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Cardiology: An Illustrated Textbook (2 Volumes)
Kanu Chatterjee, Mark Anderson, Donald Heistad, Richard E Kerber
SECTION 1: BASIC CARDIOLOGY
CHAPTER 1:
Cardiac Anatomy
INTRODUCTION
PERICARDIUM AND HEART IN THE MEDIASTINUM
CARDIAC SURFACE ANATOMY
INTERNAL STRUCTURE OF THE HEART
RIGHT ATRIUM
TRICUSPID VALVE
RIGHT VENTRICLE
PULMONIC VALVE
PULMONARY ARTERIES
LEFT ATRIUM
MITRAL VALVE
LEFT VENTRICLE
AORTIC VALVE
CONDUCTION SYSTEM
CORONARY ARTERIES
INTRAMURAL VESSELS
CORONARY VEINS
CARDIAC LYMPHATICS
CARDIAC INNERVATION
CONCLUSION
CHAPTER 2:
Cardiac Function in Physiology and Pathology
INTRODUCTION
BETA-ADRENERGIC RECEPTOR-MEDIATED SIGNALING
CALCIUM REGULATION
LINKS BETWEEN β-ADRENERGIC SIGNALING AND CALCIUM REGULATION
MITOCHONDRIA
CARDIAC HYPERTROPHY
α1-ADRENERGIC RECEPTORS AND HYPERTROPHY
CONGESTIVE HEART FAILURE
MICRO-RNAs
ISCHEMIA/REPERFUSION INJURY
MECHANISMS OF CARDIOPROTECTION
AGING
ACKNOWLEDGMENT
CHAPTER 3:
Coronary Circulation in Physiology and Pathology
INTRODUCTION
CORONARY VASCULAR ANATOMY
REGULATION OF CORONARY BLOOD FLOW
MYOCARDIAL OXYGEN DEMAND
MYOCARDIAL OXYGEN SUPPLY
CORONARY VASCULAR RESISTANCE
VISCOUS RESISTANCE
COMPRESSIVE RESISTANCE
AUTOREGULATORY RESISTANCE
MYOGENIC RESISTANCE
MODULATION OF CORONARY BLOOD FLOW
FLOW MEDIATED REGULATION
METABOLIC FACTORS
NEUROGENIC MODULATION
HORMONAL MODULATION
CORONARY COLLATERAL CIRCULATION
CORONARY CIRCULATION IN PATHOLOGIC STATES
HYPERTENSION
VALVULAR HEART DISEASE
HYPERTROPHIC CARDIOMYOPATHY
METABOLIC DISORDERS
Anemia
Diabetes
ISCHEMIC HEART DISEASE
SYSTOLIC HEART FAILURE
SECTION 2: CARDIOVASCULAR PHARMACOLOGY
CHAPTER 4:
Diuretics
INTRODUCTION
NORMAL RENAL SOLUTE HANDLING
HISTORY AND CLASSIFICATION OF THE DIURETIC COMPOUNDS
CLINICAL PHARMACOLOGY OF THE DIURETIC COMPOUNDS
GENERAL PHARMACOKINETIC AND PHARMACODYNAMIC PRINCIPLES
ADAPTIVE RESPONSES TO DIURETIC ADMINISTRATION
INDIVIDUAL DIURETIC CLASSES
CARBONIC ANHYDRASE INHIBITORS
LOOP OR HIGH-CEILING DIURETICS
THIAZIDE AND THE THIAZIDE-LIKE DIURETICS
POTASSIUM-SPARING DIURETICS
OSMOTIC DIURETICS
CLINICAL USE OF DIURETICS IN CARDIOVASCULAR DISEASES
DIURETIC USE IN HYPERTENSION
General Considerations
Comparative Efficacy
Class Effect Theory
Special Considerations
DIURETIC USE IN EDEMATOUS DISORDERS
General Considerations
Renal Insufficiency
Cirrhosis
Congestive Heart Failure
Nephrotic Syndrome
ADVERSE EFFECTS OF DIURETICS
SUMMARY
CHAPTER 5:
Vasodilators and Neurohormone Modulators
INTRODUCTION
VASODILATOR DRUGS AND LOW BLOOD PRESSURE
ARTERIAL VERSUS VENOUS EFFECTS OF VASODILATOR DRUGS IN PATIENTS WITH SYSTOLIC HEART FAILURE
ARTERIOLAR VASODILATORS
HYDRALAZINE
AMLODIPINE
ORAL NITRATES
RENIN-ANGIOTENSIN-ALDOSTERONE SYSTEM (RAAS) BLOCKERS
ANGIOTENSIN CONVERTING ENZYME INHIBITORS (ACE INHIBITORS)
ANGIOTENSIN RECEPTOR BLOCKERS (ARBs)
MINERALOCORTICOID (ALDOSTERONE) RECEPTOR BLOCKERS
ALDOSTERONE AND SYSTOLIC HEART FAILURE
SPIRONOLACTONE AND EPLERENONE IN CHRONIC HEART FAILURE
PHOSPHODIESTERASE TYPE 5 INHIBITORS
SILDENAFIL AND TADALAFIL
INTRAVENOUS VASODILATORS
NITROPRUSSIDE
METABOLISM AND TOXICITY OF NITROPRUSSIDE
NITROPRUSSIDE AND SEVERE HEART FAILURE
INTRAVENOUS NITROGLYCERIN
LIMITATIONS OF INTRAVENOUS NITROGLYCERIN IN THE TREATMENT OF PATIENTS WITH HEART FAILURE
NESIRITIDE
ORAL β-ADRENERGIC BLOCKING DRUGS
CONCLUSION
ACKNOWLEDGMENT
CHAPTER 6:
Positive Inotropic Drugs
INTRODUCTION
INTRAVENOUSLY ADMINISTERED, SHORT-TERM POSITIVE INOTROPIC THERAPY
ADRENERGIC RECEPTOR AGONISTS
Dobutamine
Dopamine
Other Adrenergic Agents
PHOSPHODIESTERASE INHIBITORS
Milrinone
OTHER INTRAVENOUSLY ADMINISTERED POSITIVE INOTROPIC INTERVENTIONS
Calcium Sensitizers
Additional Intravenously Administered Positive Inotropes
ORALLY ADMINISTERED POSITIVE INOTROPIC AGENTS
Digitalis-Digoxin
Other Orally Administered Positive Inotropic Agents
CHAPTER 7:
Antilipid Agents
APPROPRIATE USES
STATINS
EFFICACY
MUSCLE SAFETY
STATIN DRUG INTERACTIONS
RENAL EXCRETION
MANAGING MUSCLE SYMPTOMS
LIVER SAFETY
ADD-ON TO STATIN THERAPY
BILE ACID SEQUESTRANTS
EFFICACY
SAFETY
EZETIMIBE
EFFICACY
SAFETY
NIACIN
EFFICACY
FLUSHING
SAFETY
TRIGLYCERIDE-LOWERING THERAPY
FIBRATES
EFFICACY
SAFETY
OMEGA-3 FATTY ACIDS
EFFICACY
SAFETY
DRUGS IN DEVELOPMENT
ACKNOWLEDGMENT
CHAPTER 8:
Antithrombotic and Antiplatelet Agents
INTRODUCTION
CLOTTING, A PRIMER
ANTITHROMBOTIC AGENTS
THE HEPARINS AND INDIRECT Xa INHIBITORS
Indications
Limitations, Monitoring and Adherence
LOW MOLECULAR WEIGHT HEPARINS
Advantages and Indications
Limitations, Monitoring and Adherence
FONDAPARINUX
Advantages and Indications
Limitations, Monitoring and Adherence
IDRABIOTAPARINUX
AVE5206
VITAMIN K ANTAGONISTS (VKA)
WARFARIN
Mechanism and Indications
Limitations, Monitoring and Adherence
ATI-5923
DIRECT FACTOR Xa INHIBITORS
RIVAROXABAN
Mechanism
Efficacy
Limitations, Monitoring and Adherence
APIXABAN
Efficacy
DIRECT THROMBIN INHIBITORS
HIURDIN
Mechanism and Monitoring
Indications
Limitations
BIVALIRUDIN
Indications and Efficacy
Limitations and Monitoring
ARGATROBAN
Indications and Efficacy
Limitations and Monitoring
XIMELAGATRAN
DABIGATRAN
Efficacy
Limitations and Monitoring
ANTIPLATELET AGENTS
INHIBITORS OF PLATELET ADHESION
INHIBITORS OF PLATELET ACTIVATION
TXA2 Pathway Inhibitors
Inhibitors of ADP/P2Y12 Signaling
Prasugrel
Phosphodiesterase (PDE) Inhibitors
Thrombin Receptor Antagonists
INHIBITORS OF PLATELET AGGREGATION
SECTION 3: DIAGNOSIS
CHAPTER 9:
History
THE HISTORY
GENERAL APPROACH
ANALYSIS OF SYMPTOMS
Chest Pain or Discomfort
Dyspnea
Palpitation
Syncope
Edema
Cough
Hemoptysis
CHAPTER 10:
Physical Examination
GENERAL APPEARANCE
EXAMINATION OF THE SKIN
EXAMINATION OF THE MUSCULOSKELETAL SYSTEM
MEASUREMENT OF ARTERIAL PRESSURE
EXAMINATION OF THE JUGULAR VENOUS PULSE
ESTIMATION OF JUGULAR VENOUS PRESSURE
JUGULAR VENOUS PULSATIONS
ARTERIAL PULSE
EXAMINATION OF THE PRECORDIAL PULSATION
AUSCULTATION
THIRD (S3) AND FOURTH (S4) HEART SOUNDS
Pericardial Knock
Ejection Sounds
Midsystolic Click
Early Diastolic High-Frequency Sounds
Artificial Valve Sounds
AUSCULTATION OF HEART MURMURS
Ejection Systolic Murmurs
Innocent Murmurs
PULMONARY OUTFLOW OBSTRUCTION
Regurgitant Murmurs
DIASTOLIC MURMURS
Early Diastolic Murmurs
Mid-Diastolic Murmurs
Mitral Stenosis
Tricuspid Stenosis
Austin Flint Murmur
Carey-Coombs Murmur
CONTINUOUS MURMURS
CHAPTER 11:
Plain Film Imaging of Adult Cardiovascular Disease
INTRODUCTION
CHEST FILM TECHNIQUE
OVERVIEW OF CARDIOMEDIASTINAL ANATOMY
CARDIAC ANATOMY ON CHEST RADIOGRAPHS
CARDIAC CHAMBER ENLARGEMENT
LEFT VENTRICULAR ENLARGEMENT
RIGHT VENTRICULAR ENLARGEMENT
LEFT ATRIAL ENLARGEMENT
RIGHT ATRIAL ENLARGEMENT
RADIOGRAPHIC MANIFESTATIONS OF CONGESTIVE HEART FAILURE
CARDIAC CALCIFICATIONS
ACQUIRED VALVULAR HEART DISEASE
AORTIC STENOSIS
AORTIC INSUFFICIENCY
MITRAL STENOSIS
MITRAL REGURGITATION
PULMONARY VALVE STENOSIS
PULMONARY VALVE INSUFFICIENCY
TRICUSPID INSUFFICIENCY
PERICARDIAL DISORDERS
PERICARDIAL EFFUSION
PERICARDIAL CYSTS
CONGENITAL ABSENCE OF THE PERICARDIUM
CHAPTER 12:
Electrocardiogram
INTRODUCTION
BASIS OF ELECTROCARDIOGRAPHY
COMPONENT PARTS OF THE ELECTROCARDIOGRAM
LEAD SYSTEMS USED TO RECORD THE ELECTROCARDIOGRAM
COMMON ELECTRODE MISPLACEMENTS
LEFT ARM
RIGHT LEG ELECTRODE
OTHER LEAD SYSTEMS
A SYSTEMATIC WAY OF LOOKING AT THE INTERPRETATION OF THE ELECTROCARDIOGRAM
A Systematic Way of Looking at the Rhythm
IDENTIFICATION OF ATRIAL ACTIVITY
CHARACTERIZATION OF QRS COMPLEX
ST-T WAVE ABNORMALITIES
THE “U” WAVE
THE QT INTERVAL
ABNORMALITIES SUGGESTING RIGHT OR LEFT ATRIAL ENLARGEMENT, DILATATION OR HYPERTROPHY
CHAPTER 13:
ECG Exercise Testing
INTRODUCTION
BEFORE THE TEST
INDICATIONS FOR EXERCISE TESTING (PATIENT SELECTION)
EXERCISE TESTING FOR DIAGNOSIS
EXERCISE TESTING FOR PROGNOSIS
Class I (Definitely Appropriate)
Class IIb (May Be Appropriate)
EXERCISE TESTING PATIENTS PRESENTING WITH ACUTE CORONARY SYNDROMES
EXERCISE TESTING PATIENTS WITH HEART FAILURE
EXERCISE TESTING PATIENTS AFTER MYOCARDIAL INFARCTION
CONTRAINDICATIONS TO EXERCISE TESTING
METHODOLOGY OF EXERCISE TESTING
SAFETY PRECAUTIONS AND EQUIPMENT
PRETEST PREPARATIONS
EXERCISE TEST MODALITIES
Bicycle Ergometer versus Treadmill
Exercise Protocols
Add-Ons to the Exercise Test
DURING THE TEST
PHYSIOLOGY REVIEW
Oxygen Consumption
Metabolic Equivalents Term (MET)
Acute Cardiopulmonary Response to Exercise
Central Factors
Peripheral Factors (Arteriovenous Oxygen Difference)
AUTONOMIC CONTROL
Neural Control Mechanisms
AUTONOMIC MODULATION DURING IMMEDIATE RECOVERY FROM EXERCISE
CLINICAL CORRELATIONS
Hemodynamics
Heart Rate
Exercise Capacity
Recovery after Exercise
Women
Diagnostic Scores
AFTER THE TEST
ECG INTERPRETATION: FACTORS DETERMINING PROGNOSIS
ST-Segment Analysis
SILENT ISCHEMIA
EXERCISE INDUCED ARRHYTHMIAS
PROGNOSTIC UTILIZATION OF EXERCISE TESTING
SCREENING
CONCLUSION
CHAPTER 14:
The Left Ventricle
INTRODUCTION
SYSTOLIC FUNCTION
LEFT VENTRICULAR EJECTION FRACTION
Linear Measurements in the Assessment of LV Function
COMPONENTS OF EJECTION FRACTION
End Systolic Volume
Physiologic Basis of Left Ventricular End Systolic Volume
Left Ventricular End Systolic Volume and Clinical Outcomes
End Diastolic Volume
CONTRAST-ENHANCED ECHOCARDIOGRAPHY
OTHER ECHO-DERIVED INDICES OF LV SYSTOLIC FUNCTION
STRAIN-DERIVED INDICES
RECOGNIZING THE ETIOLOGY OF CARDIAC DYSFUNCTION
DILATED CARDIOMYOPATHY
ECHOCARDIOGRAPHIC FINDINGS
ISCHEMIC CARDIOMYOPATHY
HYPERTROPHIC CARDIOMYOPATHY
PRIMARY HYPERTROPHIC CARDIOMYOPATHY
ECHOCARDIOGRAPHIC FEATURES
SECONDARY HYPERTROPHIC CARDIOMYOPATHY
ECHOCARDIOGRAPHIC FEATURES
RESTRICTIVE CARDIOMYOPATHY
DIABETES MELLITUS
AMYLOID INFILTRATIVE CARDIOMYOPATHY35
ENDOMYOCARDIAL FIBROSIS
LEFT VENTRICULAR NONCOMPACTION
VISUAL QUALITATIVE INDICATORS OF SYSTOLIC DYSFUNCTION
LEFT VENTRICULAR MASS
DIASTOLIC FUNCTION
TECHNICAL ASPECTS OF RECORDING AND MEASUREMENT OF DIASTOLIC PARAMETERS
Transmitral Flow
Propagation Velocity of the Early Diastolic Flow in the Left Ventricle
Pulmonary Venous Flow
Doppler Tissue Imaging of Mitral Annular Motion in Diastole
Left Atrial Volume and Index
TYPES OF DIASTOLIC DYSFUNCTION
Impaired Relaxation of the Left Ventricle
Pseudonormal Filling
Restrictive Filling (Grades 3 and 4 Diastolic Dysfunction)
EVALUATION OF LEFT VENTRICULAR FILLING PRESSURES
FORMULAE THAT ATTEMPT TO PROVIDE QUANTITATION OF LV FILLING PRESSURE
CONCLUSION
CHAPTER 15:
Ventricular Function—Assessment and Clinical Application
INTRODUCTION
DETERMINANTS OF LEFT VENTRICULAR PERFORMANCE
PRELOAD
AFTERLOAD
VENTRICULAR-ARTERIAL COUPLING
CONTRACTILE STATE
MEASURES OF MAXIMUM RATE OF PRESSURE DEVELOPMENT
VELOCITY OF CONTRACTILE ELEMENT
LEFT VENTRICULAR PUMP FUNCTION
VENTRICULAR FUNCTION CURVE
EJECTION FRACTION
TECHNIQUES FOR ASSESSMENT OF LEFT VENTRICULAR EJECTION FRACTION
Echocardiography
Cardiac Computed Tomography
Nuclear Scintigraphy
Cardiac Magnetic Resonance Imaging
Contrast Ventriculography
PRESSURE-VOLUME RELATIONS
HEART RATE
DIASTOLIC FUNCTION
TECHNIQUES OF MEASUREMENT OF DIASTOLIC FUNCTION
Echocardiography
Nuclear Scintigraphy
Cardiac Magnetic Resonance Imaging
LEFT VENTRICULAR FUNCTIONAL ASSESSMENT DURING STRESS
RIGHT VENTRICULAR FUNCTION
CONCLUSION
CHAPTER 16:
Transthoracic Echocardiography
INTRODUCTION
CHAMBER QUANTITATION
DOPPLER ECHO
DIASTOLIC FUNCTION
PULMONARY HYPERTENSION
PERICARDIAL DISEASE
VALVULAR HEART DISEASE
AORTIC STENOSIS
AORTIC REGURGITATION
MITRAL STENOSIS
MITRAL REGURGITATION
TRICUSPID STENOSIS
TRICUSPID REGURGITATION
PULMONIC STENOSIS
PULMONIC REGURGITATION
INFECTIVE ENDOCARDITIS
INTRACARDIAC MASSES
CONTRAST ECHOCARDIOGRAPHY
CARDIAC RESYNCHRONIZATION THERAPY
VIDEO LEGENDS
CHAPTER 17:
Stress Echocardiography
A. INTRODUCTION
B. USING STRESS ECHOCARDIOGRAPHY IN CLINICAL DECISIONS
1. PATHOPHYSIOLOGY INVOLVED IN STRESS ECHO
2. STRESS ECHOCARDIOGRAPHY AND THE DIAGNOSIS OF CORONARY ARTERY DISEASE
a. Exercise Stress Echo (ESE)
b. Pharmacologic Stress Echo
3. STRESS ECHOCARDIOGRAPHY AND ESTIMATING RISK OR PROGNOSIS IN CORONARY ARTERY DISEASE
a. Assessing Prognosis—Introduction
b. Exercise Stress Echo (ESE) and Prognosis in Coronary Artery Disease
c. Dobutamine Stress Echo (DSE) and Prognosis in Coronary Artery Disease
4. STRESS ECHO AND MYOCARDIAL VIABILITY
5. STRESS ECHO AND THE ASSESSMENT OF HEMODYNAMICS OF VALVULAR DISEASE
C. THE FUTURE OF STRESS ECHO
VIDEO LEGENDS
CHAPTER 18:
Transesophageal Echocardiography
INTRODUCTION
HISTORY
GUIDELINES
PERFORMANCE
SAFETY
VIEWS
MAJOR CLINICAL APPLICATIONS
SOURCE OF EMBOLISM
Masses
Passageways for Paradoxic Embolization
Propensity for Thrombus Formation
ATRIAL FIBRILLATION
ENDOCARDITIS
STRUCTURAL VALVE ASSESSMENT
ACUTE AORTIC DISSECTION
PROCEDURAL ADJUNCT OR INTRAOPERATIVE TEE
CONCLUSION
VIDEO LEGENDS
CHAPTER 19:
Real Time Three-dimensional Echocardiography
INTRODUCTION
TECHNIQUE
CLINICAL APPLICATIONS
DETERMINATION OF LEFT VENTRICULAR VOLUMES AND FUNCTION
DETERMINATION OF REGIONAL WALL MOTION AND DYSSYNCHRONY
APPLICATIONS TO STRESS IMAGING
MYOCARDIAL CONTRAST IMAGING AND QUANTIFICATION OF PERFUSION
DETERMINATION OF LEFT VENTRICULAR MASS
ASSESSMENT OF RIGHT VENTRICULAR VOLUMES AND FUNCTION
ASSESSMENT OF LEFT AND RIGHT ATRIA
ASSESSMENT OF VALVULAR DISORDERS
Mitral Valve
Aortic Valve
Other Valves
Prosthetic Valves
MISCELLANEOUS CONDITIONS
GUIDANCE OF PERCUTANEOUS PROCEDURES
FUTURE DIRECTIONS
LIMITATIONS
VIDEO LEGENDS
CHAPTER 20:
Intravascular Coronary Ultrasound and Beyond
INTRODUCTION
INTRAVASCULAR ULTRASOUND
BASICS OF IVUS AND PROCEDURES
NORMAL VESSEL MORPHOLOGY
IVUS MEASUREMENTS
TISSUE CHARACTERIZATION
INSIGHTS INTO PLAQUE FORMATION AND DISTRIBUTION
INTERVENTIONAL APPLICATIONS
PREINTERVENTIONAL IMAGING
BALLOON ANGIOPLASTY
Guidance of Procedures
BARE METAL STENT IMPLANTATION
Guidance of Procedures
Insights into Long-Term Outcomes
DRUG-ELUTING STENT IMPLANTATION
Guidance of Procedures
Insights into Long-Term Outcomes
SAFETY
FUTURE DIRECTIONS
OPTICAL COHERENCE TOMOGRAPHY
IMAGING SYSTEMS AND PROCEDURES
IMAGE INTERPRETATION
CLINICAL EXPERIENCE
DETECTION OF VULNERABLE PLAQUE
SAFETY AND LIMITATIONS
FUTURE DIRECTIONS
ANGIOSCOPY
IMAGING SYSTEMS AND PROCEDURES
IMAGE INTERPRETATION
CLINICAL EXPERIENCE
DETECTION OF VULNERABLE PLAQUE
SAFETY AND LIMITATIONS
FUTURE DIRECTIONS
SPECTROSCOPY
IMAGING SYSTEMS AND PROCEDURES
EXPERIMENTAL DATA
CLINICAL EXPERIENCE
SAFETY AND LIMITATIONS
FUTURE DIRECTIONS
CHAPTER 21:
Cardiovascular Nuclear Medicine—Nuclear Cardiology
INTRODUCTION
PATHOPHYSIOLOGIC CONSIDERATIONS
LESION SEVERITY
