy; Pulmonary Hypertension and Thromboembolism: Long-term Management and Chronic Oral Anticoagulation; Approaches to Valvular Disease in the Primary Care Setting; and Syncope: Initial Evaluation and Workup in the Primary Care Office.
Table of Contents
| Section Title | Page | Action | Price |
|---|---|---|---|
| Front Cover | Cover | ||
| Cardiology | i | ||
| Copyright\r | ii | ||
| CME Accreditation Page | iii | ||
| PROGRAM OBJECTIVE | iii | ||
| TARGET AUDIENCE | iii | ||
| LEARNING OBJECTIVES | iii | ||
| ACCREDITATION | iii | ||
| DISCLOSURE OF CONFLICTS OF INTEREST | iii | ||
| UNAPPROVED/OFF-LABEL USE DISCLOSURE | iii | ||
| TO ENROLL | iii | ||
| METHOD OF PARTICIPATION | iii | ||
| CME INQUIRIES/SPECIAL NEEDS | iii | ||
| Contributors | v | ||
| CONSULTING EDITOR | v | ||
| EDITOR | v | ||
| AUTHORS | v | ||
| Contents | vii | ||
| Foreword: Getting Ready for Boards? | vii | ||
| Preface: Cardiology | vii | ||
| Hypertension: An Evidence Informed, Case Based Approach | vii | ||
| Evaluation of Chest Pain in the Primary Care Setting | vii | ||
| Cardiac Arrhythmias: Moving to the Beat of a Different Drummer | vii | ||
| Anticoagulation: The Successes and Pitfalls of Long-Term Management | viii | ||
| Acute Coronary Syndrome: Care After a Patient Event and Strategies to Improve Adherence | viii | ||
| Dyslipidemia: How Low Should We Go? A Review of Current Lipid Guidelines | viii | ||
| Heart Failure | viii | ||
| Ischemic Heart Disease: Evaluating for Potential Disease in the Previously Undiagnosed, Those Experiencing Angina, and in T ... | ix | ||
| Approaches to Valvular Heart Disease in the Primary Care Setting: Classic Presentations and Current Management Guidelines | ix | ||
| Syncope: Primary Care Office Evaluation and Workup | ix | ||
| Pulmonary Hypertension and Thrombembolism—Long-Term Management and Chronic Oral Anticoagulation | ix | ||
| Preventative Cardiology | x | ||
| PHYSICIAN ASSISTANT CLINICS\r | xi | ||
| FORTHCOMING ISSUES | xi | ||
| January 2018 | xi | ||
| April 2018 | xi | ||
| RECENT ISSUES | xi | ||
| July 2017 | xi | ||
| April 2017 | xi | ||
| January 2017 | xi | ||
| Foreword: Getting Ready for Boards?\r\r | xiii | ||
| Preface:\rCardiology | xv | ||
| Hypertension: An Evidence Informed, Case Based Approach | 557 | ||
| Key points | 557 | ||
| BACKGROUND | 557 | ||
| CASES | 560 | ||
| Monday | 560 | ||
| Tuesday | 561 | ||
| Wednesday | 563 | ||
| Thursday | 564 | ||
| SUMMARY | 567 | ||
| REFERENCES | 568 | ||
| Evaluation of Chest Pain in the Primary Care Setting | 571 | ||
| Key points | 571 | ||
| INTRODUCTION | 571 | ||
| STATISTICS AND DEMOGRAPHICS | 571 | ||
| CASE EXAMPLE 1 | 572 | ||
| HISTORY | 573 | ||
| RISK FACTORS | 574 | ||
| Coronary Artery Calcium Imaging | 575 | ||
| CASE EXAMPLE 2 | 575 | ||
| PHYSICAL EXAMINATION | 575 | ||
| DIFFERENTIAL DIAGNOSIS | 576 | ||
| CASE EXAMPLE 3 | 576 | ||
| CLINICAL WORK-UP | 576 | ||
