CSI Cardiology Update 2018 S Ramakrishnan, Rakesh Yadav, Kewal C Goswami, Nitish Naik
INDEX
Page numbers followed by b refer to box, f refer to figure, fc refer to flowchart, and t refer to table.
A
ABCIXIMAB 224, 241, 242, 336, 937
Abdomen 650
computed tomography of 402
Ablation catheter, tip of 774
Academic research consortium 322
Acebutolol 189
Acetate-free biofiltration 1000
Acetyl CoA carboxylase 596
Acetylcholine 764
Acetylsalicylic acid 307, 311, 315
Achilles heel 809
Acid-base balance, correction of 743
Acidosis 763
intracellular 786
Acquired immunodeficiency syndrome 700
Activated partial thromboplastin time 883
Activated prothrombin complex concentrate 340
Active muscle fibers, stiffening of 1062
Acute atrial fibrillation, immediate cardioversion of 981
Acute coronary events score, global registry of 236, 282
Acute coronary syndrome 37, 39, 57, 198, 201, 211, 235, 240, 241, 241t, 268, 276, 281, 283, 298, 305, 305f, 307, 307t, 308, 310, 311, 315, 315t, 316f, 317f, 38, 322, 324, 325, 328, 332, 351, 356, 379, 401, 412, 421, 570, 593, 656658, 674, 721, 747, 749, 831, 926, 960, 1018, 1050, 1062
assessment 785
current status 235
diagnosis of 240
evaluation 239
immediate post 749
management of 243f
risk stratification post 750
Acute heart failure
different stages of 662
factors triggering 657b
Adenoma, adrenal 139
Adenosine 412
diphosphate 305, 306, 321, 328, 723
effects of 615
triphosphate 183, 187, 221, 321, 559, 723, 833
activation of 584
Adipose derived regenerative cells 428, 429
Adjunctive reperfusion therapy 306
Adjuvant medical therapy 936
Ado-trastuzumab emtansine 621
Adrenomedullin 999
Adrenoreceptor stimulants 142
Adult cardiac surgery database 841
Advanced cardiac life support 742
monitoring 784
pharmacotherapy 784
Advanced echocardiographic techniques 794
Advanced heart failure 664
therapies 664, 669
treatment strategies 664
Adventitial cysts 942
Adverse cardiac event 173, 191, 193, 265, 419, 575, 1051
Adverse cardiovascular event 169, 328, 563
Adverse coronary events 413
Adverse drug reactions 612
Aerobic exercise 1061
Agents, newer 666
Air embolism 901
Airway disease, chronic obstructive 631, 821
Alanine aminotransferase 37, 58
Albuminuria 53
Alcohol 8, 9, 700, 1005
ablation 455
and cardiovascular disease, genetics of 10
and coronary artery disease 8
cardiovascular effects of 9
consumption 115
moderate 116
dehydrogenase 10
intake, detrimental effects of 11
Aldehyde dehydrogenase-2 10
Aldosterone
antagonists 606, 635, 638, 639
receptor antagonists 242
receptor blockade 644
secreting adenoma 146
secretion 923
synthase inhibitor 590
Aldosteronism, primary 146t
Alemtuzumab 621
Alirocumab 595
Allopurinol 182, 586
Alpha-blockers 615
Alpha-linolenic acid 47
Alpha-methyldopa 966, 1048
Alteplase, low-dose 888
Alzheimer's disease 80
Ambulatory blood pressure
measurement 144t
monitor 137, 143, 153, 160
device 154
record 157f
American Academy of Sleep Medicine 1008
American and European Hypertension Guidelines 127
American College of Cardiology 32, 74, 103, 120, 123, 124, 154, 181, 230, 282, 338, 664, 665fc, 831, 1025, 1063
American College of Cardiology Foundation 86, 383, 923
American College of Cardiology Meeting 391
American College of Chest Physicians 919
American College of Physicians 120
American College of Radiology 176, 919
American Diabetes Association 74, 79, 83
American Diabetes Association classification of diabetes 79t
American Heart Association 32, 74, 103, 120, 123, 124, 154, 176, 181, 187, 211, 338, 383, 457, 641, 664, 831, 854, 888, 919, 932, 1025, 1030, 1065, 1065, 1065b
classification 665fc
guideline 282, 923
American Society of Echocardiography 490, 511, 522
guidelines 503
Aminopeptidase A 590
Aminopeptidase inhibitor 590
Amiodarone 614, 623, 693, 716, 734, 744, 747, 748, 764, 994
drug interactions of 616t
Amiovirt 693
Amisulpride 623
Amitriptyline 623
Amlodipine 182
Amniotic fluid embolism 984
Amphetamine-like drugs 614
Amplatzer cardiac plug 470
Amplatzer muscular ventricular septal defect 465f
Amplatzer patent ductus arteriosus 535
Amplatzer septal occluder 465f
Amputation 950
Amyloid beta, catabolism of 589
Amyloidosis 577, 700, 1000
Analgesics 622
Anchoring wire 385, 388
Ancillary preoperative cardiac testing 1051
Anderson-Fabry disease 578
Anecdotal data 58
Anecdotal medicine 402
Anemia 142, 281, 636, 645, 878, 973, 1002
consequences of 1002
development of 1003fc
epidemiology of 1002
pathogenesis of 1002
severe 658
treatment of 1003
Anesthetic medications 622
Aneurysms 574
Angina 455
mild 1050
pectoris 189t, 583
pharmacotherapy for 180, 182
Angiodysplasias 857
Angiogram 928f
Angiography 272, 839, 933
conventional 566, 928
invasive 175
Angioplasty 145, 925
catheters 436
primary 223, 265
Angiopoietin-like proteins inhibitors 598
Angiosome concept 946, 948f
Angiotensin 590
Angiotensin-converting enzyme 129, 282, 614, 648, 674, 841, 854, 933, 998, 1044
inhibitor 125, 127, 129, 137, 143, 180, 181, 187, 242, 252, 606, 615, 618, 635, 636, 643, 661, 665, 690, 691, 698, 733, 791, 924, 961, 968, 974, 985, 1002, 1003, 1048, 1053
Angiotensin-receptor blockers 121, 125127, 129, 137, 145, 180, 181, 242, 252, 606, 615, 635, 637, 643, 648, 665, 674, 690, 691, 698, 733, 791, 854, 925, 968, 974, 999, 1002, 1003, 1053
Angiotensin-receptor neprilysin inhibitor 628, 632, 637, 643, 644, 690, 691, 806, 854, 986
Ankle
brachial index, assessment of 943f
swelling 908
Ankle-brachial index 176, 943
Annual sudden cardiac death rate 802f
Annular tissue velocities 493f
Anomalous coronary artery 1062
Antegrade wiring 393
Anterior thoracotomy, small 837f
Anthracycline 620
Anthracycline
cardiotoxicity 620
cytotoxic action of 620
Antianginal drugs
classification of 182b
first-line 182
second-line 183, 183t
Antianginals, newer 583t
Antiarrhythmic agent 994
Antiarrhythmic defibrillators 748
Antiarrhythmic drugs 615, 616, 710, 717, 747, 748, 1022
therapy 710, 711
Antiarrhythmic medication 622, 764
Anticoagulant 139, 282, 601, 615, 616, 980
drugs, mechanism action of 726f
patients on long-term 718
therapy 240, 1052
in atrial fibrillation, risk for 706
Anticoagulation 718, 737, 920, 1022
after intracerebral hemorrhage, resuming 882
after ischemic stroke, initiation of 882
duration of 919
failure 919
postoperative 719
therapy 921
long-term 877
type of 919
Antidepressant 699
Antidiabetic therapies 96
Antiepileptic 623
Antifungal 616, 700
medicines 623
Antihyperkalemic drugs, newer 606
Antihypertensive drug 591, 699, 1048
classes of 588
first-line 135
Antihypertensive medications 622
Antihypertensive therapy 152, 934
effect of 933
Anti-inflammatory drugs 636
Anti-ischemic therapy 230
Antimetabolites 621
Antimicrobial medications 764
Antimuscarinics 614
Antioxidant 42, 182
effects 9
phytochemicals 42
vitamins 717
Antiplatelet 241, 336t, 612, 737, 945
and anticoagulant agents 728t
and anticoagulation treatment 231t
doses of 271
drug 615
therapy 311, 337, 706, 933, 934
optimal duration of dual 311
single 338, 340
subsequent dual 317
switching 324
Antiproliferative drug 405
Antipsychotic 614
drugs 699
medications 764
Antiretroviral drugs, cardiac effects of 623
Antisense oligonucleotide 596
Antithrombotic benefit 728
Antithrombotic combinations 729f
risk and benefits of 729t
Antithrombotic drugs, effect of 339
Antithrombotic effects 9
Antithrombotic medications 86
Antithrombotic therapy 230, 231, 278, 294, 708, 897
Anxiolytics 661
Aorta 449
aortoarteritis of 1034
ascending 450
coarctation of 142, 147, 1034
Aortic aneurysm, abdominal 947
Aortic annulus 450
Aortic arch 938
atheroma 938
disease 896
tortuosity, excessive 926
type II 937
Aortic atherosclerosis 845
Aortic coarctation 139, 942, 1065
Aortic disease, inflammatory 384
Aortic dissection 978
Aortic paravalvular leak closure 466
Aortic pressure 412f
Aortic regurgitation 451, 452, 452f, 532
significant 856
Aortic root 984
basic anatomy of 449f
dilated 985, 1062
Aortic sinus 388f
Aortic stenosis 531, 897, 903, 1034, 1050, 1063
quantification of 531
severe 443, 448, 449f, 938
Aortic valve 464, 530
disease 142
gradients, elevated 446f
interventions 545
replacement 463
surgical 443, 448
Aortic vascular surgery 338
Aortocaval compression 981
Aortocoronary grafts 387
Aortogram 451f
abdominal 928f
Aorto-ostial
landing zone 387
lesion 384, 386f, 388, 388f
Aortorenal dissection 923
Apical ballooning syndrome, typical of 516f
Apixaban 468, 601, 603, 708, 880, 881, 895
dose of 602
Apnea 1005
hypopnea index 144, 1005
Apolipoprotein B 91, 596, 597
Appropriate cells, selection of 427
Arch atheroma 937
Arginine vasopressin 656, 998
Armodafinil 1009
Arrhythmia 686, 688, 732, 748, 804, 986, 995, 1021, 1065
atrial 715
diagnosis 1017, 1022
malignant 295
observation of less 800
perioperative 1053
perpetuation of 1035
rapid 658
significant 1050
Arrhythmogenic right ventricular
cardiomyopathy 570, 578, 751, 751b, 763, 1062, 1065
dysplasia 577, 756758, 984
electrocardiography of 758f
Arterial conduits
spasm of 822
types of 820
Arterial disease
prevention of progression of 86
severe 912
Arterial graft 823, 837, 845
configurations 826f
disconnection of 822
multiple 825
patency of 822
spasm, prevention of 822
total 828f
Arterial line insertion 294
Arterial oxygen saturation 230
Arterial revascularization 820
total 819, 837, 839
Arterial stenosis, iliofemoral 1034
Arterial stiffness 15
Arterial ventricular dyssynchrony, correction of 290
Arterial wall 370
structure 419
Arteriovenous fistula 1034
Arteriovenous oxygen difference 1061
Artery disease
lower-extremity 314
peripheral 942t
Artery graft, left anterior descending 819
Artery
hypothesis, open 277
infarct related 253, 265
left anterior descending 384, 387, 391, 396, 398, 411, 414, 415, 823, 825fc, 826, 846, 847
size hypothesis 1045f
Arthritis 281
Asia Pacific Heart Rhythm Society 761
Aspirin 181, 241, 306, 313, 315, 336, 379, 617, 723, 728, 1052
comprising of 320
dose 322
high doses of 616
low-dose 313, 615
mechanism action of 722, 722b, 722fc
resistance 317
mechanism of 723b
Astemizole 623
Asthma 1005
exercise induced 1063
Asymptomatic carotid stenosis, clinical impact of 932
Asymptomatic patients, secondary prevention in 933
Atenolol 189, 241, 933
Atherectomy, directional 349, 949
Atheroablation, performance of 373
Atherogenic dyslipidemia, treatment of 593
Atheromatous plaque 227
Atherosclerosis 142, 143, 145, 151, 942, 1043, 1048
accelerated 993
diffuse
coronary 828
distal 849
eradicating 29
etiology of 1043
in arterial conduits, low 819
multi-ethnic study of 175, 960
noninvasive imaging of 960
premature 623, 1046
reduces 21
theories of 28
Atherosclerotic cardiovascular disease 32, 35, 35t, 36t, 41, 53, 55, 57, 83, 121, 593, 1025, 1025f, 1051, 1062
Atherosclerotic coronary artery disease 959
Atherosclerotic disease 145
Atherosclerotic ostioproximal stenosis, severe 927f
Atherosclerotic plaques, quantification of 568
Atherosclerotic renal artery 923
stenosis 145, 923, 925927
stenosis, medical management of 924
Atherosclerotic risk factors 1062
Atherosclerotic vein graft, diffusely 843
Athlete 1061
avoidance techniques 1063
electrocardiogram 1064t
heart 1062
left ventricular wall thickness 1065
represent disease 1061
Atomoxetine 702
Atonic bladder 698
Atorvastatin 617, 618, 724
Atrial and pulmonary vein potentials, left 713f
Atrial appendage
closure device, left 468
closure, left 545f, 1035
left 435, 464, 542, 735, 874, 879
occlusion, left 435
risk factors for left 898
Atrial assessment, left 525
Atrial cardiopathy, concept of 874
Atrial enlargement, left 1064
Atrial fibrillation 181, 435, 468, 601, 602, 628, 640, 641, 648, 654, 703, 705, 708, 710, 711, 715, 716, 721, 722, 724, 725, 727, 732, 732fc, 733736, 763, 765, 873, 875, 878t, 879, 881, 882, 883, 892f, 893, 959, 978, 987, 991, 1006, 1035, 1052, 1063
ablation 711, 714
complications of 713
procedure for 712f
acute rate control 736t
and complications, prevention of 716
and stroke 873
anticoagulation 725
antithrombotic management of 706
catheter ablation of 710, 711t
complication of 705
detection 874
in stroke 875
device detected 735
in acute myocardial infarction, management of 736
in heart failure
management of 733fc
treatment of 732
managing 736
pathophysiology of 710
postoperative 715, 1054
predictors of 736
prevent stroke in patient with 724
prevention of 716
complications of 717
rate control 732
recent conversion from 764
risk stratification tools in 705
symptom control 732
treatment in 579, 732
trial 710
type of 876
Atrial fibrosis 874, 877
Atrial natriuretic peptide 206
Atrial pacing 717
Atrial premature beats 875
Atrial septal defect 1034
closure 544f
small 543
Atrial septum 577
Atrial systole 483
Atrial tachyarrhythmias 1064
Atrial thrombus, left 898
Atrial tissue properties 874
Atrial volume
index, left 641
left 488
Atrial wall, right 809
Atrioventricular block, second-degree 1062
Atrioventricular nodal blockers 718
Atrioventricular pressure gradients 482f
Atrium, left 732, 854
Atrophic kidneys 927
Atropine 981
Attenuation corrected images 550, 552554, 556, 557
Attenuation corrected stress 550, 554
myocardial perfusion imaging examination 554f
Augmented vector foot 673, 757760, 772, 773, 793
Australian National Blood Pressure study, second 134
Austrian mobile phone-based telemonitoring 1019
Autoimmune disease 958, 984,
Autologous stem cell implantation 948
Automated cardioverter defibrillator 749
Automated external defibrillator 784
Automatic implantable cardioverter defibrillator 805
implantation 804, 1035
Automatic power-generating system 809
Autonomic dysfunction, causes of 698
Autonomic failure 698
primary 698, 699
pure 698
Autonomic modulation 645
Autonomic nervous system 696, 744
Autonomic neuropathies, hereditary 700
Autonomic system 1061
Axillary artery 845
preferably 845
Axitinib 621
Ayushman bharat 839
Azilsartan medoxomil 589
Azole antifungals 617
B
Balloon angioplasty 371t, 927
subsequent to 349
Balloon dilatation, simple 390
Balloon expandable valve system 445
Balloon indentation technique 389f
Balloon mitral valvuloplasty 980, 1034
Bare-metal stent 315, 310, 339, 363, 396, 404, 406, 927, 947, 1052
Bariatric surgery 86
Baroreceptor reflex 697fc
Baroreflex 696
sensitivity 694
Basal ganglia, glial cells of 698
Baseline coronary angiography 456f
Basic fibroblast growth factor 206
Bazett's formula 752
Beating heart 833
surgery 834
Beats per minute 485, 488
Belinostat 622
Bempedoic acid 62, 596
Bench research 1037
Bendavia 645
Berlin questionnaire 1006
Beta-adrenergic
antagonists 607
receptors, physiological actions of 189t
Beta-agonist bronchodilators 614
Beta-blocker 125, 182, 230, 241, 252, 279, 616, 628, 635, 644, 690, 716, 736, 744, 747, 772, 785, 979, 985, 1048
administration 716
adverse effects of 189
pharmacotherapeutics of 188
side effects to 182t
therapy 242, 744, 1053
perioperative 1053t
Beta-cell function, homeostatic model assessment for 80
Bevacizumab 620, 621
Bezold-Jarisch reflex 701
Biatrial hypertrophy 1063
Bicuspid aortic valve 1062
Bifurcation angle, anatomy of 354f
Bifurcation lesion 353, 354
Medina classification of 354f
true 359
Bifurcation stenting 353
Bile acid sequestrants 62, 593
Bile duct surgery 338
Bilevel positive airway pressure 659
Binary restenosis 408
Binswanger's disease 142
Bioabsorbable stent implantation 424
Biodegradable drug-eluting stents 408
Biolimus-eluting stent 407
Bioprosthetic mitral valve, paravalvular defects around 535f
Bioprosthetic valve 534f
Biopsy, endomyocardial 973
Bioresorbable drug-eluting stents 408