OWING TO STRESS TESTING DEFICIENCIES
THE ISCHEMIC CASCADE
STRESS TESTING
Dynamic Exercise Testing
Pharmacologic Stress Testing
MYOCARDIAL PERFUSION IMAGING
IMAGE ACQUISITION PROTOCOLS
IMAGE DISPLAY
GATED—MYOCARDIAL PERFUSION IMAGING
INTERPRETATION
DIAGNOSTIC ACCURACY AND COST EFFECTIVENESS
INDICATORS OF MULTIVESSEL CORONARY ARTERY DISEASE AND RELATED RISK
NONPERFUSION INDICATORS OF CAD-RELATED RISK—LUNG/HEART RATIO
TRANSIENT ISCHEMIC DILATION
DENSE CAVITARY PHOTOPENIA
CLINICAL APPLICATIONS OF MYOCARDIAL PERFUSION IMAGING IN THE EMERGENCY DEPARTMENT—WITH ACUTE CHEST PAIN SYNDROMES
UNSTABLE ANGINA/NON-ST ELEVATION MYOCARDIAL INFARCTION
FOLLOW-UP AFTER INITIAL ACS EVALUATION STRATEGY
RISK ASSESSMENT OF GENERAL AND SPECIFIC PATIENT POPULATIONS
GENERAL PRINCIPLES
PREOPERATIVE EVALUATION FOR NONCARDIAC SURGERY
THE EVALUATION OF CAD IN WOMEN
DIABETICS
MYOCARDIAL PERFUSION IMAGING IN THE ELDERLY
POSTREVASCULARIZATION
HEART FAILURE
APPROPRIATENESS CRITERIA FOR PERFUSION IMAGING
POSITRON EMISSION TOMOGRAPHY PERFUSION AND METABOLISM
PET AND SPECT TECHNOLOGY
IMAGING MYOCARDIAL VIABILITY
THE PRINCIPLES
NONSCINTIGRAPHIC IMAGING OPTIONS
SCINTIGRAPHIC IMAGING OPTIONS—PERFUSION RELATED
SCINTIGRAPHIC IMAGING OPTIONS—METABOLISM BASED
IMAGING PERFUSION
RUBIDIUM (82Rb) CHLORIDE
NITROGEN (13N) AMMONIA
QUANTITATION OF REGIONAL CORONARY FLOW AND FLOW RESERVE
BLOOD POOL IMAGING—EQUILIBRIUM RADIONUCLIDE ANGIOGRAPHY AND FIRST PASS RADIONUCLIDE ANGIOGRAPHY
GUIDELINES
INTRODUCTION
LABELING THE BLOOD POOL
FIRST PASS CURVE ANALYSIS
VENTRICULAR FUNCTION
LEFT-TO-RIGHT SHUNT ANALYSIS
EQUILIBRIUM GATED IMAGING-ERNA
THE VALUE OF FUNCTIONAL IMAGING
PHASE ANALYSIS
IMAGING MYOCARDIAL SYMPATHETIC INNERVATION
RADIATION CONCERNS
CHAPTER 22:
Cardiac Computed Tomography
INTRODUCTION
TECHNICAL ASPECTS
BASIC PRINCIPLES OF COMPUTED TOMOGRAPHY
RADIATION
IMAGE ANALYSIS
IMAGE QUALITY AND ARTIFACTS
CONTRAST
CORONARY ARTERY DISEASE
NONCONTRAST CT AND CORONARY CALCIFICATIONS
CONTRAST CT AND CORONARY ANGIOGRAPHY
Appropriate Indications
CORONARY STENT
CORONARY BYPASS GRAFTS
ANOMALOUS CORONARY ARTERIES
OTHER CORONARY FINDINGS
MYOCARDIUM AND CHAMBERS
PULMONARY VEINS
CARDIAC VEINS
VALVULAR DISEASE
PERICARDIUM
MASSES
MALIGNANT CARDIAC NEOPLASM
NONCANCEROUS MASSES
Ventricular Thrombus
Hiatal Hernia
Lipomatous Hypertrophy of Intra-Atrial Septum
INCIDENTAL FINDINGS
FUTURE
CHAPTER 23:
Cardiovascular Magnetic Resonance
INTRODUCTION
INFORMATION PROVIDED BY CARDIOVASCULAR MAGNETIC RESONANCE
DIAGNOSIS OF EPICARDIAL CORONARY ARTERY STENOSIS
ASSESSMENT OF GLOBAL AND REGIONAL LEFT VENTRICULAR FUNCTION AT REST AND DURING INOTROPIC STRESS
MYOCARDIAL PERFUSION IMAGING
CARDIOVASCULAR MAGNETIC RESONANCE CORONARY ANGIOGRAPHY
UNRECOGNIZED MYOCARDIAL INFARCTION
DILATED CARDIOMYOPATHY
ETIOLOGY
Coronary Artery Stenoses
Myocarditis
PROGNOSIS
Ischemic Dilated Cardiomyopathy
Prognosis in Idiopathic Dilated Cardiomyopathy
HYPERTROPHIC CARDIOMYOPATHY
DIAGNOSIS
PROGNOSIS
CORRELATIVE FINDINGS
RESTRICTIVE CARDIOMYOPATHY
DIAGNOSIS
ETIOLOGY
CARDIOVASCULAR MAGNETIC RESONANCE-GUIDED THERAPY
VALVULAR HEART DISEASE
VALVE STENOSIS
VALVULAR REGURGITATION
DISEASES WITH RIGHT VENTRICULAR PREDOMINANCE
INTRACARDIAC SHUNT
PULMONARY ARTERY HYPERTENSION
ARRHYTHMOGENIC RIGHT VENTRICULAR CARDIOMYOPATHY
MISCELLANEOUS CONDITIONS
CARDIAC THROMBI
CARDIAC MASSES
LEFT VENTRICLE TRABECULATIONS AND NONCOMPACTION
PERICARDIAL DISEASE
ABBREVIATIONS
CHAPTER 24:
Molecular Imaging of Vascular Disease
INTRODUCTION
MOLECULAR IMAGING FUNDAMENTALS
MOLECULAR IMAGING MODALITIES
MOLECULAR IMAGING OF VASCULAR DISEASE PROCESSES
ATHEROSCLEROSIS
Inflammation
Oxidative Stress
Neovascularization
Apoptosis
Calcification
THROMBOSIS
Clinical Imaging of Fibrin-Rich Thrombi
Preclinical Thrombus Imaging Strategies
ANEURYSM
Clinical Aneurysm Inflammation Imaging
Preclinical Aneurysm Imaging Investigations
VASCULAR INJURY
OUTLOOK
ACKNOWLEDGMENT
CHAPTER 25:
Cardiac Hemodynamics and Coronary Physiology
INTRODUCTION
CARDIAC CATHETERIZATION—THE BASICS
RIGHT HEART CATHETERIZATION
CATHETERIZATION COMPUTATIONS
CARDIAC OUTPUT
FICK METHOD
INDICATOR DILUTION METHOD
VASCULAR RESISTANCE
INTRACARDIAC SHUNT RATIO
CARDIAC CYCLE PRESSURE WAVEFORMS
ATRIAL PRESSURES
VENTRICULAR PRESSURES
HEMODYNAMICS IN VALVULAR HEART DISEASE
AORTIC STENOSIS
AORTIC REGURGITATION
Chronic Aortic Regurgitation
Acute Aortic Regurgitation
MITRAL STENOSIS
MITRAL REGURGITATION
PULMONIC STENOSIS
PULMONIC REGURGITATION
TRICUSPID STENOSIS
TRICUSPID REGURGITATION
HEMODYNAMICS IN CARDIOMYOPATHY
HYPERTROPHIC OBSTRUCTIVE CARDIOMYOPATHY
RESTRICTIVE CARDIOMYOPATHY
HEMODYNAMICS IN PERICARDIAL DISEASE
CONSTRICTIVE PERICARDITIS
CARDIAC TAMPONADE
CORONARY HEMODYNAMICS
FRACTIONAL FLOW RESERVE
CORONARY FLOW RESERVE
INDEX OF MICROCIRCULATORY RESISTANCE
CHAPTER 26:
Cardiac Biopsy
INTRODUCTION
HISTORY AND DEVICES
TECHNIQUES
SAFETY AND COMPLICATIONS
ANALYSIS OF EMB TISSUE
LIGHT MICROSCOPY AND STAINS
CARDIOTROPIC VIRUS DETECTION
INDICATIONS
DISEASE STATES
EMB IN CARDIOMYOPATHY
Dilated Cardiomyopathy
Hypertrophic Cardiomyopathy
Restrictive Cardiomyopathy
Arrhythmogenic Right Ventricular Cardiomyopathy
EMB IN SPECIAL CARDIAC DISEASE STATES
Sarcoidosis
Amyloidosis
Hemochromatosis
Storage Diseases and Myopathy
Drug Toxicity
Neoplasms
Cardiac Infections
CARDIAC TRANSPLANTATION
SUMMARY
CHAPTER 27:
Swan-Ganz Catheters: Clinical Applications
INTRODUCTION
HISTORICAL PERSPECTIVE AND EVOLUTION OF CATHETER DESIGNS
PLACEMENT OF BALLOON FLOTATION CATHETERS
NORMAL PRESSURES AND WAVEFORMS
ABNORMAL PRESSURES AND WAVEFORMS
CLINICAL APPLICATIONS
CARDIAC CATHETERIZATION LABORATORY
ACUTE CORONARY SYNDROMES
NON-ACUTE CORONARY SYNDROME
CHRONIC HEART FAILURE
PULMONARY HYPERTENSION
INDICATIONS FOR PULMONARY ARTERY CATHETERIZATION
COMPLICATIONS
CONCLUSION
CHAPTER 28:
Coronary Angiography and Catheter-based Coronary Intervention
INTRODUCTION
INDICATIONS FOR CORONARY ANGIOGRAPHY
CONTRAINDICATIONS FOR CORONARY ANGIOGRAPHY
PATIENT PREPARATION
SITES AND TECHNIQUES OF VASCULAR ACCESS
FEMORAL ARTERY APPROACH
TRANSRADIAL APPROACH
BRACHIAL ARTERY APPROACH
CATHETERS FOR CORONARY ANGIOGRAPHY
JUDKINS-TYPE CORONARY CATHETERS
AMPLATZ-TYPE CATHETERS
MULTIPURPOSE CATHETER
CATHETERS FOR BYPASS GRAFTS
TRANSRADIAL SPECIFIC CATHETERS
ARTERIAL NOMENCLATURE AND EXTENT OF DISEASE
ANGIOGRAPHIC PROJECTIONS
NORMAL CORONARY ANATOMY
LEFT MAIN CORONARY ARTERY
LEFT ANTERIOR DESCENDING ARTERY
LEFT CIRCUMFLEX ARTERY
RIGHT CORONARY ARTERY
RIGHT DOMINANT CORONARY CIRCULATION
LEFT DOMINANT CORONARY CIRCULATION
CO-DOMINANT OR BALANCED CORONARY CIRCULATION
CORONARY COLLATERAL CIRCULATION
CONGENITAL ANOMALIES OF THE CORONARY CIRCULATION
ANOMALOUS PULMONARY ORIGIN OF THE CORONARY ARTERIES
ANOMALOUS CORONARY ARTERY FROM THE OPPOSITE SINUS
CORONARY ARTERY FISTULAE
CONGENITAL CORONARY STENOSIS OR ATRESIA
MYOCARDIAL BRIDGING
GENERAL PRINCIPLES FOR CORONARY AND/OR GRAFT CANNULATION
LEFT MAIN CORONARY ARTERY CANNULATION
RIGHT CORONARY ARTERY CANNULATION
CORONARY BYPASS GRAFT CANNULATION
SAPHENOUS VEIN GRAFTS
INTERNAL MAMMARY ARTERY GRAFTS
GASTROEPIPLOIC ARTERY
STANDARDIZED PROJECTION ACQUISITION
THE FLUOROSCOPIC IMAGING SYSTEM
CHARACTERISTICS OF CONTRAST MEDIA
CONTRAST MEDIA REACTIONS
CONTRAST-INDUCED RENAL FAILURE
ACCESS SITE HEMOSTASIS
COMPLICATIONS OF CARDIAC CATHETERIZATION
ACCESS SITE COMPLICATIONS
OTHER COMPLICATIONS
LESION QUANTIFICATION
QUANTITATIVE ANGIOGRAPHY
LESION COMPLEXITY
LESION LENGTH
OSTIAL LESIONS
BIFURCATION LESIONS
ANGULATED LESIONS
DEGENERATED SAPHENOUS VEIN GRAFTS
LESION CALCIFICATION
THROMBUS
TOTAL OCCLUSION
CORONARY PERFUSION
PHYSIOLOGIC ASSESSMENT OF ANGIOGRAPHICALLY INDETERMINATE CORONARY LESIONS
FRACTIONAL FLOW RESERVE
CLINICAL USE OF TRANSLESIONAL PHYSIOLOGIC MEASUREMENTS
NON-ATHEROSCLEROTIC CORONARY ARTERY DISEASE AND TRANSPLANT VASCULOPATHY
CORONARY ARTERY SPASM
SPONTANEOUS CORONARY ARTERY DISSECTION
VASCULITIS
TRANSPLANT VASCULOPATHY
POTENTIAL ERRORS IN INTERPRETATION OF THE CORONARY ANGIOGRAM
INADEQUATE VESSEL OPACIFICATION
CATHETER INDUCED SPASM
INCOMPLETE STUDY
CORONARY ANOMALIES
TOTAL OCCLUSION OF A CORONARY ARTERY
ECCENTRIC STENOSES
SUPERIMPOSITION OF VESSELS
MICROCHANNEL RECANALIZATION
PERCUTANEOUS CORONARY INTERVENTION
PHARMACOTHERAPY FOR PCI
ANTIPLATELET THERAPY
Aspirin
Thienopyridines
IIb/IIIa Platelet Receptor Inhibitors
PARENTERAL ANTICOAGULANT THERAPY
HEPARIN
ENOXAPARIN
BIVALIRUDIN
EQUIPMENT FOR CORONARY INTERVENTIONS
GUIDE CATHETERS
GUIDEWIRE
BALLOONS
General Use Balloons
OTHER SPECIALIZED INTRACORONARY BALLOONS
Cutting Balloon
Perfusion Balloon Catheter
PERCUTANEOUS TRANSLUMINAL CORONARY ANGIOPLASTY
CORONARY STENTS
TYPES OF STENTS
STENT DEPLOYMENT
ADJUNCTIVE CORONARY INTERVENTIONAL DEVICES
THROMBECTOMY
ROTATIONAL CORONARY ATHERECTOMY
DIRECTIONAL CORONARY ATHERECTOMY
EMBOLIC PROTECTION DEVICES FOR VENOUS BYPASS GRAFT PCI
DISTAL EMBOLIC FILTERS
DISTAL OCCLUSION DEVICES
PROXIMAL OCCLUSION DEVICES
CLINICAL OUTCOMES
DES VERSUS BMS
PROCEDURAL SUCCESS AND COMPLICATIONS RELATED TO CORONARY INTERVENTION
COMPLICATIONS SPECIFIC TO PCI
THREATENED OR ACUTE CLOSURE
PERFORATION
NO-REFLOW
ACUTE THROMBOTIC CLOSURE
SECTION 4: ELECTROPHYSIOLOGY
CHAPTER 29:
Arrhythmia Mechanisms
INTRODUCTION
ARRHYTHMIA INITIATION
MOLECULAR AND CELLULAR MECHANISMS
ACTION POTENTIALS REQUIRE ORCHESTRATED ION CHANNEL OPENING AND INACTIVATION
ACTION POTENTIAL PHYSIOLOGY IS A CONSEQUENCE OF ION CHANNEL AND CELLULAR PROPERTIES
ACTION POTENTIALS ARE DESIGNED FOR AUTOMATICITY AND TO INITIATE CONTRACTION
ACTION POTENTIAL PHYSIOLOGY IS REFLECTED BY THE SURFACE ELECTROCARDIOGRAM
AFTERDEPOLARIZATIONS AND TRIGGERED ARRHYTHMIAS
PROARRHYTHMIC SUBSTRATES
PROARRHYTHMIC TRIGGERS AND SUBSTRATES ARE PROMOTED IN FAILING HEARTS
CHAPTER 30:
Antiarrhythmic Drugs
INTRODUCTION
ARRHYTHMIA MECHANISMS AND ANTIARRHYTHMIC DRUGS
INDICATIONS FOR ANTIARRHYTHMIC DRUG THERAPY
PROARRHYTHMIA
CLASSIFICATION SCHEME
VAUGHAN-WILLIAMS CLASSIFICATION
CLASS I ANTIARRHYTHMIC DRUGS: SODIUM CHANNEL BLOCKERS
Class IA Antiarrhythmic Drugs
Class IB Antiarrhythmic Drugs
Class IC Antiarrhythmic Drugs
CLASS II ANTIARRHYTHMIC DRUGS: BETA-ADRENOCEPTOR BLOCKERS
CLASS III ANTIARRHYTHMIC DRUGS: DRUGS THAT PROLONG REPOLARIZATION
Sotalol
Dofetilide
Ibutilide
Amiodarone
Dronedarone
Azimilide
CLASS IV ANTIARRHYTHMIC DRUGS: CALCIUM CHANNEL ANTAGONISTS
MISCELLANEOUS DRUGS
ADENOSINE
NEWER DRUGS
TEDISAMIL
VERNAKALANT
IVABRADINE
RANOLAZINE
EMERGING ANTIARRHYTHMIC DRUGS
ANTIARRHYTHMIC DRUG SELECTION IN ATRIAL FIBRILLATION
OUT-PATIENT VERSUS IN-HOSPITAL INITIATION FOR ANTIARRHYTHMIC DRUG THERAPY
ANTIARRHYTHMIC DRUGS IN PREGNANCY AND LACTATION
COMPARING ANTIARRHYTHMIC DRUGS TO IMPLANTABLE CARDIOVERTER DEFIBRILLATORS IN PATIENTS AT RISK OF ARRHYTHMIC DEATH
ANTIARRHYTHMIC DRUG-DEVICE INTERACTIONS
CONCLUSION
CHAPTER 31:
Electrophysiology Studies
INTRODUCTION
CARDIAC ELECTROPHYSIOLOGY STUDY: PHILOSOPHY, REQUIREMENTS AND BASIC TECHNIQUES
CARDIAC ACCESS AND CATHETERIZATION
SIGNALS AND FILTERING
FUNDAMENTALS OF THE CARDIAC ELECTROPHYSIOLOGY STUDY
CONVENTIONS
NORMAL CARDIAC ELECTROPHYSIOLOGY
Normal Propagation Patterns
Sinus Rhythm and Normal Atrioventricular Conduction Parameters
PROGRAMMED ELECTRICAL STIMULATION AND ASSOCIATED ELECTROPHYSIOLOGY
CONTINUOUS PACING
INTERMITTENT OR INTERRUPTED PACING WITH EXTRASTIMULI
SIGNIFICANCE OF “SHORT-LONG-SHORT” PACING CYCLES
Relation of Pacing Technique to Anticipated Arrhythmia Mechanism and Inducibility
CLINICAL APPLICATION OF “ROUTINE” ELECTROPHYSIOLOGY STUDY AND ANTICIPATED RESPONSES TO PROGRAMMED STIMULATION
Baseline Observations
Atrial Stimulation for Evaluation of Sinus Node Function; and Atrial and Atrioventricular Nodal Conduction Properties
Evaluation of Atrioventricular Conduction Disease
Ventricular Stimulation and Assessment of Ventriculoatrial Conduction, Wide QRS Tachycardia and Sudden Death Risk
Role of Electrophysiology Study in Evaluation of Unexplained Syncope
SURVIVORS OF SUDDEN CARDIAC ARREST
Cardioactive Agents
CARDIAC ELECTROPHYSIOLOGY STUDY FOR EVALUATION OF DRUG THERAPY
ELECTROPHYSIOLOGY STUDY TO GUIDE ABLATIVE THERAPY
ROLE OF THREE-DIMENSIONAL MAPPING SYSTEMS
COMPLICATIONS
CONCLUSION
ACKNOWLEDGMENTS
VIDEO LEGEND
CHAPTER 32:
Syncope
INTRODUCTION
EPIDEMIOLOGY
INCIDENCE AND PREVALENCE OF SYNCOPE
ECONOMIC BURDEN OF SYNCOPE
CAUSES AND CLASSIFICATION OF SYNCOPE
DIAGNOSTIC TESTS
HISTORY AND PHYSICAL EXAMINATION
BLOOD TESTS
ELECTROCARDIOGRAM
ECHOCARDIOGRAPHY
EXERCISE TESTING
CONTINUOUS ECG MONITORING
External Devices (24 Hours Ambulatory ECG Recorders, Event Recorders)
Implantable Loop Recorders
SIGNAL AVERAGED ECG
UPRIGHT TILT TABLE TESTING
ELECTROPHYSIOLOGY STUDY
CARDIAC CATHETERIZATION
NEUROLOGIC TESTS
APPROACH TO THE EVALUATION OF SYNCOPE
SPECIFIC PATIENT GROUPS
VASOVAGAL (NEUROCARDIOGENIC) SYNCOPE
HYPERTROPHIC CARDIOMYOPATHY
NONISCHEMIC CARDIOMYOPATHY
CONGENITAL HEART DISEASE
ELDERLY PATIENTS
SYNCOPE AND DRIVING
CHAPTER 33:
Atrial Fibrillation
INTRODUCTION
DEFINITION AND CLASSIFICATION
EPIDEMIOLOGY
INCIDENCE AND PREVALENCE
NATURAL HISTORY
ETIOLOGY AND PATHOGENESIS
STRUCTURAL HEART DISEASE
Valvular Heart Disease
Heart Failure
Ischemic Heart Disease
Hypertrophic Cardiomyopathy
ELECTROPHYSIOLOGICAL ABNORMALITIES
Atrial Tachycardia and Pulmonary Venous Activity
Supraventricular Tachycardia
Conduction System Disease
Cardiac Nervous System Dysfunction
NON-CARDIAC CAUSES
LONE ATRIAL FIBRILLATION
DIAGNOSIS
PRESENTATION
PHYSICAL EXAMINATION
ELECTROCARDIOGRAM
DIAGNOSTIC TESTING
MANAGEMENT
NEW-ONSET ATRIAL FIBRILLATION
RATE CONTROL VERSUS RHYTHM CONTROL IN RECURRENT AF
RESTORATION OF SINUS RHYTHM
MAINTENANCE OF SINUS RHYTHM—PHARMACOLOGICAL APPROACHES
Class 1: Antiarrhythmic Drugs
Class 3: Antiarrhythmic Drugs
Modulators of the RAAS System
MAINTENANCE OF SINUS RHYTHM—INVASIVE APPROACHES
Catheter Ablation
Surgical Procedures for AF Maintenance
STRATEGIES FOR RATE CONTROL
PREVENTION OF THROMBOEMBOLISM
CONCLUSION
CHAPTER 34:
Supraventricular Tachycardia
INTRODUCTION
CLASSIFICATION
ATRIAL-BASED AV NODAL INDEPENDENT SVT
Sinus Tachycardia
Atrial Flutter
Atrial Tachycardia
Focal Atrial Tachycardia
Intra-atrial Reentrant Tachycardia
Sinoatrial Re-entry Tachycardia
Multifocal Atrial Tachycardia
AV NODAL DEPENDENT SVT
Atrioventricular Nodal Reentrant Tachycardia
Atrioventricular Re-entry Tachycardia
Pre-excitation Syndromes
Permanent Junctional Reciprocating Tachycardia
Junctional Ectopic Tachycardia
DIAGNOSIS
ELECTROCARDIOGRAPHIC RECORDINGS
P Wave Characteristics
Wide QRS Tachycardia—Is It SVT?
