Clinical Cardiology: A Disease Specific Approach Achyut Sarkar
INDEX
Page numbers followed by b refer to box, f refer to figure, fc refer to flowchart, and t refer to table.
A
Abdomen, swelling of 330
Absent pulmonary valve 138, 232, 233, 234f
syndrome 232, 232b, 234t
Acidosis 204
Activated partial thromboplastin time 274
Acute rheumatic fever 3, 5, 10, 11, 14t, 15t, 20, 27, 74, 455
diagnosis of 11t
resurgence of 7
Acute vasodilatory test 356
Adventitia 315
Alcohol septal ablation 195, 195t
Alveolar edema 439
Alzheimer's disease 341
Amato's classification 303
American College of Cardiology 175, 193
American College of Rheumatology Criteria 317b
American Heart Association 9, 9b, 10, 12, 22, 23t, 193, 299, 455
guideline 11
revision 9
Amoxycillin 21
Amplatzer duct 366
occluder 366f, 545
Amyl nitrite 101, 102, 192
inhalation 100
Amyloid
fibrils 345
light-chain 341
protein 341, 344
transthyretin 341, 345
Amyloidosis
classification of 341t
hemodialysis-associated 342
prognosis of 342
prognostic staging of 343t
Anacrotic pulse 80
Anemia 10, 272, 274
Aneurysm 141, 149
apical 189, 492f
diameter 152, 366f
formation 156, 172
unruptured 152
Angina 35, 44, 79, 95, 124126
mechanism of 95b
Angiogenesis 72
degradation factors 293f
stimulator level 293f
Angiogram
coronary 65
pulmonary 400
Angiographic classification 564t
Angiography 102, 527
selective 559
Angiotensin-converting enzyme 347
inhibitor 55, 112
Angiotensin-receptor blocker 55, 176
Ankle-brachial index 302
Ankylosing spondylosis 93
Annular dilatation 472
Annular hypoplasia 234
Annuloplasty 68, 69
devices 114
Annulus 49, 63
dilatation 49
nonplanar shape of 114
paradoxus 509, 509f
reversus 509, 510f
Antegrade Inoue technique 41
Anticardiolipin syndrome 47
Anticoagulant
indications of 41b
protocol 41
Antideoxyribonuclease 17, 17t
Anti-M protein antibody 9f
Antiplatelet protocol 384
Antistreptolysin-O 16, 17
antibody test 17
normal range of 17t
Anti-tumor necrosis factor 320
Aorta 242, 243, 280, 282, 532, 556
abdominal 490
diseases of 299
near atresia of 312
overriding of 208
posterior 242f
Aortic allograft 185
Aortic annulus 13, 175, 475f
functional 93
Aortic arch 254, 263, 442f
anomaly 263
interruption 138
right-sided 445
Aortic atresia 138
Aortic click 216
Aortic coarctation 300
Aortic component 81, 82, 362, 372
Aortic cusp, prolapse of 213
Aortic diastolic pressure 534f
Aortic dissection 93, 172, 173, 209
Aortic elastic tissue 149f
Aortic enlargement 102
Aortic flow pattern, abdominal 503f
Aortic isthmus 263
Aortic knob 436, 447
Aortic leaflet
absence of 174
congenital absence of 93
Aortic orifice 477
Aortic pressure
curve 547, 548f
pulse 547
waveform 518
Aortic reflux 123
Aortic regurgitation 13, 32, 36, 38, 48, 73, 92, 95b, 99, 104, 104f, 121, 122, 122t, 123, 124t, 150, 152, 171173, 179, 191, 209, 226, 307, 360, 419, 442, 480482, 494, 518, 533
angiographic classification of 535t
angiography 535
assessment of 123, 133
congenital 93, 94, 174
dominant 132
Doppler features of 457
echocardiographic 122
etiology of 92b
functional classification of 93t, 94f
index 534
mechanism of 173b
murmur 99, 100, 122, 133, 362t
severe 92, 124, 419, 480f, 481f, 533f, 534f
Aortic root 149f, 282f
angiogram 544, 553
angiography 535, 559
dilatation 173
disease 483
treatment 177
Aortic sclerocalcific disease 92
Aortic sclerosis 84
Aortic sinus diameter, Z-score 176
Aortic stenosis 32, 72, 76, 77fc, 80, 82f, 88, 89fc, 93, 121, 124, 125, 125t, 126, 126t, 169b, 172, 173, 196, 196t, 244, 308, 419, 422, 475, 521, 528, 531, 532, 547, 548
assessment of 528
asymptomatic 84b, 87b
congenital 74, 132, 419
continuous wave Doppler jet of 476f
dominant 132
Doppler study 476
etiology of 72b, 475, 478
grading 80t, 176t
leads 78
low-gradient 75, 75f, 76, 76fc, 77, 478
mild 528f
mild-to-moderate 84
pseudo-severe 76
severe 84, 128t, 419, 528f, 529f
severity of 83t, 475
stages of 85t
subvalvular 132, 179, 179b, 180
symptomatic 84b
true severe 76
two-dimensional feature 475
Aortic stenting 312
Aortic surgery 172
Aortic translocation 279
Aortic valve 13, 38, 103, 169, 240, 246, 475, 494
area 76, 77, 86, 476, 477, 529
measurement 86
calcification 86, 86t, 419
cardiac damage 85t
closure 392
disease 42
mixed 132, 133
immobile 476f
isolated 13
orifice 75
repair 103
replacement 72, 87, 87b, 103, 127, 133, 172, 229
indication of 104b
sclerosis 172
stenosis 73
superior 552f
thickening 318
tissue, portion of 552
Aortic valvular click 308
Aortic valvulitis 13, 457
Aortic vascular click 216t
Aortico-left ventricular tunnel 93, 174
Aortitis 92
Aortogram 148f, 448f, 544f, 553, 559, 563f
ductus, descending 559f
Aortopathy 173, 174
Aortopulmonary artery shunt 220
Aortopulmonary collateral artery 259f, 559, 559f
multiple major 442
Aortopulmonary window 146148, 148f, 436, 543, 544
classification of 147f
Apex cardiogram 81f
Apical diastolic flow murmur 141, 144
Apical four-chamber view 484f
Apical hypertrophic cardiomyopathy 189, 492f
criteria of 189b
Apical impulse 141, 214, 257
Aplasia 371
Apoptosis 48
Arch
hypoplasia 306
vessel anatomy 563
Arrhythmia 228, 292, 376
atrial 228, 346, 375
Arrhythmic sudden cardiac death 228, 228b
Arterial bruit 316
Arterial hypertension
hyperkinetic pulmonary 144
severe pulmonary 440
Arterial oxygen saturation 557
Arterial pressure 192
curve 521f
Arterial pulse 244
Arteritis, tubercular 314, 314t
Artery
brachiocephalic 499f
mixed pulmonary 542
nonconfluent pulmonary 255
pressure, femoral 531f, 534f
shunt, subclavian-pulmonary 219
single pulmonary 255
stenosis 389
subclavian 309f
Arthiritis 12
Arthralgia 9
Arthritis 12, 14
poststreptococcal reactive 15, 15t
rheumatic 14
rheumatoid 15, 32
Arthropathies 300
Ascending aorta 74f, 185, 209, 267f, 284f, 447
diameter of 304f, 504
Aspirin 19
Atheroembolism 300
Atherosclerosis 93, 150
Athlete's heart 196, 196t
Atresia 212, 304
Atria, fibrosis of 34
Atrial amyloidosis, isolated 342
Atrial contraction 39, 507f
Atrial diastole 538
Atrial dilation 34
Atrial enlargement 413
Atrial fibrillation 33, 34, 4044, 55, 56, 59, 70, 76, 85, 109111, 122, 127, 189, 195, 385, 461, 524, 537
effect of 39, 117
Atrial natriuretic peptide 330
Atrial pressure 566
Atrial septal defect 37, 38, 42, 138, 170, 209, 288, 306, 354, 368372, 372b, 376f, 379, 381t, 382, 383, 391, 436, 461, 496
anatomical classification 368
balloon sizing 381
classification of 368, 368b
diagnostic evaluation 375
echocardiogram 376
genetic 370
grading 371, 371t
large 383
management 376
margins 379f
multiple 383
natural history 374
physical examination 371
physiology 371
prevalence 368
prognosis 374
surgical closure for 377b
symptom 371
types of 369f
Atrioventricular gradient 526, 536
Atrioventricular septal defect 108, 138, 209, 232, 280, 306, 496
classification of 370t
Atrioventricular valve 245, 556
regurgitation 286
Auscultation 36, 151, 161, 173, 233, 244, 301, 308
dynamic 39, 100, 141, 192
Austin flint murmur 95, 99101, 101t, 122
Autologous pericardial tube 259f
Autosomal dominant familial elastin arteriopathy 182
Azathioprine cyclophosphamide 347
Azithromycin 21
B
Balloon assisted technique 382
Balloon coarctoplasty 311, 312
Balloon mitral
valvoplasty 462, 463, 466
valvotomy 42, 43, 43t, 44
long-term outcome of 42
valvuloplasty 41, 132, 522
Balloon pulmonary valvuloplasty 395
Basement membrane collagen fibers 9f
Becker's sign 97
Behçet's syndrome 300
Benzathine penicillin 21
interval of 22