Bioresorbable vascular scaffolds 409, 948
Biotransformation 613
Biphasic mitral flow 491f
Bisoprolol 189, 635, 690
Black-blood spin-echo sequences 572
Bleeding 603, 706, 857, 878, 894
complications, predicting 317
high risk of 603, 895
intracranial 726
management of 336, 339, 340fc
prevention of 337
risk 230, 728
assessment of 337, 878
treatment of 339
Bleomycin 620, 910
Blood 591
cell count, complete 972
component prohemostatic measures 340b
dyscrasias 1003
flow, collateral 927
test 972
urea nitrogen 637
volume 978
Blood glucose 1062
control 75
Blood pressure 5, 113, 114, 123, 129, 130, 137, 138, 139, 139b, 153, 155f, 160, 180, 188, 621, 636, 684f, 925, 927, 928f, 933, 974, 1017
average 250
categories 123t
control 85, 124f, 126, 945
diastolic 151
diastolic 120, 121, 123, 133, 959, 966, 994, 1061
digital 119
for different stages 120t
goals and targets 133
high 59, 103, 1043, 1047, 1048
higher pretreatment 925
levels, new goal for 124t
load 156
management of 73
mean 856
monitoring 144, 160
out-of-office 137
postoperatively 927
reduction 116f, 127f, 696
stage 1 of 121f
stage 2 of 121f
stages, treatment for 120t
systolic 116, 116t, 120, 121, 123, 124, 133, 184, 229, 505, 656, 943, 959, 966, 978, 1061
variability 156
Blood sugar
levels 1046
lowers 598
Blunt trauma 682, 1062
Body
frames, small 43
surface mapping 1018
mass index 22, 44, 74, 59, 80, 110, 958, 967, 1005, 1007, 1014, 1046
Bone marrow
derived mesenchymal cells 428, 429
laser revascularization 838
mononuclear cells 428, 429
Bortezomib 621
Bovine arch 937
Brachial artery blood pressure 1065
Brachytherapy 349
Bradbury-Eggleston syndrome 698
Bradyarrhythmia 809, 1061, 1062
toxic substances 657
Bradycardia 189, 487f, 764, 1063
anticipated 937
progressive 684f
Brain
natriuretic peptide 76, 206, 643, 651, 972
N-terminal prohormone of 651
stem death, notifying 868
Branch morphologies, threatened side 355
Branch ostial lesions 388
Breast
cancer 11, 958
diseases of 957
surgery 1050
British Hypertension Society 135
Bromocriptine 142, 974, 986
Bronchospasm 189
Brugada syndrome 751, 757, 758, 760f, 763
electrocardiography of 759f
genetic background 758
Brugada-like early repolarization 1064
Bruising 911
B-type natriuretic peptide 631, 641, 658, 999
Buffalo hump 146
Bulky lesions 349
Bull's eye map of global myocardial strain 512f
Bundle branch block 679, 687
left 628, 667, 772, 791, 792, 1051, 1064
right 758, 772, 773, 1063, 1064
Bupropion 623
Burning sensation 908
Buspirone 142
Butyrophenone neuroleptics 764
Bypass graft
anatomy 843
evaluation of 568
Bypass surgery 363
trials of 842
C
Cabozantinib 621
Calcific aortic stenosis, severe 857
Calcification, classification of 370
Calcified lesions, treatment of 370
Calcineurin inhibitors 139
Calcium 115
channel 764
blocker 124, 125, 127, 133, 139, 182, 184, 187, 230, 588, 615618, 622, 698, 717, 724, 772, 933, 1053
gluconate 607
influx postischemic reperfusion 559
superficial 370
Calf swelling 908
Canadian Cardiovascular Society 179, 205, 585
Canagliflozin 589
cardiovascular assessment study 96
Cancer 916
in unprovoked deep vein thrombosis, screening for 921
therapy, complications of 620
Candesartan 635, 649, 974
Cangrelor 330, 336
to clopidogrel, transition from 329
to prasugrel, transition from 330
to ticagrelor, transition from 330
Captopril 635, 974
Carbamazapine 142, 623
Carbon dioxide 1008
Carcinoid syndrome 700
Cardiac amyloidosis 514f, 577f
Cardiac arrest 252, 296, 783, 785, 786
episodes 786
out-of-hospital 749
study Hamburg 748
victims 784f
Cardiac arrhythmia 786, 1000, 1005, 1063
suppression trial 748, 1039
Cardiac artery bypass grafting 480
Cardiac biomarkers 999
Cardiac cachexia 650
Cardiac catheterization 346, 448
Cardiac chamber 778
Cardiac computed tomography 542
angiography 960
Cardiac cycle, phase of 572
Cardiac death rates 179t
Cardiac defibrillator, wearable 744
Cardiac destabilization syndromes 926
Cardiac disease 572, 756, 756f, 983, 985
detectable 687
therapy for 664
Cardiac disorders 1028
Cardiac dysfunction 997
Cardiac dyspnea 484
Cardiac electrophysiology 1029
Cardiac embolism 892, 932
Cardiac enzymes 972
Cardiac events, acute 1062
Cardiac failure 515
congestive 183, 876, 1005
Cardiac function 569
evaluation of 573
heart failure, treatment of preserved 644
Cardiac glycosides 1048
Cardiac implantable electronic devices 651, 654, 789
Cardiac index 292, 573, 657
reduced 852
Cardiac innervation 746
Cardiac insufficiency bisoprolol study 189, 691
Cardiac magnetic resonance 228, 562, 564, 573579
imaging 175, 228, 428, 429, 464, 524, 572, 672, 746, 972, 1063
additional role of 643
Cardiac masses 578
Cardiac motion quantification 518
Cardiac output 380, 382, 573, 856
Cardiac pacemakers, current leadless 810
Cardiac perfusion-imaging 568
Cardiac power output 856
Cardiac protection 620
Cardiac rehabilitation 210, 210f, 213, 283
indications of 211
Cardiac remodeling 1063
Cardiac resynchronization 800
Cardiac resynchronization therapy 480, 515, 526, 666, 667, 690, 791, 792, 797, 799, 800, 802, 811, 854, 856, 975, 1020
defibrillator 654, 748, 800, 807
pacemaker 654
Cardiac risk index, revised 1051, 1051t, 1053
Cardiac stem cells 430
Cardiac stenosis for cardiac surgery, screening of 938t
Cardiac stress testing 238
Cardiac surgery 316t, 719, 817, 836, 863
complications of 228
high-risk 666
Cardiac synchrony 382
Cardiac syncope 681
Cardiac tamponade 287, 749, 774
Cardiac toxicity 621
prevention of 621
symptoms of 621
Cardiac transplantation 669, 858
Cardiac troponin 235, 999
Cardiac tumors 898
primary 898
Cardiac valves, diseases of 973
Cardioembolic stroke
acute 874
causes of 893b
Cardioembolism, etiology of 893
Cardiogenic shock 251, 268, 273, 292, 293, 293f, 295, 296, 831, 832
complicating myocardial infarction, management of 296t
diagnosis 294
management of 661
Cardiological Society of India 300
Cardiology Society of India 1030
Cardiology
non-ischemic 693
subspecialty of 1065
telemonitoring in 1017
Cardiomyocyte apoptosis, prevention of 971
Cardiomyopathy 973, 1062
apical hypertrophic 517f
dilated 475, 575, 897, 972
hereditary 984
hypertrophic 455, 515, 516f, 552, 575, 576f, 711, 750, 751, 757, 775, 1062
obstructive 455, 684, 756
idiopathic dilated 627
inflammatory 643
ischemic 430, 514, 560, 573f, 574f, 775, 800
nonischemic 574, 576f, 690, 747, 750, 775, 776, 776f
dilated 431
reversible dilated 993
trial 691, 693
Cardioplegia 833
retrograde 846
Cardiopulmonary
bypass 397, 833, 980
collapse 910
disease, underlying 1053
exercise testing 1063
resuscitation 783, 785, 786
practice of 783
testing 1051
Cardiorenal anemia syndrome 998
Cardiorenal syndrome 9971000
acute 997
chronic 997
current update 997
secondary 997
Cardioselective beta-blockers 125, 979
Cardiosphere derived cells 428, 429
Cardiotoxic drugs 623
Cardiotoxicity 620, 622, 623
acute 620
chronic 621
types of 620
Cardiovascular abnormalities 1061
Cardiovascular adaptations 1065
Cardiovascular care, emergency 783
Cardiovascular complications, risk of 81
Cardiovascular death 309, 583
Cardiovascular disease 4, 9, 1318, 20, 32, 38, 39, 42, 43, 46, 58, 66, 67, 83, 86, 89, 95, 113, 120, 123, 129, 134, 173, 180, 204, 211, 226, 249, 251, 281, 298, 306, 426, 427, 588, 593, 606, 612, 648, 957, 983, 999, 1013, 1024, 1043, 1044, 1046, 1051
accelerated 923
burden of 249, 250
control of 74
determinants of 250
elevated risk of 994
large variety of 1035
management of 1047
pathophysiologic basis of 1043
prevention of 35, 150
risk of 73
Cardiovascular disorders 73, 74
Cardiovascular drugs, selection of proper 1048
Cardiovascular events
higher risk of 120
prevention of 130, 314
Cardiovascular functions 20
Cardiovascular intensive care unit 230
Cardiovascular intervention 345
Cardiovascular magnetic resonance 223, 289, 506
Cardiovascular management program, simplified 1014
Cardiovascular medications 9
Cardiovascular medicine 320
Cardiovascular mortality 8
risk of 95
Cardiovascular outcomes 925
Cardiovascular pharmacology 581
Cardiovascular structures to sternum, proximity of 844f
Cardiovascular system 345, 991, 998
effects on 995
functioning of 991
Cardioverter defibrillator
implantable 456, 651, 666, 667, 688, 690, 734, 742, 744, 748, 752, 760, 761, 765, 791, 792, 800, 801, 804, 805, 975, 1020
wearable 749
Carfilzomib 620, 621
Carotid artery
disease 933, 938
asymptomatic 934t, 939
management of 932
external 937
internal 819, 824, 825, 827, 843, 883, 927, 932
occlusion, contralateral 935
stenosis 935
severity 933
stenting 338, 932, 934937, 937t, 938t, 1034
technique 936, 937t
timing of 935
Carotid atherosclerosis study, asymptomatic 932
Carotid baroreceptor stimulation 140
Carotid bifurcation 933
Carotid bulbs, dilated 933
Carotid emboli study, asymptomatic 933
Carotid endarterectomy 338, 932, 934, 935, 935t, 936, 936t, 938t, 1050
Carotid femoral pulse wave velocity 17, 138
Carotid interventions, timing of 935
Carotid intima media thickness 176, 994
regression of 933
Carotid stenosis 938, 1034
asymptomatic 934
symptomatic 934
Carotid surgery trial, asymptomatic 932
Carotid territory symptoms 934
Carvedilol 189, 241, 635, 690, 974
prospective randomized cumulative survival trial 189
Cataplexy 682
Cataract 1052
surgery 1050, 1052
Catastrophic health expenditure 251
Catecholaminergic polymorphic ventricular tachyarrhythmias 1062
Catheter ablation 710, 733, 734, 743, 749
reduces mortality 749
Catheter engages ostium 385
Catheter selection 272
Catheterization, acute 230
Celiprolol 618
Cell 591
administration, determining optimum timing of 427
based therapies 838
donors, selection of 427
doses of 427
membrane 613
depolarization of 606
recipient, selection of 427
therapy 426, 427, 838
types and mechanisms 427
Cellular proliferation, induction of 91
Central aortic
blood pressure measurement 158
cannulation 845
pulse pressure 589
systolic pressure 589
Central nervous system 614, 1063
Central venous pressure 412f
elevated 998
Cephalosporins 616
Cerebral autonomic nervous system 874
Cerebral embolic events, symptomatic 897
Cerebral embolization of thrombus 1035
Cerebral ischemia, focal temporary 932
Cerebral protection device 937
Cerebral vascular
accident 310
disease 121
Cerebral veins 916
Cerebrovascular accident 58
Cerebrovascular bleeding 983
Cerebrovascular complications 858
Cerebrovascular disease 123
Cerebrovascular events 396
Cerivastatin 617
Cervical sympathetic denervation 744
Cesarean section, lower segment 980
Chagas disease 700, 775
Characterized transporter protein 613
Chemicals arsenic trioxide 622
Chemotherapy agents 621, 622
Chest
compression 783
mechanical devices for 784
pain 235, 287, 972, 1063, 1065
acute 570
exertional 1063
radiograph 972
X-ray 642, 658, 843, 979, 1024
Chloroquine 623
Chlorpromazine 614, 623, 764
Chlorthalidone 125, 134, 637
Chlorzoxazone 617
Cholecystectomy 338
Cholesterol 27, 29, 32, 48, 84
absorption inhibitors 62
and diet 40
combined 67
functions of 28
hypothesis 27
particles 901
remnant 67
total 46, 66
treatment trialists 36, 58, 84
Cholesteryl ester 54
transfer protein 53, 54, 62, 85, 597
inhibitors 62, 597
Cholestyramine 62
Chronic kidney disease, moderate-to-severe 37
Chronic total occlusion 267, 391, 393, 394, 401, 949, 1034
lesions 392
management of 391
percutaneous coronary intervention 393, 394fc
complications of 394
Chronic venous
disease 908
disorders 908, 908t
insufficiency 907
Chronotropic incompetence 645
Cilostazol 336, 616, 945
Cinacalcet hydrochloride therapy, evaluation of 407
Circulatory failure 656
Circumflex artery, left 387, 415
Cirrhosis 700
Citalopram 623
Clarithromycin 764
Clarivein mechanochemical ablation 913
Claudication
mild 942
moderate 942
severe 942
Clevidipine 589
Clinical syntax score 170
Clonidine 1048
Clopidogrel 241, 306308, 312, 314, 315, 321, 323325, 329, 330, 336, 612, 617, 618, 724, 728, 933, 1052
active metabolite 312
allergy 309
low antiplatelet effect 317
resistance 317
treatment 307
uses 618
Clot dislodgement 901
Coat hanger pain 700
Cobalt-chromium 405
Coenzyme A 586
derivative 596
Coherent, shortage of 1038
Colchicine 717
Colesevelam 62
Colestipol 62
Collaborative atorvastatin diabetes study 84
Color Doppler 476
jet area 479
Combination therapy 748
Common drug-drug interactions 615
Commotio cordis 1062
Community health
centers 1013
workers 1014
Co-morbidities, treatment of 645
Complete revascularization
advantages of 265
disadvantages of 265
Compression therapy 918
Computed tomographic angiography, multi-detector 844
Computed tomography 219, 428, 429, 464, 548, 570, 843, 883, 903, 1024
angiogram 139, 567f, 844f
angiography 175, 218, 568f, 569f, 882, 923, 933, 944, 944f
multi-detector row 174
coronary angiography 385, 566, 570, 570b, 960
applications of 567
diagnostic performance of 566
coronary calcium scoring 1025
fractional flow reserve 568
imaging protocol 449
imaging, multidetector 450f
multiple-detector 920
of pelvis 402
scan 449
Concomitant cardiac pathology 450
Concomitant therapies 724
Congenital heart disease, pre-existing 973
Congestion 656f
Congestive heart failure, symptoms of 560
Conn's syndrome 142, 145, 147
Consciousness
classification of transient loss of 680
loss of 679
transient loss of 680
classification of 680
electrocardiogram 681
high-risk features 681
low-risk features 681
past medical history 681
physical examination 681
Constipation 146, 698
Contraceptives 139
hormonal 142
Conventional guideline directed medical therapy 661
Conventional pacing system, potential complications with 809
Cool shock study 296
Copeptin 999
Copernicus trial 691f
Copolymer 406
Cor pulmonale 145
Coronary angiogram 779f
Coronary angiography 192, 194t, 238, 252, 289, 345, 392, 419, 672, 785, 844, 957, 1034, 1051
arrival of 347
invasive 167
left 457
Coronary anomalies, congenital 1062
Coronary artery 175f, 350, 567f, 671, 826, 842
angiography 173
atherosclerosis 1063
bending of 1062
bifurcations 353
bypass 398
conduits, patency of 824t
bypass grafting 179, 192, 194, 195, 198, 199, 232, 251, 252, 266, 309, 310, 316, 316t, 328, 364, 364t, 396398, 805, 825, 831, 836, 841, 843, 961, 1034, 1051
emergency 391
guideline for 195t
indications of 843t
over percutaneous coronary intervention, benefits of 396
recent advances in 836
robotic-assisted 397
surgery 230, 294, 347, 349, 372, 715
surgery, history of 370
syntax score 170
bypass surgery 204, 332, 363, 396, 583, 831, 832, 1028
evolution of 836f
calcium 35, 175, 566, 960, 1025
score 174, 175, 567, 1025f
dentification of 845
diagnosis of 347
disease 8, 15, 16f, 16t, 21b, 27, 35, 30, 39, 47, 53, 83, 89, 90f, 121, 123, 127, 130, 145, 167, 179, 187, 193, 195, 198, 204, 207t, 249, 271, 286, 307, 311, 320f, 321, 332, 419, 570, 379, 411, 513f, 514f, 548, 560, 566, 567, 575, 583, 601, 603, 604, 622, 628, 648, 674, 721, 746, 749, 765, 771, 804, 805, 814, 828, 836, 838, 841, 852, 893, 932, 935, 957, 993, 1005, 1022, 1028, 1029, 1044, 1044f, 1048, 1053, 1061, 1062 advanced 396
angiographic 179
chronic 165
consequence of 831
controversy 27
different extents of 179t
evaluation of 567
in asymptomatic adults, screening for 173
left main 363, 364t, 819
management of 370
pathophysiology of 187
prevalence of 89, 90t
prevention of 83
protection 9
proximal left anterior descending 195
risk of 1043
significant left main 363
symptomatic 363
three-vessel 195
two-vessel 195
injury 774
ischemia, detecting asymptomatic 174t
left 412
anterior descending 841
main 364, 387, 401
lesions, left main 401
lumen 569
right 272, 286, 386, 387, 412, 823, 845
role of 1025f
spasm 961, 962