ELECTROPHYSIOLOGY STUDIES
TREATMENTS
ACUTE CARE
AV Nodal Dependent SVT or Regular SVT
AV Nodal Independent SVT
When to Use DC Cardioversion
LONG-TERM MANAGEMENT
Catheter Ablation
CONCLUSION
CHAPTER 35:
Clinical Spectrum of Ventricular Tachycardia
INTRODUCTION
MONOMORPHIC VENTRICULAR TACHYCARDIA
MYOCARDIAL VT IN ASSOCIATION WITH STRUCTURAL HEART DISEASE
Myocardial VT in Association with Fibrosis/Scar8,10,13-15 (Table 1)
Monomorphic VT due to Bundle Branch Reentry20,25
Monomorphic VT in Association with Arrhythmogenic Right Ventricular Dysplasia28,29
Monomorphic VT Post Surgery for Congenital Heart Disease31,32
MONOMORPHIC VT IN ASSOCIATION WITH STRUCTURALLY NORMAL HEART
VT from Right Ventricular Outflow Tract
Idiopathic Left Ventricle VT35,36
Aortic Sinus of Valsalva, Pulmonic, Mitral Cusp VT
Bidirectional Tachycardia
Iatrogenic VT
POLYMORPHIC VENTRICULAR TACHYCARDIA
PVT IN ASSOCIATION WITH LONG QT INTERVAL (TABLE 1)
Congenital Long QT Interval Syndrome39-42
Acquired Long QT Syndrome
PVT WITH NORMAL QT PROLONGATION
Brugada Syndrome
Active Ischemia
Myocardial Hypertrophy
LV Noncompaction50
Catecholaminergic PVT51,52
J-Wave Syndromes12,53,54
Idiopathic VF
PVT IN ASSOCIATION WITH SHORT QT SYNDROME56,57
CHAPTER 36:
Bradycardia and Heart Block
INTRODUCTION
CONDUCTION SYSTEM ANATOMY AND DEVELOPMENT
BRADYCARDIA SYNDROMES/DISEASES
IATROGENIC AND NONCARDIAC CAUSES
FAMILIAL
VAGAL TONE
CARDIAC TRANSPLANTATION
CLINICAL PRESENTATION
MEASUREMENT/DIAGNOSIS
SINUS NODE DISEASE
SICK SINUS SYNDROME
AV NODE DISEASE
PATHOLOGY
FIRST-DEGREE AV BLOCK
SECOND-DEGREE AV BLOCK
THIRD-DEGREE AV BLOCK
PAROXYSMAL AV BLOCK
HEMIBLOCK
BUNDLE BRANCH BLOCK
LEFT BUNDLE BRANCH BLOCK
RIGHT BUNDLE BRANCH BLOCK
TREATMENT
CHAPTER 37:
Arrhythmogenic Right Ventricular Dysplasia/Cardiomyopathy
INTRODUCTION
MOLECULAR AND GENETIC BACKGROUND
DESMOSOME STRUCTURE AND FUNCTION
DESMOSOMAL DYSFUNCTION AND ARVD/C PATHOPHYSIOLOGY
AUTOSOMAL RECESSIVE DISEASE
AUTOSOMAL DOMINANT DISEASE
OTHER NON-DESMOSOMAL GENES
EPIDEMIOLOGY
CLINICAL PRESENTATION
CLINICAL DIAGNOSIS
GLOBAL AND/OR REGIONAL DYSFUNCTION AND STRUCTURAL ALTERATIONS
ENDOMYOCARDIAL BIOPSY
ECG CRITERIA
DEPOLARIZATION ABNORMALITIES
REPOLARIZATION ABNORMALITIES
ARRHYTHMIAS
FAMILY HISTORY
NON-CLASSICAL ARVD/C SUBTYPES
NAXOS DISEASE
CARVAJAL SYNDROME
LEFT DOMINANT ARVD/C (LDAC)
DIFFERENTIAL DIAGNOSIS
MOLECULAR GENETIC ANALYSIS
PROGNOSIS AND THERAPY
SUMMARY
CHAPTER 38:
Long QT, Short QT and Brugada Syndromes
INTRODUCTION
LQT SYNDROME
CLINICAL MANIFESTATIONS
PATHOGENESIS
MOLECULAR GENETICS
GENOTYPE-PHENOTYPE CORRELATION STUDIES AND RISK STRATIFICATION STRATEGIES
DIAGNOSIS
GENETIC TESTING
THERAPY
ICD THERAPY
LEFT CARDIAC SYMPATHETIC DENERVATION
GENOTYPE-SPECIFIC THERAPY
SQT SYNDROME
CLINICAL MANIFESTATIONS
MOLECULAR GENETICS
PATHOGENESIS
DIAGNOSIS
THERAPY
BRUGADA SYNDROME
CLINICAL MANIFESTATIONS
GENETICS
PATHOGENESIS
DIAGNOSIS
PROGNOSIS, RISK STRATIFICATION AND THERAPY
ACKNOWLEDGMENTS
CHAPTER 39:
Surgical and Catheter Ablation of Cardiac Arrhythmias
SUPRAVENTRICULAR TACHYCARDIA
INTRODUCTION
HISTORY OF CLINICAL ELECTROPHYSIOLOGIC STUDIES
CARDIAC-SURGICAL ABLATION
CATHETER ABLATION
ATRIOVENTRICULAR NODAL RE-ENTRANT TACHYCARDIA
ELECTROPHYSIOLOGY OF AVNRT
SURGICAL ABLATION OF AVNRT
CATHETER ABLATION OF AVNRT
WOLFF-PARKINSON-WHITE SYNDROME AND ATRIOVENTRICULAR RE-ENTRANT TACHYCARDIA
HISTORICAL EVOLUTION OF VENTRICULAR PRE-EXCITATION AND AVNRT
CARDIAC-SURGICAL CONTRIBUTION
DEVELOPMENT OF CATHETER ABLATION
CLINICAL IMPLICATIONS OF WPW SYNDROME AND AVRT
CLASSIFICATION AND LOCALIZATION OF ACCESSORY PATHWAYS
EFFICACY AND CHALLENGES OF CATHETER ABLATION FOR ACCESSORY PATHWAYS
COMPLICATIONS OF CATHETER ABLATION
FOCAL ATRIAL TACHYCARDIA
MECHANISMS AND CLASSIFICATIONS OF AT
DIFFERENTIATION OF THE MECHANISMS OF AT
INDICATIONS OF CATHETER ABLATION FOR FOCAL AT
TECHNIQUES OF CATHETER ABLATION FOR FOCAL AT
EFFICACY OF CATHETER ABLATION OF AT
ATRIAL FLUTTER
CLINICAL IMPLICATIONS OF AFL AND INDICATION FOR CATHETER ABLATION
HISTORY OF NONPHARMACOLOGIC TREATMENT IN PATIENTS WITH AFL
ABLATION OF CTI DEPENDENT AFLs
END-POINT OF CTI ABLATION
ABLATION OF NON-CTI DEPENDENT AFLs
RIGHT ATRIAL FLUTTER CIRCUITS
LEFT ATRIAL FLUTTER CIRCUITS
ABLATION OF VENTRICULAR TACHYCARDIA IN PATIENTS WITH STRUCTURAL CARDIAC DISEASE
ANATOMIC SUBSTRATE
PATIENT SELECTION
PRIOR TO ABLATION
12-LEAD LOCALIZATION
APPROACH TO ABLATION
ACTIVATION MAPPING (FOCAL TACHYCARDIAS)
RE-ENTRANT TACHYCARDIA
ENTRAINMENT MAPPING
ELECTROANATOMIC THREE-DIMENSIONAL MAPPING
VOLTAGE MAPPING
PACE MAPPING
SUBSTRATE-BASED ABLATION
SAFETY
EPICARDIAL VT
IDIOPATHIC VENTRICULAR TACHYCARDIA
OUTFLOW TRACT-VENTRICULAR TACHYCARDIA (OT-VT)
RVOT VT
VT ARISING FROM THE PULMONARY ARTERY
LVOT VT
CUSP VT
EPICARDIAL VT
MANAGEMENT
CATHETER ABLATION
IDIOPATHIC LEFT VENTRICULAR TACHYCARDIA (ILVT) OR FASCICULAR VT
ECG RECOGNITION
MANAGEMENT
CATHETER ABLATION
MITRAL ANNULAR VT
ECG RECOGNITION
CATHETER ABLATION
TRICUSPID ANNULAR VT
SUMMARY
CHAPTER 40:
Cardiac Resynchronization Therapy
INTRODUCTION
CRT: RATIONAL FOR USE
CRT IN PRACTICE
MIRACLE STUDY
COMPANION STUDY
CARE-HF
SUMMARY OF CRT BENEFIT
PREDICTION OF RESPONSE TO CRT THERAPY
IS THERE ADEQUATE BIV CAPTURE?
OPTIMIZATION OF CRT DEVICE
ROLE OF DYSSYNCHRONY IMAGING
SEPTAL TO POSTERIOR WALL MOTION DELAY
TISSUE DOPPLER IMAGING
TISSUE SYNCHRONIZATION IMAGING
STRAIN RATE IMAGING (SRI)
SPECKLED TRACKING
THE PROSPECT TRIAL
OTHER DYSSYNCHRONY IMAGING TECHNIQUES
MAGNETIC RESONANCE IMAGING
NUCLEAR IMAGING
REAL-TIME THREE-DIMENSIONAL ECHOCARDIOGRAPHY
MULTIDETECTOR COMPUTED TOMOGRAPHY
DYSSYNCHRONY SUMMARY
LV LEAD PLACEMENT
CRT COMPLICATIONS
PHRENIC NERVE SIMULATION
LOSS OF CRT
CRT AND VENTRICULAR ARRHYTHMIAS
EMERGING CRT INDICATIONS
NARROW QRS
ATRIAL FIBRILLATION
PACEMAKER DEPENDANT PATIENTS
MINIMALLY SYMPTOMATIC HEART FAILURE
CRT FOR ACUTE DECOMPENSATED HEART FAILURE
SUMMARY
CHAPTER 41:
Ambulatory Electrocardiographic Monitoring
INTRODUCTION
HOLTER MONITORING
EVENT RECORDERS
MOBILE CARDIAC OUTPATIENT TELEMETRY
IMPLANTABLE LOOP RECORDERS
KEY CONSIDERATIONS IN SELECTING A MONITORING MODALITY
CHAPTER 42:
Cardiac Arrest and Resuscitation
OVERVIEW OR BACKGROUND
EVOLUTION OF CARDIAC RESUSCITATION
CARDIOPULMONARY ARREST
EMERGENCY MEDICAL SERVICES
BASIC LIFE SUPPORT
ROLE OF BYSTANDERS
EMERGENCY MEDICAL SERVICES ACTIVATION
DISPATCHER ASSISTED CARDIOPULMONARY RESUSCITATION
COMPRESSION ONLY CARDIOPULMONARY RESUSCITATION
CHEST COMPRESSIONS OR AIRWAY MANAGEMENT
MECHANICAL DEVICES FOR CARDIOPULMONARY RESUSCITATION
USE OF AUTOMATIC EXTERNAL DEFIBRILLATORS
PACEMAKER OR AUTOMATIC IMPLANTABLE CARDIOVERTER DEFIBRILLATOR PATIENT IN CARDIAC ARREST
COMPLICATIONS OF CARDIOPULMONARY RESUSCITATION
ADVANCED CARDIAC LIFE SUPPORT
OVERVIEW-STATISTICS OF SUCCESS
ADVANCED AIRWAY MANAGEMENT
PHARMACEUTICAL INTERVENTIONS
Epinephrine
Vasopressin
Lidocaine
Amiodarone
Procainamide
Atropine
Magnesium Sulfate
Calcium Chloride
Morphine and Oxygen
DEFIBRILLATION OR CARDIOVERSION
Risk to the Patient
Risk to the Environment or Equipment
Risks to the Rescuer
CESSATION OF RESUSCITATION
POST-RESUSCITATION CARE
CARDIOPULMONARY SUPPORT
CARDIAC INTERVENTIONS
THERAPEUTIC HYPOTHERMIA
SUMMARY
CHAPTER 43:
Risk Stratification for Sudden Cardiac Death
INTRODUCTION
HEALTHY ATHLETES
BRUGADA SYNDROME
LONG QT INTERVAL SYNDROME
EARLY REPOLARIZATION
SHORT QT SYNDROME
CATECHOLAMINE POLYMORPHIC VENTRICULAR TACHYCARDIA
WOLFF-PARKINSON-WHITE SYNDROME
ARRHYTHMOGENIC RIGHT VENTRICULAR CARDIOMYOPATHY
HYPERTROPHIC CARDIOMYOPATHY
MARFAN SYNDROME
NONCOMPACTION
CONGENITAL HEART DISEASE
NON-ISCHEMIC CARDIOMYOPATHY
CORONARY ARTERY DISEASE
SUMMARY
CHAPTER 44:
Cardiocerebral Resuscitation for Primary Cardiac Arrest
INTRODUCTION
ETIOLOGY AND PATHOPHYSIOLOGY OF CARDIAC ARREST
PRIMARY CARDIAC ARREST IN CHILDREN AND ADOLESCENTS
PATHOPHYSIOLOGY OF PRIMARY CARDIAC ARREST
CORONARY PERFUSION PRESSURES DURING RESUSCITATION EFFORTS
ASSISTED VENTILATION IN PRIMARY CARDIAC ARREST
NOT FOLLOWING GUIDELINES FOR PRIMARY CARDIAC ARREST
THE PUBLIC HAS MADE UP ITS MIND
INCREASING THE PREVALENCE OF BYSTANDER RESUSCITATION EFFORTS
INCREASING THE ABILITY TO PROMPTLY IDENTIFY PRIMARY CARDIAC ARREST
THE THREE PHASES OF VENTRICULAR FIBRILLATION (VF)
Electrical Phase (0–4 minutes)
Circulatory Phase (4–10 minutes)
Metabolic Phase (> 10 minutes from Onset of Untreated Cardiac Arrest)
CARDIOCEREBRAL RESUSCITATION: PREHOSPITAL COMPONENT
DRUG THERAPY IN CARDIAC RESUSCITATION
CARDIAC RESUSCITATION CENTERS
THERAPEUTIC MILD HYPOTHERMIA
MYOCARDIAL ISCHEMIA CAUSING CARDIAC ARREST
ENDING RESUSCITATIVE EFFORTS
SUMMARY
SECTION 5: CORONARY HEART DISEASES
CHAPTER 45:
Coronary Heart Disease: Risk Factors
INTRODUCTION
CHD SCREENING AND PREVENTION
CLUSTERING AND MULTIPLICATIVE EFFECTS OF RISK FACTORS
CHD RISK ESTIMATION
FRAMINGHAM RISK SCORE (FRS)
EUROPEAN RISK SCORES
NEWER RISK SCORES
MEASURES TO EVALUATE RISK PREDICTION MODELS
TRADITIONAL CHD RISK FACTORS
NON-MODIFIABLE RISK FACTORS FOR CHD
MODIFIABLE RISK FACTORS FOR CHD
Lifestyle Risk Factors
Hypertension
Hyperlipidemia
Diabetes Mellitus
Alcohol
EMERGING RISK FACTORS
HIGH-SENSITIVITY C-REACTIVE PROTEIN (hs-CRP)
LIPOPROTEIN (A) [LP(A)]
HYPERHOMOCYSTEINEMIA
LIPOPROTEIN-ASSOCIATED PHOSPHOLIPASE A2 (LP-PLA2)
APOLIPOPROTEIN B
FIBRINOGEN AND OTHER HEMOSTATIC FACTORS
SUB-CLINICAL ATHEROSCLEROSIS
TRANSLATING RISK FACTOR SCREENING INTO EVENT REDUCTION
CHAPTER 46:
Changing Focus in Global Burden of Cardiovascular Diseases
INTRODUCTION
CVD IN HIGH INCOME COUNTRIES
LOW AND MIDDLE INCOME COUNTRIES
RISK FACTORS
GLOBAL RESPONSE FOR COMBATING CVD
CONCLUSION
CHAPTER 47:
Evaluation of Chest Pain
SCOPE
HISTORY
DIFFERENTIAL DIAGNOSIS
PATIENT'S DESCRIPTION
LOCATION
RADIATION
QUALITY
INTENSITY
ASSOCIATED SYMPTOMS
ONSET OF PAIN
DURATION
ALLEVIATING AND AGGRAVATING FACTORS
ANGINA
PAST MEDICAL HISTORY
PHYSICAL EXAMINATION
INVESTIGATIONS
CHEST X-RAY
ECG
LABORATORY INVESTIGATIONS
ESTIMATION OF RISK
DIAGNOSTIC TESTING
TREADMILL EXERCISE STRESS TESTING
STRESS TESTING WITH MYOCARDIAL IMAGING
STRESS MYOCARDIAL PERFUSION IMAGING
POSITRON EMISSION TOMOGRAPHIC PERFUSION IMAGING
STRESS TESTING WITH ECHOCARDIOGRAM IMAGING
COMPARISON OF MPI TO STRESS ECHO
NONINVASIVE COMPUTED TOMOGRAPHIC ANGIOGRAPHY
INVASIVE CORONARY ANGIOGRAPHY
SUMMARY
CHAPTER 48:
Acute Coronary Syndrome I (Unstable Angina and Non-ST-Segment Elevation Myocardial Infarction): Diagnosis and Early Treatment
INTRODUCTION
PATHOPHYSIOLOGY
ETIOLOGY
VULNERABLE PLAQUE
SYSTEMIC FACTORS (VULNERABLE PATIENT)
ROLE OF PLATELETS AND COAGULATION SYSTEM
CLINICAL FEATURES
PHYSICAL EXAMINATION
ELECTROCARDIOGRAM
BIOMARKERS
Creatinine Kinase
Troponin
RISK STRATIFICATION-PUTTING IT ALL TOGETHER TO DETERMINE THE OPTIMAL TREATMENT STRATEGY
HISTORY
ELECTROCARDIOGRAM
CARDIAC BIOMARKERS
EARLY MEDICAL THERAPY
GENERAL MEASURES
NITRATES
MORPHINE
BETA BLOCKERS
CALCIUM CHANNEL BLOCKERS
ANTIPLATELET AGENTS
Aspirin
Adenosine Dinucleotide Phosphate Receptor Antagonists
Clopidogrel
Clopidogrel Resistance
Newer Antiplatelet Agents
ANTITHROMBOTIC AGENTS
Heparin
Low-Molecular Weight Heparin
Fondaparinux
Direct Thrombin Inhibitors
Warfarin
EARLY INVASIVE OR INITIAL CONSERVATIVE STRATEGY
REVASCULARIZATION
SUMMARY AND CONCLUSIONS
CHAPTER 49:
Acute Coronary Syndrome II (ST-Elevation Myocardial Infarction and Post Myocardial Infarction): Complications and Care
INTRODUCTION
PATHOPHYSIOLOGY
STENT THROMBOSIS
COCAINE OR METHAMPHETAMINE
CLINICAL PRESENTATION
PREHOSPITAL ASSESSMENT
EMERGENCY ROOM EVALUATION
Electrocardiogram
Other Early Diagnostic Evaluation
REPERFUSION
THROMBOLYSIS
FACILITATED PERCUTANEOUS CORONARY INTERVENTION
Full Dose Thrombolytic Agent
Elective Angiography and PCI after Successful Thrombolysis
PRIMARY CORONARY INTERVENTION
EARLY MEDICAL THERAPY
GENERAL MEASURES
NITRATES
MORPHINE
ANTIPLATELET AGENTS
ANTICOAGULATION
BETA BLOCKERS
POST MYOCARDIAL INFARCTION CARE
ASSESSMENT OF LEFT VENTRICULAR EJECTION FRACTION
STRESS TESTING PRIOR TO DISCHARGE
CORONARY ANGIOGRAPHY AND REVASCULARIZATION
COMPLICATIONS
RIGHT VENTRICULAR INFARCTION
HEART FAILURE OR CARDIOGENIC SHOCK AND MECHANICAL COMPLICATIONS AFTER A MYOCARDIAL INFARCTION
DYSRHYTHMIAS
RECURRENT CHEST DISCOMFORT
SPECIAL CONSIDERATIONS
DIABETES
WOMEN
ELDERLY
ACUTE CORONARY SYNDROME WITH COCAINE (AND METHAMPHETAMINE) USE
POST MYOCARDIAL INFARCTION DEPRESSION