Berman balloon flotation catheter 559
Beta-blocker 40, 55
evaluation of survival trial 66
Beta-hemolytic streptococci 3, 9
Biatrial enlargement 415
Bicommissural pulmonary valve 278
Bicuspid aortic valve 9294, 150, 170174, 176b, 179, 182, 226, 483
consortium classification 170f
eccentricity index of 175f
echo feature of 174
Bicuspid valve 94, 173, 216
complication 174
types of 171t
Bidirectional cavopulmonary shunt 287
Bidirectional Glenn 159, 287, 288
Bilateral femoral artery technique 531
Bilateral renal artery involvement 564f
Biliary atresia 159
Bioprosthetic valve degeneration 92
Biopsy 344, 347
Biventricular endomyocardial fibrosis 340
Bjork modification 287
Blalock-Taussig shunt 219, 288, 442
advantages of 219b
complications of 219b
Bleeding 79
diastases 272, 272t, 275
gastrointestinal 79
gingival 272
Blood
brain natriuretic peptide 55
pressure 79, 81, 89, 96, 316
diastolic 534
maintain 330
systolic 96, 534
streaked sputum 35
urea nitrogen, higher 113
viscosity 271
Blurred vision 272
Body surface area 56
Bone
Paget's disease of 72
scintigraphy 344
Bonnet's classification 303t
Bottleneck Fontan circuit 286f
Bradyarrhythmia 345
Brain natriuretic peptide 140
Branch pulmonary artery 496, 498, 562
pattern 255t
Breathlessness, exertional 339
Brockenbrough-Braunwald-morrow sign 547
Bronchial situs 430f
Buerger's disease 300
C
Calcific aortic stenosis 72, 73b, 132, 396, 478, 478f
calcium grade in 478t
pathogenesis of 73f
Calcific aortic valve disease, prevalence of 73
Calcification 72
Calcium, absence of 114
Camelback appearance 526
Cannonball pulse 96
Carabello's sign 528, 529f
Carcinoid 108
disease 32
syndrome 119
Cardiac amyloidosis 341, 341b, 343345, 345fc
classification 341
diagnosis 344
investigation 343
management 344
pathobiology 341
prognosis 342
Cardiac border 443
Cardiac catheterization 175, 184, 234, 334, 393, 566, 576
and angiocardiography 393
and angiography 142, 148, 152, 156, 163, 559, 562
Cardiac compression 329
Cardiac computed tomography 258, 278, 334t
Cardiac death, sudden 181, 187, 193, 194, 196, 228
Cardiac dysfunction 344
Cardiac enlargement 102, 376
Cardiac erosion 384
Cardiac implantable electronic device 108, 113, 113fc
Cardiac index and left ventricular function 522
Cardiac involvement 318, 342
Cardiac light-chain amyloidosis 342b
Cardiac magnetic resonance 347
imaging 171, 192, 228, 258, 278, 309, 309f, 347
Cardiac mitral regurgitation 188
Cardiac output 78, 537, 557
Cardiac resynchronization therapy 59, 64
Cardiac sarcoidosis 345, 346, 346f, 347
diagnosis of 347
etiopathogenesis 346
investigation 346
management 347
prevalence 345
prognosis 346
signs of 346
Cardiac silhouette 432, 442, 443, 445, 451
transverse diameter of 430
volume 431
Cardiac size 430, 442, 443
Cardiac Society of Australia and New Zealand 22
Cardiac tamponade 571, 573
Cardiac volume 431f
Cardiomyopathy 188
dilated 62, 155
hypertrophic obstructive 50, 180, 196t, 548
nonobstructive hypertrophic 195
Cardiophrenic angle, acute 435f
Cardiopulmonary exercise testing 55, 56, 227, 228
Cardiothoracic ratio 430, 430f, 450
Cardiovocal syndrome 35
Carditis 7, 912
clinical evidence of 12b
recurrent 12
smoldering 13
subclinical 8, 12, 13, 455
Carey Coombs murmur 13
Carotid artery 301, 499, 499f
diameter of 307
Carotid bodies 203
Carotid pulse 80t, 190, 196
tracing 80
Carotid subclavian artery index 504
Carotid upstroke, delayed 125, 126
Carpentier classification 50, 51f, 108
Carpentier secondary mitral regurgitation 67
Carvallo's sign 112
CATCH 22 syndrome 264
Catheter gradient 390t
Catheter tip 532
Central aortic arterial waveform 518t
Central aortic pressure 518, 533
curve 528, 533f
tracing 518, 518f
Central nervous system involvement 7
Central pulmonary artery 256, 559
complete absence of 258
Cephalization 439
Cephalosporin 21
Cerebral
bleeding, acute 220
embolism 34
Cerebrovascular accident 273
Cervical lymphadenitis, anterior 21
Chamber collapse 571, 572
Char syndrome 140
Chest
computed tomography of 163f
pain 35
trauma 159
X-ray of 40, 55, 85, 102, 112, 117, 123126, 131, 133, 141, 151, 156, 162, 162f, 234, 237, 244, 258, 266, 309, 376f, 393f, 427, 429, 432f, 445, 451f
Chordae 49
Chordal apparatus, muscularization of 48
Chordal lengthening 49
Chordal replacement 68, 69
Chorea 912, 15
Choussat's ten commandments 289b
Chromosomal abnormities 211
Chronic aortic regurgitation
mild-to-moderate 419
Carpentier etiopathological classification of 50
Chronic obstructive pulmonary disease 415, 508
Chylopericardium 293
Chylothorax 310
Circle of Willis, aneurysm of 310
Clarithromycin 21
Cleft
mitral valve 48
tricuspid valve 108
Clindamycin 21, 22
Clockwise depolarization 408
Closed mitral commissurotomy 4143
Coagulation function, abnormal 272
Coandă effect 183
Coarctation of aorta 150, 173, 179, 182, 240, 303, 447, 503, 563
indirect clues 503
measurement 504
stent trial study 311
two-dimensional imaging 503
Coarctoplasty, surgical 312
Cohn theory 18
Collagen vascular disease 47
Collateral circulation, acquired 558
Collins syndrome 371
Color flow imaging 469, 480
Commissural calcium score 463, 464
Common arterial trunk 138, 252, 252f
Complex atrial septal defect 381, 382b
Complex congenital cyanotic heart disease 253, 277, 278
spectrum 277, 277b
Computed tomography
angiography 302
guided bicuspid aortic valve classification 171f
scan 175
Conal septum, Tear-drop appearance of 555f
Conal tissue 245
Concomitant coronary artery disease 77
Conduction tissue 263
Confluent branch pulmonary artery 498f
Confluent hypoplastic pulmonary arteries 258
Confluent pulmonary artery 255, 258, 267f
Congenital anomalies registry
angioplasty of 311
valvuloplasty of 311
Conjunctivitis 21
Connective tissue disease 119
Constrictive pericarditis 327, 327t, 331f, 332, 333, 333f, 450, 450f, 451, 506, 540, 540t, 566, 569, 570, 572
clinical signs 331
effective 329
electrocardiography 334
etiology of 327
hemodynamic 566
investigation 334
management 334
pathophysiology 328
symptoms 330
treatment of 334
types of 329, 329b
Continuous flow pattern 503f
Continuous murmur 135, 216, 249, 251, 257, 265, 308, 445, 542
Continuous wave Doppler 471, 482
Contrast saline study 162
Cor pulmonale 111
Cor triatriatum 32
Cormier score 463, 463t
Coronary arteriovenous fistula 154, 154b, 155, 156
acquired 155
closure of 157f
complications of 156b
Coronary artery 93, 154, 209, 245, 262, 283f, 562, 564
abnormalities 209
anomalies 182
bypass grafting 58, 65, 68, 87, 104, 155, 185
disease 88
involvement 318
origin of 500
single 396
stenosis 184
Coronary sinus 114, 154, 369, 370f
atrial septal defect 369
Coronary syndrome, acute 47
Corrigan's pulse 95, 96
Corrigan's sign 95
Coryza 21
Costocervical trunk 448
Cough 35
Counterclockwise
depolarization 408, 426
loop 413f
C-reactive protein 912
Crista
supraventricularis 551f
terminalis 369
Crochet hook 375
Crochet sign 375f
Cyanose tardive 371
Cyanosis 212, 253, 257, 264, 265, 275, 371, 372b, 391
central 163, 391
chronic 204
Cyanotic burden 202, 257
Cystic fibrosis 159
Cystic medial necrosis 150
D
D'cruz sign 507
Damus operation, original 284f
Damus-Kaye-Stansel technique 280, 283, 284
Dancing carotid 95
Danon disease 188
De Musset's sign 97
Dennison's sign 97
Dental hygiene 176
Descending aorta 303, 304f, 447
post-coarctation dilation of 448f
Dexfenfluramine 120
Dextrocardia 430
Diaphragmatic pericardium 334
Diarrhea 21
Diastasis 533, 534, 534f