| LABORATORY STUDIES | 578 | ||
| Complete Blood Count | 578 | ||
| Comprehensive Metabolic Profile | 578 | ||
| Troponin | 578 | ||
| Brain Natriuretic Peptide | 579 | ||
| Other Blood Testing | 580 | ||
| ANCILLARY TESTING | 580 | ||
| Electrocardiogram | 580 | ||
| Chest Radiograph | 580 | ||
| Echocardiogram | 581 | ||
| NONINVASIVE TESTING | 581 | ||
| Can the Patient Perform the Test Being Ordered? | 582 | ||
| Does the Patient Have Evidence of Abnormal Changes to the Electrocardiogram? | 582 | ||
| Does the Patient Need an Assessment of Myocardial Viability or Evidence of Disease? | 582 | ||
| Regular Treadmill Stress Test | 583 | ||
| Nuclear Stress Testing | 584 | ||
| Pharmacologic | 584 | ||
| Stress Radionuclide Myocardial Perfusion Imaging | 584 | ||
| Vasodilator | 584 | ||
| Inotrope or Chronotropic | 584 | ||
| Stress Echocardiography | 585 | ||
| Stress MRI | 585 | ||
| Sensitivity and Specificity of Testing | 585 | ||
| INVASIVE TESTING | 587 | ||
| Cardiac Catheterization | 587 | ||
| TREATMENT CONSIDERATIONS | 587 | ||
| SUMMARY | 587 | ||
| REFERENCES | 587 | ||
| Cardiac Arrhythmias | 589 | ||
| Key points | 589 | ||
| INTRODUCTION | 589 | ||
| ATRIAL FIBRILLATION | 589 | ||
| Risk Factors | 590 | ||
| What is Atrial Fibrillation? | 590 | ||
| Symptoms | 591 | ||
| Treatment | 591 | ||
| Rate Control Strategies | 592 | ||
| Rhythm Control | 593 | ||
| Anticoagulation | 594 | ||
| ATRIAL FLUTTER | 595 | ||
| ATRIOVENTRICULAR BLOCK | 596 | ||
| SICK SINUS SYNDROME | 597 | ||
| LONG QT SYNDROME | 597 | ||
| WOLFF-PARKINSON-WHITE SYNDROME | 598 | ||
| SINUS ARRHYTHMIA | 599 | ||
| REFERENCES | 599 | ||
| Anticoagulation: The Successes and Pitfalls of Long-Term Management | 603 | ||
| Key points | 603 | ||
| INTRODUCTION | 603 | ||
| ANTICOAGULATION MEDICATIONS | 604 | ||
| VITAMIN K ANTAGONISTS | 604 | ||
| DIRECT ORAL ANTICOAGULATION | 605 | ||
| DIRECT THROMBIN INHIBITOR | 605 | ||
| Dabigatran Etexilate Mesylate | 605 | ||
| FACTOR XA INHIBITORS | 605 | ||
| Rivaroxaban | 605 | ||
| Apixaban | 607 | ||
| Edoxaban | 607 | ||
| Reversal Agents | 607 | ||
| What Direct Oral Anticoagulant Should I Choose for My Patient? | 608 | ||
| Anticoagulation: Indications and Duration of Therapies | 611 | ||
| Venous Thromboembolism/Pulmonary Embolism | 612 | ||
| Atrial Fibrillation/Atrial Flutter | 613 | ||
| Prevention of Deep Vein Thrombosis/Pulmonary Embolism Following Joint Surgery | 613 | ||
| Discontinuation | 613 | ||
| SUMMARY | 614 | ||
| REFERENCES | 614 | ||
| Acute Coronary Syndrome | 623 | ||
| Key points | 623 | ||
| MEDICATION THERAPY IN THE POST–MYOCARDIAL INFARCTION OR POSTINTERVENTION PATIENT | 623 | ||
| FOLLOW-UP SCHEDULE IN THE POST–MYOCARDIAL INFARCTION OR POSTINTERVENTION PATIENT | 625 | ||
| STRATEGIES TO IMPROVE PATIENT ADHERENCE | 626 | ||
| POSTINTERVENTION COMPLICATIONS | 628 | ||
| SUMMARY | 629 | ||
| REFERENCES | 630 | ||