SURVIVORS OF OUT OF HOSPITAL CARDIAC ARREST
CONTINUED MEDICAL THERAPY FOR PATIENTS WITH A MYOCARDIAL INFARCTION
INHIBITION OF THE RENIN-ANGIOTENSINALDOSTERONE AXIS
LIPID MANAGEMENT
GLUCOSE MANAGEMENT
SMOKING CESSATION
DISCHARGE
NITRATES
CARDIAC REHABILITATION AND SECONDARY PREVENTION OF CORONARY HEART DISEASE FOR PATIENTS WITH MYOCARDIAL INFARCTION
Advantages of Cardic Rehabilitation
Utilization of Cardiac Rehabilitation in the United States
Predischarge Education
SUMMARY
CHAPTER 50:
Management of Patients with Chronic Coronary Artery Disease and Stable Angina
INTRODUCTION
CURRENT THERAPEUTIC APPROACHES FOR STABLE ANGINA
ANTIANGINAL DRUG THERAPY
NITRATES
BETA-BLOCKERS
CALCIUM CHANNEL BLOCKERS
NEWER ANTIANGINAL DRUGS
RANOLAZINE
IVABRADINE
COMBINATION THERAPY
OTHER DRUGS IN PATIENTS WITH STABLE ANGINA AND CHRONIC CAD
ANGIOTENSIN CONVERTING ENZYME INHIBITORS
LIPID LOWERING THERAPY
ROLE OF MYOCARDIAL REVASCULARIZATION
COMPARISON OF REVASCULARIZATION WITH PHARMACOLOGICAL ANTIANGINAL THERAPY
MEDICAL THERAPY VERSUS PERCUTANEOUS REVASCULARIZATION OR STRATEGIES COMPARING INVASIVE VERSUS OPTIMAL MEDICAL THERAPY
CONCLUSION
CHAPTER 51:
Variant Angina
INTRODUCTION
INCIDENCE AND PREDISPOSING RISK FACTORS
PATHOPHYSIOLOGY
CLINICAL PRESENTATION
DIAGNOSIS
HISTORY AND PHYSICAL EXAMINATION
Laboratory Findings
NONINVASIVE STUDIES
ECG Studies
Ambulatory ECG Monitoring
Self-Initiated Transtelephonic ECG Monitoring
In-Hospital ECG Recording
Treadmill Exercise Testing
Radionucleotide Scintigraphy
CORONARY ARTERIOGRAPHY
PROVOCATIVE TESTINGS
DIFFERENTIAL DIAGNOSIS
MANAGEMENT
MEDICAL THERAPY
Treatment of Arrhythmias
Calcium Antagonists
SURGICAL AND PERCUTANEOUS INTERVENTION
NATURAL HISTORY AND PROGNOSIS
CHAPTER 52:
Cardiogenic Shock in Acute Coronary Syndromes
INTRODUCTION
INCIDENCE
MORTALITY
PREDICTORS OF CARDIOGENIC SHOCK
PATHOPHYSIOLOGY
PATHOLOGY
OTHER CARDIAC CAUSES OF CARDIOGENIC SHOCK
RIGHT VENTRICULAR INFARCTION
VENTRICULAR SEPTAL RUPTURE
CARDIAC RUPTURE
MITRAL REGURGITATION
DIAGNOSTIC EVALUATION
MEDICAL MANAGEMENT
MECHANICAL SUPPORT
INTRA-AORTIC BALLOON PUMP
LEFT VENTRICULAR ASSIST DEVICE
TANDEMHEART
IMPELLA
REVASCULARIZATION
CHAPTER 53:
Acute Right Ventricular Infarction
INTRODUCTION
PATTERNS OF CORONARY COMPROMISE RESULTING IN RVI
RIGHT VENTRICULAR MECHANICS AND OXYGEN SUPPLY-DEMAND
EFFECTS OF ISCHEMIA ON RV SYSTOLIC AND DIASTOLIC FUNCTION
DETERMINANTS OF RV PERFORMANCE IN SEVERE RVI
IMPORTANCE OF SYSTOLIC VENTRICULAR INTERACTIONS
COMPENSATORY ROLE OF AUGMENTED RIGHT ATRIAL CONTRACTION
DELETERIOUS IMPACT OF RIGHT ATRIAL ISCHEMIA
NATURAL HISTORY OF ISCHEMIC RV DYSFUNCTION
EFFECTS OF REPERFUSION ON ISCHEMIC RV DYSFUNCTION
RHYTHM DISORDERS AND REFLEXES ASSOCIATED WITH RVI
BRADYARRHYTHMIAS AND HYPOTENSION
VENTRICULAR ARRHYTHMIAS
MECHANICAL COMPLICATIONS ASSOCIATED WITH RVI
CLINICAL PRESENTATIONS AND EVALUATION
NONINVASIVE AND HEMODYNAMIC EVALUATION
DIFFERENTIAL DIAGNOSIS OF RVI
THERAPY
PHYSIOLOGIC RHYTHM
OPTIMIZATION OF PRELOAD
ANTI-ISCHEMIC THERAPIES
REPERFUSION THERAPY
INOTROPIC STIMULATION
MECHANICAL ASSIST DEVICES
SUMMARY
CHAPTER 54:
Surgical Therapy in Chronic Coronary Artery Disease
TECHNIQUE OF SURGICAL THERAPY FOR CHRONIC CORONARY ARTERY DISEASE
INDICATIONS FOR SURGICAL CORONARY REVASCULARIZATION ADVANTAGES OF CABG OVER MEDICAL TREATMENT
COMPARING CABG TO PTCA
THE CHANGING CABG POPULATION
WHEN CABG MAY BE INDICATED
WHEN CABG IS NOT INDICATED
RISK FACTORS FOR IN-HOSPITAL MORTALITY FOLLOWING CABG
MODIFIABLE RISK FACTORS
NONMODIFIABLE RISK FACTORS
OUTCOMES OF SURGERY
GRAFT PATENCY
SURVIVAL
LEFT VENTRICULAR FUNCTION
RELIEF OF ANGINAL SYMPTOMS
QUALITY OF LIFE
MAJOR CLINICAL TRIALS IN CHRONIC CORONARY ARTERY DISEASE
CABG VERSUS MEDICAL MANAGEMENT
CASS (1983)
VA-CABSCSG (1984)
European CSS (1988)
PCI VERSUS MEDICAL MANAGEMENT
ACME (1992)
RITA-2
TIMI-IIIB
CABG VERSUS MULTIVESSEL PTCA (TRIALS COMPARING)
BARI (1997)
RITA (1993)
ERACI (1993)
GABI (1994)
EAST (1994)
CABRI (1995)
TRIALS COMPARING CORONARY ARTERY BYPASS GRAFTING VERSUS PERCUTANEOUS CORONARY TRANSLUMINAL ANGIOPLASTY USING BARE METAL STENT
ARTS I (2001)
SoS (2002)
ERACI II (2001)
TRIALS COMPARING CORONARY ARTERY BYPASS GRAFTING VERSUS PERCUTANEOUS CORONARY TRANSLUMINAL ANGIOPLASTY USING DES
SYNTAX (2009)
ERACI III Registry (2006)
ARTS II Registry (2008)
The New York State Registry (2008)
The Beijing Registry (2009)
SUMMARY
SECTION 6: VALVULAR HEART DISEASES
CHAPTER 55:
Aortic Valve Disease
INTRODUCTION
AORTIC STENOSIS
ETIOLOGY
Calcific Aortic Stenosis
Rheumatic Disease
Other Causes
PATHOPHYSIOLOGY OF AORTIC STENOSIS INDUCED LEFT VENTRICULAR PRESSURE OVERLOAD
Growth and Physiologic versus Pathologic LVH
NATURAL HISTORY AND THE ROLE OF SYMPTOMS
Angina
Syncope
Heart Failure
PHYSICAL EXAMINATION
DIAGNOSIS
Electrocardiograph and Chest X-Ray
Echocardiography
Calcium Scoring
Natriuretic Peptides
Cardiac Catheterization
TREATMENT
Medical Therapy
AVR for Symptomatic AS
AVR in Asymptomatic AS
SPECIAL CASES
Low Gradient, Low Ejection Fraction AS
Low Gradient Normal Ejection Fraction
AS in the Elderly Patients
SUMMARY
AORTIC REGURGITATION
ETIOLOGY
Aortopathy
Leaflet Abnormalities
PATHOPHYSIOLOGY
NATURAL HISTORY AND THE ROLE OF SYMPTOMS
PHYSICAL EXAMINATION
DIAGNOSIS
Electrocardiograph and Chest X-Ray
Echocardiography
Other Imaging Modalities
Exercise Testing
Cardiac Catheterization
TREATMENT
Medical Therapy
Surgery and the Timing of AVR
Acute Severe AR: A Dangerous Masquerader
SUMMARY
CHAPTER 56:
Mitral Valve Disease
NORMAL MITRAL VALVE MORPHOLOGY AND FUNCTION
GLOBAL BURDEN OF RHEUMATIC HEART DISEASE
MITRAL STENOSIS
ETIOLOGY AND PATHOLOGY
PATHOPHYSIOLOGY AND HEMODYNAMICS
CLINICAL DIAGNOSIS
Symptoms
Physical Signs
INVESTIGATIONS
Electrocardiogram
Radiological Evaluation
Echocardiography
Stress Testing
Invasive Evaluation
NATURAL HISTORY
SPECIAL POPULATIONS
MANAGEMENT
Medical Treatment
Mechanical Relief of Obstruction
MITRAL REGURGITATION
PATHOPHYSIOLOGY AND HEMODYNAMICS
ETIOLOGY
RHEUMATIC MITRAL REGURGITATION
CLINICAL DIAGNOSIS
Natural History and Complications
DEGENERATIVE MITRAL VALVE REGURGITATION
Pathology
Pathophysiology
Clinical Diagnosis
Natural History and Complications
MITRAL REGURGITATION CAUSED BY INFECTIVE ENDOCARDITIS
ACUTE MITRAL REGURGITATION
SECONDARY MITRAL REGURGITATION
INVESTIGATIONS
Electrocardiogram
Radiological Evaluation
Echocardiography
Cardiac Catheterization
Computed Tomography
Cardiovascular Magnetic Resonance Imaging
MANAGEMENT
Medical Treatment
Surgical Treatment
Treatment of Secondary Mitral Regurgitation
ACKNOWLEDGMENTS
CHAPTER 57:
Tricuspid Valve Disease: Evaluation and Management
INTRODUCTION
TRICUSPID VALVE—FORGOTTEN NO MORE
EMBRYOLOGY
VALVE ANATOMY
ANNULUS
LEAFLETS
CHORDAE TENDINEAE
PAPILLARY MUSCLES
NORMAL TRICUSPID VALVE FUNCTION
TRICUSPID VALVE DYSFUNCTION
ETIOLOGY OF TRICUSPID VALVE DISEASE
Primary Tricuspid Valve Disease
Secondary or Functional Tricuspid Valve Disease
CLINICAL PRESENTATION
SYMPTOMS
PHYSICAL SIGNS
LABORATORY DIAGNOSIS
ELECTROCARDIOGRAM
CHEST RADIOGRAPH
ECHOCARDIOGRAPHY
Tricuspid Valve Morphology
Detection and Quantitation of Tricuspid Valve Disease
TRANSESOPHAGEAL ECHOCARDIOGRAPHY
CARDIAC CATHETERIZATION AND SELECTIVE ANGIOGRAPHY
TREATMENT
APPROPRIATE TIMING
MANAGEMENT STRATEGIES
Medical Treatment
Surgical Treatment
Tricuspid Valve Replacement
SURGICAL TREATMENT OF PRIMARY TRICUSPID VALVE REGURGITATION
Rheumatic Valve Disease
Ebstein's Anomaly
Carcinoid Heart Disease
Infective Endocarditis
Cleft Tricuspid Valve
Traumatic Tricuspid Regurgitation
CHAPTER 58:
Congenital Pulmonic Stenosis
INTRODUCTION
VALVAR PULMONIC STENOSIS
ANATOMY AND PATHOLOGY
PATHOPHYSIOLOGY
THE EFFECTS OF EXERCISE
NATURAL HISTORY AND CLINICAL COURSE
CLINICAL FINDINGS
History
Physical Examination
LABORATORY INVESTIGATIONS
Chest Roentgenogram
Electrocardiogram
Echocardiography
Cardiac Catheterization
DIFFERENTIAL DIAGNOSIS
TREATMENT
Surgery
Balloon Valvotomy
ISOLATED INFUNDIBULAR STENOSIS
PATHOLOGICAL ANATOMY
PATHOPHYSIOLOGY
NATURAL HISTORY
CLINICAL FINDINGS
LABORATORY INVESTIGATIONS
Chest Roentgenogram
Electrocardiogram
Echocardiogram
Cardiac Catheterization
DIFFERENTIAL DIAGNOSIS
TREATMENT
SUPRAVALVAR STENOSIS
PATHOLOGICAL ANATOMY
PATHOPHYSIOLOGY
NATURAL HISTORY AND COURSE
CLINICAL FINDINGS
History
Physical Examination
LABORATORY INVESTIGATIONS
Chest Roentgenogram
Electrocardiogram
Echocardiogram
Cardiac Catheterization
TREATMENT
Williams-Beuren Syndrome
Alagille Syndrome
CHAPTER 59:
Catheter-based Treatment of Valvular Heart Disease
INTRODUCTION
CATHETER-BASED TREATMENT OF MITRAL VALVE DISEASE
PERCUTANEOUS BALLOON MITRAL VALVULOPLASTY
Procedure
MITRAL VALVULOPLASTY IN PREGNANCY
Summary
PERCUTANEOUS THERAPIES FOR MITRAL REGURGITATION
PERCUTANEOUS MITRAL ANNULOPLASTY
PERCUTANEOUS MITRAL LEAFLET REPAIR
CATHETER-BASED TREATMENT OF PULMONARY VALVE DISEASE
PERCUTANEOUS PULMONIC BALLOON VALVULOPLASTY
PERCUTANEOUS PULMONARY VALVE IMPLANTATION
PERCUTANEOUS TRICUSPID BALLOON VALVULOPLASTY
CATHETER-BASED THERAPIES FOR AORTIC STENOSIS
PERCUTANEOUS AORTIC BALLOON VALVULOPLASTY
Aortic Valvuloplasty in Special Circumstances
Summary
PERCUTANEOUS AORTIC VALVE IMPLANTATION
SUMMARY/FUTURE DIRECTIONS
CHAPTER 60:
Infective Endocarditis
INTRODUCTION
EPIDEMIOLOGY
ADULTS
Native Valve Endocarditis
Prosthetic Valve Endocarditis
Endocarditis in Illicit Drug Use
Healthcare-Associated Endocarditis
CHILDREN
PATHOGENESIS
PREDISPOSING CARDIAC CONDITIONS AND CONTRIBUTIONS OF ABNORMAL FLOW
NON-BACTERIAL THROMBOTIC ENDOCARDITIS (NBTE)
MICROBIAL FACTORS
HOST RESPONSE
MANIFESTATIONS OF INFECTION
Valvular Destruction and Periannular Extension
Embolization
Metastatic Foci of Infection
Immunologic Manifestations
MICROBIOLOGY
NATIVE VALVE
Non-Drug Users
Injection Drug Users
PROSTHETIC VALVE
Early Prosthetic Valve Endocarditis
Late Prosthetic Valve Endocarditis
CULTURE-NEGATIVE ENDOCARDITIS
PATIENT PRESENTATION AND DIAGNOSIS
CLINICAL PRESENTATION
BLOOD CULTURE
USE OF ECHOCARDIOGRAPHY
OTHER DIAGNOSTIC STUDIES
MIMICKERS OF INFECTIOUS ENDOCARDITIS
MANAGEMENT
EMPIRIC MEDICAL THERAPY
DEFINITIVE MEDICAL THERAPY
Streptococcal Endocarditis
Staphylococcal Endocarditis
Enterococcal Endocarditis
Culture-Negative Endocarditis
SURGICAL THERAPY AND TIMING OF SURGERY
PERSISTENT FEVER
ANTICOAGULATION
PREVENTION OF ENDOCARDITIS
SUMMARY AND CONCLUSION
CHAPTER 61:
Prosthetic Heart Valves
RISK OF VALVE REPLACEMENT
TYPES OF PROSTHETIC VALVES
MECHANICAL VALVES
Caged-ball Design
Single Tilting-disk Design
Bileaflet Tilting-disk Design
BIOPROSTHETIC VALVES
Stented Porcine Valves
Stented Bovine Pericardial
Stentless
HOMOGRAFT
ROSS PROCEDURE (PULMONIC VALVE AUTOTRANSPLANTATION)
SELECTING THE OPTIMAL PROSTHESIS
PROSTHESIS-PATIENT MISMATCH
LONG-TERM MANAGEMENT
ANTITHROMBOTIC THERAPY
General Management
Pregnancy
Noncardiac Surgery
ECHOCARDIOGRAPHY FOLLOW-UP
LONG-TERM COMPLICATIONS
THROMBOEMBOLIC AND BLEEDING COMPLICATIONS
Prosthetic Valve Thrombosis
Bleeding Complications
STRUCTURAL VALVE DETERIORATION
Endocarditis
Endocarditis Prophylaxis
PARAVALVULAR REGURGITATION
HEMOLYSIS
CHAPTER 62:
Antithrombotic Therapy in Valvular Heart Disease
INTRODUCTION
GENERAL CONSIDERATIONS
PROPHYLACTIC ANTITHROMBIC THERAPY
NATIVE VALVULAR HEART DISEASE
RHEUMATIC VALVULAR HEART DISEASE
MITRAL VALVE PROLAPSE
CALCIFIED OR DEGENERATIVE VALVULAR DISEASE
PROSTHETIC VALVES
MECHANICAL VALVES
BIOPROSTHETIC VALVES
VALVULOPLASTY AND VALVE REPAIR
MANAGEMENT ISSUES
DIAGNOSIS OF THROMBOTIC VALVE COMPLICATIONS
VALVE THROMBOSIS
PREGNANCY
ELECTIVE SURGERY
ENDOCARDITIS
SECTION 7: VASCULAR DISEASES
CHAPTER 63:
Evaluation and Management of the Patient with Essential Hypertension
INTRODUCTION
EVALUATION OF THE PATIENT WITH HYPERTENSION
CLINICAL MANIFESTATIONS
PHYSICAL FINDINGS
Blood Pressure Measurement
Optic Fundi
Peripheral Pulses
Cardiac Examination
LABORATORY STUDIES
Complete Blood Count
Blood Chemistries
Urinary Studies
CHEST ROENTGENOGRAM
ELECTROCARDIOGRAPHY
ANTIHYPERTENSIVE THERAPY
LIFESTYLE MANAGEMENT
Obesity
Salt
Other Electrolytes
Exercise
Alcohol Restriction
Cigarette Smoking
Non-antihypertensive Drugs
PHARMACOLOGICAL THERAPY
HEMODYNAMIC CONCEPTS
CLINICAL PHARMACOLOGIC CONCEPTS
DIURETICS
THIAZIDES AND CONGENERS
MECHANISMS OF ACTION
METABOLIC EFFECTS
Hypokalemia
Hyperuricemia
Loop Diuretics
Potassium-sparing Agents (Spironolactone and Eplerinone)