Diastolic dysfunction 343, 510, 567
Diastolic filling
period 521, 521f, 531
sound 333
Diastolic pressure 548f
equalization of 540, 572
Dicrotic notch 80f
DiGeorge syndrome 206, 211, 232, 264
Digital subtraction angiography 163
Digoxin 345
Distal pulmonary artery 551
Distal transverse arch 504f
Disuse hypofunction 291
Dizziness 272
Dobutamine stress echocardiography 76
Dopaminergic agonists 120
Doppler
flow 148
gradient 75, 489
information 469, 471
interrogation 504
parameters 505b
spectrum 486, 498f
study 510
Double antiplatelet therapy 384
Double-inlet left ventricle 285
Double-lumen catheter 532
Double-outlet right ventricle 201, 239, 240, 244, 277, 279, 280, 285, 411, 413, 425, 497, 550, 554
classifications of 239
pulmonary stenosis 247
subaortic ventricular septal defect pulmonary stenosis 239, 243
Down syndrome 211
Drug effect 119, 120
Dry ulcer 301
Ductal aneurysm 141
Ductal constriction 140
Ductal occluder 143
Ductal shock 305
Ductal theory 305
Ductus arteriosus 263
Ductus occluder 143f
Ductus, agenesis of 138
Duroziez's murmur 97
Duroziez's sign 95
Dysplasia, fibromuscular 300
Dysplastic disease 300
Dysplastic leaflets 182
Dysplastic myocardium 179
Dysplastic pulmonary valve 395
stenosis 394
Dyspnea 33, 51, 78, 95, 124126 190, 202, 203, 371, 390
class of 33
exertional 44
mechanism of 204b
paroxysmal 33
Dysrhythmias 371
Dyssynchrony 109
E
Ebstein's anomaly 111, 115
Echocardiogram 10, 11, 55, 65, 86, 121, 123126, 132, 133, 147, 152, 156, 162, 192, 234, 244, 266, 278
aortopulmonary window 147f
transesophageal 380, 381
Echocardiographic appearance 180
Echocardiography 40, 70, 102, 112, 118, 142, 143, 174, 180, 184, 188, 227, 228, 258, 309, 453
role of 17, 455b
transesophageal 40, 113, 485
Eddy sound 140
Edema 456
interstitial 439
pulmonary 45
septal 438
Edwards’ classification 303, 355f
Edwards’ syndrome 211
Ehlers–Danlos syndrome 93, 300
Eisenmenger's complex 267, 355
Eisenmenger's syndrome 355, 440
Ejection click 99, 173b, 215, 257, 265, 308, 391, 392
Ejection fraction 104, 345, 458
Ejection sounds 191
Ejection systolic murmur 99, 100, 191, 216, 233, 257
Elastin arteriopathy 182
Elective surgery 310
Electrocardiogram 37, 38, 40, 55, 85, 112, 117, 123126, 131, 133, 141, 147, 151, 156, 162, 181, 188, 192, 234, 237, 257, 266, 309
ambulatory 192
Electrocardiography 84, 244, 309, 403, 405, 412f
age-related variation 405
axis deviation 406
floodgate-surface 405
frontal plane axis 405
northwest axis 407
T wave 406
ventricular dominance 406
Embolism, peripheral 300
Emphysema 412
Endarteritis 156, 310
End-diastolic diameter 66
End-diastolic pressure 568, 576
Endocardial cushion defect 408, 413
Endocardial thrombus 338
Endocarditis 12, 108, 172
Endomyocardial fibrosis 115, 337, 451, 451f, 510, 574
clinical presentation 339
epidemiology 337
etiopathogenesis 338
investigation 340
management 340
natural history 340
pathological anatomy 338
Endothelial cells 9f
Endothelial damage 72
Endothelial dysfunction 286, 305
Endothelial injury 73
Endothelial nitric oxide synthase, reduced 171
Endovascular valve edge-to-edge repair study 68
Entrapment syndrome 300
Enzymatic abnormalities 115
Eosinophilia 339
Epistaxis 16, 272
abdomen anemia 10
Eponymous signs 95
Ergot alkaloids 120
Ergotamine 120
Erythema
anulare 16
marginatum 912, 16
Erythrocyte sedimentation rate 1012
Erythrocytosis 271, 272
adaptive 271
compensated 271
decompensated 271
maladaptive 271
Esophageal displacement 434
Esophagus 434, 435f, 448
Euroheart survey 120, 120fc, 127
European Association of Cardiothoracic Surgery 239
European Society of Cardiology 68, 193, 194
guideline 68
Exercise
isometric 203
treadmill test 85
Extensive mitral annular calcification 32
Extracardiac Fontan
advantages of 290
disadvantages of 290
Eye involvement 319
Eyler sign 433
F
Fabry disease 32, 115, 188, 337
Facial anomalies 213
Faintness 272
Fallot's physiology 199, 558
assessment of 426
Fallot's tetralogy 206, 210, 216
morphology of 206
neonatal 212
nonsyndromic 211
Fatigue 78, 110, 124, 126, 202, 203, 204b, 272, 390
Femoral pressure curve 308f, 534f
Fenestration, closing down of 289
Fenfluramine 120
Fever 912, 16, 21, 33
Fibromuscular ridge 285
Fibrosis 34, 72, 115
pulmonary 439
Ficolin-2 4
Figure of 3 447, 448f
Figure of E 448, 448f
Fingers, paresthesias of 272
First heart sound 36b, 52, 65, 81, 82, 98, 111, 131, 191, 215, 257, 265, 308, 333, 362, 372, 391, 392
Fistula
bilateral 154
drainage of 154
Flail leaflet prolapse 50
Flow murmur 100t, 112
Flow theory 304
Fluorodeoxyglucose-positron emission tomography 347
Fontaine classification 300t
Fontan anatomy 286
Fontan circuit 285
obstruction 292
Fontan completion 287, 289
desaturation after 292, 292b
Fontan fenestration 290, 292
Fontan original operation 288f
Fontan physiology 285
Fontan procedures 288
Fourth heart sound 52, 82, 99, 191, 216, 308
Framingham study 107
Friederich's ataxia 188
Functional ischemic mitral regurgitation 62, 63, 65
pathophysiology of 63
Functional nonischemic mitral regurgitation 62
pathophysiology of 62
Functional tricuspid regurgitation 107f, 108, 109, 109b, 110, 112t, 113
pathophysiology of 109
surgical management for 113
Fundarò classification 67, 67t
G
Gadolinium enhancement 334
Gallavardin's murmur 83t
Gallavardin's phenomenon 83, 126
Gas pharyngitis scoring 21t
Gasul phenomenon 201, 212, 443
Genetic
mutation 138
pattern 186f
screening 186, 187fc
Genital anomalies 213
Gerbode defect 108
Gerhardt's sign 97
Giant blood cyst 115
Giant cell
arteritis 93, 300
formation of 315
Gianturco-Grifka vascular occlusion device 142
Global longitudinal strain 196, 345, 477
Glomerulonephritis, poststreptococcal 5
Glycogen storage disease 337, 421
Goldenhar's syndrome 214b
Gorlin's famous flow-pressure graph 520f
Gorlin's formula 520, 521, 529, 530
Gradient versus heart rate 521, 530
Grading Pulsation American Heart Association 301t
Graham Steell murmur 122, 362t
absence of 144
Granulomatous infiltration 346
Great artery
congenitally corrected transposition of 48, 201, 211, 277, 410, 413
dextrotransposition of 201
D-transposition of 282f
level 353
relation 245
transposed 280, 280f
transposition of 138, 146, 232, 273, 277
Great vessels 242
Group A streptococci
eradication of 19
isolation of 16
Group A Streptococcus 3
pyogenes 5, 8, 9, 11, 15, 21, 20, 27
Guo classification 152b
H
Hakacove gave 409
Hakacove theory 408
Hakki formula 529
Hangout interval theory 373
Hausdorf sheath 382f
Headache 21, 272, 316
Heart
block 385
complete 419
boot-shaped 442
border 431
defect, congenital 232, 371
disease
carcinoid 115
congenital 93, 137, 154, 211, 230, 249, 269, 271, 363, 407, 408, 412, 445
critical congenital 251
cyanotic congenital 251, 271, 273, 274fc
diabetic 119
rheumatic 1, 3, 5, 9, 10, 18, 20, 23, 27, 47, 92, 108, 115, 119, 121b, 130, 132, 419, 472
valvular 119, 120b
failure 13, 20, 194, 265, 309, 310, 558, 563
congestive 12, 97, 111, 141, 156, 157, 212, 219, 226b
management 365
right-sided 233
sudden 153
rate 530
effect of 521t, 530
small 431, 432f
sound 36, 98, 116, 140, 155, 161, 191, 215, 316, 333
transplantation 293
typical boot-shaped 442f
Heart-hand syndrome 371
Heat-shock protein 314
Hemiplegia 273
Hemitruncus 209, 252
Hemochromatosis 337
Hemodynamic 138, 183, 193, 513
and angiography 246
and cardiac catheterization 86, 258, 267
classification 210, 210f
study 40, 55, 112, 118
Hemoptysis 35, 40, 272
Hemorrhage