stent 570
left main 365
surgery 315
Coronary atherectomy, directional 349
Coronary atherosclerosis
noninvasive visualization of 566
risk of 958
Coronary balloon angioplasty, development of 347
Coronary bifurcation
anatomy of 353f
lesion 353
stenting 355
Coronary blood flow 559
linear relationship of 412f
restoration of 289
Coronary bypass surgery 820
Coronary calcification 15
diagnosis of 370
Coronary calcium score 168
assessment 167
Coronary care unit 294, 299, 659, 661, 662
Coronary catheter angiography 566
Coronary computed tomography 563
angiogram 168
angiography 167, 228
Coronary dissection, risk of 385
Coronary flow reserve 411, 994
calculation of 556
diminished 173
Coronary heart
disease 9, 20, 21, 32, 34f, 39, 40, 42, 46, 90, 114, 133, 173, 599, 1043
management of 962
premature 958
disorders 73, 74
Coronary injury 570
Coronary intervention 343
evolution of 345
history of 345
study 401
Coronary ischemia
consequences of 805
preventing 722b
Coronary lithoplasty 437
Coronary microvascular dysfunction 959
Coronary occlusion, acute 559
Coronary ostia 774
Coronary ostium, height of 450
Coronary perfusion 382
Coronary reoperations 843, 845
mortality of 849
Coronary revascularization 593
hybrid 396398
Coronary risk factors, management of 180
Coronary sinus
lead implantation 797
pacing from 713f
reducer 437
Coronary stent 349
contemporary 404
evaluation of 569
implantation 341
Coronary vasomotor, invasive 961
Coronary vasospasm, catheter induced 384
Coronary veins 774
Coronary venous bypass grafting 838, 839f
Cost-benefit ratio 1028
Cost-effective care 1036
Cough 786, 972
Coumarin derivatives 618
Coumarins, actions of 616
Craniofacial abnormalities 1008
C-reactive protein 9, 90, 1044
Creatine kinase 58, 59, 61
Creatinine 972, 998
clearance 241, 312, 337
Critical limb ischemia 941, 943t, 952
current management 941
evaluation of 943
pathophysiology of 941
Crush techniques 366
Crushing syndrome 139
Cryoablation balloon 712, 712f
Cryoplasty 948
Cryoprecipitate 340
Cryosclerosis 913
C-type natriuretic peptide 1044
Culotte technique 366
Culprit-only percutaneous coronary intervention 293
Culprit-shock trial 293
Cushing's syndrome 146
Cutting balloon 387
angioplasty 371, 947
Cyanobacterium 62
Cyclic adenosine monophosphate 723
Cyclic guanosine monophosphate 206, 585, 641, 643
Cyclic guanylate monophosphate stimulators 644
Cyclooxygenase 336, 722, 723
inhibiting nitric oxide donating 591
inhibitor of 306
Cyclopentyl triazolopyrimidine 307, 321
Cyclophosphamide 620
Cyclosporine 139, 616, 617, 864
Cyclosporine-A 224
Cystatin C 999
Cystectomy, total 338
Cytochrome p450 591
Cytotoxic drugs 620, 622
cardiotoxicity of 620
D
Dabigatran 468, 601, 603, 707, 880, 881, 894
low-dose 603
Dabrafenib 622
Daily activities 1062
Dapagliflozin 589
Dasatinib 622
Death
dominant cause of 298
prevention of 191
DeBakey heart assist device 855f
Debulking devices 948, 949
Deceleration time 485
Decitabine 621
Decompensation, acute 636b
Decompression cardiopulmonary resuscitation 786
Deep sternal wound infection 847
Deep vein thrombosis 208, 908, 912, 916, 916fc, 918, 919
acute proximal 918
controversies and consensus 916
evaluation of 916
isolated distal 918t
management of 916
isolated distal 917
treatment of 917t
Deflection index, maximum 776
Degenerative bioprosthetic aortic valves 444
Dehydroepiandrosterone 40
Dementia 123
Deoxyribonucleic acid 998
Depolarization, abnormalities of 766
Depression 1043
Descending artery, posterior 286
Desflurane 622
Desipramine 623
Desmopressin 340
Device implantation 470
Device migration 452
Device motion and ablation speed 375
Dewoods landmark demonstration 273
Dextrose 607
Dhadkan app 629f
Diabetes 53, 73, 211, 640, 698, 814, 876, 893, 901, 958, 1043, 1047, 1048
and cardiovascular disease 73
and coronary artery disease 89, 90
classification 79, 80t
new dimensions 79
control and complications trial 74
duration of 201
history of 79
management of 95, 934
mellitus 16, 35, 46, 58, 73, 73f, 79, 83, 89, 90f, 95, 121, 145, 155, 181, 191, 194, 198, 233, 242, 250, 408, 636, 706, 724, 879, 935, 945, 958, 1000, 1050
development of 84
gestational 79
insulin-dependent 79
management of 181
medication 622
noninsulin-dependent 79, 90
type 1 53, 79, 81
type 2 42, 47, 53, 79, 81, 95, 95t, 606, 1015
mild age-related 80
prevalence of 89
type of 79, 201
Diabetic interventions and complications, epidemiology of 74
Diabetic nephropathy 74, 590
Diacylglycerol, production of 92
Diagonal artery 826, 846
Dialysis 607, 812
Diaphoresis 287
Diarrhea 306, 607, 698
Diastasis 484, 486
Diastole, physiology of 482
Diastolic blood pressure, low 150, 151
Diastolic dysfunction 286, 481, 482, 494f, 577, 640, 923, 994
advanced 494
classification of 642f
grading of 501t
Diastolic function 487, 496
significance of 483
Diastolic heart failure, pure 483f
Diastolic hypertension, mild 993
Diastolic stress testing 500, 643
Diffusion fluid-attenuated inversion recovery 888
Digital stethoscope 1018f
Digital subtraction angiography 944
Digoxin 613, 616, 617, 661, 717, 736, 974, 985, 1048
absorption 613
bioavailability of 613
Dihydropyridine 127, 182, 184
Dilated cardiomyopathy
nonischemic 799, 800, 800t, 801
pathophysiology of 690
pre-existing 973
Diltiazem 182
Dimethylarginine, asymmetrical 1044
Diode laser therapy, low-dose 946
Dipeptidyl peptidase-4 inhibitors 75, 76, 97, 589
Diphenhydramine 623
Dipyridamole 336
interferes 722
Direct oral anticoagulant 734, 892, 1052
Direct thrombin inhibitor 601, 707, 881
Disability-adjusted life years 892
Disodium ethylenediaminetetraacetic acid 374
Disopyramide 614, 623, 748, 764
Displacement, degree of 613
Disseminated intravascular coagulation 898
Distal chronic total occlusion 272
Diuretic 125, 133, 289, 607, 638, 644, 658, 980, 985, 999
low doses of 144
optimization strategies evaluation trial 999
therapy 985
Dizziness 700
DK crush technique 360f
Dobutamine 294, 659661, 764, 974, 999
stress 564
echocardiography 561
imaging 561
low-dose 560
magnetic resonance 561
Docosahexaenoic acid 47, 62
Donor heart 866
Dopamine 294, 659, 660, 1000
Doppler tissue imaging 490
Doppler wave 479
continuous 479
Dorsalis pedis artery 951
Double kissing and crush 366
Doxazosin 140, 588, 615
Doxepin 623
Doxorubicin 620
Doxycycline 910
Dragonfly imaging catheter 420
Droperidol 623
Droxidopa 702
Drug 657, 984, 998
absorption of 612, 613
administration 894
causing prolong QT 623t
coated balloon 315, 947, 948
combinations 184t
distribution 612, 613
drug interaction 321, 612
actual incidence of 612
mechanism of 612
eluting stent 274, 310, 315, 339, 405, 406t, 407, 423, 927, 948, 1052
platform, cross-section of 405f
safety 198, 232, 278, 353, 363, 384, 408, 409
excretion interaction 613
food interactions 618
induced torsade de pointes, risk factors for 764b
interactions 613, 880
in cardiology 612
metabolism 612, 613
monitoring 859
newer 610
of P2Y12 inhibitor 316
provocation 684f
therapy 734
toxicity 1053
transport proteins 613
Dual antiplatelet therapy 241, 251, 303, 305, 310312, 313t, 315317, 320, 322, 336340, 360, 408, 470, 604, 706, 729, 737, 933, 1052
duration of 318
history of 320f
reimplementation of 338
score 311
Dual drug combinations 127
Duodenopancreatic surgery 338
Duration of therapy 919
Dyslipidemia 32, 37, 167, 593, 724, 945, 958, 1048
development of 995
drug for management of 36
inadequate management of 34
management of 34, 53, 181, 598, 599
pathophysiology of 53
prevalence of 33f
treatment of 1047
Dyspepsia 881, 895
Dyspnea 455, 961, 962
Dysrhythmias 620, 757, 794
Dyssynchrony, intraventricular 494
E
Ecchymoses 911
Echocardiogram 1021
Echocardiography 228, 428, 429, 463, 481, 503, 521, 560, 564, 642, 658, 672, 960, 973
intracardiac 980
two-dimensional 524, 1024
Echolucent plaque 938
Eclampsia 973
severe 973
Ectopic atrial rhythm 1064
Ectopy, atrial 1063
Edema
chronic tissue 918
high attitude pulmonary 1033
interstitial 942
Edoxaban 601, 603, 708, 880, 895
Eicosapentaenoic acid 47
Eighth Joint National Committee 133
Ejection fraction 18, 194, 195, 205, 428, 429, 506, 513, 522, 573, 627, 641, 792, 800, 802, 805, 856
determination of 572
midrange 647, 648
normal 640
preserved 436, 641, 641f, 643f
reduced 97, 650, 665, 732, 733fc, 804
Elastic compression therapy, duration of 919
Elastic lamina, external 420
Elective double stent strategy 359
Electrical cardioversion 657, 734
Electrical storm, catheter ablation of 744
Electrocardiogram 29, 173, 182, 235, 240, 484, 548, 570, 572, 642, 658, 772, 972, 979, 1024, 1046, 1050, 1051, 1063, 1064
artifact 476
gated stress imaging 550552, 554, 556, 557
monitoring, prolong 687t
Electrocardiography 89, 204, 287, 300, 672, 756, 843, 960, 973, 1017
diagnosis 761
Electrocardiography-based tests 765, 765t
Electroencephalogram 1008
Electrolytes 972
Electromyography 61
Electronic batch record 811
Electronic clinical decision support system 1013
Electronic decision support system 1013
Electronic health record 1013
Electrophysiological device therapy 666
Electrophysiological studies-guided pacemaker implantation 679
Electrophysiology
interventional 1035
study 694
Embolic protection device 926, 938
Emergency department, management in 679
Emerging molecules 590, 590t
Empagliflozin 589
Enalapril 589, 635, 974
Encainide 623
End diastolic
velocity 923
volume 428, 429, 522, 573
wall thickness 561
End stage disease 664
End systolic volume 428, 429, 522, 573
Endocardial pacing 797
Endocardial radiofrequency catheter, failure of 775
Endocarditis 452, 1021
active 465
infective 533, 893, 898
risk of 465
Endocardium 746
Endogenous catecholamine levels 683
Endogenous tissue restoration 437
Endomyocardium, apical 577
Endoscopic bypass grafting 397
Endoscopic coronary artery bypass
grafting, total 397
total 836
Endoscopic procedures 1050
Endothelial cells 92
Endothelial dysfunction 91, 942, 959, 1043, 1047
Endothelin 586, 923, 998
receptor blockers 586
secretion 631
Endovascular aneurysm repair 338
Endovascular revascularization 946
techniques for 946
Endovascular therapy 889, 890
intracranial 935
Endovascular treatment, primary 890
Endovenous cyanoacrylate closure 913
Endovenous laser ablation 909, 911914
catheter and laser fiber 912f
machine 911f
mechanism action of 912f
Endovenous laser treatment 912
Endovenous steam ablation 913
Endovenous therapies
advantages of 914t
disadvantages of 914t
Endurance exercise 1061
Energy 559
Enflurane 622
Enhanced external counterpulsation therapy 206, 206fc
acute hemodynamic effects of 206f
Enoximone 660
Enzyme 613, 725
Eosinophilic neoplasm 577
Epicardial ablation 775
Epicardial access, posterior approach for 777t
Epicardial space 774
Epicardial stenosis, assessment of hemodynamic severity of 192
Epicardial ventricular tachycardia 775, 781
Epicardium 746
Epidemiology 941, 983
Epigastric artery, inferior 820
Epinephrine 294, 660, 785
Epirubicin 620
Epithelial sodium channel 589
Eplerenone 635
Epoxide hydrolases 613
Eptifibatide 241, 336
Epworth sleepiness scale 1006
Erectile dysfunction 698, 1008, 1043, 1044f, 1046, 1047, 1047t, 1048
management of 1047
Erythrocyte fluidity 942
Erythromycin 623, 764
Erythropoietin 139, 998, 1002, 1003
Escalation 323, 324
Escitalopram 623
Esmolol 736
Esophageal cancer 11
Esophagectomy 338
Estrogens, cardiovascular benefits of 21, 21b
Ethanol 910
abuse 878
Ethanolamine oleate 910
Ethylhexanoic acid 40
European Association for Cardiothoracic Surgery 831
European Association of Cardiovascular Imaging 501
European Association of Echocardiography Guidelines 490
European Atherosclerosis Society 57, 58
European Carotid Surgery Trial 932
European Collaborative Acute Stroke Study III 887
European Heart Rhythm Association 761
European Lacidipine Study on Atherosclerosis 933
European Medicines Agency 183, 894
European Society of Cardiology 34, 35, 96, 124, 134, 154, 176, 190, 236, 262, 279f, 338, 468, 603, 641, 659, 679, 736, 799, 831, 875, 1003, 1052, 1063
guidelines 271, 682, 923, 934t
recommendations 935t
European Society of Hypertension 124, 134, 154
European Thyroid Association Guidelines 994
Everolimus 621
eluting stents 406, 407
Evolocumab 595
Excess salt consumption 970
Excimer laser coronary angioplasty 371
Exenatide plus dapagliflozin 589
Exercise
benefits of 1062
capacity 1062
echocardiography 1063
risks of 1062
stress testing 960, 1046
treadmill test, 167, 168
types of 1061
External iliac artery, endofibrosis of 942
Extracardiac diseases 208
Extracellular fluid volume 998
Extracorporeal life support 381
advantages 381
disadvantages 381
Extracorporeal membrane oxygenator 742, 743, 784
Extracorporeal techniques 784
Extracranial carotid artery stenosis 932
Extravascular tissue pressure 188
Extremity veins, lower 907
Extrinsic compression 923
Eyes 747
Ezetimibe 593
F
Facial plethora 146
Familial chylomicronemia syndrome 597
Fatal bleeding 309
Fatal coronary heart disease 6
Fatigue 146, 908, 972, 993, 1065
Fats, composition of 46
Fatty acid 40, 42, 46
binding protein 60
fraction of 41f
hydrogenated 47
nonesterfied 53, 54, 54f
transport 598
Femoral arterial access 926
Femoral artery 845
common 947
size 382
stenosis of superficial 944f
superficial 947
Femoral pulses 1065
Femoral vascular ultrasound 402
Femoral vein 907, 912
Femoropopliteal segment endovascular revascularization, technique for 950
Ferric carboxymaltose 1003
Ferric gluconate 1004
Ferric hydroxide sucrose 1004
Fetal antigen autoimmunity 970
Fetal biophysical profile, abnormal 969
Fetal microchimerism 970
Fetal myocardium 559
Fever 142
Fibrates 62, 617
Fibrin specificity 258, 889
Fibrinogen 20, 942
concentrate 340
depletion 258, 889
Fibrinolysis 256, 261, 737, 786
Fibrinolytic 257t
drugs, classification 257
therapy 242, 261
treatment 256
Fibroatheroma, thin-cap 421
Fibroblast growth factor 426
Fibrocalcific pancreatic diabetes 79
Fibromuscular dysplasia 139, 142, 923, 927, 928f, 942, 963
Fibroplasia 842
FIbrosis 874, 1047
endocardial 577f
endomyocardial 577, 577f
Fibrotic plaques 387, 421f
Filling pressure, right-sided 287
Filtered back projection images 551, 552, 557
Final kissing balloon inflation 357, 360, 365
Finet's law 355
Finger plethysmogram 206f
First human heart transplant 863
Fixed dose combination 126
Flash pulmonary edema 145, 926
Floating wire technique 388, 388f
Flow-mediated dilatation 16, 17, 1046
Fluconazole 616
Fludrocortisone acetate 702
Fluid, intravenous 289
Fluorodeoxyglucose 175
positron emission tomography 561
Fluoroquinolones 764
Fluoroscopy 451, 464, 1021
Foam sclerotherapy 914
ultrasound-guided 909
Folate deficiency 1003
Fondaparinux 241, 279
Food-drug interaction 618t
Foot infection 942
Formation of blood clot, mechanism of 727f
Fractional flow reserve 167, 180, 193, 198, 265, 266, 272, 350, 372, 397, 411, 412414, 416, 422, 436
advantages of 412
clinical utility of 413
history of 350
Framingham heart study 95, 114
Free fatty acid 586
Freedom trial 199
Frequent ventricular extrasystole 476
Fresh frozen plasma 340
Functional mitral regurgitation, ultrasound assessment of 475
Functional syntax score 170, 413
Functional tricuspid regurgitation, significance of 434
Furosemide 637, 974
Fused single-photon emission computed tomography 555f
Fusidic acid 617
Fusion echocardiography 542
Fusion imaging, understanding 542
G
Gadolinium
concentration 563, 802
enhancement, late 561, 693, 751
postadministration of 577
Galectin-3 633
Gastroepiploic artery 820, 825
right 824, 847
Gastroesophageal reflux 1008, 1063
Gastrointestinal bleeding 857, 881, 895
GEA grafts, patency of 823