Amiloride and Triamterene
Beta-Adrenergic Receptor Blockers (Beta-Blockers)
Postulated Mechanisms of Action of the Beta-Blockers (Table 8)
Calcium Antagonists
Angiotensin Converting Enzyme (ACE) Inhibitors
Angiotensin II Receptor Blockers (ARB) or Antagonists
Renin Inhibitors
Adrenergic Inhibitors
Ganglion Blockers
Rauwolfia Alkaloids
Postganglionic Neuronal Depletors
Centrally-acting Postsympathetic Alpha-adrenergic Agonists
Postsynaptic (Peripheral) Alpha-receptor Antagonists
Smooth Muscle Vasodilators
TREATMENT ALGORITHMS ADVOCATED OVER THE YEARS
STEPPED CARE APPROACH
INDIVIDUALIZED STEPPED-CARE APPROACH (TABLE 10)
HYPERTENSIVE EMERGENCIES
CHAPTER 64:
Peripheral Vascular and Cerebrovascular Disease
INTRODUCTION
PERIPHERAL ARTERIAL DISEASE
EPIDEMIOLOGY
VASCULAR HISTORY AND PHYSICAL EXAMINATION
RISK FACTORS FOR PAD
CLINICAL PRESENTATION AND NATURAL HISTORY
Asymptomatic and Symptomatic (IC) PAD
Critical Limb Ischemia
Acute Limb Ischemia
Screening for PAD
DIAGNOSIS
Ankle-Brachial Index
Other Noninvasive Vascular Modalities
MANAGEMENT
Management of Atherosclerotic Risk Factors
Management of Symptoms
CAROTID ARTERY DISEASE
PATHOPHYSIOLOGY
NATURAL HISTORY AND RISK STRATIFICATION
SCREENING
DIAGNOSIS
Noninvasive Testing
Conventional Angiogram
MANAGEMENT
Antiplatelets, Dipyridamole and Warfarin
Carotid Endarterectomy
Carotid Stenting
RENAL ARTERY STENOSIS
EPIDEMIOLOGY AND NATURAL HISTORY OF ARAS
Renal Artery Stenosis and Hypertension
Fibromuscular Dysplasia
SCREENING AND DIAGNOSTIC TESTS
MEDICAL MANAGEMENT
REVASCULARIZATION
SUBCLAVIAN ARTERY STENOSIS
VERTEBROBASILAR ARTERY STENOSIS
MESENTERIC ISCHEMIA
SUMMARY
ACKNOWLEDGMENTS
CHAPTER 65:
Aortic Dissection
INTRODUCTION
PREDISPOSING FACTORS
ATHEROSCLEROSIS
INHERITED DISEASE
Thoracic Aortic Aneurysms and Dissections
Marfan's Syndrome
Loeys-Dietz Syndrome
Non Syndromic Familial Thoracic Aortic Aneurysms and Dissections
Ehler-Danlos Syndrome
Bicuspid Aortic Valve
Other Conditions
CLASSIFICATION
STANFORD CLASSIFICATION
DEBAKEY CLASSIFICATION
ANATOMICAL CLASSIFICATION (FIG. 2)
NEW CLASSIFICATION
Class I
Class II
Class III
Class IV or Plaque Ulceration
Class V
CLINICAL MANIFESTATIONS
CLINICAL SYMPTOMS
PHYSICAL FINDINGS
DIAGNOSIS
CHEST X-RAY
ELECTROCARDIOGRAPHY
D-DIMER
IMAGING
Transthoracic Echocardiogram
Transesophageal Echocardiogram
CT Angiogram
Magnetic Resonance Imaging
Aortography
Coronary Angiography
TREATMENT
INITIAL TREATMENT
Cardiac Tamponade
Type A Acute Aortic Dissection
Type B Acute Aortic Dissection
ENDOVASCULAR REPAIR
ACUTE AORTIC DISSECTION: OUTCOME
Type A Dissection
Type B Dissection
CONCLUSION
CHAPTER 66:
Endovascular Treatment of Aortic Aneurysm and Dissection
INTRODUCTION
HISTORY OF ENDOVASCULAR AORTIC REPAIR
DEVICES
STENT GRAFT DESIGN: THE LESSONS OF EXPERIENCE
ANATOMIC SUBSTRATE FOR ENDOVASCULAR ANEURYSM REPAIR
CURRENT STENT GRAFT DESIGNS FOR ABDOMINAL AORTIC ANEURYSM (AAA)
MODULAR Z-STENT-BASED STENT GRAFTS
UNIBODY STENT GRAFTS
UNI-ILIAC STENT GRAFTS
RINGED STENT GRAFTS
POLYMER FILLED STENT GRAFTS
ADJUNCTIVE DEVICES AND TECHNIQUES
NARROW ILIAC ARTERIES
ANGULATED NECK
SHORT NECK
ILIAC ANEURYSM
ENDOLEAK
LATE-OCCURRING COMPLICATIONS OF ENDOVASCULAR ANEURYSM REPAIR
MIGRATION
ENDOTENSION
NECK DILATATION
FOLLOW-UP IMAGING
BRANCHED AND FENESTRATED STENT GRAFTS
CURRENT THORACIC AORTIC STENT GRAFT DESIGNS
ENDOVASCULAR REPAIR OF THORACIC AORTIC ANEURYSMS
THORACIC AORTIC DISSECTION
ACUTE TYPE B DISSECTION
CHRONIC TYPE B DISSECTION
COMPLICATIONS OF THORACIC ENDOVASCULAR AORTIC REPAIR
ENDOLEAK
NEUROLOGICAL COMPLICATIONS
FAILED INSERTION
INTRAMURAL HEMATOMA
PENETRATING AORTIC ULCER
CONCLUSION
CHAPTER 67:
Autonomic Dysfunction and the Cardiovascular System
INTRODUCTION
AUTONOMIC REGULATION OF THE CARDIOVASCULAR SYSTEM
REGULATION OF BLOOD PRESSURE
HEART RATE CONTROL
CHEMOREFLEX INFLUENCE ON HEART RATE AND BLOOD PRESSURE
ORTHOSTATIC HYPOTENSION
AUTONOMIC TESTING
ORTHOSTATICS
VALSALVA MANEUVER
RESTING HEART RATE
BAROREFLEX SENSITIVITY
HEART RATE VARIABILITY
HEART RATE RECOVERY
CATECHOLAMINE BLOOD MEASUREMENT
CARDIAC SYMPATHETIC IMAGING
PRIMARY CHRONIC AUTONOMIC FAILURE
PURE AUTONOMIC FAILURE
MULTIPLE SYSTEM ATROPHY
SECONDARY AND CONGENITAL AUTONOMIC FAILURE
CHRONIC ORTHOSTATIC INTOLERANCE
POSTURAL ORTHOSTATIC TACHYCARDIA SYNDROME
TREATMENT OF ORTHOSTATIC HYPOTENSION/INTOLERANCE
Non-Pharmacologic Therapy
Pharmacologic Therapy
SYNDROMES ASSOCIATED WITH EPISODIC AUTONOMIC FAILURE
HEMORRHAGE
NEUROCARDIOGENIC SYNCOPE
INFERIOR WALL MYOCARDIAL ISCHEMIA/INFARCTION
CAROTID SINUS HYPERSENSITIVITY
AUTONOMIC PERTURBATIONS ASSOCIATED WITH CARDIOVASCULAR CONDITIONS
BAROREFLEX FAILURE: NEUROGENIC HYPERTENSION
HEART FAILURE AND ISCHEMIC HEART DISEASE
OBSTRUCTIVE SLEEP APNEA
PHEOCHROMOCYTOMA
CARDIAC ARRHYTHMIAS
SECTION 8: HEART FAILURE
CHAPTER 68:
Heart Failure: Epidemiology
INTRODUCTION
EPIDEMIOLOGY
PREVALENCE
INCIDENCE
RACIAL DIFFERENCES
GEOGRAPHIC DIFFERENCES
GENDER DIFFERENCES
SECULAR TRENDS
CHAPTER 69:
Heart Failure: Diagnosis
ANALYSIS OF SYMPTOMS
PHYSICAL EXAMINATION
ELECTROCARDIOGRAM
CHEST RADIOGRAPH
ECHOCARDIOGRAPHY
RADIONUCLIDE VENTRICULOGRAPHY
CARDIAC MAGNETIC RESONANCE
CARDIAC TOMOGRAPHY
ROUTINE LABORATORY TESTS
BIOMARKERS
EXERCISE TESTS
SIX-MINUTE WALK TEST
CORONARY ARTERIOGRAPHY
MYOCARDIAL ISCHEMIA
ENDOMYOCARDIAL BIOPSY
GENETICS STUDIES
CHAPTER 70:
Systolic Heart Failure (Heart Failure with Reduced Ejection Fraction)
INTRODUCTION
HISTORICAL PERSPECTIVE
DEFINITIONS
RISK FACTORS
VENTRICULAR REMODELING
FUNCTIONAL DERANGEMENTS AND HEMODYNAMIC CONSEQUENCES
INITIAL TREATMENT OF SYSTOLIC HEART FAILURE
SYMPTOMATIC SYSTOLIC HEART FAILURE
PHARMACOLOGIC TREATMENTS
NON-PHARMACOLOGIC TREATMENTS
FOLLOW-UP EVALUATION
CHAPTER 71:
Diastolic Heart Failure (Heart Failure with Preserved Ejection Fraction)
INTRODUCTION
DEFINITION
EPIDEMIOLOGY
PATHOPHYSIOLOGY
VENTRICULAR REMODELING
NEUROHORMONAL CHANGES
FUNCTIONAL DERANGEMENTS
HEMODYNAMIC CONSEQUENCES
CLINICAL PRESENTATION
DIAGNOSIS
PROGNOSIS
TREATMENT STRATEGIES
FUTURE DIRECTIONS
CHAPTER 72:
Anemia in Patients with Chronic Heart Failure (Prevalence, Mechanism, Significance and Treatment)
OVERVIEW OF THE PROBLEM
PREVALENCE OF ANEMIA IN HEART FAILURE PATIENTS
MECHANISMS UNDERLYING ANEMIA IN HEART FAILURE PATIENTS
PROGNOSTIC SIGNIFICANCE OF ANEMIA IN HEART FAILURE PATIENTS
SHOULD ANEMIA BE TREATED IN HEART FAILURE PATIENTS?
SAFETY CONCERNS RELATED TO ESPs IN A VARIETY OF ANEMIC PATIENTS
TREATMENT OF ANEMIA IN HEART FAILURE PATIENTS
ERYTHROPOIETIN STIMULATING PROTEINS (ESPs)
IRON DEFICIENCY AND IRON REPLACEMENT IN HEART FAILURE
SUMMARY AND CONCLUSIONS
CHAPTER 73:
Hyponatremia and Congestive Heart Failure
INTRODUCTION
MECHANISMS CAUSING HYPONATREMIA IN HEART FAILURE
SYMPATHETIC NERVOUS SYSTEM
RENIN-ANGIOTENSIN-ALDOSTERONE SYSTEM
ARGININE VASOPRESSIN
TREATMENT OF HYPONATREMIA
ROLE OF DIURETIC THERAPY IN HYPONATREMIA
ROLE OF VASOPRESSIN RECEPTOR ANTAGONISTS IN HYPONATREMIA
TOLVAPTAN
LIXIVAPTAN
CONIVAPTAN
CONCLUSION
CHAPTER 74:
Cardiorenal Syndrome: The Interplay Between Cardiac and Renal Function in Patients with Congestive Heart Failure
INTRODUCTION
EPIDEMIOLOGY OF CHRONIC KIDNEY DISEASE IN PATIENTS WITH HEART FAILURE
PROGNOSIS OF WORSENING RENAL FUNCTION
DEFINITION OF THE CARDIORENAL SYNDROME
PATHOPHYSIOLOGY OF THE CARDIORENAL SYNDROME
ROLE OF DECREASED CARDIAC OUTPUT
ROLE OF ELEVATED CENTRAL VENOUS PRESSURE
ROLE OF EVIDENCE BASED THERAPIES IN PATIENTS WITH HEART FAILURE AND THE CARDIORENAL SYNDROME
DIURETICS
Loop Diuretics
Distal Convoluted Tubule Diuretics
Potassium Sparing Diuretics
Effect of Diuretic Use on Morbidity and Mortality
ACE-I AND ARB
INOTROPES
Dobutamine
Milrinone
Levosimendan
Dopamine
ROLE OF ULTRAFILTRATION ON DIURETIC RESISTANCE AND THE CARDIORENAL SYNDROME
TREATMENT OF THE CARDIORENAL SYNDROME: AN APPROACH TO THE INDIVIDUAL PATIENT
CHAPTER 75:
Acute Heart Failure Syndromes
INTRODUCTION
DEFINITION
EPIDEMIOLOGY
PATIENT'S CHARACTERISTICS
CLASSIFICATION
PATHOPHYSIOLOGY
CONGESTION
MYOCARDIAL INJURY
RENAL IMPAIRMENT
VASCULAR FAILURE
CARDIAC METABOLISM
UNTOWARD DRUG EFFECTS
VIABILITY
ACUTE HEART FAILURE SYNDROMES MANAGEMENT
STABILIZATION PHASE
Diagnosis
Treatment According to Clinical Profile
Precipitants for Admission
Disposition
Goals of Stabilization Phase
TRANSITION TO EVIDENCE-BASED PHASE
Goals of Transitional Phase
Quality Measures
RECONSTRUCTION PHASE
Vulnerable Phase
CLINICAL TRIALS IN ACUTE HEART FAILURE SYNDROMES
T1 TRANSLATIONAL PHASE
CONCLUSION
CHAPTER 76:
Cardiopulmonary Exercise Testing and Training in Heart Failure
INTRODUCTION
NORMAL RESPONSE TO EXERCISE
EXERCISE RESPONSE IN HEART FAILURE
CENTRAL FACTORS
PERIPHERAL FACTORS
CARDIOPULMONARY EXERCISE TESTING
TECHNICAL ASPECTS
EXERCISE MEASUREMENTS BY CPX
Oxygen Uptake
Ventilatory Threshold or Anaerobic Threshold
Oxygen Pulse
Respiratory Exchange Ratio (RER)
Ventilatory Efficiency
Ventilation
CONDUCTING THE EXERCISE TEST
INDICATIONS FOR CPX TESTING IN HEART FAILURE
PEAK VO2 AND PROGNOSIS
EVALUATION OF DYSPNEA: PRESENCE OF VENTILATORY LIMITATIONS
EXTENT OF DECONDITIONING AND DERIVING AN EXERCISE PRESCRIPTION
EXERCISE TRAINING IN HEART FAILURE
DELETERIOUS EFFECTS OF BED REST
HISTORY OF EXERCISE TRAINING IN HEART FAILURE
BENEFITS OF EXERCISE TRAINING IN HEART FAILURE
SAFETY
MORTALITY AND MORBIDITY
GUIDELINE RECOMMENDATION
EXERCISE PRESCRIPTION RECOMMENDATION
SUMMARY
CHAPTER 77:
Hibernating Myocardium
INTRODUCTION
HISTORICAL PERSPECTIVE
DEFINITION
PATHOPHYSIOLOGY
HIBERNATION AND STUNNING: CLINICAL PREVALENCE
DETECTION OF HIBERNATING MYOCARDIUM
RATIONALE
TECHNIQUES
REVASCULARIZATION OF HIBERNATING MYOCARDIUM AND CHANGES IN VENTRICULAR FUNCTION
REVASCULARIZATION OF HIBERNATING MYOCARDIUM AND CHANGES IN PROGNOSIS
SUMMARY
CHAPTER 78:
Advanced Cardiac Therapies for End Stage Heart Failure: Cardiac Transplantation and Mechanical Circulatory Support
INTRODUCTION
IDENTIFYING CANDIDATES FOR ADVANCED CARDIAC THERAPIES
RECOGNITION OF ADVANCED HEART FAILURE WITH POOR PROGNOSIS
PROGNOSTIC DETERMINANTS AND RISK SCORES IN HEART FAILURE
PROGNOSTIC SCORES
FUNCTIONAL ASSESSMENT
A PERSPECTIVE ON OPTIMAL MEDICAL MANAGEMENT
EVALUATION OF PATIENT REFERRED FOR ADVANCED CARDIAC THERAPIES
GENERAL APPROACH TO PREOPERATIVE ASSESSMENT OF ADVANCED CARDIAC THERAPIES
HEART TRANSPLANTATION
INDICATIONS AND CONTRAINDICATIONS FOR CARDIAC TRANSPLANTATION
Management of Patients on the Transplant List
DONOR SELECTION AND PERIOPERATIVE PERIOD
Donor Management21
Organ Explantation and Preservation
Donor Heart Implantation
Immediate Post-transplant Physiology and Management
Hemodynamic Stabilization
Early Immunosuppressive and Antimicrobial Management
Long-term Management of Transplant Patients
Cardiac Retransplantation
SURVIVAL WITH CARDIAC TRANSPLANTATION
MECHANICAL CIRCULATORY SUPPORT
SELECTION OF A VENTRICULAR ASSIST DEVICE PATIENT
INDICATIONS AND CONTRAINDICATIONS FOR MECHANICAL CIRCULATORY SUPPORT
DESIGN OF VENTRICULAR ASSIST DEVICE AND IMPACT ON POST-IMPLANT PHYSIOLOGY
Design of a Ventricular Assist Device
Physiology of Ventricular Assist Devices
Structural and Molecular Effects of Mechanical Unloading
CARING FOR THE MECHANICAL CIRCULATORY SUPPORT DEVICE RECIPIENT
Preoperative Management
Intraoperative Management
POSTOPERATIVE PATIENT AND DEVICE MANAGEMENT
Hemodynamic Stabilization
Anticoagulation
Pump Management
Long-term Management of Ventricular Assist Device Patients
SURVIVAL WITH MECHANICAL CIRCULATORY SUPPORT
MYOCARDIAL RECOVERY WITH DEVICE EXPLANTATION
FUTURE DIRECTIONS
CONCLUSION
CHAPTER 79:
Palliative Medicine and End of Life Care in Heart Failure
INTRODUCTION
EPIDEMIOLOGY OF HEART FAILURE
ECONOMIC IMPACT OF HEART FAILURE
HISTORY OF PALLIATIVE CARE/DEFINITIONS
FEASIBILITY OF THE USE OF PALLIATIVE CARE IN HEART FAILURE
ISSUES OF PROGNOSTICATION
COMMUNICATION AND PATIENT'S UNDERSTANDING OF THEIR DISEASE
SUFFERING IN END STAGE HEART FAILURE
SYMPTOM MANAGEMENT IN HEART FAILURE
DYSPNEA
PAIN: ANGINAL AND NON-ANGINAL
EDEMA
FATIGUE
ANOREXIA/CACHEXIA
DEPRESSION
MANAGEMENT OF IMPLANTABLE CARDIAC DEVICES
CONCLUSION
ACKNOWLEDGMENT
SECTION 9: MYOCARDIAL AND PERICARDIAL DISEASES
CHAPTER 80:
Hypertrophic Cardiomyopathy
DEFINITION
EPIDEMIOLOGY AND GENETIC CONSIDERATIONS
PATHOLOGY
PATHOPHYSIOLOGY
LEFT VENTRICULAR OUTFLOW TRACT OBSTRUCTION
DIASTOLIC DYSFUNCTION
SYSTOLIC DYSFUNCTION
MYOCARDIAL ISCHEMIA