intracerebral 306
pulmonary 275
Hemosiderosis 439
Hepatic circulation 293f
Hepatic dysfunction 273
Hepatic pulsation 332
Hepatic vein 154, 508
Doppler, normal 507f
Hepatic venous flow 507, 508, 508f
pattern 507
Hepatojugular reflux 112
Hepatopulmonary syndrome 159
Heterotopic balloon-expandable caval valve implantation 114
Hill sign 9597, 97b
His bundle 114
Hoarseness 35
Hoffman's Fallot's tetralogy 217
Hoffman–Rigler sign 433, 433f
Holter monitoring 227, 228
Holt–Oram syndrome 140, 371
Human leukocyte antigen 4, 315
Hurwitz and Robert's classification 170f
Hydroxyindoleacetic acid 116
Hypercarbia 204
Hypercholesterolemia, familial 72, 74
Hypereosinophilic syndrome, part of 339
Hyperkalemia 412
Hypertension 93, 305
paradoxic rebound 311
systemic 226
Hypertrophic cardiomyopathy 51, 62, 63, 155, 170, 186, 187, 191f, 193, 194, 196, 421, 491, 492b, 546, 547, 548f
end-stage 195
phenocopies of 188t
Hypertrophy 491
asymmetric 491
biventricular 363
eccentric 286
grades of 492
inadequate 77
types of 491
Hyperuricemia 273
Hyperventilation 204
Hyperviscosity syndrome 202, 271, 272b, 274
grading of 272t
Hypocalcemia 264
neonatal 213
Hypoplasia 212, 220, 371, 504
criteria for 304
moderate 303
severe 303
tubular 303, 303t, 304
Hypoplastic annulus 220, 278
Hypoplastic left heart syndrome 285, 305
Hypoxemia 203
Hypoxia 138, 204, 226, 272
and cyanotic burden 210
chronic 203, 273
Hypoxic spell 202, 219
I
Immunoglobulin light-chain 341
Implantable cardioverter defibrillator 109, 189, 195, 345
Indian Academy of Paediatrics 22
Indian Council of Medical Research 5, 27
Indian Takayasu Clinical Activity Score 319
Indolent carditis 13
Infectious Disease Society if America 4
Infective endocarditis 32, 47, 92, 93, 108, 119, 150, 156, 173, 174, 226, 363
large vegetation of 115
Inferior sinus venosus 369
Inferior vena cava 114, 288, 328, 368, 369, 372, 379, 383, 432, 433, 507, 507f, 510, 544, 551
flow 286
Inflammation 72, 456
Inflammatory disease 93
Inflammatory disorders, chronic 341
Infliximab 347
Infundibular obstruction 207
secondary 395
Infundibular pressure 394
Infundibular pulmonary stenosis 213
Infundibular septum 552f, 553
posterior deviation of 285
Infundibulum, hypertrophied 394
Initial carditis, severity of 40
Inlet septum 358
Interatrial septum 368
Interleukin-1 receptor antagonist 4
Internal thoracic artery 448, 449
Internodal fiber 34
Interventricular septum 246, 278
Intra-abdominal pressure 328f
Intracardiac pressures 572
Intracardiac repair 227
Intracardiac shunt 490
Intracavitary and intrathoracic pressures, dissociation of 568
Intrapericardial pulmonary artery 254
Intrathoracic and intracardiac pressures, dissociation of 572
Intrathoracic pressure 328f, 568f, 572
Intraventricular gradient pressure recovery 532
In-utero closure 137
Iron therapy 274
Ishikawa criteria 317b
Isolated pulmonary valve stenosis, prevalence of 389
Isthmus 504f
narrowing, mechanism of 304
J
Jaccoud's arthritis 14
Jaten classification 255t
Joint involvement, frequency of 14t
Jones criteria 9, 9b
modifications of 11
Jugular pressure tracing 110f
Jugular venous pressure 244, 331, 372
Jugular venous pulse 35, 51, 79, 110, 111, 116, 117, 140, 151, 155, 161, 173, 190, 213, 233, 257, 264, 307, 331, 331f, 362, 391, 573
normal 538
K
Kaplan–Meier estimates 367
Katz–Wachtel phenomenon 363, 364, 364f
Kawasaki disease 93
Kawashima procedure 291
Kidney disease, chronic 73, 84, 119
Kirklin's classification 358b
Klippel–Feil syndrome 151
Konno classification 152b
Korotkoff sound, muffling of 96
Kreutzer modification 287
Krichenko angiographic views 543f
Krichenko morphological classification 542b
Kussmaul sign 331, 332, 539, 540, 572
L
Lancefield group A beta-hemolytic streptococci 3
Landolfi's sign 97
Late gadolinium enhancement 192, 194, 229, 344, 345, 347, 348
Lateral tunnel Fontan
advantages of 290
disadvantages of 290
Leaflet 49
abnormality 49, 92b
angle 472
displacement 464, 465
fenestration 93
mobility 459
grades of 459t
thickness 458
grades of 459t
Leflunomide 320
Left atrial
appendage 432, 468
clot 466
compliance 524
enlargement 55, 413f, 414, 415, 417, 434, 434f
index 434, 435f
myxoma 32, 130
oblique diameter 434
pressure 49, 516, 517t, 519, 550
curve 519, 525
tracing 517, 517f, 519f
thrombus 466
classification of 466
presence of 34
Left atrium 67, 68, 150, 154, 156, 282, 283, 328, 369, 432, 456, 466, 469, 472, 524, 568, 573
dimensions 466t
Left axis deviation 364b, 407, 412, 413, 417
mechanism of 408
Left bundle branch block 55, 65, 82, 195, 417, 419
Left coronary artery 154, 185, 504
anomalous origin of 412
Left coronary cusp 171
Left coronary sinus 149
Left heart
border 431, 443
obstruction 243
Left leaf diaphragm 433
Left pulmonary artery 207, 209, 234f, 355, 432, 443, 488, 489, 498, 542, 552
absent 233
anomalous origin of 252
Left subclavian artery 432, 448, 448f, 504, 544
Left ventricle 54, 67, 68, 122, 154, 156, 194, 196, 227, 230, 242, 243, 280283, 328, 432, 433, 471, 477, 482, 495, 501
Left ventricular 32, 36, 38, 63, 66, 85, 432, 472, 481, 540, 553, 576
angiogram 552
apical
aneurysm 189
impulse 144
diastolic
dysfunction 77, 189, 477, 548
function 48, 461, 492
pressure 534f
dissociation 568
dysfunction 34, 49, 77, 87, 99, 191, 228, 561
features of 54b
ejection fraction 56, 58, 59, 59f, 66, 68, 7577, 84, 85, 89, 127, 195, 230, 289, 335, 347, 348, 501
end-diastolic
diameter 104
pressure 56, 226, 228, 286, 289, 516, 526, 533, 534f, 574, 575
endomyocardial fibrosis 339
end-systolic diameter 56, 59, 104
enlargement 141, 433
failure, acute 439
fistula 93, 174
function 228, 500
hypertrophy 77, 84, 173, 181, 186188, 345, 416, 417, 418f, 419, 421, 426, 433
hypoplasia 425
inflow obstruction 138
outflow tract 48, 85, 149, 179, 188, 194, 277, 285, 286, 477, 481, 493, 494f, 546f, 547, 548f, 550, 552
obstruction 138, 188, 278, 278b, 279, 281, 306
pressure 238
tracing 517, 517f
puncture, direct 530
strain 477
systolic
dysfunction 78, 189, 477
function 230, 494
waveform 517t
Leukocyte count 10
Levocardia 430
Light-chain amyloidosis 341
Limbus, superior 368, 369
Lipoprotein 73
low-density 73
Lips, paresthesias of 272
Liver disease, severe 159
Low diastolic pressure 95, 533f
Low glomerular filtration rate 113
Low output syndrome 36, 38, 526f
Low transpulmonary gradient 290
Low-dose dobutamine stress echocardiography 76
Lung 355
fields, nonoligemic 238f
Lutembacher's syndrome 38
Lymphatic dysfunction 292
Lymphoma 337
Lysosome-associated membrane protein-2 188
M
Macrofistula 154
Macrolides 23
Macruz index 414, 415f
Magnetic resonance angiography 302
Main pulmonary artery 146, 234, 255, 256, 488, 489, 497, 499, 544
Major aortopulmonary collateral
arteries 226, 255257, 259, 259f, 498, 558
types of 256f
Major cardiac shadow 430
position of 430
Major hemodynamic determinants 328b
Major histocompatibility complex 315
Mannose-binding protein 4
Marfan syndrome 92, 93, 119, 300
Matrix metalloproteinase 174, 293
Maximal systolic peak 81f
Mayne sign 97
Mayo clinic criteria 509
Mean corpuscular hemoglobin 272
Mean pulmonary artery 432, 552
pressure 289, 526
Mechanical aortic valve repair 103
Mediastinal radiation therapy 119
Mediastinum 448
Membranous septum 358, 368, 369
aneurysm of 213
Memory T cells, effect of 9f
Mendelian inheritance 371
Menorrhagia 272
Mental
growth 213
stress 33
Mesocardia 430
Methotrexate 320, 347
Methylprednisolone 19
Methysergide 120