Gemcabene 596
Gene therapy 941, 948
Genome-wide association study 972
Gestational hypertension, treatment of 966
Giant cell arteritis 942
Gianturco-Roubin stent 404f
Glitazones, cardiac effects of 622
Global burden of disease study 39, 109, 226
Glomerular filtration rate 84, 139, 241, 606, 998
estimated 876, 925, 926, 1052
Glomerulonephritis 997
chronic 997
Glucagon-like peptide 1 75, 583, 587
analogs 77
receptor agonists 97
Glucocorticoid 139, 717
remediable aldosteronism 139, 142
Gluconate 1004
Glucose
advantages of 29
disadvantages of 29
insulin-potassium, combine administration of 224
metabolism 559
modulators 224
Glue 913, 914
Glutamic acid decarboxylase 80
Glutathione, reduced 93
Gluten-free diet 43
Glycation end products, advanced 90, 91, 91b
Glycemia control 85, 96
Glycemic control, worsening of 189
Glycemic status, management of 73
Glyceryl trinitrate 182
Glycogen
accumulation 874
storage 559
disease 942
Glycoprotein IIB/IIIA inhibitor, selective 937
Glycosuria 76
Glycoxidation 93
Gordon syndrome 139
Gorlin's equation 531
Grace risk score 229
Grafting vessels with stenosis 414
Great saphenous vein 907, 912
Greater antithrombotic molecules 819
Growth differentiation factor-15 633
Growth factor, transforming 426
Guide catheter 359
Guide wire exchange 357
Guiding catheter 388
maneuvers 385
selection 385
tendency 385
H
Hair loss 942
Haloperidol 614, 623, 764
Halothane 622
Handling saphenous vein grafts 847
Hardwares, selection of 385
Harmonize trial 609f
Harvesting technique 822
Head and neck surgery 338, 1050
Headache 700
Head-up tilt test 682, 683f, 684
response to 683
Health professional's follow-up study 42
Health survey, district level 110
Healthcare quality index 110
Heart 669, 777, 1061
and renal protection trial 1000
block 189
catheterization, right 973
murmur 1065
rhythm
disorders, detection of 652
irregular 892f
structurally normal 746
transplantation 668, 853, 858, 863, 864, 854f
utilization 864
Heart disease 33, 1028
chronic rheumatic 978
congenital 570, 1021, 1065
cyanotic 984, 985
effect of 994
hypertensive 973
ischemic 6, 34, 39, 49, 66, 87, 195t, 221, 226, 249, 249f, 513, 569, 573, 583, 593, 627, 648, 684, 749, 756, 758, 853, 958, 959, 961, 973, 984, 1050, 1051
patients with structural 763
treatment of 1029
Heart failure 15, 18, 95, 95t, 96, 121, 130, 133, 151, 182, 204, 207t, 251, 426, 436, 483, 570, 584, 588, 615, 627, 628, 631, 635, 636, 640, 641, 647651, 651t, 654, 656f, 664, 665, 665fc, 691, 710, 711, 732, 732fc, 735, 799, 800, 802, 804, 852, 853, 854fc, 856, 896, 901, 984, 993, 998, 1002, 1003f, 1005, 1015, 1017, 1019, 1050, 1053
acute 233, 620, 656, 659, 659fc, 660, 661, 998
decompensated 628, 656, 657f, 660t, 997
biomarkers in 631
burden 631
cases 647
causes 627
chronic 17, 635t, 636b, 637t, 1000, 1003, 1019
congestive 638
clinical syndrome of 483
coexistence of 95
compensated 211
congestive 151, 96, 123, 127, 189, 311, 312, 337, 462, 606, 647, 691, 692, 706, 763, 764, 791, 792, 853, 876, 879, 890, 893, 997
diagnosis of 631, 641t, 650
diastolic 644
discharge acute decompensated 662
disease-wise 852
end stage 858
etiologies of 853f
in pregnancy 983
in type 2 diabetes mellitus, screening for 95
incidence of 852
indication of 983
interventions, mHealth-based 1015
ischemic 560, 565
management of 650, 791, 853
acute 660fc, 662
strategies 1020
managing 732
monitoring therapy in 650
pathophysiology of 641f
progression of 732
remote monitoring of 651
risk of 75
sign of 645, 656
symptomatic 970
symptoms of 465, 645, 656
systolic 483, 498
telemonitoring of 651
treatment 204, 579, 643f, 650
in acute decompensated 662b
modalities, end-stage 859t
acute 658
trial 993
total annual mortality in large 802f
with midrange ejection fraction 647
with preserved ejection fraction 643
with recovered ejection fraction 648
with reduced ejection fraction 733
worsening 692f
in hemodynamics 653
Heart rate 5, 182, 184, 185, 229, 488, 522, 1061
control, acute 736
detection 765
reducing 584, 636
reduction of 188
resting 766
turbulence 694, 765
variability 694, 765, 805
Heart Rhythm Society 761
Heart transplant
centers, number of 864
number of 866f
Heartmate 667f
left ventricular assist device 855f
Heartware system 855f
Heat stroke 1062
Heavy calcification 938
HELLP syndrome 968
Hematopoietic stem cells 428
Hemimotor deficits 934
Hemochromatosis 576
Hemodialysis, discontinue 927
Hemodynamic instability, absence of 265
Hemodynamic monitoring device, implantable 1020f
Hemodynamic support devices 380
Hemofiltration 244
Hemoglobin 1002, 1014
glycated 584
Hemoglobinuria 910
Hemorrhage
gastrointestinal 603
intracranial 258, 468, 469
Hemorrhagic stroke, risk factor for 901b
Heparin 252, 612
unfractionated 241, 279, 305, 1052
Hepatic disease 878
Hepatic lipase 54
Hepatocyte growth factor 206
Hepatotoxicity 58
Hiatal hernia 281
repair 338
Hibernating myocardium 559
High arginine vasopressin 638
High-density lipoprotein 15, 20, 21, 27, 33, 36, 40, 47, 53, 54, 74, 83, 90, 958
cholesterol 5, 9, 41, 42, 593, 597, 1062
infusion therapy 597
Highly active antiretroviral therapy 623
High-resolution epicardial coronary ultrasonography 839
High-sensitivity cardiac troponin 236, 237, 237t
assays 236fc
High-sensitivity C-reactive protein 176, 206
High-sensitivity troponin 632
Hip surgery 338
Hirsutism 146
His bundle pacing 796, 797
Histone deacetylase inhibitors 622
Home blood pressure monitoring 153
current status 160
diagnostic performance of 160t
Home sleep apnea testing 1008
Hormone
replacement therapy 20, 21b
clinical studies of 21
effects of 21
trials, large 957
Household survey, district level 103, 109
Hriday card 629f
Human development index 110
Human immunodeficiency virus 700, 856
Hybrid cell design 937f
Hybrid revascularization, goals of 398b
Hydralazine 974
isosorbide dinitrate 986
Hydrochlorothiazide 637, 974
Hydrogen peroxide 93
Hydroxychloroquine 623
Hyperaldosteronism
idiopathic 146
primary 139, 142, 145
secondary 139, 145
Hyperbaric oxygen therapy 941, 946
Hypercalcemia 763
Hypercholesterolemia 33f, 35f, 1043
familial 27, 33, 35, 37, 60
primary 595
Hypercontractile basal segment 673f
Hyperemic pressure gradient, mean 924
Hyperemic systolic pressure gradient 924
Hypereosinophilic syndrome 576, 577
Hyperglycemia 53, 92, 93
treatment of 86
Hyperhomocysteinemia 993
Hyperkalemia 606, 607, 609, 763
clinical manifestations of 606
electrocardiography changes of 607f
history of 610
incidence of 588
moderate 609
moderate-to-severe 609
newer drugs for 607
old drugs for 607t
therapy for 607
Hyperlipidemia 211, 593, 1047
Hypernatremia 786
Hyperparathyroidism 142
Hyperpigmentation 909
Hyperplasia
adrenal 147
bilateral adrenal 139
congenital adrenal 139, 142
idiopathic adrenal 146
Hyperprolactinemia 1043
Hypertension 46, 58, 101, 104t, 105, 111, 116, 121, 123, 125, 129, 133, 134, 146, 147, 151, 152, 154t, 156, 160, 180, 181, 184, 211, 588, 603, 620, 621t, 627, 636, 640, 648, 690, 706, 814, 853, 876, 878, 879, 893, 894, 901, 925, 927, 958, 983, 993, 995, 1007
acute 259
and preeclampsia intervention trial 968
anticancer drugs causing 620
chronic 966, 968
classification of 113
coat 137, 142, 143
cutoff for 119
daytime 154
diagnosis of 119
enhanced control of 888
epidemiology of 103
essential 142
gestational 958, 966
grading of 966
high attitude pulmonary 1033
in pregnancy 966
incidence of 113
intra-abdominal 998
isolated systolic 133, 150, 152
lower prevalence of 103
malignant 926
management of 933
newer drugs for 588
pattern 143
perioperative 142
pharmacological treatment of 123
pregnancy-induced 970
prevalence 104t, 106t, 108t, 109f, 110
correlation of 110, 110t, 111f
recent multisite studies of 105f
prevention of 115t, 117
primary
drugs for 125t
prevention of 113, 114, 116
resistant 137
rule out secondary 137
secondary 137, 139t, 142, 142b, 143, 143b, 144, 144fc, 146, 147
causes of 121
severe 146, 926
sustained 156
treatment of 933, 934
treatment-resistant 139
uncomplicated 123
Hypertensive disorders, classification of 966
Hyperthyroidism 139, 142, 147, 991
Hypertriglyceridemia 33f, 598
drug for management of 36
Hypertrophic cardiomyopathy
electrocardiographic features of 757
electrocardiography of 757f
symptom-free 984
Hypertrophy 1047
express extreme 1065
Hypoglossal nerves 936
Hypoglycemia 616
Hypoglycemic drugs 75
Hypogonadism 1043
Hypokalemia 135, 764
significant 144
Hypokalemic symptoms 146
Hypomagnesemia 135
severe 764
Hypoosmolar contrast media 243
Hypopneas 1005, 1009
Hypotension 287
ambulatory 157
anticipated 937
classical triad of 287
isolated diastolic 151
symptomatic 659
Hypothalamus 874
Hypothermia 763
moderate 296
Hypothesis, two-hit 972
Hypothyroidism 60, 139, 142, 147, 993, 994, 1005
and heart, treatment of 994
cases of 993
include bradycardia, symptoms of 993
subclinical 994
Hypovolemia 701
Hypoxia 763, 981
intermittent 1006
Hysterectomy 959
I
Ibritumomab 621
Ibrutinib 621
Ibutilide 764
Idarubicin 620
Idioventricular rhythm, accelerated 743
Iliac artery
common 947
external 947
Imipramine 623
Immunosuppressive drugs, standard 864
Immunosuppressive therapy 930
Impella 381, 667f
advantages 381
disadvantages 381
Implantable cardioverter defibrillator
meta-analysis of 801t
primary prevention 800t
role of 691
Implanted monitoring-only devices, remote monitoring with 654
Implanted therapeutic devices, remote monitoring with 651, 652
In vitro interactions 613
Inaccessible lesions, surgically 935
Incidental cancer-related pulmonary embolism, treatment of 920
Indapamide 125, 637
Indian Heart Rhythm Society 873
Infection 657
Inflammation 222
Infusion of dobutamine, low-dose 574
Inherited primary arrhythmia syndromes
diagnosis of 760f
management of 760f
Inotropes 666, 999
empirical use of 669
Inotropic action, negative 188
In-stent restenosis 405, 948
Insulin 98, 607
hormone 98
resistance 958
homeostatic model assessment for 80
Intensive care unit 659, 662, 866, 998
Intercellular adhesion molecule 874, 1044
Internal mammary artery
bilateral 826
right 823, 826
Internal thoracic artery, right 846, 847
International Carotid Stenting Study 937
International Congestive Heart Failure 627
International Index of Erectile Function Score 1046
International Lipid Expert Panel 57
International normalized ratio 618, 706, 883
International Olympic Committee 1065
International Society for Heart and Lung Transplantation 864
International Society on Thrombosis and Haemostasis Registry 920
International stroke, third 887
Interstitial fibrosis, idiopathic 1005
Interstitial plus replacement 576
Intervention cardiology, practitioner of 345
Interventional cardiology 1029, 1033, 1035
Research Incooperation Society 193
Intima-media thickness 15, 176
Intra-aortic balloon
counterpulsation 290
pump 293, 295, 296, 372, 380, 382, 661, 667f, 674, 833, 1000
advantages 381
disadvantages 381
Intracardiac defibrillator implantation 211
Intracellular calcium 747
overload 221
Intracerebral bleed 969
Intracranial small vessel disease 932
Intrapartum hypertension, management of severe 968b
Intraprocedural pain ratings, mean 913
Intrathoracic lesions 932
Intrauterine growth
restriction 979
retardation 978
Intravascular ultrasound 218, 240, 278, 350, 354, 366, 370, 372, 385, 411, 419
Intravenous iron complexes
administration of 1004t
dosage of 1004t
Intravenous p2y12 receptor inhibitor 322
Intravenous tissue plasminogen activator 903
Intraventricular dyssynchrony, evaluation of 484
Ion channel polymorphism 764
Ionizing radiation exposure 944
Iron
binding capacity, total 1003
carbohydrate nanoparticles 1004
deficiency 1000, 1002, 1003
functional 645
hydroxide dextran 1004
intravenous 1003
Ischemia 559, 932, 942, 959, 998, 1053
detection of 175
reperfusion injury 221
Ischemia-mediated ventricular tachycardia, presumed 195
Ischemic cardiomyopathy, management of 563
Ischemic heart disease
assessment of 960
clinical spectrum of 961
electrocardiography of 759f
evaluation of 573
Ischemic injury, therapy to reduce 223
Ischemic myocardium, protection of 188b
Ischemic stroke
management of acute 887
risk factor for 901t
thrombolysis in acute 887
Ischemic syndromes study 89
Isoflurane 622
Isosorbide
5-mononitrate 182
dinitrate 182, 660
mononitrate, use of 644
Isovolumic contraction 483
phase 484
time 483485
Isovolumic relaxation 483, 484, 486f
phase 484
time 483, 484, 485f
Itching 908
Ivabradine 182, 183, 584, 586, 986
J
J-wave syndrome 762, 763
Jailed guide wire 360
Jaipur heart watch 33
studies 32
Japanese Association for Thoracic Surgery 841
J-curve
concept 150f
pathophysiology of 150
Joint National Committee 113, 123
Judkin's transfemoral approach 400
Jugular venous pressure 95, 287, 650, 985
Juxtalesional skin necrosis 909
K
Kaplan-Meier survival curve 849f
Ketamine 981
Ketosis-prone diabetes 79
Kidney disease 243, 1053
chronic 18, 35, 36, 95, 121, 181, 241, 243f, 370, 408, 603, 606, 609, 627, 631, 648, 938, 997, 1002, 1036, 1052
intraventricular 637
Kidney injury
acute 243, 296, 997
molecule-1 999
Kissing balloon inflation 355
Korotkoff sounds 153
L
Labetalol 189, 967, 968b
Lacidipine 933
Lactate dehydrogenase 967
Lange-Nielsen syndrome 761
Lapatinib 622
L-arginine 182, 587
Laryngeal nerves 936
Laryngeal palsy 935
Laser 948
angioplasty 349
Lead
fracture 810f
implantation 795
Leadless pacemaker 809, 811t, 813
Leaflet thrombosis 452
Lecithin-cholesterol acyltransferase 62
Left atrial appendage
occlude, role of 735
role of 881
Left main bifurcation stenting strategy, selection of 365
Left renal angiogram, postintervention selective 927f
Left ventricle 575, 751
analysis results 573t
dyssynchrony analysis 526
ejection fraction 575
mass 523
morphology of 673f
regional wall motion abnormalities 523
systolic function of 511
takotsubo cardiomyopathy 673f
Left ventricular
assist device 743, 853, 854, 855f, 856, 858
therapy 211
diastolic pressure 481
dysfunction 195, 706, 747, 849, 896
ejection fraction 181, 242, 278, 311, 312, 337, 372, 380, 391, 427429, 465, 479, 480, 560, 751, 765, 805, 812, 897, 970, 1046
end-diastolic
diameter 477, 975
pressure 382, 672
volume 391
endomyocardial fibrosis 515, 515f
end-systolic
diameter 477
volume 477, 477
function 771, 841, 1051
global longitudinal strain 794
hypertrophy 121, 127, 143, 145, 146, 665, 757, 764, 1063, 1064
myocardial infarction 286
noncompaction 577, 1065
outflow tract 450, 463, 531, 751
gradient 456
pressure-volume loop 483f
systolic function 185, 277
Leg
cramps 908
pain, differential diagnosis of 942
warmth 908
Lenient rate control 733
Leptin resistance 1006
Lesion revascularization, target 358, 384, 407, 948
Lethal arrhythmia 664
Leukocyte migration 959
Leukoencephalopathy, posterior 902
Levosimendan 659, 660
Licorice 142
Liddle syndrome 139
Lidocaine 785
intravenous 748
Life-threatening ventricular arrhythmias 831
Limb ischemia, treatment of critical 945
Linoleic acid 47
Linum usitatissimum 50
Lipid
lowering therapy 84, 933
modification trial 597
profile 29, 66, 1046
status, monitoring of 54
rich plaque 420
Lipodermatosclerosis 907
Lipoprotein 20, 21, 28, 67
cholesterol
low-density 5, 42, 46, 61, 83, 593, 594, 1015, 1047
safety of low-density 599
intermediate density 596
lipase 54
lipids, abnormal values of 32
low-density 9, 21, 27, 32, 33, 35, 36, 54, 55, 57, 74, 90, 91, 180, 187, 262, 595, 596, 958, 993
metabolism 593
modifications 91
non-high-density 250
receptor, low-density 594
synthesis, very-low-density 28
very low density 28, 32, 596
Lisinopril 635
Liver 747
cirrhosis 183, 606
function 603, 878