MITRAL REGURGITATION AND MITRAL VALVE ABNORMALITIES
ARRYTHMOGENIC SUBSTRATE AND SUDDEN DEATH
MYOCARDIAL FIBROSIS
AUTONOMIC DYSFUNCTION
CLINICAL PRESENTATION
SYMPTOMS
PHYSICAL EXAMINATION
Jugular Venous Pressure
Carotid Pulse
Cardiac Apical Impulse
Murmurs and Other Heart Sounds
DIAGNOSIS
ELECTROCARDIOGRAM
HOLTER MONITORING
CHEST X-RAY
ECHOCARDIOGRAPHY
Left Ventricular Hypertrophy and the Thick Ventricle
Systolic Anterior Motion of the Mitral Valve
DOPPLER INFLECTIONS
Mitral Regurgitation
Diastolic Dysfunction
CARDIAC MAGNETIC RESONANCE IMAGING
CARDIAC CATHETERIZATION
STRESS TEST
NATURAL HISTORY
MANAGEMENT
GENOTYPING, GENETIC COUNSELLING AND FAMILY SCREENING
ASSESSMENT, RISK STRATIFICATION AND PREVENTION OF SUDDEN DEATH
ATHLETES WITH HYPERTROPHIC CARDIOMYOPATHY
MEDICAL THERAPY
SEPTAL MYECTOMY
PERCUTANEOUS ALCOHOL SEPTAL ABLATION
DUAL-CHAMBER PACEMAKER
ADDITIONAL POINTS OF INTEREST
ATRIAL FIBRILLATION
OBSTRUCTIVE SLEEP APNEA AND HCM SYMPTOMS
END-STAGE HYPERTROPHIC CARDIOMYOPATHY (BURNT-OUT OR DILATED STAGE)
PREGNANCY AND HYPERTROPHIC CARDIOMYOPATHY
INFECTIVE ENDOCARDITIS
CONCLUSION
ACKNOWLEDGMENT
CHAPTER 81:
Dilated Cardiomyopathy
DEFINITION
EPIDEMIOLOGY
PATHOLOGY
POSTMORTEM EXAMINATION
HISTOLOGICAL EXAMINATION
ETIOLOGY
ISCHEMIC VERSUS NONISCHEMIC ETIOLOGY
Clinical Course
Response to Treatment
MYOCARDITIS
FAMILIAL DILATED CARDIOMYOPATHY
TACHYCARDIA-INDUCED CARDIOMYOPATHY
STRESS-INDUCED CARDIOMYOPATHY
DILATED HYPOKINETIC EVOLUTION OF HYPERTROPHIC CARDIOMYOPATHY
HEMODIALYSIS AND END-STAGE RENAL FAILURE
CIRRHOSIS
NUTRITIONAL DEFICIENCY
Selenium Deficiency
Vitamin D and Calcium
Vitamin B
Carnitine Deficiency
Trace Element Accumulation
PROGNOSIS
PREDICTORS OF MORTALITY
CHAPTER 82:
Restrictive and Obliterative Cardiomyopathies
INTRODUCTION
RESTRICTIVE CARDIOMYOPATHIES
TROPICAL ENDOMYOCARDIAL FIBROSIS (DAVIE'S DISEASE)
DEFINITION
EPIDEMIOLOGY
NATURAL HISTORY
CLINICAL FEATURES
RIGHT VENTRICULAR ENDOMYOCARDIAL FIBROSIS
HEMODYNAMICS
LEFT VENTRICULAR ENDOMYOCARDIAL FIBROSIS
HEMODYNAMICS AT CARDIAC CATHETERIZATION
ANGIOGRAPHIC DIAGNOSIS OF EMF
Pathology
Etiology
Treatment
LOEFFLER'S ENDOCARDITIS
HEMOCHROMATOSIS
IDIOPATHIC RESTRICTIVE CARDIOMYOPATHY
OTHER FORMS OF CARDIOMYOPATHIES
CHAPTER 83:
Amyloid Heart Disease
INTRODUCTION
HISTORY OF AMYLOID
AMYLOIDOGENESIS
OVERVIEW OF CARDIAC AMYLOIDOSIS
CLASSIFICATION OF AMYLOIDOSIS
CARDIAC AMYLOIDOSIS
LIGHT CHAIN (AL) AMYLOIDOSIS
SENILE SYSTEMIC AMYLOIDOSIS
FAMILIAL (HEREDITARY) SYSTEMIC AMYLOIDOSIS (ATTR AND OTHERS)
SECONDARY AMYLOIDOSIS
ISOLATED ATRIAL NATRIURETIC FACTOR
CLINICAL FEATURES OF CARDIAC AMYLOIDOSIS
HISTORY AND PHYSICAL EXAMINATION
DIAGNOSTIC TESTS
TISSUE DIAGNOSIS
RADIOLOGIC FINDINGS
ELECTROCARDIOGRAPHY
ECHOCARDIOGRAPHIC FINDINGS
LABORATORY FINDINGS
CARDIAC MAGNETIC RESONANCE IMAGING
CARDIAC CATHETERIZATION HEMODYNAMICS
SERUM AMYLOID P COMPONENT SCINTIGRAPHY
PROGNOSIS
TREATMENT OF AMYLOID CARDIOMYOPATHY
HEART FAILURE MEDICAL MANAGEMENT
DEVICE THERAPIES
TREATMENT OF THE UNDERLYING AMYLOID DISEASE
HEART TRANSPLANTATION
SUMMARY
CHAPTER 84:
Peripartum Cardiomyopathy
DEFINITION
INCIDENCE
ETIOLOGY
RISK FACTORS
CLINICAL PRESENTATION
BIOMARKERS
LABORATORY EVALUATION
PROGNOSIS
MORTALITY
RECOVERY OF CARDIAC FUNCTION
OUTCOME OF SUBSEQUENT PREGNANCY
TREATMENT
EXPERIMENTAL THERAPY
IMPLANTABLE CARDIOVERTER DEFIBRILLATORS
CARDIAC ASSIST DEVICES
CARDIAC TRANSPLANTATION
LABOR AND DELIVERY
CHAPTER 85:
Chemotherapy-induced Cardiomyopathy
INTRODUCTION
CLASSIFICATION OF CHEMOTHERAPY-INDUCED CARDIOTOXICITY
RISK FACTORS
PATHOPHYSIOLOGY OF ANTHRACYCLINEINDUCED CARDIOMYOPATHY
CARDIAC MORPHOLOGIC AND FUNCTIONAL CHANGES
HISTOPATHOLOGIC CHANGES
MECHANISM OF CHEMOTHERAPY-INDUCED CARDIAC DYSFUNCTION
ANTHRACYCLINES
ALKYLATING AGENTS
Cyclophosphamide
Ifosfamide
ANTIMETABOLITES
ANTIMICROTUBULE AGENTS
MONOCLONAL ANTIBODY-BASED TYROSINE KINASE INHIBITORS
PROTEASOME INHIBITORS
SMALL MOLECULE TYROSINE KINASE INHIBITORS
Imatinib Mesylate
Dasatinib
Lapatinib
Sunitinib
DIAGNOSIS
MONITORING
MANAGEMENT
PREVENTIVE STRATEGIES
Angiotensin-Converting Enzyme Inhibitors
Beta-Adrenergic Blocking Agents
Iron Chelators
Dose Limitation and Dosing Regimens
Lyposomal Anthracyclines
TREATMENT
ANGIOTENSIN INHIBITION THERAPY
ADRENERGIC INHIBITION THERAPY
CONCLUSION
CHAPTER 86:
Pericardial Disease
INTRODUCTION
ACUTE PERICARDITIS
PRESENTATION AND ETIOLOGY
EXAMINATION
DIAGNOSIS
TREATMENT
CHRONIC RELAPSING PERICARDITIS
PRESENTATION AND ETIOLOGY
DIAGNOSIS
PERICARDIAL EFFUSION AND PERICARDIAL TAMPONADE
PRESENTATION AND ETIOLOGY
EXAMINATION
DIAGNOSIS
TREATMENT
CONSTRICTIVE PERICARDITIS
PRESENTATION AND ETIOLOGY
EXAMINATION
DIAGNOSIS
TREATMENT
CONCLUSION
CHAPTER 87:
Radiation-induced Heart Disease
INTRODUCTION
RADIATION-INDUCED PERICARDIAL DISEASE
RADIATION-INDUCED MYOCARDIAL DISEASE
RADIATION-INDUCED CORONARY ARTERY DISEASE
RADIATION-INDUCED VALVULAR HEART DISEASE
CONDUCTION SYSTEM DISEASE
CAROTID AND OTHER VASCULAR DISEASE
PREVENTION
CONCLUSION
CHAPTER 88:
Chagas Disease
INTRODUCTION
LIFE CYCLE
TRANSMISSION
EPIDEMIOLOGY
CLINICAL MANIFESTATIONS
ECHOCARDIOGRAPHY
CARDIAC MAGNETIC RESONANCE IMAGING
TREATMENT
PREDICTORS OF MORTALITY
PREVENTION
CHAGAS DISEASE IN THE UNITED STATES
SECTION 10: PULMONARY VASCULAR DISEASE AND ADULT CONGENITAL HEART DISEASE
CHAPTER 89:
Pulmonary Arterial Hypertension
INTRODUCTION
DEFINITIONS AND CLASSIFICATIONS
HEMODYNAMIC CLASSIFICATION OF PULMONARY HYPERTENSION
CLINICAL CLASSIFICATION OF PULMONARY HYPERTENSION
Pulmonary Arterial Hypertension (WHO Group 1 PH)
Pulmonary Venous Hypertension (WHO Group 2 PH)
Pulmonary Hypertension due to Lung Disease and/or Chronic Hypoxemia (WHO Group 3 PH)
Chronic Thromboembolic Pulmonary Hypertension (WHO Group 4 PH)
Pulmonary Hypertension with Unclear Multifactorial Mechanisms (WHO Group 5 PH)
PATHOPHYSIOLOGY AND EPIDEMIOLOGY OF PULMONARY ARTERIAL HYPERTENSION
IDIOPATHIC PULMONARY ARTERIAL HYPERTENSION
HERITABLE PULMONARY ARTERIAL HYPERTENSION
DRUG-INDUCED AND TOXIN-INDUCED PULMONARY ARTERIAL HYPERTENSION
PULMONARY ARTERIAL HYPERTENSION ASSOCIATED WITH CONNECTIVE TISSUE DISEASES
PULMONARY ARTERIAL HYPERTENSION ASSOCIATED WITH HUMAN IMMUNODEFICIENCY VIRUS INFECTION
PORTOPULMONARY HYPERTENSION
CONGENITAL HEART DISEASE ASSOCIATED WITH PULMONARY ARTERIAL HYPERTENSION
PULMONARY ARTERIAL HYPERTENSION ASSOCIATED WITH SCHISTOSOMIASIS
PULMONARY ARTERIAL HYPERTENSION ASSOCIATED WITH CHRONIC HEMOLYTIC ANEMIAS
WHO GROUP 1: PULMONARY CAPILLARY HEMANGIOMATOSIS AND PULMONARY VENO-OCCLUSIVE DISEASE
DIAGNOSTIC EVALUATION
CLINICAL PRESENTATION AND PHYSICAL EXAMINATION
ROLE OF ECHOCARDIOGRAPHY
LABORATORY STUDIES
PULMONARY FUNCTION TESTING
NOCTURNAL POLYSOMNOGRAPHY
SCREEN FOR CHRONIC THROMBOEMBOLIC PULMONARY HYPERTENSION
RIGHT HEART CATHETERIZATION
VASOREACTIVITY TESTING
SURVIVAL AND PROGNOSTIC FACTORS OF PULMONARY ARTERIAL HYPERTENSION
SURVIVAL IN PULMONARY ARTERIAL HYPERTENSION ASSOCIATED WITH CONNECTIVE TISSUE DISEASE
SURVIVAL IN HUMAN IMMUNODEFICIENCY VIRUS RELATED WITH PULMONARY ARTERIAL HYPERTENSION
SURVIVAL IN PULMONARY ARTERIAL HYPERTENSION ASSOCIATED WITH PORTAL HYPERTENSION
SURVIVAL IN CONGENITAL HEART DISEASE ASSOCIATED WITH PULMONARY ARTERIAL HYPERTENSION
SURVIVAL IN PULMONARY ARTERIAL HYPERTENSION ASSOCIATED WITH SCHISTOSOMIASIS
THERAPEUTIC OPTIONS FOR THE TREATMENT OF PULMONARY ARTERIAL HYPERTENSION
ADJUVANT/CONVENTIONAL THERAPIES
Anticoagulation
Diuretics
Oxygen
Digitalis
Calcium Channel Blockers
DISEASE SPECIFIC THERAPIES FOR PULMONARY ARTERIAL HYPERTENSION
Prostacyclin Analogs
Endothelin Receptor Antagonists
Phosphodiesterase Type 5 Inhibitors
INVASIVE AND SURGICAL OPTIONS
Atrial Septostomy
Lung Transplantation
TREATMENT ALGORITHM AND EVALUATING RESPONSE TO THERAPY
THERAPY OF DECOMPENSATED RIGHT HEART FAILURE IN PULMONARY ARTERIAL HYPERTENSION
CONCLUSION
CHAPTER 90:
Congenital Heart Disease in the Adult Patient
CONGENITAL VALVAR AORTIC STENOSIS
GENERAL CONSIDERATIONS
ASSOCIATED ANOMALIES
GENETIC INHERITANCE
CLINICAL FINDINGS
Signs and Symptoms
Physical Examination
DIAGNOSTIC STUDIES
Electrocardiogram and Chest X-ray
Echocardiogram
Magnetic Resonance Imaging and Computed Tomography
Catheterization
TREATMENT
Medical
Surgical
PROGNOSIS
PREGNANCY
SUPRAVALVAR AORTIC STENOSIS AND SUBVALVAR AORTIC STENOSIS
COARCTATION OF THE AORTA
GENERAL CONSIDERATIONS
PATHOPHYSIOLOGY
ASSOCIATED ANOMALIES
GENETIC INHERITANCE
CLINICAL FINDINGS
Signs and Symptoms
Physical Examination
DIAGNOSTIC STUDIES
Electrocardiogram and Chest X-ray
Echocardiogram
Magnetic Resonance Imaging and Computed Tomography
Catheterization
PROGNOSIS AND TREATMENT
Medical
Surgical and Interventional Correction
PREGNANCY
GUIDELINES
Class I
Class Ilb
RIGHT VENTRICULAR OUTFLOW TRACT OBSTRUCTION
VALVAR PULMONIC STENOSIS
GENERAL CONSIDERATIONS
PATHOPHYSIOLOGY
ASSOCIATED ANOMALIES
GENETIC INHERITANCE
CLINICAL FINDINGS
Signs and Symptoms
Physical Examination
DIAGNOSTIC STUDIES
Electrocardiogram and Chest X-ray
Echocardiogram
Magnetic Resonance Imaging and Computed Tomography
Cardiac Catheterization
TREATMENT AND PROGNOSIS
Surgical and Interventional
PREGNANCY
ENDOCARDITIS PROPHYLAXIS
GUIDELINES
SUBVALVAR AND SUPRAVALVAR PULMONIC STENOSIS
GENERAL CONSIDERATIONS
GUIDELINES
ATRIAL SEPTAL DEFECTS
GENERAL CONSIDERATIONS
PATHOPHYSIOLOGY
ASSOCIATED ANOMALIES
GENETIC INHERITANCE
CLINICAL FINDINGS
Signs and Symptoms
Physical Examination
DIAGNOSTIC STUDIES
Electrocardiogram and Chest X-ray
Echocardiogram
Magnetic Resonance Imaging and Computed Tomography
Catheterization
TREATMENT AND PROGNOSIS
Surgical and Interventional
PREGNANCY
ENDOCARDITIS PROPHYLAXIS
GUIDELINES
Class I
Class IIa
Class Ilb
Class III
VENTRICULAR SEPTAL DEFECTS
GENERAL CONSIDERATIONS
PATHOPHYSIOLOGY
ASSOCIATED ANOMALIES
Genetics
CLINICAL FINDINGS
Signs and Symptoms
Physical Examination
DIAGNOSTIC STUDIES
Electrocardiogram and Chest X-ray
Echocardiogram
Catheterization
TREATMENT AND PROGNOSIS
PREGNANCY
GUIDELINES
Class I
Class IIa
Class III
PATENT DUCTUS ARTERIOSUS
GENERAL CONSIDERATIONS
PATHOPHYSIOLOGY
ASSOCIATED ANOMALIES
CLINICAL FINDINGS
Signs and Symptoms
Physical Examination
DIAGNOSTIC STUDIES
Electrocardiogram and Chest X-ray
Echocardiogram
Magnetic Resonance Imaging and Computed Tomography
Catheterization
TREATMENT AND PROGNOSIS
Medical
Surgical and Interventional
PREGNANCY
GUIDELINES
Class I
Class IIa
Class III
EBSTEIN'S ANOMALY
GENERAL CONSIDERATIONS
ASSOCIATED ANOMALIES
PATHOPHYSIOLOGY
GENETIC INHERITANCE
CLINICAL FINDINGS
Signs and Symptoms
Physical Examination
DIAGNOSTIC STUDIES
Electrocardiogram and Chest X-ray
Echocardiogram
Catheterization
TREATMENT AND PROGNOSIS
Medical Treatment
Catheter-based Intervention
Surgical Intervention
PREGNANCY
GUIDELINES
Class I
INTRODUCTION
PALLIATIVE SHUNTS
ENDOCARDITIS
PREGNANCY AND CONTRACEPTION
TETRALOGY OF FALLOT
GENERAL CONSIDERATIONS
PATHOPHYSIOLOGY
ASSOCIATED ANOMALIES
CLINICAL FINDINGS
Signs and Symptoms
Physical Examination
DIAGNOSTIC STUDIES
Electrocardiogram and Chest X-ray
Echocardiography
Magnetic Resonance Imaging and Computed Tomography
Catheterization
TREATMENT
PROGNOSIS
PREGNANCY
GUIDELINES
Evaluation and Follow-up
Recommendations for Surgery in Patients with Previous Repair of Tetralogy of Fallot
Recommendations for Arrhythmias: Pacemaker/Electrophysiology Testing
TRUNCUS ARTERIOSUS
GENERAL CONSIDERATIONS
Classifications
GENETIC INHERITANCE
CLINICAL FINDINGS
Signs and Symptoms
DIAGNOSTIC STUDIES
Electrocardiogram and Chest X-ray
Echocardiography and Magnetic Resonance Imaging
TREATMENT AND PROGNOSIS
PREGNANCY
d-TRANSPOSITION OF THE GREAT ARTERIES
GENERAL CONSIDERATIONS
ASSOCIATED ANOMALIES
CLINICAL FINDINGS
Symptoms
Physical Examination
DIAGNOSTIC STUDIES
Electrocardiogram
Chest X-ray
Echocardiography
Magnetic Resonance Imaging
Catheterization and Percutaneous Intervention
TREATMENT
Atrial Switch
Rastelli Procedure
PROGNOSIS
PREGNANCY
GUIDELINES
Evaluation, Follow-up and Imaging
Recommendations for Interventional Catheterization in Patients with d-Transposition of the Great Arteries
Recommendations for Surgical Interventions: After Atrial Baffle Procedure (Mustard, Senning)
Recommendations for Surgical Interventions: After Arterial Switch Operation
Recommendations for Arrhythmias: Pacemaker/Electrophysiology Testing
CONGENITALLY CORRECTED TRANSPOSITION OF THE GREAT ARTERIES
GENERAL CONSIDERATIONS