| Dyslipidemia | 633 | ||
| Key points | 633 | ||
| INTRODUCTION | 633 | ||
| LABORATORY ASSESSMENT OF HYPERLIPIDEMIA | 635 | ||
| DIFFERENCES BETWEEN THE GUIDELINES | 636 | ||
| Focus | 636 | ||
| Therapeutic Target | 636 | ||
| Risk Assessment | 637 | ||
| SPECIFIC PROVISIONS OF THE 2013 GUIDELINE | 637 | ||
| NONSTATIN DRUG THERAPY | 640 | ||
| LIPID MANAGEMENT IN SPECIAL POPULATIONS | 642 | ||
| Children and Adolescents | 642 | ||
| The Elderly | 644 | ||
| Chronic Kidney Disease | 644 | ||
| Comorbid Conditions Affecting Statin Therapy | 645 | ||
| Human Immunodeficiency Virus Patients | 645 | ||
| SUMMARY | 646 | ||
| ADDITIONAL RESOURCES | 646 | ||
| REFERENCES | 646 | ||
| Heart Failure | 651 | ||
| Key points | 651 | ||
| INTRODUCTION | 651 | ||
| Definition of Heart Failure | 651 | ||
| Clinical case | 652 | ||
| Epidemiology | 652 | ||
| Impact on Health Care System | 653 | ||
| Pathophysiology of Heart Failure | 653 | ||
| Classifications of Heart Failure | 654 | ||
| Systolic heart failure | 654 | ||
| Diastolic heart failure | 654 | ||
| Combined systolic and diastolic heart failure | 655 | ||
| Clinical case | 655 | ||
| Risk Factors and Comorbidities | 655 | ||
| The Heart Failure Continuum | 655 | ||
| History and Physical Examination | 656 | ||
| Differential Diagnosis | 658 | ||
| Testing and Diagnostic Studies | 658 | ||
| Natriuretic peptides | 659 | ||
| Echocardiography | 659 | ||
| Chest radiography | 660 | ||
| Electrocardiogram | 660 | ||
| Goals for Treatment | 661 | ||
| Clinical Management | 661 | ||
| Drug Therapies | 662 | ||
| Angiotensin-converting enzyme inhibitors | 664 | ||
| Angiotensin receptor blockers | 664 | ||
| β-Adrenergic receptor blockers | 664 | ||
| Hydralazine and nitrates | 665 | ||
| Diuretics | 665 | ||
| Angiotensin II receptor blocker/neprilysin inhibitor | 665 | ||
| Ivabradine | 666 | ||
| Lifestyle Modifications | 666 | ||
| Weight and fluid monitoring | 666 | ||
| Sodium restriction and diet | 667 | ||
| Blood pressure management | 667 | ||
| Activity and exercise | 667 | ||
| Additional therapies | 667 | ||
| End of Life and Palliative Care | 667 | ||
| SUMMARY | 669 | ||
| REFERENCES | 669 | ||
| Ischemic Heart Disease | 671 | ||
| Key points | 671 | ||
| NONINVASIVE STRESS TESTING MODALITIES: STRESSING METHODS | 672 | ||
| Exercise (Treadmill) Electrocardiogram Stress | 672 | ||
| Approaches to Valvular Heart Disease in the Primary Care Setting | 689 | ||
| Key points | 689 | ||
| INTRODUCTION | 689 | ||
| Aortic Stenosis | 691 | ||
| Risk factors for aortic stenosis | 691 | ||
| Presentation and natural history of aortic stenosis | 692 | ||
| Key features of the physical examination:8 | 692 | ||
| Key features of the history:8 | 693 | ||
| Natural history | 693 | ||
| Evaluation and grading of aortic stenosis | 693 | ||
| Treatment: surgical versus nonsurgical | 693 | ||
| Aortic Regurgitation | 697 | ||