abnormal 706, 893, 894
test 972
microsomal enzymes 613
resection 338
specific thyroid hormone 993
transplant 1050
Loeffler's syndrome 577
Logistic clinical syntax score 170
Lomitapide 596
Loratadine 623
Losartan 635
Lovastatin 617, 618
Low cholesterol diet 27
benefits of 31
Low fat, benefits of 31
Lower limb revascularization, open 338
Low-molecular weight heparin 241, 279, 617, 917, 920, 980
Luminal diameter, minimal 422
Lung 669, 747, 1063
diseases, chronic 1005
fluid accumulation 1021
ventilation 848
M
Macrolide 764
antibiotics 617
Macrovascular disorders 83
Magnesium
intravenous 717, 748
sulfate 786
supplementation 115
Magnetic resonance
angiography 139, 882, 923, 933, 944, 944f
imaging 174, 446, 448, 463, 751, 888, 973, 1046
Mammary artery
left internal 195, 396, 398, 819, 823, 824, 826, 837
right internal 820
Mandibular advancement devices 1008
Marfan syndrome 985
physical stigmata of 1065
Mass, adrenal 147
Mastocytosis 700
Maternal sepsis 973
Mechanical circulatory support 295, 375, 661, 667, 857
devices, types of 668b
Mechanically assisted circulatory support 856
Mechanochemical ablation 914
Medical services, emergency 298
Medical therapy 179, 467, 665, 800, 801, 896, 925, 933, 934
guideline directed 799
requirements for 791
Medication compliance problems 895
Medroxyprogesterone acetate 21
Membrane attack complex 91
Meperidine 981
MERIT heart failure 691f
Metabolic
acidosis 606
alkalosis 786
disturbances 682
syndrome 37, 958, 1043
treatment of 606
vasodilators 187
Metformin 96
Methodological hierarchies
emergence of 1039
top of 1039
Methotrexate 614
Methyltransferases 613
Metolazone 637
Metoprolol 189, 224, 241, 306, 974
myocardial infarction trial 724
succinate, sustained-release 690
tartrate 736
Mevastatin 618
Mianserin 623
Miconazole significantly potentiates 616
Micra device 811f
Microalbuminuria 998
Microsomal triglyceride transfer protein 596
inhibitor 596
Microvascular thrombosis 942
Midodrine 702
Milrinone 660, 974
Mineralocorticoid receptor antagonist 588, 590, 644, 665, 691, 974
Minimally invasive
cardiac surgery 837
coronary artery bypass grafting 837
direct coronary artery bypass 837
grafting 837f
surgery 397
Mipomersen 596
Mitochondria, redistribution of 874
Mitochondrial permeability transition pore 222
Mitraclip 480t, 535
implantation 543
procedure 545f
Mitral annular
calcification 897
motion with atrial contraction, velocity of 642
velocities 492
Mitral annulus 476
Mitral filling assessment 478
Mitral flow propagation 499
Mitral inflow 491
measurements 491
velocities 490
Mitral regurgitation 293, 448, 475, 477, 480, 527, 732
diastolic 666
echocardiographic impact of 479
etiology of 475
functional 479t, 529f
management of functional 475
mechanism of 475
quantification of 476
replacement in secondary 480t
severe 433
severity, assessment of 529
Mitral replacement 980
Mitral stenosis 478, 530, 978, 1050
in pregnancy 978
pathophysiology of 979
severity 530
Mitral stroke volume 478
Mitral transcatheter paravalvular leak closure 465
Mitral valve 449, 450, 462, 464, 477, 480, 504, 527
analysis software 529f
deformation 477
disease 897
en face view of 528f
function 452
interventions 545
morphology, assessment of 528
pathologies 528f
prolapse 897, 985
repair 477b
replacement 463
stenosis 897
surgical repair of 433
Mitral valvoplasty, surgical 980
Modafinil 1009
Molecular weight heparin, low 305, 1052
Molsidomine 182, 587
dilates venous 587
Monascus purpureus 61
Monoamine oxidase 613
inhibitors 139, 142
Monoclonal antibody 621
based tyrosine kinase inhibitors 621
Monocyte
chemoattractant protein 1044
chemotactic protein-1 206
derived macrophages 92
Monomorphic ventricular tachycardia, sustained 743
Monophasic transmitral flow pattern 492f
Monounsaturated fatty acids 41, 42, 46, 47
Motion artifacts 550
Motor vehicle accidents 144
Mountain sickness, acute 1033
Multicenter automatic defibrillator implantation trial 804, 805
Multicenter chronic total occlusion registry of Japan 379
Multiorgan dysfunction 296
Multiple scoring systems 296
Multipotent cardiac stem cells 426
Multislice computed tomography 175, 542
angiography 175
Multivessel coronary artery disease 265, 266
trial 396
Multivessel percutaneous coronary intervention
advantages of 266t
disadvantages of 266t
Multivessel sternotomy 836
Murray's law 355
Muscle
atrophy 942
blood flow 1062
exercising 1062
hypertrophied 515
pump 698, 1062
weakness 146
Muscular artery 820
Myalgia 58
Mycophenolate mofetil 864
Myeloid 577
Myeloperoxidase 999
Myocardial biopsy 859
Myocardial blood flow, restoration of 831
Myocardial contraction 512f
Myocardial contrast echocardiography 561
Myocardial delayed-enhancement 574
Myocardial disorders 576
heterogeneous 690
Myocardial dysfunction 575
Myocardial edema 576
Myocardial fibrosis 146, 575
Myocardial glucose metabolism 561
Myocardial hypertrophy 579
Myocardial infarction 9, 14, 33, 35, 16f, 58, 74, 81, 115, 133, 173, 179, 187, 191, 204, 221, 261, 271, 278, 286, 292, 293, 307, 309, 312, 314317, 323, 337, 364, 383, 401, 405, 414, 514, 570, 573f, 574, 574f, 583, 665, 706, 741, 746, 804, 842, 843, 876, 893, 896, 916, 934, 962, 1018, 1050, 1051
acute 167, 222f, 236, 238, 249, 257, 260, 266t, 278t, 293f, 379, 408, 426, 428, 428t, 429, 721, 736, 737, 741, 742fc, 748, 765, 804, 809, 831, 832, 957, 1053
anterior wall 492f
evaluation of 573
inferior wall 287
long-term evaluation 279
perioperative 833
recurrent 198
risk of 604
secondary prevention after 314
surgery in acute 831
thrombolysis in 237, 256, 332
trial 261, 306
uncomplicated 994
Myocardial injury 207f
Myocardial iron deposition 576
Myocardial ischemia 995
acute regional 763
Myocardial necrosis 239
Myocardial oxygen 188
consumption 991
Myocardial performance index 288, 506
Myocardial perfusion 560, 568
imaging 174, 555f
positron emission tomography 277
scintigraphy 549f, 553, 557f
scores 271
single-photon emission computed tomography 167, 168, 548
Myocardial protection 845, 846
Myocardial reperfusion 222
injury 223f
mediators of 221
Myocardial revascularization, hybrid 838
Myocardial siderosis 577
Myocardial strain
imaging 564
of myocardial segment 512f
Myocardial viability
assessment of 559, 565
diagnosis of 561t
Myocarditis 515, 574, 575, 1062, 1065
acute 575f, 973
pericarditis like syndrome 620
Myocardium 564t
dysfunctional 559
Myolysis 874
Myonecrosis 58
Myopathy 58
Myosin light chain 60
Myositis 58, 942
N
N-acetyl D glucosaminidase 999
N-acetylcysteine 243, 717, 1000
N-acetyltransferases 613
Nadolol 189
Naftidrofuryl 945
Nanostim device 811f
Naproxen 717
Narcotics 1005
Narrowed pulse pressure 993
Nasal congestion 1008
National Cholesterol Education Program 89
National Consumer Disputes Redressal Commission 1055
National Diabetes Data Group 79
National Family Health Survey 103, 105, 106t, 107, 250
National Heart, Lung, and Blood Institute 32, 177
National Informatics Center 305
National Institute for Health and Care Excellence 966, 967
guidelines 66
National Institute of Health 30
Stroke Scale 888, 890, 902, 903
National Institute of Neurological Disorders and Stroke 887, 902
National Interventional Council 191
National Lipid Association 57
National Organ and Tissue Transplant Organization 866
National Program for Prevention and Control of Cancer, Diabetes, Cardiovascular Diseases, and Stroke 1013
Native coronary artery stenosis 822
Natriuretic peptide 235, 631, 641, 658, 1000
receptor agonist 590
Nausea 287, 306, 700, 961
N-butyl cyanoacrylate 909
Near-field communication technology 1019
Nebivolol 189, 1048
Neck irradiation, ipsilateral 935
Necrotic myocardial cells 561
Nefazodone 617
Neodymium-doped yttrium aluminum garnet 1034
Neonatal diabetes 79
Nephropathy
contrast-induced 243
ischemic 923, 926
prevention of 130
Nephrotoxic drugs 637
Nephrotoxins 998
Neprilysin inhibitor 589
Nerve 747
Neurofibromatosis 142
Neurogenic hypertension 142
Neurohormonal blockade 610
Neurohumoral control 188
Neurologic
disorders 142
dysfunction, episode of 932
prognostication 785
Neurological function, loss of 932
Neurosurgical procedures 785
Neurotoxic drugs 700
Neurotransmitter uptake reactions 614
Neutrophil gelatinase-associated lipocalin 998
New York Heart Association 98, 428, 429, 434, 462, 480, 526, 644, 651, 666, 747, 791, 792, 807, 842, 856, 857, 935, 979, 1003, 1020
Newer oral anticoagulants 881
Niacin 62, 617
Nicorandil 182, 183, 184, 230, 584, 586
effect of 584
mechanism action of 585fc
Nicotiana rustica 3
Nicotiana tabacum 3
Nicotinamide adenine dinucleotide 833
phosphate 998
Nielsen syndrome 752
Nifedipine 967, 968b
Nilotinib 621, 622
Nitinol 947
feet, self-expanding 389
Nitrates 182, 230, 279, 289
Nitric oxide 188, 290, 998, 1044
donors 1047
Nitroglycerin 660, 684f, 961, 974, 999
Nitroprusside 660
Nitrous oxide 41
Nocturnal hypertension 154, 156
Nonacute chest pain 570
Nonadherence with salt 657
Nonantithrombotic therapies 279
Nonarrhythmic mortality 804
Nonbacterial thrombotic endocarditis 897
Noncardiac diseases 658
Noncardiac dyspnea 484
Noncardiac surgery 330, 1050, 1052
timing of 338
undergo 1050
Noncommunicable diseases 39, 1013, 1014
Noncontrast computed tomography 882, 903
Noncoronary aortic cusp 774
Noncoronary artery bypass graft 323, 401
Noncoronary sinus left ventricular pacing 795
Nondiabetic chronic kidney disease 17
Nondihydropyridine 182, 772
Nonfasting lipid levels 66
Nonfatal
myocardial infarction 120, 593
stroke 120
Nonhealing ulcer 942
Noninvasive functional syntax score 169
Nonischemic cardiomyopathy
care in 799
natural history of 806
recent onset 806
Nonischemic dilated cardiomyopathy, primary prevention in 801t
Non-obstructive coronary arteries 962
Nonpharmacological treatment 645, 701
Nonrandomized well-designed controlled trials 1037
Nonreceptor-mediated mechanisms 91
Nonshockable rhythm 785
Non-ST elevation
acute coronary syndrome 226, 231t, 236fc, 243, 252f
management of 230b
acute myocardial infarction 306
myocardial infarction 211, 237, 237f, 240, 262, 328, 413, 961
Non-sternotomy coronary artery bypass 836
Nonsteroidal anti-inflammatory drugs 126, 139, 142, 614, 636, 999
Nonstructural heart disease 758, 764
Non-ST-segment elevation
acute coronary syndromes 308
myocardial infarction 308, 383, 832
Nonsustained ventricular tachycardia 743, 751, 805
Nonthienopyridine 308
Nonvalvular atrial fibrillation 232f, 468, 601, 1035
Nonvasoactive pharmacologic therapy 294
Nonviable myocardium 563
Non-vitamin K antagonist oral anticoagulants 601603, 728, 729
Norepinephrine 660
preferable over dopamine 661
uptake inhibitors, selective 139
Normal myocardial perfusion
scan and variants 548
single-photon emission computed tomography 548f, 549f
Normal pregnancy, physiology of 970
Normotension 156
North American Paradox 308
North American Symptomatic Carotid Endarterectomy Trial 932
Nortriptyline 623
No-touch technique 926
Novel oral anticoagulants 1052
Novel therapy 645
N-terminal pro-B-type natriuretic peptide 631, 658
Nuclear
chromatin 874
medicine 564
equipment 556
stress test, interpretation of 548
Nurses
health study 42
telephone support 1019
O
Obesity 46, 146, 181, 958, 1043, 1047
education initiative 74
related diabetes, mild 80
Obstructive coronary artery disease 391, 1046
Obstructive pulmonary disease 379
Obstructive sleep apnea 137, 139, 142, 144, 874, 1005, 1007t
complications of 1006
consequences of 1006
diagnosis of 1008
management of 1009
screening tools for 1006
Occlutech paravalvular leak device 465f
Occult blood loss 1003
Occult coronary disease 1063
Off-pump coronary artery bypass 836, 837
grafting 833, 848
Olanzapine 623
Omega-3 fatty acids 47
Omeprazole 724
OPAL-HK trial 609f
OPAL-K trial 609f
Opiates relieve dyspnea 661
Opioid overdose 785
Optical coherence tomography 350, 351, 372, 385, 419, 421, 423
correlation of 422
disadvantages of 422
future of 351
imaging, clinical utility of 422
interpretation 420
intracoronary 419
principles of 419
role of 367
Optimal medical
management 179
therapy 179, 180, 191, 193, 204, 266, 843, 945
treatment 933, 945
Optimal replacement fatty acid 41
Optimizing platelet inhibition 309
Oral acetylsalicylic acid 278
Oral anticoagulant 468, 448t, 469, 879, 882, 883, 894
chronic 721
Drugs Act 601
new 468, 705, 707, 880, 881, 883, 895, 895t
Oral anticoagulation therapy 879
Oral antiplatelet agents 307t
Oral cavity 11
Oral contraceptive 918
Oral dental surgery 1052
Oral glucose 561
Oral soluble guanylate cyclase stimulators 644
Orbital atherectomy 371, 372, 373t, 376
Oregon-sudden unexpected death 766
Organ
damage, target 143
donation 864
states in 867f
protection, target 125
supply 859
Orthopedic surgery 916, 1050
Orthopnea 972
Orthostatic hypotension 681, 696, 700702
causes of 698, 699t
clinical presentation 700
differential diagnosis 701
leading to syncope 680
management 701
nonpharmacological treatment 701
pharmacological treatment 701
prevalence of 696
testing for 700
treatment 701
Orthostatic
intolerance 701
response, physiology of normal 696
testing 700, 701
Oslo Diet-Heart study 27
Osteoarthritis
hip 942
knee 942
Ostial coronary lesions 384
Ostial disease, evaluation of 384
Ostial dissection 386f
Ostial internal iliac artery, stenosis of right 944f
Ostial lesions 384, 390
Ostial stent 390b
placement, techniques for 388
Ostial superficial femoral artery 949f
Oxidative stress 90, 92, 93, 221, 923
injury 923
Oxygen
consumption, substantial increase in 1061
peak volume of 644
pulse curve 1063
support 658
uptake, maximum 1063
P
Pace mapping 773
Pacemaker implantation, permanent 445
Paclitaxel-eluting stents 406
Pain 700, 908
abdominal 306
prevention of 981
Painful gynecomastia 639
Palatine tonsils, enlargement of 1008
Pallor 147
Palmaz Schatz coronary stent 347, 404f
Pancuronium 981
Pansystolic murmur 985
Papaverine 412
Papillary muscle rupture 295, 831
Paraneoplastic autonomic neuropathies 700
Parasternal long-axis 505
Parasympathetic nervous system 997
Paravalvular leak 450, 463, 543
closure 465, 467, 535, 543
devices 465f
etiology of 462
percutaneous management of 462
Parenteral direct thrombin inhibitor 279
Paresthesia 911, 913
Parkinson's disease 698, 1043
Paroxysmal
arrhythmias, diagnosis of 1022
atrial fibrillation 814, 1022
hypertension 147
nocturnal dyspnea 961, 972, 985
supraventricular tachycardia, ablation of 1035
Paroxysms 873
Patent bilateral internal mammary artery 823f
Patent ductus arteriosus 505, 985, 1034
Patent foramen ovale 435, 856, 893, 895, 896
occluder device 290
occlusion 435
Patent vein 845
Pathak trial 263
Patiromer
adverse effects of 610b
sorbitex calcium 607, 610
adverse effects of patiromer 610
dosage and administration 610
OPAL-K trials 609
Pazopanib 621
Peak plasma concentration, time to 880
Peak systolic velocity 923
Pedal edema 145
Pediatric
cardiology 1029
heart transplant 865
Pemafibrate 598
Penbutolol 189
Penicillins 616
Penile artery 1045
Pentoxifylline 945
Percutaneous balloon mitral valvuloplasty 980
Percutaneous closure, program of 1034
Percutaneous coronary intervention 37, 95, 167, 179, 180, 191, 192, 194, 195, 195t, 199, 221, 230, 232, 242, 243, 252, 262, 266, 268, 271, 276, 279f, 282, 283, 289, 294, 296, 300, 310, 312, 313, 315f, 332, 336, 337, 339, 353, 363, 364, 364t, 370, 372, 380, 384, 391, 393, 396, 398, 400, 404, 411, 413415, 419, 433, 448, 583, 603, 604, 721, 721f, 722, 722b, 727, 783, 831, 842, 843t, 961, 1018, 1051, 1052
benefits of 1028
high-risk 383t
in atrial fibrillation 721
primary 223, 242, 256, 261, 271, 298, 305, 265, 283, 283f, 737