RECOMMENDATIONS FOR EVALUATION AND FOLLOW-UP OF PATIENTS WITH CONGENITALLY CORRECTED TRANSPOSITION OF THE GREAT ARTERIES
Class I
RECOMMENDATIONS FOR SURGICAL INTERVENTION
Class I
TOTAL ANOMALOUS PULMONARY VENOUS RETURN
DOUBLE-OUTLET RIGHT VENTRICLE
GENERAL CONSIDERATIONS
ASSOCIATED ANOMALIES
TREATMENT AND PROGNOSIS
TRICUSPID ATRESIA/UNIVENTRICULAR HEART
DOUBLE-INLET LEFT VENTRICLE
FONTAN OPERATION
CLINICAL FINDINGS
Symptoms
Physical Examination
DIAGNOSTIC STUDIES
Electrocardiogram and Chest X-ray
Echocardiography
Magnetic Resonance Imaging and Computed Tomography
Catheterization
TREATMENT AND PROGNOSIS
GUIDELINES FOR MANAGEMENT STRATEGIES IN PATIENTS WITH FONTAN REPAIR
Class I
RECOMMENDATIONS FOR MEDICAL THERAPY
Class I
Class IIa
RECOMMENDATIONS FOR SURGERY FOR ADULTS WITH PRIOR FONTAN REPAIR
Class I
HYPOPLASTIC LEFT HEART
EISENMENGER'S SYNDROME
CONGENITAL HEART DISEASE: PULMONARY ARTERIAL HYPERTENSION
RECOMMENDATIONS FOR EVALUATION OF THE PATIENT WITH CONGENITAL HEART—DISEASE PULMONARY ARTERIAL HYPERTENSION
Class I
Class IIa
RECOMMENDATIONS FOR MEDICAL THERAPY OF EISENMENGER'S PHYSIOLOGY
Class I
Class Ila
RECOMMENDATIONS FOR REPRODUCTION
Class I
Class llb
Class Ill
SECTION 11: SECONDARY DISORDERS OF THE HEART
CHAPTER 91:
Alcohol and Arrhythmia
DIRECT EFFECTS OF ETHANOL EXPOSURE ON HEART CELLS AND TISSUES
ETHANOL INGESTION AND THE NORMAL CARDIAC CONDUCTION SYSTEM
BINGE DRINKING AND TRANSIENT CLINICAL ARRHYTHMIAS—HOLIDAY HEART
ALCOHOL CONSUMPTION, CHRONIC ATRIAL FIBRILLATION AND ATRIAL FLUTTER
ALCOHOL CONSUMPTION AND SUDDEN CARDIAC DEATH
SUMMARY AND CLINICAL GUIDELINES
CHAPTER 92:
Insulin-resistance and Cardiomyopathy
INTRODUCTION
EPIDEMIOLOGY
DIASTOLIC HEART FAILURE AND INSULIN-RESISTANCE
PATHOPHYSIOLOGY
MYOCARDIAL ENERGY METABOLISM
METABOLIC EFFECTS OF INSULIN RESISTANCE–ENERGY METABOLISM
OTHER METABOLIC EFFECTS OF INSULIN-RESISTANCE
DYSLIPIDEMIA OR LIPOTOXICITY
DETECTION OF METABOLIC EFFECTS OF INSULIN-RESISTANCE
STRUCTURAL EFFECTS OF INSULIN-RESISTANCE
DIASTOLIC DYSFUNCTION
Detection of Diastolic Dysfunction
SYSTOLIC DYSFUNCTION
Detection of Systolic Dysfunction
ANTIADRENERGIC THERAPY
INSULIN THERAPY
INSULIN SENSITIZATION
METABOLIC MODULATORS
CONCLUSION
CHAPTER 93:
Cardiac Complications of Substance Abuse
INTRODUCTION
MAGNITUDE OF THE PROBLEM
ADOLESCENTS
COLLEGE AND MEDICAL STUDENTS
UNEMPLOYED ADULTS
TRAUMA ASSOCIATIONS
IATROGENIC ISSUES
SUBSTANCES OF ABUSE
COCAINE
Epidemiology
Pharmacology
Cardiovascular Complications
Coronary Artery Vasoconstriction
Acute Coronary Artery Thrombosis
Direct Myocardial Damage
Coronary Artery Atherosclerosis
Cardiac Arrhythmias
Channelopathies
Myocardial Ischemia and Infarction
ECG Changes
Chest Pain
Treatment
Subacute and Chronic Problems
METHAMPHETAMINE
Epidemiology
Pharmacology
Cardiovascular Complications
Noncardiac Complications
PHENCYCLIDINE
PHENYLPROPANOLAMINE
Pharmacology
Complications
MARIJUANA, TETRAHYDRIOCANNABINOL, HASHISH
CARDIAC COMPLICATIONS
CLUB DRUGS: MDMA, GHB, KETAMINE, ROHYPNOL
METHYLENEDIOXYMETHAMPHETAMINE
Complications
Cardiac Complications
GAMMAHYDROXYBUTYRATE
Adverse Effects
KETAMINE
Pharmacology
Adverse Effects
ROHYPNOL
Adverse Effects
HALLUCINOGENIC DRUGS
LYSERGIC ACID DIETHYLAMIDE
Adverse Effects
BODY IMAGE DRUGS
ANABOLIC STEROIDS
Cardiovascular Complications
DIET DRUGS
ANOREXIA AND BULEMIA
INHALANTS
NARCOTICS
HEROIN
METHADONE
PRESCRIPTION AND OVER THE COUNTER DRUGS
ALCOHOL AND TOBACCO
CONCLUSIONS
CHAPTER 94:
HIV/AIDS and Cardiovascular Disease
INTRODUCTION
HIV AND CORONARY HEART DISEASE
EPIDEMIOLOGY
CLINICAL CHARACTERISTICS OF CHD IN HIV-INFECTED INDIVIDUALS
PATHOGENESIS OF CORONARY HEART DISEASE IN HIV INFECTION
HIV and Cardiovascular Risk Factors
TREATMENT
Highly-active Antiretroviral Therapy
Hyperlipidemia
Modification of Other Risk Factors
SURROGATE MEASURES OF ATHEROSCLEROSIS
CAROTID ARTERY INTIMA-MEDIA THICKNESS
BRACHIAL ARTERY FLOW-MEDIATED DILATION
CORONARY ARTERY CALCIUM SCORING
OTHER CARDIOVASCULAR CONDITIONS
HIV-ASSOCIATED PULMONARY ARTERIAL HYPERTENSION
HIV-RELATED LEFT VENTRICULAR DYSFUNCTION AND MYOCARDITIS
CEREBROVASCULAR DISEASE
MISCELLANEOUS
CONCLUSION
CHAPTER 95:
Systemic Autoimmune Diseases and the Heart
RHEUMATOID ARTHRITIS
CLINICAL FEATURES
Pericardial Involvement
Myocardial Involvement
Endocardial and Valvular Involvement
Disease of the Conducting System
Coronary Artery Disease
SPONDYLOARTHROPATHIES
ANKYLOSING SPONDYLITIS
REACTIVE ARTHRITIS
SCLERODERMA
Clinical Features
POLYMYOSITIS-DERMATOMYOSITIS
CLINICAL FEATURES
TREATMENT
MIXED CONNECTIVE TISSUE DISEASE
SYSTEMIC LUPUS ERYTHEMATOSUS
CLINICAL FEATURES
Pericarditis
Myocarditis
Endocarditis
Electrophysiological Disturbances
Coronary Artery Disease
ANTIPHOSPHOLIPID ANTIBODY SYNDROME
CORONARY ARTERITIS
POLYARTERITIS NODOSA
KAWASAKI DISEASE
CHURG-STRAUSS VASCULITIS
WEGENER'S GRANULOMATOSIS
GIANT CELL ARTERITIS
TAKAYASU'S ARTERITIS
CHAPTER 96:
Cardiac Neoplastic Disease
INTRODUCTION
CLINICAL SYMPTOMS
IMAGING TECHNIQUES
BENIGN CARDIAC NEOPLASMS
CARDIAC MYXOMA
Imaging Techniques
Treatment
Gross Pathology
Microscopic Findings
PAPILLARY FIBROELASTOMA
Imaging
Gross Pathology
Histology
RHABDOMYOMA
Imaging
Gross Pathology
CARDIAC FIBROMA
Imaging
Gross and Histology
HEMANGIOMA
LIPOMAS AND LIPOMATOUS HYPERTROPHY
CARDIAC PARAGANGLIOMA
ATRIOVENTRICULAR NODE TUMORS
MALIGNANT TUMORS
PRIMARY CARDIAC SARCOMAS
Imaging
ANGIOSARCOMA
Imaging
Gross Pathology
Histologic Findings
MALIGNANT FIBROUS HISTIOCYTOMA
Gross Pathology
Histologic Findings
OSTEOSARCOMA
Gross Pathology
Histological Findings
LEIOMYOSARCOMA
Gross Pathology
Histologic Findings
RHABDOMYOSARCOMA
Gross and Histology
SYNOVIAL SARCOMA
UNCLASSIFIABLE OR UNDIFFERENTIATED SARCOMAS
OTHER SARCOMAS
PRIMARY CARDIAC LYMPHOMA
Imaging
Gross Pathology
Histological Findings
PERICARDIAL MESOTHELIOMA
Gross Pathology
Histologic Findings
METASTATIC TUMORS
Imaging
Gross Pathology
CHAPTER 97:
Neurogenic and Stress Cardiomyopathy
INTRODUCTION
NEUROGENIC CARDIOMYOPATHY
CLINICAL FEATURES
ECG Abnormalities
Arrhythmias
Release of Cardiac Biomarkers
Left Ventricular Dysfunction
PATHOPHYSIOLOGY
DIAGNOSIS
TREATMENT
PROGNOSIS
STRESS CARDIOMYOPATHY
CLINICAL FEATURES
ECG Abnormalities
Arrhythmias
Release of Cardiac Biomarkers
Left Ventricular Dysfunction
PATHOPHYSIOLOGY
DIAGNOSIS
TREATMENT
PROGNOSIS
CONCLUSION
CHAPTER 98:
Kidney and the Heart
DEFINITION
EPIDEMIOLOGY
PATHOPHYSIOLOGY
CARDIOVASCULAR RISK FACTORS IN CHRONIC KIDNEY DISEASE
HYPERTENSION
HYPERLIPIDEMIA
SMOKING
DIABETES MELLITUS
LEFT VENTRICULAR HYPERTROPHY
ANEMIA
HYPOALBUMINEMIA
INCREASED EXTRACELLULAR VOLUME
ARTERIOVENOUS FISTULAE
ARTERIOSCLEROSIS
HYPERHOMOCYSTEINEMIA
OXIDATIVE STRESS AND INFLAMMATION
ABNORMAL DIVALENT ION METABOLISM AND VASCULAR CALCIFICATIONS
PROTHROMBOTIC FACTORS
SPECTRUM OF CARDIOVASCULAR DISEASE IN CHRONIC KIDNEY DISEASE
ISCHEMIC HEART DISEASE
Coronary Heart Disease in Chronic Kidney Disease
Coronary Heart Disease as a Risk Factor for Chronic Kidney Disease
Medical Therapy
Interventional Therapy
CONGESTIVE HEART FAILURE
PERICARDIAL DISEASE
INFECTIVE ENDOCARDITIS
VALVULAR HEART DISEASE
ARRHYTHMIAS
DIAGNOSTIC TESTS
CARDIAC MARKERS
ELECTROCARDIOGRAPHY
ECHOCARDIOGRAPHY
STRESS TESTS
COMPUTERIZED TOMOGRAPHY SCANS
CORONARY ANGIOGRAPHY
PRINCIPLES OF TREATMENT OF CARDIOVASCULAR DISEASE
KIDNEY TRANSPLANT RECIPIENTS
CHAPTER 99:
Endocrine Heart Disease
INTRODUCTION
DIABETES MELLITUS
CORONARY ARTERY DISEASE
METABOLIC SYNDROME
CONGESTIVE HEART FAILURE
SUDDEN DEATH
THYROID DISEASE
HYPERTHYROIDISM
HYPOTHYROIDISM
AMIODARONE-INDUCED THYROID DISEASE
PITUITARY DISORDERS
GROWTH HORMONE EXCESS
HYPOPITUITARISM
ADRENAL DISORDERS
PHEOCHROMOCYTOMA AND PARAGANGLIOMA
PRIMARY ALDOSTERONISM
CUSHING'S SYNDROME
ADRENAL INSUFFICIENCY
PARATHYROID DISORDERS
PRIMARY HYPERPARATHYROIDISM
HYPOPARATHYROIDISM
CARCINOID SYNDROME
SUMMARY
CHAPTER 100:
Cardiovascular Trauma as Seen by the Cardiologist
HISTORY
CLASSIFICATION AND PHYSICS OF TRAUMATIC INJURY TO THE CARDIOVASCULAR SYSTEM
PENETRATING INJURY
NON-PENETRATING INJURY (BLUNT INJURY)
CLASSIFYING THE PATHOLOGY OF CARDIAC TRAUMA
MANAGEMENT OF THE ACUTELY INJURED PATIENT WITH THORACOABDOMINAL INJURY
CARDIOVASCULAR INJURIES
PENETRATING CARDIAC INJURY AND CARDIAC TAMPONADE
PERICARDIAL INJURY
CARDIAC LACERATION
MYOCARDIAL CONTUSION—BLUNT CARDIAC INJURY
Incidence of Myocardial Contusion
Clinical Picture of Myocardial Contusion
Diagnosis of Myocardial Contusion
Imaging Techniques
Laboratory Data
Management of the Patient with Myocardial Contusion
Prognosis and Development of Late Complications
INTRACARDIAC INJURIES FROM BOTH PENETRATING WOUNDS AND BLUNT CARDIAC INJURY
SEPTAL DEFECTS
VALVULAR INJURIES
Tricuspid Regurgitation
Mitral Regurgitation
Aortic Regurgitation
Pulmonic Valvular Regurgitation
NON-VENTRICULAR SEPTAL DEFECT AND NON-ATRIAL SEPTAL DEFECT INTRACARDIAC FISTULAS
CORONARY ARTERY LACERATION AND THROMBOSIS
AORTIC AND ARTERIAL TRAUMA
RETAINED FOREIGN BODIES
IATROGENIC CARDIOVASCULAR INJURIES
CHAPTER 101:
Venous Thromboembolism and Cor Pulmonale
INTRODUCTION
VENOUS THROMBOEMBOLISM
EPIDEMIOLOGY
ETIOLOGY
PATHOPHYSIOLOGY
OUTCOMES
CLINICAL MANIFESTATIONS
SYMPTOMS
SIGNS
DIAGNOSTIC TESTING
DIAGNOSTIC APPROACH
Patients with a Low Probability Clinical Assessment
Patients with a Moderate Probability Clinical Assessment
Patients with a High Probability Clinical Assessment
OPTIONAL PATHWAYS
ACUTE MANAGEMENT
MORTALITY RISK ASSESSMENT
MANAGEMENT OF PATIENTS AT HIGH RISK OF DEATH
THROMBOLYSIS
SURGICAL AND CATHETER-BASED THROMBECTOMY
INTERMEDIATE RISK POPULATIONS
LOW RISK POPULATIONS
ANTICOAGULATION THERAPY
Introduction
Parenteral Anticoagulants
Inferior Vena Cava Filters
New Anticoagulants
COR PULMONALE
SIGNS AND SYMPTOMS
STUDIES
PULMONARY FUNCTION TESTING
ECHOCARDIOGRAPHY
THERAPY
Oxygen Therapy
Therapy for Acute Decompensation
Long-Term Therapy
SECTION 12: RELEVANT ISSUES IN CLINICAL CARDIOLOGY
CHAPTER 102:
Noncardiac Surgery in Cardiac Patients
INTRODUCTION
PREOPERATIVE CARDIAC RISK ASSESSMENT
GENERAL RISK STRATIFICATION
ISCHEMIC HEART DISEASE
HYPERTENSION
HEART FAILURE
VALVULAR HEART DISEASE
Aortic Stenosis
Aortic Regurgitation
Mitral Stenosis
Mitral Regurgitation
Prosthetic Valves
CONGENITAL HEART DISEASE
ARRHYTHMIAS
PREOPERATIVE DIAGNOSTIC TESTING
12-LEAD RESTING ELECTROCARDIOGRAPHY
AMBULATORY ELECTROCARDIOGRAPHY
HEART RATE VARIABILITY
ASSESSMENT OF LEFT VENTRICULAR FUNCTION
NONINVASIVE STUDIES FOR MYOCARDIAL ISCHEMIA
CORONARY ANGIOGRAPHY
CARDIAC BIOMARKERS
PREOPERATIVE RISK MITIGATION STRATEGIES
PHARMACOLOGIC INTERVENTIONS
Beta-Adrenergic Blockade
Statin Therapy
Calcium Channel Blockers
Alpha-2 Adrenergic Receptor Agonists
Nitrates
Antiarrhythmic Agents
Aspirin
NONPHARMACOLOGIC AND OTHER INTERVENTIONS
Coronary Revascularization
Interventions for Valvular Lesions
Arrhythmias and Conduction Abnormalities
Hemodynamic Optimization
INTRAOPERATIVE MANAGEMENT
CHOICE OF ANESTHESIA
Volatile Agents versus Opiates
General, Neuraxial and Monitored Anesthesia Care
HEMODYNAMIC MONITORING
MANAGEMENT OF PATIENTS WITH IMPLANTED ELECTRONIC DEVICES
POSTOPERATIVE MANAGEMENT
PULMONARY ARTERY CATHETERS
SURVEILLANCE FOR ISCHEMIA
POSTOPERATIVE ARRHYTHMIAS
PAIN MANAGEMENT
APPENDIX
CHAPTER 103:
Gender and Cardiovascular Disease
INTRODUCTION
PREVALENCE OF IHD IN WOMEN
IDENTIFICATION AND MANAGEMENT OF IHD RISK FACTORS IN WOMEN
ASSESSMENT OF SYMPTOMS AND MYOCARDIAL ISCHEMIA IN WOMEN
SYMPTOM ASSESSMENT
APPROACHES FOR DIAGNOSING IHD IN WOMEN
Exercise Electrocardiographic Evaluation
Stress-induced Perfusion Abnormality Assessment
Stress-induced Wall Motion Abnormality Assessment
Cardiovascular MR Assessment
Coronary Computed Tomographic Angiography
Coronary Angiography
MANAGEMENT OF IHD IN WOMEN
ACUTE ISCHEMIC SYNDROMES: DIFFERENCES IN PRESENTATION AND TREATMENT IN WOMEN
TREATMENT STRATEGIES FOR WOMEN WITH STABLE CORONARY ARTERY DISEASE
MEDICAL THERAPY AND RISK FACTOR MANAGEMENT FOR STABLE CAD
CORONARY ANGIOGRAPHY AND REVASCULARIZATION FOR STABLE CAD
HEART FAILURE IN WOMEN
SEX AND CARDIAC ARRHYTHMIAS
CALL FOR MORE SEX-SPECIFIC RESEARCH
CHAPTER 104:
Overview of the Athlete's Heart
INTRODUCTION
HISTORICAL PERSPECTIVE
EXERCISE PHYSIOLOGY AND THE ATHLETE'S HEART: OVERVIEW
EXERCISE-INDUCED CARDIAC REMODELING
THE LEFT VENTRICLE
THE RIGHT VENTRICLE
THE AORTA
THE LEFT ATRIUM