therapy 32, 115
Mexican Fallot's tetralogy 211
Microdeletion 211
Microfistula 154
Microvascular dysfunction 189
Midcavity obstruction 189
Mid-diastolic murmur 37, 54, 117
Minervini's sign 97
Minimally invasive mitral valve surgery 58
Mitral annular
area 473
calcification 83, 130, 466, 522
dilatation 70
tissue velocity 509
Mitral annuloplasty 68
Mitral atresia 138, 240, 285
Mitral facies 35
Mitral inflow doppler pattern 508
Mitral leaflet 62, 455
anatomy of 458, 468f
anterior 13, 33, 42, 49, 51, 63, 188, 339, 456, 459, 480, 481, 493, 494
nonpliable 44
normal coaptation of 64f
pseudoprolapse of 456f
separation index 460f
septal relation 493
true prolapse of 456f
Mitral regurgitation 32, 3637, 42, 44, 47, 50, 54, 56, 59, 6264, 67, 68, 76, 83t, 85, 110, 119, 121, 123, 124t, 125, 126, 126t, 127b, 128t, 180, 184, 190, 192, 281, 456, 462, 468, 469, 471, 472, 494, 522, 524
acute 47, 526, 526f
anatomy 468
angiographic classification of 527t
asymptomatic severe 58
atrial 62
functional 69
chronic
rheumatic 47
severe 55
degenerative 110
diastolic 100
Doppler features of 456
etiology of 47, 472
functional 47, 62, 66f, 110, 470, 472
hemodynamic phase 524
ischemic 47, 64f, 68, 470, 472, 473
mechanism of 13b, 63, 456b
medical management of 55
mild 41, 132
mild-to-moderate 13
murmur 52, 53, 65, 65f, 83, 339
shapes of 53f
primary 70
progressive 42
residual 49
severe 53, 131
severity 60, 469
grade 469b
Mitral restenosis after balloon mitral valvotomy 42
Mitral scallops 468f
Mitral stenosis 17, 3234, 3638, 44, 45, 76, 101t, 115, 116, 117t, 121, 122, 122t, 124, 125t, 159, 306, 420, 458, 458f, 461, 461t, 466, 519, 521, 526, 530, 531, 537
assessment 132
congenital 32
Doppler assessment of 460
juvenile 44
severity 458
supravalvular 179
Mitral valve 13, 36, 38, 49, 131, 132, 175, 188, 240, 465f, 468
abnormalities 57
arcade 48
area 33t, 34, 4144, 459, 460f, 465, 520, 520f
calcification 131
closure 48
premature 534
competent 265, 289
deformation 66
disease, mixed 130
dysplasia 48
Ebstein's-like anomaly of 48
hypoplasia 48
involvement 12
premature closing position of 98f
prolapse 52, 54, 170, 190
repair 56, 57t, 110, 127
advantages 57t
disadvantages 57t
replacement 41, 43, 57
straddling 48
Mitral valvulitis 12, 455, 456, 456b
Mitralign and Tricinch devices 114
Mixed single valve disease 130
M-mode
echo 181f
mitral valve 493f
Moguls of heart 432
Monarc annuloplasty ring 69f
Monoarthralgia 1012
Monoarthritis 10, 12, 14
aseptic 11
Mononuclear cells 315
Morgan classification 239b
Morris index 414, 415f
Muller's sign 97
Multidetector computed tomography 65, 122, 309, 309f
angiography 309
Multifunctional occluder 366f
Multisystem disorder 271
Multivalvular heart disease 119, 128
etiology of 119b
management of 127
pathophysiology of 121
Multivalvular lesions 121, 121fc
Murmur 83, 99, 111, 116, 133, 140, 155, 156, 161, 191, 192, 196, 216, 251, 308, 334, 374, 392
appearance of 361
classical 140
diastolic 131, 191, 216, 257, 265, 267, 308, 362
early diastolic 265
length of 99
peaks 230f
quality of 99
systolic 131, 191, 265, 308
decrescendo 362
Muscle weakness 272
Muscular arterioles, pulmonary 355
Mutant transthyretin amyloidosis 342
Myalgia 272
Mycobacterium tuberculosis 314
Myeloma 8f
proteins 9f
Myocardial biopsy 14, 344
Myocardial disarray 189
Myocardial fibrosis 229
Myocardial infarction 66, 156
acute 155
thrombolysis in 65
Myocardial involvement 14b, 318
Myocardial ischemia 152
chronic 562
Myocardial oxygen consumption 557
Myocarditis 13
smoldering 33
Myocardium, restrictive 570
Myocytes 189
Myxomatous degeneration 47, 92
N
Nakamura classification 170f
Narrow pulmonary artery 561
National Heart Foundation 22
Necrotizing enterocolitis 220
Neoportal system 285
Neutral septum 492f
New York Heart Association 24, 43, 57
Nikaidoh procedure 282284
Nitric oxide 159
Nodule, subcutaneous 912, 16
Noncardiac anomaly 306
severe associated 220
Noncoronary sinus 149, 150
Nondihydropyridine calcium channel blocker 40
Nonrheumatic mitral stenosis, etiology of 32b
Nonsteroidal anti-inflammatory drugs 14
Noonan syndrome 93, 151, 371, 389
Norfenfluramines 120
Normal abdominal aortic flow pattern 503f
Northwest axis, causes of 412b
N-terminal pro-brain natriuretic peptide 227
Nuclear perfusion imaging 156
O
Obsessive-compulsive disorder 15
Obstruction
dynamic 493
features of 192b
intrapulmonary 558
pulmonary 243
resection of 185
Obstructive hypertrophic cardiomyopathy 194
Obstructive lesions, left-sided 563
Occult constrictive pericarditis 329
Ochronosis 72, 119
Oculo-auriculo-vertebral dysplasia 214b
Oligemia, pulmonary 438, 438f
Open mitral commissurotomy 41, 43
Open valvotomy 118
Opening snap 36, 37, 52, 131
presence of 131
Operability vascular resistance 356
Oral penicillin 23
Organic aortic stenosis 100t
Orthodeoxia test 162
Orthopnea 33, 78
Ortner's syndrome 35
Osteogenesis imperfecta 93
Ostial pulmonary stenosis 561
Ostium primum 369
atrial septal defect 370, 370f
Ostium secundum 369
atrial septal defect 369, 381
Oximetry 562
data 551
Oxygen 156
carrying capacity 210
delivery 210
P
P congenitale 414f
P mitrale 414f
P pulmonale 414, 414f
P wave 425
Pacemaker implantation 281
Packed cell volume 272, 274
Padial mitral stenosis score 462, 463t
Paget's disease 72
Pain 21
abdomen 10, 16, 21
Palatal anomalies 213
Palfrey's sign 97
Palliative surgery 258
Pallor time 301t
Palpation 36, 51, 81, 97, 111, 116, 124, 132, 140, 151, 155, 161, 173, 190, 214, 233, 244, 264, 301, 308, 332, 362, 372, 391
Papillary muscle 64, 64f, 458
dysfunction 49
hypertrophy 493
normal position of 48
Paradoxical low-flow 76
Parasternal impulse 52, 124
Parasternal pulsation 214
Paroxysmal atrial
fibrillation 190
tachycardia 203
Paroxysmal nocturnal dyspnea 33, 34, 78, 117, 122, 125, 190
Patau syndrome 211
Patent ductus arteriosus 37, 137, 138, 141, 142, 144, 146, 151, 156, 170, 173, 179, 209, 214, 232, 255, 260, 263, 288, 303, 353, 488, 489, 503, 542
anatomical
classification of 139f
information 488
classification of 139f, 141t
dependent dual circulation 138
dependent pulmonary circulation 138
dependent systemic circulation 138
detrimental circulation 138
diameter 489
hemodynamic information 488
physiological closure of 137
presence of 563
related circulation 138
staging 143, 143t
Patent foramen ovale 140, 162, 305, 354, 371
Pectus excavatum 431
Penicillin 21
allergy 23
G benzathine 22
Percutaneous transluminal coronary angioplasty 155
Pergolide 120
Pericardial calcification 450f
Pericardial knock 333
Pericardial patch 283f
Pericardial pressure, normal 571
Pericardial rub 374
Pericardial tamponade 572
Pericardiectomy, mortality of 335
Pericarditis 13, 19, 329
annular constrictive 329
tuberculous 451
Pericardium 328
absent 431
respiratory 567
Perimembranous ventricular septal defect, angiographic classification of 365b
Peripheral arterial waveform 518, 518t
Peripheral artery disease 299, 302
etiology of 299, 300b
Peripheral artery pressure 528
tracing 518f
Peripheral artery stenosis 400f
Peripheral pulmonary artery stenosis 184, 216
saw-tooth appearance of 498f
Peripheral signs 97
Perloff's hemodynamic classification 361t
Pharyngitis, streptococcal 15, 16
Phenocopies 187
Phenoxymethyl penicillin 21
Phlebogram 538
Phlebotomy protocol 274
Phrenic nerve injury 310
Plasma
cell dyscrasias 341
oncotic pressure 39
Plateau pulse 80
Platelet derived growth factor 315
Platelet function, abnormal 272