| Risk factors for aortic regurgitation | 698 | ||
| Syncope: Primary Care Office Evaluation and Workup | 715 | ||
| Key points | 715 | ||
| INTRODUCTION | 715 | ||
| CAUSES | 716 | ||
| NEURAL CAUSES | 716 | ||
| Vasovagal | 717 | ||
| Carotid Sinus Sensitivity | 717 | ||
| Situational | 717 | ||
| Postexertional | 717 | ||
| ORTHOSTATIC CAUSES | 718 | ||
| Volume Deficit | 718 | ||
| Medications | 718 | ||
| Autonomic Failure | 719 | ||
| Shock | 719 | ||
| CARDIOVASCULAR CAUSES | 719 | ||
| Arrhythmias | 720 | ||
| Sinus bradycardia and heart blocks | 720 | ||
| Congenital long QT syndrome and secondary QT prolongation | 720 | ||
| Brugada syndrome | 720 | ||
| Other potential arrhythmia causes to consider | 721 | ||
| Postural orthostatic tachycardia syndrome | 721 | ||
| Pacemaker or automatic implantable cardioverter defibrillator | 722 | ||
| Structural | 722 | ||
| Indirect Cardiac | 722 | ||
| WORKUP | 722 | ||
| Laboratory Testing | 722 | ||
| Electrocardiogram and Telemetry | 722 | ||
| Holter Monitor | 723 | ||
| Event Monitor | 723 | ||
| Electrophysiologic Study | 723 | ||
| Tilt-Table Testing | 723 | ||
| Echocardiogram | 723 | ||
| Stress Test | 724 | ||
| Head Computed Tomography | 724 | ||
| DISPOSITION | 724 | ||
| REFERENCES | 725 | ||
| Pulmonary Hypertension and Thrombembolism—Long-Term Management and Chronic Oral Anticoagulation | 727 | ||
| Key points | 727 | ||
| INTRODUCTION | 727 | ||
| GROUP 1—PULMONARY ARTERY HYPERTENSION | 728 | ||
| Group 1.1—Idiopathic Pulmonary Arterial Hypertension | 729 | ||
| Group 1.2—Heritable Pulmonary Arterial Hypertension | 730 | ||
| Group 1.3—Drugs and Toxin Induced | 730 | ||
| Group 1.4—Associated with | 730 | ||
| Group 1.4.1—Connective tissue disease | 730 | ||
| Group 1.4.2—HIV infection | 731 | ||
| Group 1.4.3—Portal hypertension | 731 | ||
| Group 1.4.4—Congenital heart disease | 731 | ||
| Group 1.4.5—Schistosomiasis | 731 | ||
| Group 1’ | 731 | ||
| GROUP 1’’ | 731 | ||
| GROUP 2—PULMONARY HYPERTENSION DUE TO LEFT HEART DISEASE | 731 | ||
| GROUP 3—PULMONARY HYPERTENSION DUE TO LUNG DISEASES AND/OR HYPOXIA | 731 | ||
| GROUP 4—CHRONIC THROMBOEMBOLIC PULMONARY HYPERTENSION | 732 | ||
| GROUP 5—PULMONARY HYPERTENSION WITH UNCLEAR MULTIFACTORIAL MECHANISMS | 732 | ||
| Symptoms | 732 | ||
| Evaluation and Screening | 732 | ||
| Treatment and Management of Pulmonary Artery Hypertension | 734 | ||
| Medical Therapies | 734 | ||
| Anticoagulation | 735 | ||
| REFERENCES | 736 | ||
| Preventative Cardiology | 743 | ||
| Key points | 743 | ||
| INTRODUCTION | 743 | ||
| PATHOGENESIS OF ATHEROSCLEROSIS | 747 | ||
| IDENTIFICATION OF RISK FACTORS | 748 | ||
| QUANTIFICATION AND MEASUREMENT OF CARDIOVASCULAR RISK | 750 | ||
| STRATEGIES FOR RISK PREVENTION | 751 | ||
| CONNECTING RISK ASSESSMENT AND PREVENTION STRATEGIES TO INTERVENTIONS | 753 | ||
| SUMMARY | 755 | ||
| REFERENCES | 755 |