procedural planning of 422
techniques 393
Percutaneous mitral valve
repair 545
therapies 433
Percutaneous paravalvular leak closure 465
Percutaneous robotically enhanced coronary intervention trial 436
Percutaneous septal ablation, historical development of 455
Percutaneous transluminal
balloon angioplasty 946, 948
coronary angioplasty 191, 243, 278, 347, 385, 415, 1034
renal angioplasty 925
septal myocardial ablation 455, 456f
Percutaneous tricuspid valve therapies 434
Percutaneous valve implantation 437
Percutaneous ventricular restoration 437
Percutaneous ventriculoplasty devices 434
Perfusion pressure, preserved 294
Periarteriolar autoregulation 187
Pericardial disease 484, 578
Pericardial mass 228
Pericarditis 1062, 1065
constrictive 228, 287, 519f, 578f
Perimedial fibroplasia 928, 928f
Peripartum cardiomyopathy 970, 971, 971f, 972b, 974t, 978, 983, 984
Association 984
differential diagnoses of 973b
etiopathogenesis of 970
medications 974t
Peripheral angiography 944, 945f
Peripheral angioplasty 1034
Peripheral arterial
angioplasty 338
disease 893
Peripheral artery 1034
disease 317, 318, 941
management of 946, 947f
Peripheral health centers 669
Peripheral ischemic complications 295
Peripheral vascular
disease 83, 123, 145, 211, 636, 819, 905
resistance 1061
surgery 1050
Periprocedural myocardial infarction 391
Periprocedural stroke 713, 937
Permeability glycoprotein 602
P-glycoprotein 601, 602, 613
Pharmacoinvasive strategy 256, 262
Pharmacokinetic interaction 612, 616
Pharmacological testing 1051
Pharmacological therapy 658
Pharmacological treatment 701
Pharmacology therapy 734
Pharyngeal cancers 11
Phenothiazine 614
neuroleptics 764
Pheochromocytoma 139, 142, 147
Phillips volcano system 416f
Phone-based systems 1019
Phosphodiesterase
inhibitor 999
type 5 inhibitor 644
agents 1047
Phosphorylcholine 405, 406
Photodynamic therapy 948
Photon emission computed tomography, single 277, 548
Phrenic nerve 712
Phytosterolemia 593
Pickering syndrome 145
Pickwickian syndrome 1005
Pindolol 189
Piroxicam 617
Placenta, hypoperfusion of 967
Placental abruption 969
Plain balloon angioplasty 947
Plain old balloon angioplasty 833
Plaque progression, reduce 181
Plasma
aldosterone
concentration 146
renin ratio 137
cholesterol profile 68t
Plasminogen activator
inhibitor 20, 90, 889
type 9
Platelet
aggregation 21, 336, 942, 959
assessment of 316
inhibition of 317
count 882
dependent enzyme cyclooxygenase 722
derived growth factor 999
function
inhibitors of 722
testing of 316, 332
inhibition 308
and patient outcomes 309
management of 329
rich
clot 258
thrombus 889
transfusion 340
timing of 336
Platinum-chromium 405
Pneumatic compression, intermittent 941
Pneumonectomy 338
Pneumonia 658, 973, 1050, 1054
Pneumothorax 809
Polidocanol 910
Polycystic kidney disease 142
Polycystic ovarian
disease 958
syndrome 1005
Polydipsia 146
Polylactic acid 407
Polymer coating 405
Polymorphic ventricular tachycardia 743
Polysomnography 1005
Polytetrafluoroethylene 433
Polytrauma 919
Polyunsaturated fatty acid 40, 41, 47
Polyuria 146
Polyvinyl chloride 347
Ponatinib 621
Positive airway pressure, continuous 658, 659, 1006
Positive exercise stress test 549f
Positive pressure ventilation 658
Positron emission tomography 174, 416, 417, 561, 694, 960
Postatheroablation angioplasty 376
Postcardiac resynchronization therapy 793f
Postcardiac surgery 211
Postcardiac transplantation 579
Postcardioversion anticoagulation 737
Postcoronary angioplasty 211
Postcoronary artery bypass graft 569
Postdilatation 273
Postdischarge period 212
Posterior descending artery 824, 826, 846, 847
Postexertional syncope 1063
Postgadolinium administration 576
Postheart transplantation 579
Post-myocardial infarction 242
Postpartum hypertension 966
Postprandial hypotension 154, 157
Postprandial lipemia 53
Postprandial metabolic issues 43
Poststenting hypotension 937
Post-stress ejection fraction 552
Post-thrombotic syndrome 916, 918
Post-transcatheter aortic valve 453f
Postural orthostatic tachycardia syndrome 701
Postventricular assist device implantation management 856
Pot technique 356
Potassium
channel blockers 748
depleting drugs 614
intake 115
supplementation 115
Potential cardiac recipients, categorization of 668
Pot-side-pot technique 359f
Prasugrel 241, 282, 308, 312, 314, 321, 323325, 330, 336, 728
to ticagrelor, switch from 326
Pravastatin 617
Precordial thump 786
Preeclampsia 966, 967, 967t, 973, 983
clinical symptoms of 967
prevention of 967
risk factors for developing 967t
severe 967
Pregnancy 142, 983, 984
hormonal milieu of 971
hypertensive disorders of 966
Premature ventricular complexes, ablation of 774
Preparticipation screening 1063, 1065
Pressure
half-time 463
measurement 530
ratio, resting 924
Pro-adrenomedullin, mid-regional 999
Proatrial natriuretic peptide, mid-regional 633
Procainamide 623, 764
Procalcitonin 633
Progenitor cells, circulating 428, 429
Proinflammatory markers and mediators, production of 1047
Prolactin 970
Proliferator-activated receptors gamma 590
Promotility medications 764
Prone cardiopulmonary resuscitation 785
Prone free-breathing stress imaging 553
Prophylactic hemodialysis 244
Propranolol 189, 241, 618
Proprotein convertase subtilisin/kexin inhibitors 55, 61, 62, 594, 595
Prostaglandin 615, 1048
therapy 1048
Prostate
carcinoma of 1043
surgery 1050
Prosthetic cardiac valves 897
Prosthetic heart valves 985
dysfunction, assessment of 534f
Prosthetic valve 534, 893, 1017, 1021, 1052
annulus 465
endocarditis 534
rocking motion of 465
Proteasome inhibitors 620, 621
Protein
activated 707
from plant sources, role of 42t
kinase C 90, 92
activation 93
source 42
Proteolysis 874
Prothrombin
complex concentrate 339, 340
time 616
Proton pump inhibitors 616
interaction of 618
Provisional one-stent technique 365
Provisional side branch stenting strategy 356
Proximal isovelocity surface area 477
method 477
Proximal right coronary artery 289f
Proximal veins 918t
of legs 916
Pseudoaneurysms 574
Pseudo-delta wave 775, 776
Pseudohypertension 143
Pseudomonas aeruginosa 857
Psychogenic pseudosyncope 682
Psychosocial stress 1043
Pubic symphysis 980
Pulmonary arterial
hypertension 644, 1006
systolic pressure 979
Pulmonary artery 438, 1020, 1047
catheterization 890
denervation 438
pressure 438
diastolic 504, 505
mean 504, 505
Pulmonary capillary wedge pressure 379, 436, 489, 643, 657
Pulmonary disease, chronic obstructive 174, 636, 814, 935, 1005, 1008
Pulmonary edema 927, 927f, 969, 978, 983
mild 984
Pulmonary embolism 657, 763, 910, 916, 919, 1050, 1054
acute 287, 658, 973
treatment of 601
Pulmonary hypertension 145, 576, 648, 984, 1017
severe 287, 863
sustained 910
telemonitoring in 1021
Pulmonary stenosis, mild 985
Pulmonary thromboembolism 208, 973
Pulmonary tuberculosis, streptomycin treatment of 1039
Pulmonary vascular resistance 504, 505
Pulmonary vein 479, 642, 874
flow 496, 497f, 498f
parameters 499
pattern 497f
signals, acquisition of 498
isolation 713
ostia 713f
Pulmonary venous return 286
Pulse 1017
Pulsed Doppler wave 478
Pulsed wave Doppler mitral flow 487f
Pump
failure, progressive 664
inhibitors 724
thrombosis 857
Purkinje fibers 749
Pursuit risk score 229
Q
QT interval, short 1064
QT syndrome
diagnosis short 762
diagnostic scoring scheme, short 763t
long 752, 757, 761, 763, 763t, 1062
short 757, 762, 763, 1062
subclinical long 764
Quantitative flow ratio 417, 436
Quetiapine 623
Quinidine 623, 748, 764
Quinine 623
Quinolones 616
Q-wave myocardial infarction 363
R
RADAR systems 1022
Radial artery 819, 820, 824826, 846, 847
bilateral 820
unilateral 820
Radiation
injury 391
therapy 932
Radio detection and ranging 1017
Radiofrequency ablation 909, 910, 913, 914
Radionuclide
myocardial perfusion imaging 174
single proton emission computed tomography 174
ventriculography 288
Radiopaque contrast media 243
Ramipril 635, 974
Ramucirumab 621
Randomized clinical trials 443, 932
Randomized controlled trial 21, 43, 162, 211, 443, 604, 710, 733, 801, 875, 890, 1003, 1015, 1036, 10381041
Ranolazine 182, 183, 230, 583, 586, 623
mechanism action of 584fc
RAO cranial projection 416f
Rapamycin, mammalian target of 621
Rapid onset of dyspnea 972
Raynaud's phenomena 189
Reactive oxygen species 221, 222, 971, 998
Receptor neprilysin inhibitor 638
Recombinant tissue plasminogen activator 902
Recurrent sustained ventricular tachycardia, catheter ablation of 744
Red blood cell 462, 1003
deformability, reduced 942
Reflex syncope 680, 681
Reflux 908
Refractory angina 430, 437
Refractory ventricular
fibrillation, management of 744
tachycardia, management of 744
Regional wall motion abnormality 671
Regorafenib 621
Regurgitant fraction 463
Regurgitant orifice 477
effective 463, 479
Regurgitant volume 463, 479
Rehabilitation 233
Remote monitoring in heart failure, role of 652t
Renal angioplasty 928f
Renal artery
chronic total occlusion, bilateral 927
lesion 925
occlusions 927
stenosis 139, 145, 923, 924, 924b, 929, 1034
atheromatous 142
detection of 923
evaluation 924t
stenting 925
no touch technique of 927f
Renal atherosclerotic lesion 925
Renal biomarker 998
Renal cell carcinoma 142
Renal denervation 140, 438
catheter based 140
Renal disease 60, 603t, 878
end-stage 123, 242, 876, 881, 1005
Renal double curve 927
Renal dysfunction 240, 241t, 281, 603, 881
Renal failure 133, 658, 901, 969, 1054
Renal flow reserve 924
Renal fractional flow reserve 924
Renal function 145, 637
abnormal 706, 893, 894
significant deterioration of 143
tests 1046
Renal injury 391
Renal insufficiency 966, 1050
Renal parenchymal disease 146
Renal replacement therapy 243, 661
Renal segmental hypoplasia 142
Renal sympathetic activity 631
Renal tumors 142
Renin inhibitor 590
Renin promotes 698
Renin-angiotensin
aldosterone 636
axis 923
system 15, 85, 96, 125127, 139, 144, 207, 279, 606, 609, 643, 656, 698, 997, 1002, 1003
system 129, 631, 923
local 691
Renocardiac syndrome
acute 997
chronic 997
Renovascular hypertension 142, 923
Reperfusion
injury, reduce 224
therapy 276, 283, 293
Repolarization, abnormalities of 766
Reproductive system 957
Rescue percutaneous coronary intervention 261
Research study designs, types of 1038
Reserpine 1048
Residual aortic regurgitation 444
Residual cholesterol risk 599
Residual syntax score 170
Resins 607
Resistant hypertension 137, 138fc, 926
treating 137
Respiratory disturbance index 1009
Respiratory failure 656
Rest pain, ischemic 942
Restenosis 927, 938
Resting pressure gradient, mean 924
Restless legs 908
Restrictive cardiomyopathy 287, 576
Reticuloendothelial system 240, 241, 1003
Retinopathy 74, 121
hypertensive 143
Revascularization 191, 560, 925, 945, 946
modality 926
surgical 950
Revascularizing nonculprit artery 265
Rhabdomyolysis 58
Rheumatic
disease 475
heart disease 627, 710, 852, 873
mitral stenosis 530f
Rheumatoid arthritis 958
Rhythm control 718, 733, 736, 878
Ridaforolimus-eluting stent 407
Rifamycins 616
Right ventricle 791
assessment 524
Takotsubo cardiomyopathy 673f
Right ventricular
assist device 290, 296
chamber dimensions
and volumes 505t
assessment 503
echocardiography 503
ejection fraction, reduced 750
fractional area change 506
function 506t
hypertrophy 979, 1064
pattern 1064
infarction 296
ischemia 286
myocardial
infarction 286, 288f
performance index 506
outflow tract 504, 505, 752, 773f, 814
perforation of 809
strain imaging 507
wall motion assessment 509
Rituximab 621
Rivaroxaban 468, 601, 603, 708, 880, 881, 894, 895
bioavailability 601
dose of 602
plus aspirin 318
Robotic percutaneous coronary intervention 436
Romano-Ward syndrome 761
Rotablation 948
Rotational atherectomy 349, 371, 372, 373t, 376
Rutherford classification of peripheral artery disease, modified 942t
S
Sacubitril 589
Safe pressure resistant cylindrical balloons 347
Salpingo-oophorectomy, bilateral 959
Saphenofemoral junction 907, 912, 912f
Saphenopopliteal junction 907
Saphenous vein
graft 397, 819, 824, 825, 841, 843, 844, 846
short 907
Sapheon 913
Sapien 3 valve 445
Sarcoidosis 576, 643
Sarcopenic adiposity 43
Sarcoplasmic reticulum 222, 874
Saroglitazar 598
Saturated fatty acid 41, 46
Scar ventricular tachycardia 758
Scientifically trustworthy empirical evidence 1036
Scleroderma 142
Sclerosing agents 909, 910t
Sclerosis, multiple 1043
Sclerotherapy 909
efficacy of 910
technique 910f
Scoring balloon 387, 947
angioplasty 371
Screening abnormalities 1063
Screening tests 173
safety of 176
Seagull's sign 475
Second-generation drug-eluting stents 200
Sedative drugs 1005
Sedentary counterparts 1062
Seizure disorder 682
Selenium deficiency 970
Sensitive inversion recovery 574, 575
Sepsis 1050, 1054
Septal
ablation 455, 459
technique of 456
defect closure, interatrial 543
hypertrophy, asymmetrical 758
puncture 544f
wall thinning 573f
Septum
interatrial 504, 544
intraventricular 457
wall 550
Serotonin reuptake inhibitor, selective 139
Serum 25-hydroxy vitamin D level 16
Serum amyloid 90
Serum biomarkers 877
Serum creatinine 637
Serum ferritin 1003
Serum lactate dehydrogenase 462
Serum potassium 609, 637
Serum vitamin D levels
after supplementation 18
before supplementation 18
Sevoflurane 622
Sexual function 698
Sheath size 382
Shock 735
trial 294
registry 293
Shunting, right to left 896f
Shy-Drager syndrome 698
Side branch ostial disease 356
Siesta dipping 154
Sildenafil 614, 616
Simcard trial 1014
Simultaneous kissing stent 366
technique 366
Simvastatin 616618
Single-chamber pacemakers 813
Single-photon emission computed tomography 428, 429, 550f, 551f, 554f557f, 561, 694
Sinotubular junction 449f, 450
Sinus
arrhythmia 1062, 1064
bradycardia 494, 496f, 1063, 1064
rhythm, restoration of 718
Sirolimus-eluting stent 406, 407, 927
Sitosterolemia, homozygous 593
Six-minute walk distance 434
Sjögren's syndrome, primary 700
Skeletal muscle 1063
diseases of 1063
Skeletonized harvesting 822
Skin 747
atrophy 942
fissures 942
necrosis 914
Sleep
disorders in heart failure by remote monitoring 652
disruption, arousals 1006
Small dense low density lipoprotein 53
Small diameter vessels 349
Small molecule tyrosine kinase 622
inhibitors 621
Smokeless cardiovascular
disease 3, 6
risk factors 5
Smokeless tobacco
disease 3, 6
risk factors 5
types of 3t
Smoking 145, 958, 1048
cessation 945
meta-analysis 1015
Snoring 144
Snuff 4
Sodium 589
bicarbonate 607, 786
channel 764
blockers 748
chloride 1004
current inhibition, late 645
fecal contents of 607
glucose co-transporter 2 75, 76, 86
inhibitors 76, 96
intake 115
polystyrene sulfonate 606, 607
reduction 115, 923
tetradecyl sulfate 909, 910
zirconium cyclosilicate 607, 608, 608f
Soft tissue attenuation, artifacts of 549
Sole therapy 838
Solitary 927
Soluble nutrients 28
Soluble vascular endothelial growth factor receptor-1 999
Sorafenib 620, 621
Sotalol 189, 623, 716, 734, 748, 764
Speckle tracking 794
echocardiography 561
imaging method 507
Spinal cord
disorders 1043
injury 919
stimulation 941
ultrasound therapy 945
Spinal immobility of neck 935
Spinal stenosis 942
Spine surgery 338
Spironolactone 635, 974, 985, 1048
Splanchnic veins 916
Splenectomy 338
Spontaneous coronary artery 963
dissection 959, 961, 963, 978
Spontaneous echocardiographic contrasts 877
Sports
and heart diseases 1061
cardiology 1062
Stabilization, ischemic 306
Stable angina 184, 185, 192
chronic 179, 191, 204, 211
Stable coronary artery disease 58, 179, 187, 191, 1028
Stable ischemic heart disease 179, 194, 194t, 195, 200
guideline 204
Stamina 1061
Standalone instantaneous wave-free ratio approach 417