Pleural effusion 439
Plexogenic arteriopathy 440f
Poland's syndrome 214b
Polyarteritis nodosa 300
Polyarthralgia 1012, 15
Polyarthritis 912
Polycythemia 271
Polysplenia syndrome 159
Pompe's disease 188
Popliteal artery entrapment 300
Postaortic balloon valvuloplasty 93
Postaortic valve replacement 93
Postballoon mitral valvoplasty 461
Postchemotherapy 337
Postcoarctectomy syndrome 310, 311
Posterior atrioventricular septum 552f
Posterior mitral leaflet 13, 33, 51, 52, 63, 188, 458, 468, 494
Posterior rib 429
Postinfarction papillary muscle 64f
Postleft heart valve surgery 110
Poststenotic dilatation 238f
Post-tricuspid shunt 355
Potts shunt 220
Pre-Fontan palliation 285
Pressure
curve 235f
gradient, transpulmonary 49
half-time 123, 461, 482, 487
tracing 400f, 522f
wire 531
Presystolic murmur 54, 116
Pretricuspid shunt 354, 355
Primary tricuspid regurgitation 108
pathophysiology of 108
Prophylaxis failure 24
Prosthetic valve dysfunction 47, 49
Proteasome inhibitors 345
Proximal coronary artery 500
Proximal isovelocity surface area 123, 132, 461, 469471, 482, 486
Proximal right ventricular outflow tract 281f
Pseudocoarctation 304
Pseudoejection click 192
Pseudoejection sound 191
Pseudotruncus arteriosus 252, 254
P-terminal force, calculation of 415f
Pullback pressure 184
tracing 546f
Pulmonary annulus 283f, 498
hypoplasia of 220
Pulmonary arterial hypertension 36, 38, 54, 56, 59, 141, 147, 354, 383, 439, 446, 489, 503, 524, 554, 561
assessment of 542
grading 440, 440t
Pulmonary arterial pressure 226
Pulmonary arteriolar resistance 289
Pulmonary arteriovenous fistula 159, 160, 160f, 162f, 163, 163f, 164, 251, 292
acquired 159
Anabtawi classification of 160f
mechanism of 293f
Pulmonary arteriovenous malformation 293
Pulmonary artery 154, 156, 206, 208, 209, 216, 220, 234, 235f, 240242, 242f, 243, 243f, 263, 266f, 279, 280f, 282, 282f, 283, 283f, 284f, 355, 398, 412, 432, 436, 437, 437f, 488, 498, 516, 543, 553, 554, 556, 558, 562
absent 255
aneurysm 396
branching abnormality of 232
capillary wedge pressure tracing 516
diastolic pressure 233
distortion, absence of 289
end-to-side anastomosis of 284f
extrapericardial 255
flow 210
idiopathic dilatation of 233
involvement 318
management of 400
murmur of 399
natural history of 400
origin 437f
ostial stenosis 263
pressure 44, 56, 110, 234, 516, 550, 563
tracing 516
proximal 394
stenosis 397, 398f, 401, 498
systolic pressure 41, 49, 365, 567
waveform, camelback appearance of 526f
wedge pressure 551
Pulmonary atresia 138, 209, 251, 252, 254, 255, 257, 260, 285, 445, 445f, 499, 558
Pulmonary autograft 185
Pulmonary blood flow 557
additional source of 499
classification of 256t
Pulmonary capillary wedge pressure 41, 65, 439, 517f, 517t, 520, 522f, 525, 526, 534, 570, 575, 576
curve 522f
Pulmonary circulation 285, 354, 558
Pulmonary click, absence of 144
Pulmonary component 82, 362, 372, 392
presence of 215
Pulmonary congestion 438
manifestation of 438
Pulmonary flow, unobstructed 561
Pulmonary hypertension 34, 44, 49, 77, 108, 109, 112, 113, 117, 148, 219, 220, 355, 365, 383, 472, 522, 526
assessment of 545
Pulmonary in situ thrombosis 273
Pulmonary infundibular stenosis 395, 396
features of 392b
Pulmonary orifice 281
Pulmonary stenosis 201, 237, 238f, 239, 240, 243, 277279, 280f, 282f, 393f, 425, 554, 556, 557
Brock anatomical classification of 389b
murmur
duration of 392f
shape of 392f
severity of 390, 392t
types of 390t
Pulmonary trunk 254, 281, 400
Pulmonary valve 13, 207, 235f, 285, 389
leaflet 237
replacement 227, 229, 501
indications for 501
stenosis 389
tissue 232
Pulmonary valvular stenosis, mild 394
Pulmonary vascular click 216t, 374
Pulmonary vascular obstructive disease 49, 141, 355, 356, 375, 558, 561
Edwards’ classification of 355b
Pulmonary vascular resistance 34, 49, 138, 201, 289, 354, 356, 356t, 365, 383, 556558, 562
indication of 230t
Pulmonary vascularity 286, 364, 436, 443, 446
Pulmonary vein 328, 379, 436, 470, 568, 572
Pulmonary veno-occlusive disease, development of 363
Pulmonary venous Doppler 493f
Pulmonary venous hypertension 33, 35, 49, 130, 437439, 450, 524, 556, 561
staging of 438
Pulmonary venous pressure 524, 569
Pulmonary venous wedge
angiography 560
pressure 517
Pulsatile flow, lack of 286
Pulsatile Fontan 291
Pulse 35, 51, 79, 95, 132, 155, 161, 173, 190, 214, 257, 264, 265, 307, 316, 362, 372, 391
pressure 547
wave
Doppler 471, 482
Lobster claw appearance of 495f
Pulsus alternans 80
Pulsus bisferiens 96, 141, 192
Pulsus celer 96
Pulsus paradoxus 332, 572, 573
incidence of 332
mechanism of 332
Pulsus parvus et tardus 79
Q
Quadricuspid aortic valve
Hurwitz and Robert's classification of 170f
Nakamura classification of 170f
Quadricuspid valve 93, 170, 174
Quincke's sign 97
Q-wave, ischemic 55
R
Radiation 83
arteritis 300
associated cardiac disease 119
exposure 429
Rapid antigen detection test 17
Rapid filling wave 333, 540, 540f, 568
Rastelli operation 280, 284
Recurrent laryngeal nerve injury 310
Red blood cell 271
Red cell distribution width 272
Regurgitant jet area 469
Regurgitant orifice, effective 48, 65, 470, 486
Regurgitation
acute aortic 93b, 534
atrioventricular 293
mild-to-moderate 122
pulmonary 226, 229, 500, 501
severe pulmonary 232
Reid score 464t
Reiter's syndrome 93
Renal dysfunction, mechanism of 274fc
Renal failure, chronic 72
Renal function 273
Renin–angiotensin system 87, 113, 305
Respiration, effect of 117, 537
Respiratory hemodynamic 568, 569b, 575
Restrictive cardiomyopathy 62, 337, 337b, 348, 510, 574
causes of 337
etiology 337
Restrictive physiology 576t
Restrictive pulmonary flow 561
Retinopathy
hypertensive 319
ischemic 319, 319t
Retrograde pullback method 530
Revisited echo score 463, 465b
Rheumatic aortic
regurgitation 93
stenosis 73, 478, 478f, 478t
Rheumatic carditis 1214, 20, 47, 49, 73
prognosis of 17
Rheumatic disease 57
Rheumatic fever 3, 6, 9, 17, 18, 21, 23, 32, 44
management of 19
pathogenesis of 7
Rheumatic mitral regurgitation 55, 473
pathological anatomy of 49
surgical management of 56
Rheumatic mitral valve disease 115
Rheumatic tricuspid valve disease 115
Rib notching 448
Richardon's classification 146
Right anterior oblique 189, 551
Right aortic arch 209
Right atrial
appendage 432
dissociation 568
enlargement 413, 413f, 435, 436f
pressure 328f, 537, 550, 566, 567, 570, 571, 574
curve 536, 538
pulse 567b
tracing 515, 515f
tumor 115
volume, normal 289
wave pattern 574f
Right atrium 150, 154, 156, 282, 283, 328, 369, 431, 456, 544, 573
Right axis deviation 416
Right bundle branch block 195, 227, 309, 375, 407, 423, 426
Right coronary artery 114, 154, 149, 150
fistula, large 157f
Right coronary cusp 171
anterior 475
Right coronary sinus 150
Right heart border 431
enlargement of 435
Right heart catheterization 184, 526
Right heart chambers 567
Right hilar vascular complex 433
Right hilum 432
Right pulmonary artery 146, 234, 287f, 288, 489, 498, 499f, 542, 552
distal origin of 252
proximal origin of 252
Right upper
abdominal pain 330
lobe bronchus 432
pulmonary vein 369, 382
Right ventricle 109f, 113, 122, 125, 154, 156, 227, 230, 234, 240244, 280283, 328, 501
outflow tract 356
Right ventricular 540, 544, 552
angiocardiogram 393f
angiogram 551, 551f
compliance 226
diastolic pressure 235, 540f
dilatation 226, 442
dysfunction 109
ejection fraction 230, 348, 501
end-diastolic
pressure 574
volume 227, 501