ISSUES RELEVANT TO THE CARDIOVASCULAR CARE OF ATHLETES
OVERVIEW OF THE CLINICAL APPROACH TO THE TRAINED ATHLETE
ETIOLOGY OF LEFT VENTRICULAR HYPERTROPHY
ARRHYTHMIA
SYNCOPE
STEROIDS AND SPORT PERFORMANCE SUPPLEMENTS
SUDDEN DEATH AND PREPARTICIPATION DISEASE SCREENING
CONCLUSION
CHAPTER 105:
Cardiovascular Aging
INTRODUCTION
AGE-RELATED CHANGES
CELLULAR AGING
VASCULAR CHANGES
MYOCARDIAL CHANGES
ELECTROPHYSIOLOGIC CHANGES
EXERCISE-RELATED CHANGES
ATTENUATING AGE-RELATED CHANGES
CLINICAL SYNDROMES
HEART FAILURE
Epidemiology
Pathogenesis
Therapy
VASCULAR DISEASE-ISOLATED SYSTOLIC HYPERTENSION
Epidemiology
Pathogenesis
Management
ISCHEMIC HEART DISEASE
Epidemiology
Pathogenesis
Management
CONDUCTION DISEASE
Epidemiology
Pathogenesis
Management
VALVULAR DISEASE
Epidemiology
Pathogenesis
Management
SPECIAL ISSUES
PREVENTION
END-OF-LIFE CARE
CONCLUSION
SECTION 13: PREVENTIVE STRATEGIES FOR CORONARY ARTERY DISEASES
CHAPTER 106:
Pathophysiology of Atherothrombosis
INTRODUCTION
SITES OF PREDILECTION FOR ATHEROSCLEROSIS
ENDOTHELIAL ACTIVATION AND INFLAMMATION IN INITIATION AND PROGRESSION OF ATHEROSCLEROSIS
MACROPHAGE HETEROGENEITY IN ATHEROSCLEROSIS
TRIGGERS OF INFLAMMATION IN ATHEROSCLEROSIS
INNATE IMMUNITY, TOLL-LIKE RECEPTORS AND ATHEROSCLEROSIS
INFLAMMATION, ANGIOGENESIS AND ATHEROSCLEROSIS
INFLAMMATION, PLAQUE RUPTURE AND THROMBOSIS
CONCLUSION
CHAPTER 107:
Dyslipidemia
INTRODUCTION
LIPID TRANSPORT AND LIPOPROTEIN METABOLISM
DIAGNOSIS OF THE DYSLIPIDEMIAS
LABORATORY ANALYSIS
LIPOPROTEIN TREATMENT GOALS
HYPERLIPOPROTEINEMIA
PATTERN 1: CHOLESTEROL ELEVATED; TRIGLYCERIDES USUALLY NORMAL
Secondary Causes
Genetic Disorders
PATTERN 2: TRIGLYCERIDES PREDOMINANTLY INCREASED; CHOLESTEROL MAY BE MODERATELY INCREASED
Secondary Causes
Genetic Disorders
PATTERN 3: BOTH CHOLESTEROL AND TRIGLYCERIDES INCREASED
Secondary Causes
Genetic Disorders
HYPOALPHALIPOPROTEINEMIA
OTHER MANAGEMENT CONSIDERATIONS
FREE RADICALS IN DISEASE
Vitamin D
ANNEXURE
NCEP Evidence Statements
CHAPTER 108:
Smoking and Air Pollution
INTRODUCTION
CARDIOVASCULAR BENEFITS OF SMOKING CESSATION
EPIDEMIOLOGY OF SMOKING AND EXPOSURE TO SECOND-HAND SMOKE
ACTIVE SMOKING AND CARDIOVASCULAR DISEASE
SECOND-HAND SMOKE AND CARDIOVASCULAR DISEASE
LOW-TAR (“LIGHT”) CIGARETTES
PATHOPHYSIOLOGY OF TOBACCO SMOKE AND CARDIOVASCULAR DISEASE
ATHEROSCLEROSIS
ENDOTHELIAL DYSFUNCTION
PLATELET ACTIVATION AND THROMBOSIS
ARTERIAL STIFFNESS
DYSLIPIDEMIA
INFLAMMATION
OXIDATIVE STRESS
AUTONOMIC EFFECTS AND HEART RATE VARIABILITY
IMPAIRED OXYGEN TRANSPORT
SMOKING CESSATION
NICOTINE WITHDRAWAL
PHARMACOTHERAPY
Nicotine Replacement Therapy
Bupropion
Varenicline
Second-line Treatments
SMOKE-FREE ENVIRONMENTS AND THEIR EFFECT ON HEART ATTACK ADMISSIONS
SIMILAR EFFECTS AND MECHANISMS OF PARTICULATE AIR POLLUTION
CARDIOLOGISTS AS TOBACCO CONTROL ADVOCATES
CHAPTER 109:
Exercise and Rehabilitation
INTRODUCTION
EXERCISE: DEFINITIONS
EXERCISE: RECOMMENDATIONS
RESPONSES TO EXERCISE
BENEFITS OF EXERCISE
EXERCISE CAPACITY
INFLAMMATION AND ENDOTHELIAL FUNCTION
SAFETY CONSIDERATIONS
CARDIAC REHABILITATION DEFINITION AND GOALS
CARDIAC REHABILITATION PHASES
INPATIENT (PHASE I)
EARLY OUTPATIENT (PHASE II)
LONG-TERM OUTPATIENT (PHASE III)
CARDIAC REHABILITATION CORE COMPONENTS
MEDICAL ASSESSMENT
PSYCHOSOCIAL ASSESSMENT AND MANAGEMENT
NUTRITION
RISK FACTOR MANAGEMENT
EXERCISE TRAINING
Warm-Up
Cool-Down
MEDICATION ASSESSMENT AND MANAGEMENT
CLINICAL POPULATION CONSIDERATIONS
POSTSURGICAL
ANGIOPLASTY (WITH OR WITHOUT STENT)
CLAUDICATION/PERIPHERAL ARTERY DISEASE
ATRIAL FIBRILLATION
HYPERTENSION
DIABETES
ELDERLY
REFERRAL
REIMBURSEMENT ISSUES
SECTION 14: PREVENTIVE STRATEGIES FOR OTHER CARDIOVASCULAR DISEASES
CHAPTER 110:
Prevention of Heart Failure
INTRODUCTION
STAGING OF HEART FAILURE
STAGE A HEART FAILURE
Age, Race and Gender
Family History
Hypertension
Obesity, Diabetes Mellitus, Dyslipidemia and the Metabolic Syndrome
Coronary Artery Disease
Exposure to Cardiotoxins
Treatment for Stage A Heart Failure
STAGE B HEART FAILURE
Asymptomatic Left Ventricular Systolic Dysfunction
Electrocardiogram and Biomarker Evaluation
Cardiac Imaging for Screening
Cost-effect Screening for Stage B Heart Failure
Treatment for Stage B Heart Failure
FUTURE PERSPECTIVES
CHAPTER 111:
Stroke: Prevention and Treatment
INTRODUCTION
DEFINITIONS
STROKE AS A SYMPTOM
EPIDEMIOLOGY AND HIGHEST RISK GROUPS
CLINICAL PRESENTATIONS
DIFFERENTIAL DIAGNOSIS
DIAGNOSTIC EVALUATION
PREVENTION
GENERAL ACUTE TREATMENT
TREATMENT OF ACUTE ISCHEMIC STROKE
TREATMENT OF ACUTE HEMORRHAGIC STROKE
GENERAL IN-HOSPITAL CARE
REHABILITATION
CHAPTER 112:
Rheumatic Fever
INTRODUCTION
PATHOGENESIS
GROUP A BETA HEMOLYTIC STREPTOCOCCI (GABHS) INFECTION
HOST FACTORS—SUSCEPTIBILITY TO ACUTE RHEUMATIC FEVER
HLA Association
B Cell Alloantigens
IMMUNE RESPONSE
ASCHOFF'S BODY
EPIDEMIOLOGY
DIAGNOSIS OF RHEUMATIC FEVER
RECURRENT RHEUMATIC FEVER
CLINICAL FEATURES
AGE AND GENDER
ARTHRITIS
Jaccoud's Arthritis
Post Strep Reactive Arthritis (PSRA)
CARDITIS
Carditis—Role of Echo
CHOREA
Signs
Duration
Sequlae
ERYTHEMA MARGINATUM
SUBCUTANEOUS NODULES
PRECEDING GROUP A STREP INFECTION
TESTS FOR ACTIVE INFLAMMATION (ESR/CRP)
TREATMENT
ERADICATION OF STREPTOCOCCI: AHA STATEMENT (CIRCULATION MARCH 2009)7
ANTI-INFLAMMATORY DRUGS: SALICYLATES OR STEROIDS
RECOMMENDED BED REST OF VARYING DURATION
SECONDARY PREVENTION OF RHEUMATIC FEVER
DURATION OF SECONDARY PROPHYLAXIS
RHEUMATIC FEVER RECURRENCE RATES USING DRUGS
TREATMENT ALGORITHM FOR RHEUMATIC FEVER (FLOW CHART 1)
PREVENTION IN RF/RHD
RESIDUAL HEART DISEASE
MANAGEMENT OF CHOREA
CONCLUSION
SECTION 15: EVOLVING CONCEPTS
CHAPTER 113:
The Genomics of Cardiovascular Disease
INTRODUCTION
A GENOMIC PRIMER
INTERMEDIATE PHENOTYPES
LIPID TRAITS
HYPERTENSION
CORONARY ARTERY DISEASE
LIPOPROTEIN (a)
9p21
ARRHYTHMIAS
ATRIAL FIBRILLATION
QT INTERVAL AND SUDDEN CARDIAC DEATH
CARDIOVASCULAR PHARMACOGENOMICS
ANTIPLATELET AGENTS
WARFARIN
STATINS
BETA-BLOCKERS IN HEART FAILURE
SNP PROFILING STUDIES
FUTURE DIRECTIONS
CHAPTER 114:
Cardiovascular Pharmacogenetics
INTRODUCTION
PRINCIPLES OF PHARMACOGENETICS
HMG-CoA REDUCTASE INHIBITORS
LOW-DENSITY CHOLESTEROL LOWERING
ABCB1
HMGCR
APOE
PCSK9
REDUCTION IN CARDIOVASCULAR EVENTS
STATIN INDUCED MUSCULOSKELETAL SIDE EFFECTS
SLCO1B1
CYP450 Drug Metabolizing Enzymes
COMPLIANCE WITH STATIN THERAPY
CLINICAL IMPLICATIONS
THIENOPYRIDINES
LABORATORY RESPONSE TO CLOPIDOGREL
CYP2C19
ABCB1
Additional Loci
CLINICAL RESPONSE TO CLOPIDOGREL
CYP2C19
Additional Loci
CLINICAL IMPLICATIONS
ASPIRIN
WARFARIN
WARFARIN DOSE REQUIREMENTS
CYP2C9
VKORC1
CYP4F2
Additional Loci
CLINICAL RESPONSE TO WARFARIN
TAILORED WARFARIN THERAPY
DIURETICS
BLOOD PRESSURE LOWERING RESPONSE
CLINICAL OUTCOMES
BETA-BLOCKERS
HEART RATE AND BLOOD PRESSURE REDUCTION
CYP2D6
ADRB1
ADRB2
GRK5
IMPROVEMENT IN VENTRICULAR FUNCTION IN PATIENTS WITH SYSTOLIC HEART FAILURE
CLINICAL BENEFIT IN PATIENTS WITH CARDIOVASCULAR DISEASE
ADRB1
ADRB2
GRK5
ADVERSE EVENTS
CLINICAL IMPLICATIONS
ANTIARRHYTHMIC DRUGS
DIGOXIN AND CALCIUM CHANNEL BLOCKERS
PROCAINAMIDE
PROPAFENONE
ANTIARRHYTHMIC EFFICACY
TOXICITY
CLINICAL IMPLICATIONS
FUTURE DIRECTIONS
CHAPTER 115:
Preventing Errors in Cardiovascular Medicine
INTRODUCTION
MODERN APPROACH TO PATIENT SAFETY
HOW TO IMPROVE PATIENT SAFETY?
REDUNDANCIES, STANDARDIZATION AND FORCING FUNCTIONS
ROLE OF COMPUTERIZATION
COMMUNICATION AND CULTURE
LEARNING FROM MISTAKES
CREATING A SAFE WORKFORCE
PREVENTING DIAGNOSTIC ERRORS
WHAT CAN PATIENTS DO TO KEEP THEMSELVES SAFE?
CHANGING POLICY CONTEXT FOR PATIENT SAFETY
CHAPTER 116:
Economics in Cardiovascular Medicine
COST OF CARDIOVASCULAR CARE
TRENDS IN HEALTH EXPENDITURES (US VERSUS NON-US)
CV CONTRIBUTION TO THE RISING COST OF CARE
VARIATION IN RESOURCE USE
RESOURCE SCARCITY AND VALUE
BASIC CONCEPTS OF HEALTH ECONOMICS
DETERMINING ECONOMIC AND HEALTH OUTCOMES: TRIALS VERSUS MODELING
MEASURING COST
MEASURING OUTCOME
INCORPORATING QUALITY OF LIFE
BENCHMARKS FOR COST-EFFECTIVENESS
EVALUATING UNCERTAINTY
PERSPECTIVE
EFFICIENCY
GOVERNMENT'S USE OF COST-EFFECTIVENESS
UNITED STATES
NON-US: BRITAIN's NICE
COST-EFFECTIVENESS OF INDIVIDUAL TREATMENTS AND STRATEGIES
HEART FAILURE
CORONARY ARTERY DISEASE
ATRIAL FIBRILLATION
COST-EFFECTIVENESS OF QUALITY IMPROVEMENT INTERVENTIONS
FUTURE ESTIMATES OF THE COST OF HEART DISEASE
SUMMARY
GLOSSARY
CHAPTER 117:
Stem Cell Therapy in Cardiology
ABSTRACT
INTRODUCTION
STEM CELL
EMBRYONIC STEM CELLS
ADULT STEM CELLS
BONE MARROW DERIVED STEM CELLS
SKELETAL MYOBLAST
ADIPOSE TISSUE DERIVED STEM CELLS
CARDIAC STEM CELLS
FETAL AND UMBILICAL CORD BLOOD CELLS
INDUCED PLURIPOTENT STEM CELLS
STEM CELL CLINICAL TRIALS
ACUTE MYOCARDIAL INFARCTION
Bone Marrow Mononuclear Cells
Circulating Angiogenic Cells
Mesenchymal Stem Cells
Adipose-derived Stem Cell
Cardiosphere-derived Stem Cells
CHRONIC CORONARY ARTERY DISEASE AND CHRONIC HEART FAILURE
Bone Marrow Cells
Mesenchymal Stem Cells
Skeletal Myoblast Cells
REFRACTORY ANGINA
PULMONARY HYPERTENSION
ROUTES AND METHODS OF CELL DELIVERY
CONCLUSION AND FUTURE DIRECTIONS
CHAPTER 118:
Gene Therapy and Angiogenesis
INTRODUCTION
GENE THERAPY OVERVIEW
GENE REPLACEMENT, GENE CORRECTION AND GENE OVEREXPRESSION
PLASMID DNA DELIVERY VERSUS VIRAL TRANSDUCTION
Adenovirus
Adeno-Associated Virus
Lentivirus
EX VIVO GENE THERAPY WITH RETROVIRUS
GENE TRANSFER TO MYOCARDIUM
BASIC CONCEPTS OF ANGIOGENESIS
BLOOD VESSEL GROWTH: VASCULOGENESIS, ANGIOGENESIS AND ARTERIOGENESIS
CELLULAR INVOLVEMENT IN BLOOD VESSEL GROWTH
ANGIOGENIC GROWTH FACTORS AND RESPONSE TO HYPOXIA
ANGIOGENIC PROTEIN THERAPY
ANGIOGENIC GENE THERAPY
ANGIOGENIC GENE THERAPY IN ANIMAL MODELS
ANGIOGENIC GENE THERAPY CLINICAL TRIALS IN HEART
GENE THERAPY FOR CHRONIC HEART FAILURE
CONCLUSION
CHAPTER 119:
Sleep and the Heart
PHYSIOLOGIC SLEEP
EFFECTS OF NON-RAPID EYE MOVEMENT SLEEP ON CARDIOVASCULAR PHYSIOLOGY
EFFECTS OF RAPID EYE MOVEMENT SLEEP ON CARDIOVASCULAR PHYSIOLOGY
AROUSAL
ARRHYTHMIAS AND SLEEP
HEART RATE VARIABILITY
BRADYARRHYTHMIAS
NOCTURNAL QT INTERVAL CHANGES
SUDDEN INFANT DEATH SYNDROME
VENTRICULAR ARRHYTHMIAS
BRUGADA SYNDROME AND SUDDEN UNEXPLAINED NOCTURNAL DEATH SYNDROME
ATRIAL FIBRILLATION
SLEEP DISORDERED BREATHING
OBSTRUCTIVE SLEEP APNEA
EFFECTS OF OBSTRUCTIVE SLEEP APNEA ON CARDIOVASCULAR PHYSIOLOGY
Hypertension
Atrial Fibrillation
Coronary Artery Disease and Sudden Cardiac Death
Hypertrophic Cardiomyopathy
Stroke
DIAGNOSIS OF SLEEP APNEA
SCREENING QUESTIONNAIRES
OVERNIGHT OXIMETRY
POLYSOMNOGRAPHY
TREATMENT OF OBSTRUCTIVE SLEEP APNEA
OBESITY AND SLEEPING POSITION
CONTINUOUS POSITIVE AIRWAY PRESSURE
ORAL APPLIANCES AND SURGERY
CENTRAL SLEEP APNEA
HEART FAILURE
TREATMENT OF CENTRAL SLEEP APNEA
CHAPTER 120:
Integrative Cardiology: The Use of Complementary Therapies and Beyond
NON-CONVENTIONAL THERAPIES AND CARDIOLOGY
WHAT IS INTEGRATIVE MEDICINE?
WHAT IS INTEGRATIVE CARDIOLOGY?
LIFESTYLE HEART TRIAL
WHAT OTHER INTEGRATIVE MEDICINE THERAPIES ARE EFFECTIVE FOR CARDIOVASCULAR CONDITIONS?
DYSLIPIDEMIA
DIET
EXERCISE
WEIGHT LOSS
BOTANICAL MEDICINES AND SUPPLEMENTS
Fish Oil
Red Rice Yeast
Plant Stanols and Sterols
Psyllium
Beta-Glucan
Artichoke Leaf Extract
Garlic
Cocoa
Niacin
Green Tea Extract (Camellia sinensis)
Guggul (Commiphora mukul)
Policosanol
Coenzyme Q10
HYPERTENSION
DIET
EXERCISE
WEIGHT LOSS
SLEEP
MENTAL HEALTH
MIND-BODY MEDICINE
Biofeedback
Meditation
BOTANICAL MEDICINES AND SUPPLEMENTS
Garlic
Fish Oil
Coenzyme Q10
Hibiscus (Hibiscus sabdariffa)
Pycnogenol
Pomegranate (Punica granatum)
Potassium
L-Arginine
Stevia (Stevia rebaudiana)
WHOLE MEDICAL SYSTEMS
CORONARY ARTERY DISEASE
DIET
EXERCISE
WEIGHT LOSS
SLEEP
MENTAL HEALTH
Stress
Personality
Mood
Social Factors
Spirituality
MIND-BODY MEDICINE THERAPIES
ENHANCED EXTERNAL COUNTERPULSATION
BOTANICAL MEDICINES AND SUPPLEMENTS
Fish Oil
Garlic
Arginine
Carnitine
Ribose
Folate and B Vitamins
Vitamin E
Beta-Carotene
Calcium
CHELATION
HEART FAILURE
DIET
EXERCISE
SLEEP
MENTAL HEALTH
MIND-BODY THERAPIES
THERMAL VASODILATION
ENHANCED EXTERNAL COUNTERPULSATION
BOTANICAL MEDICINES AND SUPPLEMENTS
Hawthorn (Crataegus monogyna)
Coenzyme Q10 (Ubiquinone)
Fish Oil
Ribose
Taurine
Carnitine
Arginine
Creatine
Magnesium (Mg++)
Thiamine
BOTANICAL MEDICINES WITH ADVERSE CARDIOVASCULAR EFFECTS
CONCLUSION
INDEX
TOC
Index
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