Standard-dose alteplase 888
Staphylococcus aureus 857
Stasis 916
State hypothesis, low-flow 997
Statin 53, 84, 182, 241, 242, 280, 618, 717, 945, 1048
alternatives, second-line 62b
associated muscle symptoms 5759
during carotid artery stenting 934
induced muscle disease 61f
intensity of 55t
intolerance 57
evaluation of 59
management of 62t
types of 57
therapy 934, 1048, 1053
initiation of 54
Status epilepticus 469
Stearic acid 49
ST-elevation
in takotsubo cardiomyopathy 673f
myocardial infarction 211, 223, 243, 256, 258, 265, 266, 268, 276, 281, 282, 295, 298, 306, 321, 379, 400, 657, 958, 1017
India project 299
treated 308
Stem cell 426
cardiopoietic 430
retention of 427
therapy 579, 941, 946
trials 428t
in ischemic cardiomyopathy 428t
in nonischemic cardiomyopathy 429t
Stenosed aortic valve 1034
Stenosis 925
angiographic 932
degree of 568, 822
iliofemoral 1034
left main 842
progression 933
severity, reliable measurement of 933
tubular areas of 928
Stenotic vein graft 847
multiple 843
Stent
choice of 274
deployment 387
diameter 423
expansion 423
length selection 423
malapposition 423
platforms, contemporary 406f
positioning 387
pull back technique 389, 389f
related complication 391
restenosis 843
selection 387, 423
and deployment 360
self-expandable 947
strut malapposition 422f
thrombosis 322, 405, 721
risk of 721
six 930
Stenting strategy in bifurcation lesions 356
Sterility 1059
Sternal wires, lifting of anterior 845f
Sternotomy
and dissection 845
lifting 845f
Steroid 142
anabolic 139, 1063
Sterol regulatory element-binding protein 2 595
Stitching artifact 421f
Stop-bang questionnaire 1006
Strain curves, velocities of 514f
Strain imaging, speckle tracking for 512
Streptokinase 257
fibrinolytic property of 256
global utilization of 282
Stress
cardiomyopathy 578
cardiovascular magnetic resonance 960
echocardiogram 168
echocardiography 167, 174, 574, 960
management 115
myocardial perfusion
positron emission tomography 960
single-photon emission computed tomography 960
positron emission tomography myocardial perfusion scintigraphy 548
testing 277, 1051
transthoracic echocardiogram 479
Stroke 74, 83, 133, 251, 309, 401, 446, 603, 706, 871, 873, 874, 878, 892, 894, 901, 903, 916, 933, 1005
acute ischemic 875, 882, 887, 888
algorithm 903fc
and transient ischemic attack 874
cardioembolic 892
cryptogenic 875
ischemic 435
definition of 932
evolution, understanding 889
hemorrhagic 249f, 902
high risk of 895
in atrial fibrillation 879fc
epidemiology of 705
primary prevention of 879, 881
in cardiac patients, prevention of 892
in cath lab 901, 902
differential diagnosis 902
evaluation 902
incidence 901
mechanism and risk factors 901
treatment 902
incidence of 901
index 573
ischemic 18, 902
mechanism in atrial fibrillation 874
perioperative 937
physicians 932
predictors in atrial fibrillation 877
prevention 37, 601, 705, 732, 734, 879
existing options of 468
in atrial fibrillation 705, 706, 725, 881, 893
primary 880t
secondary 880t
previous 895, 901
remains 892
risk 705, 722, 873
episodes predictive of 876
estimation of 705
in atrial fibrillation 877
stratification scores 876
thrombolysis 903
recent advances in 888
treatment of 937
volume 573, 852, 1061
Structural heart disease 542, 687, 757, 772, 775
Strut thickness in drug-eluting stents, significance of 407
ST-segment
depression 1064
elevation acute coronary syndrome 401
elevation myocardial infarction 226, 235, 247, 249, 260, 262, 311, 832
acute 261t, 271, 276
guidelines 262t
treatment delay in 260
Stump morphology 393
Stunning myocardium 560
phenomenon of 560
Subacute cardiotoxicity 620
Subarachnoid hemorrhage 763
Subclavian thrombosis 812
Subclinical hypothyroidism, treatment of 994
Subcutaneous cardioverter defibrillator 749
Subcutaneous fibrosis 918
Subcutaneous tissue 942
Subdiaphragmatic radiotracer activity, artifacts of 550
Subintimal angioplasty 949
Substance abuse 1005
Sucrose 1004
Sudden cardiac arrest, history of 763
Sudden cardiac death 690, 744, 746, 748, 749, 751, 756, 756f, 760, 801, 805, 993, 1061
burden of 799
electrocardiography in 756t
in heart failure 799
prevention of 799
risk of 804
drug therapy in 690
survivors of 195, 756
therapies for 747
Sudden death in dilated cardiomyopathy 690
Sudden infant death syndrome 763, 1022
Sulfonylureas 97
Summation reaction 614t
Sunflower oil 49
Sunitinib 620, 621
Superficial venous system, anatomy of 907f
Superoxide dismutase 971
Supine electrocardiogram-gated stress imaging 553, 555
Supra-aortic trunks 933
Supraventricular tachycardia, lower incidence of 583
Surgery
bleeding risk of 1052
types of 337, 338t
Swelling 909
Sympathetic nervous system 126, 139, 997, 998
Synchronous bilateral carotid interventions 936
Syncope 677, 679, 682, 687, 700, 962, 985
diagnosis of 680
during exercise 1063
exercise-related 455
patients with 686
severity 680
tilt table testing in 682
unexplained 687, 763
Synergistic reaction 614t
Syntax score 169, 170, 368
prognostic value of 169
Syntax trial 199
Systemic arterial vasodilation 1047
Systemic blood pressure 142, 1009
elevated 1065
Systemic diseases and heart 989
Systemic hypertension 123, 153
Systemic lupus erythematosus 958, 967, 1000
Systemic vascular resistance 978, 991
fall of 983
Systemic ventricular dysfunction 979
Systolic blood pressure reduction of 150
Systolic dysfunction 628, 970
Systolic dyssynchrony index 526
Systolic heart failure, nonischemic 692, 693
Systolic hypertension 151
Systolic pressure gradient
peak hyperemic 924
peak resting 924
resting 924
Systolic pulmonary artery pressure 504, 505
Systolic volume 522
Szabo's technique 388, 388f, 389f
T
T wave inversion 1064
Tachyarrhythmia 657, 1061
treatment of 994
Tachy-Brady syndrome 711, 812
Tachycardia 656, 981
focal ventricular 780f
incessant ventricular 807
Tacrolimus 139, 617, 864
Tail wire technique 388, 388f, 389f
Takayasu arteritis 384, 923, 929
Takotsubo cardiomyopathy 578, 671, 962
management of 674t
Tamil Nadu Health Systems Project 299
Tamponade 809
TandemHeart 295, 381, 667f
advantages 381
disadvantages 382
percutaneous ventricular assist device 290
Tapered stents, self-expanding 937
Technetium-99m 561
labeled tracer 550, 551, 553, 554556
Technological advancements 809
Telangiectatic matting 909
Tele-echocardiography 1021
services 1017
Tele-electrocardiography 1018
Telehealthcare 1017
Telemonitoring systems 1022
Temporary pacemakers 786
Temporary pacing 374
Temsirolimus 621
Tenecteplase 257
Terfenadine 623
Termination of pregnancy, timing of 968
Tessari technique 910
Testosterone 586
deficiency 1048
replacement therapy 1048
role of 1048
Tetralogy of Fallot, repaired 985
Thallium-201 561
Therapeutic implications 648
Therapeutic range 603
time in 602
Thermal coronary angiography 839
Thiazide
diuretic 135, 637, 1048
like diuretic 134
type diuretic 125, 135
Thiazolidinediones 98, 622
Thienopyridine 278, 307, 314, 321
Thioridazine 623, 764
Thiothixene 614
Thoracic artery, left internal 820, 844f, 845f, 846, 847
Thoracic epidural anesthesia 744
Thoracotomy 848
Three-dimensional echocardiography 521, 530
Thrombectomy
solitaire with intention for 890
standard 882
Thrombocytopenia 920, 920f, 966
Thromboembolism 874, 1021
prevention of 737
prophylaxis 661
Thrombolysis 298, 918
catheter directed 918
in myocardial infarction, risk of 313
in wake-up stroke 888
role of 888
stroke study 888
Thrombolytic agent
activates plasminogen 887
next generation 888
Thrombolytic therapy, effects of 918
Thrombophilia 916
Thrombophlebitis 909
Thromboplastin time, partial 617
Thromboprophylactic and therapeutic realm 882
Thrombosis 942
cancer-associated 919
endovenous heat-induced 911
prevention of 601
risk of 336, 721
Thrombosuction 273
Thromboxane 257, 722, 723
Thrombus 901
direct imaging of 917
Thyroid 747
disorders 146
dysfunction, amiodarone induced 994
function 994
hormone 991, 992f
effects of 991
metabolism 994
response elements 991
receptors 991
replacement therapy 994
stimulating hormone 147, 972, 991
Thyrotoxicosis 973
Ticagrelor 241, 282, 308, 312, 322, 330, 336, 728
to prasugrel, switch from 326
Ticlopidine 306, 321, 616, 617
Timolol 189
Timothy syndrome 752
Tirofiban 241, 336
Tissue
Doppler imaging 503, 561
of right ventricular 507
factor pathway inhibitor 707
inhibitor of metalloproteinases 643
loss, minor 942
motion 487
plasminogen activator 20, 278, 889, 903
prolapse 424
Tobacco
control policy 4
use of 115, 1043
Toe-brachial index 943
Torasemide 140, 612, 637
Torsade de pointes 764t
Tortuous carotid artery 937
Total arterial revascularization 820, 825fc
Total ischemic time, function of 276f
Toxic substances 657
Toxicity, mechanism of 620
Tracheostoma 935
Tractus solitaries, nucleus of 697
Traditional syntax score, limitations of 170
Trametinib 621
Tranexamic acid 315, 340
Trans fatty acids 47
Transcatheter aortic valve 445
implantation 443, 448, 451, 465, 531, 545
replacement 443, 444, 444t, 445, 448, 467, 535, 542, 903, 1029
limitations of 445
procedure 546t
Transcatheter heart valve 450
Transcatheter mitral valve replacement 536, 545
Transcatheter paravalvular leak closure, technique of 465
Transcriptase inhibitors, reverse 623
Transcutaneous energy transmission 854
Transendocardial stem cell injection 428, 429
Transesophageal echocardiogram 476
three-dimentional 476f
Transesophageal echocardiography 434, 449, 451, 463, 469, 509, 533, 542, 893
role of 451
Transferrin saturation 1003
Transfusion dependent 576
Transient ischemic
attack 307, 682, 705, 706, 876, 879, 882, 892, 932, 935, 1045
dilation 175, 552
Transluminal extraction catheter 349
Transmitral flow 482, 498f
velocity with atrial contraction 642
Transmyocardial laser revascularization 838
Transoesophageal echocardiogram 476
Transradial interventions 400
Transthoracic echocardiogram 476, 972
two-dimensional 476
Transthoracic echocardiography 434, 448, 449f, 973
Trauma 916, 923, 941
Treadmill test 1024
Trendelenburg position, reverse 912
Tricuspid annular planar systolic excursion 288, 503, 506, 506f
Tricuspid regurgitation 286, 288, 505, 532
severe 809
velocity 503
Tricuspid stenosis 533
Tricuspid valve 434, 504, 532
closure 507f
en face view of 532f
Triglyceride 33, 46, 53, 66, 596, 958, 1062
high 59
reduction 597
rich lipoproteins 54f
transport protein 596
Trimetazidine 182, 183, 230, 585, 586
Triple drug combination 127
Triple vessel disease 842, 938
Trivandrum heart failure registry 95
Trophoblast invasion 967
Troponin 972
True bifurcation lesions, treatment of 359
Tumescent anesthesia 909, 911, 914
Tumor necrosis factor 9, 206, 636, 874, 967
alpha 91
T-wave alternans 765
Twiddler's syndrome 810f, 812
Two-catheter technique 389, 389f
Tyrosine kinase inhibitors 139
U
Ulcers 918
Ultrasonography 917, 967
Ultrasound, duplex 933, 943
Ultra-thin drug-eluting stents, clinical efficacy of 408
Umbilical cord derived mesenchymal stem cells 428
United States Food and Drug Administration 183, 910
Unsaturated fatty acids 46
Unscientific pathophysiologic rationale 1036
Unstable angina 211, 226, 235, 243, 251, 315, 413, 383
Upper limb 916
Urea 972
V
Valsalva maneuver 493f
end of 493f
Valsartan 589, 635, 974
Valve
assessment 527
durability 447
gradient 452
implantable 1034
in-valve international data registry 444
morphology 450
perforation 774
replacement or repair 290
thrombosis 446, 1021
Valvular disease 578
Valvular heart disease 534, 690, 893, 897, 973, 1050, 1065
pre-existing 973
Valvular injury 918
Valvular lesions 984
Valvular stenosis 973
Valvular surgery 211
Vandetanib 621, 622
Varicose vein 907, 914t
management of 909
sealing system 913
treatment for 908
Vascular access
approach, selection of 373
complication 391
Vascular cell adhesion molecule 92, 1044
Vascular disease 879
causes of 916
noninflammatory 927
Vascular endothelial growth factor 139, 207, 426, 971, 999
Vascular function 994
Vascular injury 916, 918
Vascular lesions 92
Vascular psychiatry 839
Vascular rarefaction 923
Vascular resistance, elevated 985
Vascular surgeons 932
Vascular surgery 338
Vascular thrombosis, risk of 722b
Vasoactive drugs 294
Vasoconstriction, excessive 942
Vasoconstrictor prostaglandins 923
Vasodilatory kinins, functions of 125
Vasopressin 294, 784
use of 784
Vasopressors 661
Vasospastic angina 763
Vasovagal syncope 682, 1063
pathophysiology of 682
Vein grafts 846
Vein thrombus, target 912
Veins of leg, superficial 907f
Velocity time integral 505
Vemurafenib 622
Vena cava
filter
retrievable 919
role of inferior 919
inferior 434, 919, 920, 978
superior 434, 544
Vena contracta 477, 529
width of 477
Venlafaxine 623
Venoarterial extracorporeal membrane oxygenation 295, 382
Venous cannulation 845
Venous thromboembolism 601, 916, 918, 918t, 919, 920
despite anticoagulation, recurrent 920
treatment of 601
Venous ulcers 907
Ventricular arrhythmias 221, 739, 741, 744, 746, 761, 1064
and sudden death 746
malignant 858
management of 743
mechanisms of 746
pathogenesis of 741
risk factors for 763t
sustained 741
therapies for 747
treatment of 747, 748
types of 741
Ventricular assist device 853, 856fc, 859, 860
classification of 854
implantation 858
pros and cons of 860t
Ventricular cavities, dilatation of 636
Ventricular complex
ablation, technique of premature 772
premature 751, 771773, 773f, 774, 778
Ventricular contractions, premature 1064
Ventricular dysfunction 805
Ventricular dyssynchrony 666
Ventricular ectopy 1035
Ventricular fibrillation 694, 741743, 746, 751, 758, 760, 761, 763
incidence of 741
management of sustained 743
syndromes 763t
therapy 1021
Ventricular hypertrophy 923
Ventricular pre-excitation 1064
Ventricular premature beats 743, 746
Ventricular pseudoaneurysm 831
Ventricular rate, rapid 736
Ventricular septal
defect 505, 831, 1034
rupture 293
Ventricular single-chamber rate-modulated 811
Ventricular structure and systolic function, evaluation of 570
Ventricular tachyarrhythmias 690
Ventricular tachycardia 498, 672, 742, 751, 760, 763, 775, 776f, 805, 1035
management of sustained 743
predictors of sustained 741
storm 742fc
management of 742fc
Ventricular thrombus 893
Verapamil 182
Vessel
failure, target 359
last surviving 379
occlusion, large 882, 888
revascularization, target 169
tortuosity 938
Viable myocardium, types of 559
Vinca alkaloids 620
Vincristine 700
Vinylidene fluoride-co-hexafluoropropylene 406
Viral and bacterial assays 973
Viral myocarditis 518f
Virchow's triad 916fc
Visceral obesity 1048
Vitamin
B12 30
deficiency 700
C 93
D 1315, 16t, 17
deficiency 13
mechanism of 15
nutritional status 13
receptors 13
supplementation 18, 18t
synthesis 14f
E 42, 93
K
antagonist 601, 707, 725, 725f, 726, 728, 729, 734, 879, 883, 893, 894, 920, 980, 1052, 1053
anticoagulants 602
dependent coagulation factor proteins 601
drugs 601
epoxide 725
K2 substances 616
Vomiting 287
Vorapaxar 336
Vorinostat 622
Vulnerable coronary plaques 217
Vulnerable plaque 217
assessment 421
W
Warfarin 612, 616, 617, 618
arm 603
indications 616
superior to 602
therapy, long term 881
Weightlifting 1062
White blood cells 312, 337
White coat hypertension 156
White thrombus 421
WICS-LV system 813
Wilms tumor 142
Window endovascular trials, late 889
Window paradox, late 890
Wireless cardiac stimulation system for left ventricle 812f
Wireless health care delivery systems 1013
Wolff-Parkinson-White syndrome 757, 1062
World Health Organization 103, 249, 932, 1002, 1018, 1024
Worsen angina 180
Wound care 945
Wrestling 1062
Y
Yttrium-aluminum-garnet 838
Z
Ziv-aflibercept 621