endomyocardial fibrosis 339
end-systolic volume 501
enlargement 435
function 229
hypertrophy 36, 38, 226, 228, 415, 416, 423, 425, 435, 442
features of 393f
infundibulum 202
morphology 114
outflow 401
obstruction 245, 279, 387
stenosis 184
outflow tract 108, 150, 152, 206, 210, 227, 230, 233, 234, 255, 260, 279, 282f, 283f, 488, 497, 500, 501, 552
dilated 234f
normal 206f
obstruction 208t, 213b, 225, 360, 389
stenosis 244f
outlet obstruction 207
pressure 237, 423, 516, 537, 550
tracing 516, 516f
remodeling 109
systolic pressure 567
normal 516
volume overload 233
waveform 517t
Right-noncoronary cusp fusion 170f
Rim deficiency, incidence of 381t
Romhilt–Estes point score system 417, 417t
Root abnormality 93b
Rosenbach's sign 97
Ross procedure 103
Rubella syndrome, congenital 138, 140
Rupture sinus of Valsalva 149, 152, 153f, 170, 174, 545
aneurysm 544
angiographic classification of 153b, 544b
Rutherford classification 301t
S
Saint Vitus dance 15
Sakakibara classification 152b, 157b
Salicylates 19
Sarcoidosis, prevalence of 345
Scarlatiniform rash 21
Scarlet fever 9
Schistomiasis 159
Scleroderma 47, 337
Seagull appearance 559f
Seagull sign 559f
Second heart sound 36, 52, 81, 82, 98, 111, 131, 191, 215, 257, 265, 308, 333, 362, 363, 372, 373, 391, 392
aortic component of 98, 184
Secondary attack rate 18t
Secondary mitral regurgitation 62, 67t, 70
functional classification of 67
Secondary tricuspid regurgitation 108
Seizures 273
Selzar and Cohn theory 33
Semilunar-atrioventricular valve continuity 553
Sepsis 220
Septal aneurysm 360, 366f, 383
Septal defect, aortopulmonary 146
Septal hypertrophy 285
grades of 492b
Septal margins, atrial 379f
Septal motion 506
Septal myectomy, surgical 194, 195, 195t
Septal reduction therapy 194
Septal shudder 506b
Septal tricuspid leaflet 107
Septomarginalis 262f
Septum
aortopulmonary 562
beak-shaped deflection of 506f
Severe mitral stenosis 34, 35
features of 33
Severe tricuspid regurgitation 486, 539f, 540, 540f
Doppler imaging of 486f
Severe tricuspid stenosis, giant P wave of 420f
Sharma modified criteria 317b
Shock syndrome 310
Shunt 371
grading 489
pathophysiology 353
post-tricuspid 353
surgery 219
ventricular level 353
Sigmoid septum 491f
Significant aortic regurgitation, presence of 34
Silent patent ductus arteriosus 141b
Simon grading 438
Single arterial trunk 252, 252f
Single gene mutation 140, 211
Single valve surgery 127
Single ventricular physiology 159
Sinoatrial node 34
Sinotubular junction 93, 475f
Sinus aneurysm, acquired 150
Sinus arrhythmia, respiratory 376
Sinus of Valsalva 149f, 152, 170, 174, 360
acquired aneurysm of 150
aneurysm of 93, 149151, 173
level, midpoint of 475f
Sinus reconstruction, multiple 185
Sinus rhythm 289, 419
presence of 519
Sinus venosus 369
atrial septal defect 369f
Situs 430
Skeletal abnormality 430
Skeletal anomalies 213
Skin 7
lesion 316
Society of Thoracic Surgeons 239
Sokolow–Lyon criteria 416
Sore throat, sudden onset of 21
Soto's classification 359b
Sound 374
Spell management 219fc
Spherical remodeling 286
Spike-and-dome pulse 190f
Spinal artery, anterior 448, 449
Spinal cord ischemia 311
Spironolactone 340
Split outflow right ventricle 213
Spontaneous echo contrast 44, 464, 466
Sporadic elastin arteriopathy 182
Standard Tessellation language 246
Steal phenomenon 156
Stenosis 499
mild-to-moderate 390
pseudo-severe 75
recurrent 401
severe 400f, 422
severe pulmonary 390
valve 394
severe valvular pulmonary 237
subaortic 179, 277
subvalvular 173
supravalvular 173
Stenotic lesion 132
Steroid 19, 345
sparing agents 320
Streptococcal antibody 9
detection of 17
Streptococcal antigen, detection of 17
Streptococcus pyogenes 3
Stress
mechanical 72
testing 85
Stroke 273, 316
Subaortic membrane 93, 180f, 181f
Subaortic obstruction 182
management of 283
Subaortic stenosis, idiopathic hypertrophic 191
Subclinical left ventricular dysfunction 58
Subpulmonary conus 278
Subvalvular apparatus 459, 464
Subvalvular disease 464
Subvalvular fusion, severe 44
Subvalvular membrane 278
Sulfonamide 23
Superior sinus venosus atrial septal defect 369
Superior vena cava 154, 156, 282, 283, 286, 287f, 288, 328, 368, 369, 379, 431, 432, 507
bilateral 557
left 557
persistent left 179
Suprasternal ductal view 489
Suprasystemic right ventricular pressure 424f
Supravalvular aortic stenosis 93, 132, 182
angiographic view of 184f
types of 183f
Surgery, single-stage 259
Surgical aortic valve replacement 88, 88fc, 89, 127b, 128
Swelling, abdominal 339
Sydenham's chorea 15
Syncope 79, 125, 126, 316
Syndromic Fallot's tetralogy 211
Systemic elastin arteriopathy 182
Systemic lupus erythematosus 16, 32, 47
Systemic oxygen saturation 554
Systemic vascular resistance 139, 192, 210, 225, 353, 365, 426, 556
Systemic venous
blood 556
return, normal 289
Systolic anterior motion 50, 51, 188, 196, 493
grades of 493t
mechanism of 493
Systolic area index 569, 575
Systolic ejection
period 521, 530f, 531
time 80f
Tachypnea 361
Takayasu's arteritis 93, 314t, 565
childhood 318b
Takayasu's conference 563
Takayasu's disease 300, 314, 315, 317319, 319t, 321, 449, 563
angiography 318
autoimmune etiology 314
biochemical parameters 318
clinical presentation 316
diagnostic criteria 317
disease activity 319, 320b
epidemiology 315
etiology 314
genetic etiology 315
infective etiology 314
management 320
medical treatment 320
natural history 319
pathology 315
percutaneous intervention 320
prognosis 319
surgical intervention 320
vascular phase feature 316
X-ray chest 318
Takayasu's retinopathy 319
Tamponade 571
Taussig–Bing heart 243
Taussig–Bing malformation 280
T-cell deficiency 213
Telangiectasia
hereditary hemorrhagic 159
pulmonary 159
Tension apparatus, abnormal 285
Tetralogy of Fallot 37, 138, 146, 201, 202, 206, 209t, 215b, 215t, 218f, 225, 225f, 227, 230, 232, 235f, 237, 240, 251, 254, 257, 260, 263, 273, 407, 412, 423, 424f, 442, 445, 445f, 496, 550552, 558
angiography 551
classical 234t
clinical types of 212t
fatigue in 204b
grading 217t
hemodynamic 550
physiology 554
pink 424f
postcorrection 425
postneonatal 212
postoperative 443
postrepair 226, 226b, 500
typical 424f
Tetralogy physiology 201, 204, 210, 243, 423
presentation of 202b
Third heart sound 53, 99, 111, 131, 191, 216, 265, 308, 362, 363
Thoracic aorta, magnetic resonance angiography of 309
Thoracic outlet syndrome 300
Thoracic radiation therapy 119
Three-dimensional
echocardiogram 122, 278, 473
transesophageal echocardiography 56
Throat culture 16
Thromboangiitis obliterans 300
Thromboembolic event 79, 292, 384
Thrombosis in situ 300
Thrombotic diastases 274
Thrombotic diathesis 272, 273
Thrombotic milieu 464
Thymus 211
Thyrocervical trunk 448
Thyroxine 342
Tinnitus 272
Tissue
Doppler
imaging 188
velocity 59
tags 285
T-lymphocyte protein 4
Tocilizumab 320
Toes, paresthesias of 272
Tofler's series 215t
Tonsillopharyngeal patchy exudative involvement 21
Total anomalous pulmonary venous connection 251, 372
Total cavopulmonary connection 159, 285
Total pulmonary outflow resistance 201
Total stroke volume 524
Trabecula septomarginalis 262
Trabecular bands obstructing right ventricular outflow 213
Trabecular septum 358
Trabeculo-septomarginalis 206208, 240, 241, 244
Trabeculo-septoparietalis 208
Tracheal bifurcation 434
Transannular patch 221, 228
Transcatheter aortic valve replacement 88fc, 89, 120, 127b, 128, 177, 419, 479, 532