Z-offset drift 421
Zotarolimus-eluting stent 406, 407
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Chapter Notes

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1Coronary Artery Disease Risk Factors2

Smokeless Tobacco and Cardiovascular DiseaseCHAPTER 1

Surender Deora
Kewal C Goswami
 
INTRODUCTION
Tobacco has been used by human beings since 600 AD.1 Columbus came to know about tobacco from Caribbean and introduced it in Europe. It was introduced in India in early 1600 AD by Portuguese traders mainly as a barter commodity to trade Indian textiles.2 The harmful effect of tobacco was also known since the Mughal era and the Jahangir, the Mughal emperor of India, had even passed orders to ban it.3 The spiritual leader, Guru Gobind Singh, the 10th Sikh guru, prohibited smoking for the Sikh community. He said, “Wine is bad, Indian hemp (bhang) destroys one generation, but tobacco destroys all generations”.4 Not only in India, the king James I of England and Shah Abbas of Persia were aware of the harmful effect of tobacco. King James described tobacco smoking as “a custom loathsome to the eye, hateful to the nose, harmful to the brain, and dangerous to the lungs”. Initially, it was mainly used by affluent class but gradually penetrated at all socioeconomic strata in various forms.
The term “smokeless tobacco” (SLT) mainly refers to chewing, spitting, sniffing unburned tobacco in one or the other form either alone or mixed with other constituents. The SLT is mainly obtained from Nicotiana rustica which contains more nitrosamines as compared to the tobacco for smoking obtained from Nicotiana tabacum. Mainly, it was consumed with betel quid (pan) for decades and later in the form of bidi (tobacco wrapped in dried leaves of special trees). Some people used for its presumed medicinal value which although has never been proved in any system of medicine being practiced in India.
The various forms and different names of SLT consumed in India are Pan, Gutkha, Zarda, Naswar, and Mishri or Gul (Table 1 and Figs. 1 to 3).
  • Pan is a betel leaf containing mixture of tobacco, areca nuts, spices, and lime (to increase the bioavailability of nicotine)
  • Gutkha is nothing but powdered form of scented tobacco, areca nut mixed with lime.
  • Zarda is Indian chewing tobacco flavored with spices and flavored form of tobacco is also used in pan
  • Naswar is a moist, powdered tobacco snuff consumed mostly in India, Pakistan, Afghanistan and neighboring countries.
    TABLE 1   Various types of smokeless tobacco
    Common name
    Ingredients
    Gutkha
    Tobacco, areca nut, condiments, flavoring agent
    Khaini
    Tobacco flakes, lime
    Naswar
    Tobacco, slaked lime, indigo, cardamom oil, menthol
    Gul
    Burned tobacco powder, molasses
    Zarda
    Boiled tobacco
    Pan
    Betel leaf, areca nut, tobacco, lime, spices
    Moist snuff (US type)
    Pulverized tobacco, fermented
    Moist snuff or snus (Swedish type)
    Pulverized tobacco, nonfermented
    4
    zoom view
    FIG. 1: Dried tobacco leaves and Zarda.
    zoom view
    FIG. 2: Gul and Naswar in Indian market.
    zoom view
    FIG. 3: Snuff and Tapkeer in Indian market.
    Naswar is snuffed in the floor of mouth, under the lower lip, or inside the cheek for prolong period to get desired effect
  • Mishri or Gul is tobacco powder applied to teeth and gums with index fingers and used as dentifrices
  • Snuff is a pulverized tobacco either fermented (US type) or nonfermented (Swedish type). The pattern of use of snuff is slightly different in these two countries where in Sweden it is placed under the upper lip and in United States between the lower gum and chin.5 It is usually inhaled or snuffed into the nasal cavity, delivering a swift hit of nicotine. It is usually in the flavored form.
Smokeless tobacco is not only common in middle income and poor countries but is also quite commonly used as snuff in North America and in Europe mainly Sweden. Inhalation of tobacco or snuff is relatively less common in India as compared to western countries
There are more than 350 million populations globally using SLT with the majority living in Southeast Asian region.6 The prevalence of SLT in this region is 1.3–38% in males and 4.6–27.9% in females.7 India is one of the largest consumers of tobacco products both in number and relative share. The prevalence of tobacco use in Indian population more than 15 years age is 34.6% (47.9% males, 20.3% females) and is mainly consumed as SLT (49.3% males, 85.5% females).8 The average age of initiation was 17.9 years similar to that of smoking.9 It is specially increasing in younger children in India. A cross-sectional study in Delhi and Chennai (Project MYTRI) reported higher use of SLT in 6th grade students than 8th grade.10 Tobacco use in any form accounts for 6 million deaths globally every year which is expected to increase 8 million by 2030. According to Tobacco Control Policy (TCP) Indian cohort survey, Gutkha was the most common form of SLT used in India followed by chewing of tobacco (Fig. 4).11
The association of tobacco consumption mainly in form of smoking and cardiovascular disease (CVD) is well established.12 The historical trend of smoking and CVD in Unites states ran parallel in last century. The rate of smoking and CVD increased till first half of 20th century and later decreased gradually because increased awareness and well proven causation of various diseases.13,14 The use of SLT which was common in middle income countries became gradually increased in developed countries as the trends for smoking decreased whereas the smoking and SLT both increased in developing countries especially Southeast Asia.155
zoom view
FIG. 4: Prevalence of smokeless tobacco used in India.Source: Gravely S, Fong GT, Driezen P, et al. An examination of the effectiveness of health warning labels on smokeless tobacco products in four states in India: findings from the TCP India cohort survey. BMC Public Health. 2016;16:1246.
The main reason of increased use of SLT is because of its easy availability, lack of awareness of its harmful effect, aggressive marketing by the companies, presumption of it being medicinal value, as mouth freshener, and dentifrices. Tobacco consumption is the most important preventable risk factor for premature death especially in young middle-aged adults.16
 
PHARMACOKINETICS OF SMOKELESS TOBACCO
Nicotine is the main constituent in tobacco causing addiction and most of its harmful effect. The level of nicotine in blood depends upon the concentration of tobacco in the product, its pH level, moisture level, and the size of tobacco cutting.17,18 It is water- and lipid-soluble weak base and readily crosses the mucosa in unionized form. If the pH of the SLT is higher, i.e., if it is more alkaline then more nicotine remains in unionized form, hence more absorbed resulting in higher nicotine blood level.19 The maximum level of nicotine is similar in both smoking and SLT but the level of nicotine is more sustained in SLT as compared to smoking where rapid peaks and troughs are seen.20
 
SMOKELESS TOBACCO AND CARDIOVASCULAR RISK FACTORS
Nicotine increases the blood pressure (BP) and heart rate (HR) by enhancing the release of dopamine, epinephrine, norepinephrine, vasopressin, etc. and activation of sympathetic nervous system. The long-term effect of SLT on BP depends on many factors including the type and amount of SLT used and level of physical activity. Increase in BP is not only because of nicotine but also because of high sodium content of the tobacco product and licorice in SLT. This has been proved by measuring the urinary sodium content in various types of SLT.21 The licorice increases the sodium level by inhibiting the metabolism of mineralocorticoids and thus increases the BP. The acute effects of SLT causes increase in HR and BP which in one of the study shows increase by 19 beats/min of HR and by 21/14 mm Hg of BP.22 In a population-based survey of more than 30,000 participants in Sweden, the chronic SLT users were more likely to have higher BP (>160/90 mm Hg).23 More often it is the diastolic BP which is elevated as shown in a study of 135 middle aged healthy volunteers with ambulatory BP monitoring.24 But in those who are physically active like baseball players, no significant elevation in BP and HR was noted in SLT users.25 Use of tobacco has been shown to be associated with insulin resistance and incident diabetes. Higher serum level of insulin and fibrinogen was noted in SLT users as compared to non-users.26 A prospective population-based study in middle aged Swedish men using snuff found significant risk of developing diabetes at follow-up of 10 years.27 SLT has also been associated with abnormal lipid profile. A study conducted in Asians with regular tobacco chewing habits reported significantly high level of low-density lipoproteins cholesterol (LDL-C) and low level of high-density lipoproteins cholesterol (HDL-C).28 Similarly, Tucker et al. in a population based study reported 2.5 times higher prevalence of hypercholesterolemia in SLT users.29 Gupta et al. studied association between SLT and CV risk factors in a population based case control study in Bikaner region, India.30 They found significant higher prevalence of hypertension, tachycardia, dyslipidemia and diabetes as compared to nontobacco users. All these studies were in isolation and in different regions of the globe where different types of SLT products with different tobacco content and other constituents were being used. The effect of SLT on vascular inflammation, atherosclerosis and thrombosis is still unclear and needs large studies with all types of SLT products.6
 
SMOKELESS TOBACCO AND CARDIOVASCULAR DISEASE
Smokeless tobacco has been associated with various diseases including cancer of the oral cavity, esophagus, and pancreas.31,32 It has also been associated with low birth weight, preterm or stillbirth.30 The association of SLT with CVD is not very well established as it is for smoking.33 Various studies in different regions of the world produced different results depending upon the type of SLT consumed and their level of chemical constituents. Apart from the Southeast Asian countries, the main consumer of SLT although in different forms is in Sweden and United States. The SLT consumed in India have high levels of tobacco-specific nitrosamines as compared to that present in moist snuff available in European market.34,35 Also, the SLT available in India has varied methods of preparation, variable tobacco content and varied methods of using it which causes different effects as compared to SLT available in western countries. The meta-analysis by Boffetta and Straif calculated SLT-attributable fraction of CVD.36 In their analysis, SLT use contributed 5.6% of fatal coronary heart disease (CHD) in Sweden and 0.5% in America. This meta-analysis included eight studies that evaluated the risk of fatal myocardial infarction and five studies that evaluated the risk of fatal stroke but this analysis did not include Asian studies. Three studies showed significant association of SLT and CV death (including stroke and CV death) but other studies did not show that strong association. But the overall cohort has shown positive association between CV death and SLT. The meta-analysis by Vidyasagaran et al. has shown increased risk of fatal ischemic heart disease (IHD) and stroke with SLT.37 Another study by Gupta et al. also known as Mumbai cohort study the results was mixed. At follow-up of 5 years, SLT use was associated with significant fatal CV event in females but not in males.38 The study including patients from India, China, and Taiwan has shown insignificant association of SLT and CV mortality in India but significant association in China and Taiwan.39 The incidence of nonfatal stroke did not show an increased risk in SLT users but most of the studies with this end point have been conducted in Nordic region like Sweden.40 The incidence of nonfatal IHD shows significant heterogeneity depending upon the geographical area of study. The studies conducted in Nordic region did not show an increased risk for nonfatal IHD but those from the Asian region showed a 40% increased risk.41 No data available for this outcome from North American studies. There are limited data on the risk of CHD with different type of SLT products. Gupta et al. first time did a meta-analysis with different SLT products and risk of CHD.42 They found a significant association between snuff use or snus (most commonly consumed in Europe) and fatal CHD. But there was no significant association between chewing tobacco (most commonly consumed in Asia) and fatal CHD which may be due to small studies and significant heterogeneity between the studies. This study also analyzed the fraction of fatal CHD attributable to SLT in different regions where it was found to be highest in Sweden (5%) followed by Southeast Asia (0.77%), and least in United States (0.14%).
 
HEALTH POLICY IMPLICATIONS
Smokeless tobacco has not received much focus among policy makers and researchers because it is presumed to be less harmful than smoked tobacco. It is also thought to be a regional rather than global problem although the most population in developing countries consumes SLT rather than cigarettes. The problem in policy making is lack of concrete evidence against SLT because of its various types and composition. Moreover, the pattern of consumption of the various types of SLT differs in these countries therefore all studies have not shown consistent results. SLT is found to be equally detrimental as compared to smoking at least in Indian subcontinent with little data available with us. The tobacco specific nitrosamine available in the Indian SLT is much higher and varied as compared to that available in Sweden and hence more injurious to health.43 Therefore, the policy needs to be as strict as that for smoking tobacco. Cigarettes and Other Tobacco Products Act (COTPA) 2003 prohibits all type of advertisement of any type of tobacco products. India is a signatory of WHO Framework Convention on Tobacco control (FCTC) and MPOWER package and has implemented tobacco control awareness programs.44 The impact of the FCTC is that the prevalence of smoking has declined in the countries who have strictly implemented it.45 But it is difficult to assess the effect of these measures in controlling the SLT use because of the little available quality data.46 Continuous government efforts, effective advocacy by NGOs, and inclusion of harmful effect of tobacco in all forms in school curriculum are some of the ways in dealing with this problem.
 
CONCLUSION
In India, SLT is the dominant form of tobacco used and is equally dangerous to health as smoked tobacco. It causes more sustained raised nicotine level in blood as compared to smoked tobacco and hence is more addictive. It causes raised BP, impaired blood sugar level and dyslipidemia and hence is prone to cause CVD. The available literature from the Indian subcontinent shows an association of SLT and increased risk of fatal IHD and stroke. A multipronged approach is needed for the control of all types of tobacco use so that the younger and productive population of the country remains healthy.
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