Transcatheter closure 142, 377, 379
Transcatheter intervention 128
Transcatheter mitral
regurgitation intervention 68b
valve replacement 68, 69
Transcatheter therapy 113
Transcathether aortic valve implantation 72
Transeptal puncture 530
Transesophageal echocardiography, perioperative 65
Transient arterial occlusion 101
Translocated aortogenic patch closure 283, 283f
Transmitral gradient 521, 522b
Transmitral pandiastolic gradient 522f
Transthoracic echocardiogram 109, 379, 380, 381, 490
Transthyretin 342
amyloidosis, wild type 341, 342
hereditary 341
tetramer 342
Transvalvular gradient 79, 420, 530
techniques of measurement of 531b
Transvalvular pressure gradient 531b
Transverse arch 304f, 504
proximal 504f
Transverse cardiac diameter 430, 430f
Transverse thoracic diameter 430f
Traub's sign 97
Trauma 47, 93, 150
Tricuspid annular
dilatation 109
plane systolic excursion 85, 501
Tricuspid annulus 107, 107f, 110, 485
large 114
Tricuspid aortic valve 94, 169
Tricuspid atresia 138, 201, 277, 285, 409
Tricuspid leaflet
anterior 107
posterior 107
Tricuspid murmur 537
Tricuspid opening snap 117t
Tricuspid pulmonary annulus distance 246, 278
Tricuspid regurgitation 76, 107109, 110f, 111, 112, 114, 116, 128t, 150, 176, 226, 229, 230, 233, 281, 360f, 485, 486, 500, 538, 540, 540t
congenital 108
management 113, 113fc
mechanism of 485
mild-to-moderate 538f
moderate 127, 486f
murmur 111
noncongenital organic 108t
organic 112t
physiological 485
prevalence of 107
severity, newer grading of 486t
Tricuspid stenosis 115, 116f, 117, 118, 420, 487, 536, 536f, 537
effect of 537
etiology of 115b
frequency of 115
severity, grading of 487t
Tricuspid valve 13, 107, 109, 113, 368, 537, 540f
anatomy 107
annulus 551f
bioprosthetic 115
echocardiographic 108
flow pattern 508
involvement, primary 108
lesion 484
normal 484
prolapse 108
Triple apical impulse 192, 196
Trisomy 13 211
Trisomy 18 140, 211
Trisomy 21 140
Truncal anomalies 252, 252b
Truncal regurgitation 264, 265, 265t
Truncal valve 262
regurgitation 265, 561
stenosis 561
Truncus arteriosus 211, 251, 252, 262, 445, 446f, 561, 562f
angiography 562
Collett and Edwards classification of 263f
hemodynamic 561
T-sign 147
Tumor necrosis factor 4, 9, 73
Turner's syndrome 93, 173, 306, 312, 371
T-wave 416, 425
giant inverted 422f
Two-dimensional echocardiogram 458, 510
U
Uhl's anomaly 108
Unequivocal roentgenographic sign 447
Unicommissural valve 278
Unicuspid aortic valve 169, 169f
Unicuspid unicommissural valve 93
Univentricular connection 201, 277
Upper lobe pulmonary venous redistribution 438
Uric acid metabolism 273
V
Valve
area 487
calcification 44
dysplasia 169
involvement 13t, 120, 338
lesion 385
surgery 127
Valvular aortic stenosis 180, 183
congenital 169
Valvular endothelial cell 9f
Valvular obstruction 207
Valvulitis 12, 456
murmur 457
rheumatoid 11, 49
severity of 17
Valvulo-vascular impedance 75
van Praagh classification 264f, 359b
Vascular cell adhesion molecule 8
Vascular endothelial growth factor 293, 315
Vasculitis 300
Vector direction 411f, 412f
Velocardiofacial syndrome 213b
Vena contracta 469, 470, 481, 481f
Venogram, superior 331f
Ventricular assist device 59
Ventricular diastole 516, 536
Ventricular diastolic pressure 567
Ventricular dysfunction 290, 293
management of 292
Ventricular dyssynchrony 64
Ventricular fibrillation 193
Ventricular function 271
Ventricular interdependence 539, 569, 569f, 572
Ventricular outflow tract 277
Ventricular papillary muscle dysfunction 67
Ventricular premature beat 190
Ventricular pressure 550
tracing 567
Ventricular septal aneurysm 360
Ventricular septal defect 37, 93, 138, 146, 147, 170, 173, 174, 180, 201, 208f, 226, 229, 232, 237, 238f, 239241, 241f, 242, 245, 260, 262, 277, 279, 280f283f, 303, 353, 356, 358, 359, 359b, 363b, 364, 365, 366f, 367, 370, 396, 410, 413, 426, 496, 497, 550, 558
additional 496
anatomical classification 358, 359b
aortogenic closure of 279
association 360
closure 247
indication of 365f
different type of 359f
grading 360, 361t
Kirklin's classification of 358b
large 237
location 208f
management 364
moderate to large defect 361
murmur 362
natural history 363
noncommitted 241, 241f, 278280
patch 500
physical findings 362
physiology 361, 554
prevalence 358
prognosis 363
residual 281
restrictive 138
small 364
defect 361
subaortic 240, 241f
subpulmonic 241, 241f, 280
syndrome 360
Ventricular septal
rupture 525
segments 358f, 358b
Ventricular septum crest-aortic valve distance 246, 278
Ventricular systole 400
Ventricular tachycardia 189, 193, 195, 227, 228, 346, 348, 347, 412
nonsustained 194, 228
Ventriculoaortic junction 93
Ventriculo-arterial alignment 245
Ventriculoinfundibular fold 207, 240
Ventriculotomy incision 228
Venturi effect 96, 149
Vertigo 316
Vestibular defect 369
Viral pharyngitis 21t
Vitamin D 338
Voltage criteria 416
Von Willebrand factor 79
W
Water hammer pulse 96
Waterston shunt 220
Watson's water hammer pulse 96
Well's index 37
Werner forssmann 518f
Whipple disease 32, 115
Wide pulse pressure 124, 141, 533f
Wilkins score 462, 463, 463t
Williams syndrome 182, 185
Winter bronchitis 35
Wolff–Parkinson–White syndrome 188, 413, 421
World Health Organization 6, 9, 10, 10b, 22, 23
World Heart Federation 5
×
Chapter Notes

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Clinical Cardiology A Disease Specific Approach
Clinical Cardiology A Disease Specific Approach
Achyut Sarkar MD DM (Cardiology) FACC Professor of Cardiology Institute of Post Graduate Medical Education and Research, Kolkata Senior Interventional Cardiologist BM Birla Heart Research Center, Kolkata, West Bengal, India
Jaypee Brothers Medical Publishers (P) Ltd
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© 2021, Jaypee Brothers Medical Publishers
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Clinical Cardiology: A Disease Specific Approach / Achyut Sarkar
First Edition : 2021
9789389776041
Printed at
Dr Asima Sarkar for her love and unwavering support without measure
Preface
The whole art of medicine is in observation
— William Osler
‘Clinical Cardiology: A Disease Specific Approach’ is my second book, after Bedside Cardiology. The theme is same—A Clinical Approach. Now- a-days, cardiology is synonymous with intervention. Moreover, a reader is more likely to consult the latest journal article from his smartphone rather than to pick up a physical book. Then what is the necessity of a book on clinical cardiology! As Kugler and Verghese commented that the two-dimensional rendering of the patient through imaging occupies us more than the three-dimensional reality of the patient. Thus, we still need to examine the patient at bedside and we still need to read the clinical formulation from a book, as both the patient and as well as the book are three-dimensional!
Achyut Sarkar
Acknowledgments
I wish to thank M/S Jaypee Brothers Medical Publishers (P) Ltd. New Delhi for whom the creation of this book has become possible. I thank my late mother and father. Their memories are still great inspiration. I thank my daughter, Parnisha, my son Arjab, and my son-in-law Baishakh. Their academic aptitude has always been encouraging to me. And Dr Asima Sarkar, my wife, who is a great blessing in my life. She has sacrificed her invaluable professional time and supported my academic activities. I thank her with immense gratitude.