Practical Cardiovascular Medicine

Elias B Hanna MD, Assistant Professor of Clinical Medicine, Section of Cardiovascular Disease, Louisiana State University School of Medicine, New Orleans, LA, USA

Preface, xix

Abbreviations, xx

PART 1. Coronary Artery Disease, 1

1. Non-ST-Segment Elevation Acute Coronary Syndrome, 1

Appendix 1. Complex angiographic disease, moderate disease, 13

Appendix 2. Women and ACS, elderly patients and ACS, CKD, 14

Appendix 3. Bleeding, transfusion, prior warfarin therapy, gastrointestinal bleed, 15

Appendix 4. Antiplatelet and anticoagulant therapy, 16

Appendix 5. Differences between plaque rupture, plaque erosion, and spontaneous coronary dissection, 19

Appendix 6. Harmful effects of NSAIDs and cyclooxygenase-2 inhibitors in CAD, 19

Questions and answers, 19

References, 25

2. ST-Segment Elevation Myocardial Infarction, 30

1. Definition, reperfusion, and general management, 31

2. STEMI complications, 42

Appendix 1. Out-of-hospital cardiac arrest: role of early coronary angiography and therapeutic hypothermia, 52

Questions and answers, 54

References, 59

3. Stable CAD and Approach to Chronic Chest Pain, 65

Appendix 1. Note on outcomes with various surgical grafts, 77

Appendix 2. Coronary vasospasm (variant angina, Prinzmetal angina), 79

Appendix 3. Women with chest pain and normal coronary arteries, 81

Appendix 4. Myocardial bridging, 81

Appendix 5. Coronary collaterals, chronic total occlusion, 82

Appendix 6. Hibernation, stunning, ischemic preconditioning, 82

Questions and answers, 83

References, 87

PART 2. Heart Failure (Chronic and Acute Heart Failure, Specific Cardiomyopathies, and Pathophysiology), 93

4. Heart Failure, 93

Definition, types, causes, and diagnosis of heart failure, 94

1. Definition and types of heart failure, 94

2. Causes of heart failure, 97

3. Diagnostic tests, 100

Chronic treatment of heart failure, 102

1. Treatment of systolic heart failure, 102

2. Treatment of HFpEF, 114

Acute heart failure and acutely decompensated heart failure, 115

Appendix 1. Management of isolated or predominant RV failure, 125

Questions and answers, 127

References, 135

5. Additional Heart Failure Topics, 142

1. Specific cardiomyopathies, 142

2. Advanced heart failure: heart transplant and ventricular assist devices (VADs), 146

3. Pathophysiology of heart failure and hemodynamic aspects, 149

References, 155

PART 3. Valvular Disorders, 157

6. Valvular Disorders, 157

1. Mitral regurgitation, 158

2. Mitral stenosis, 167

3. Aortic insufficiency, 173

4. Aortic stenosis, 178

5. Tricuspid regurgitation and stenosis, 186

6. Pulmonic stenosis and regurgitation, 187

7. Mixed valvular disease; radiation heart disease, 188

8. Prosthetic valves, 189

9. Auscultation and summary ideas, 193

Questions and answers, 197

References, 206

PART 4. Hypertrophic Cardiomyopathy, 211

7. Hypertrophic Cardiomyopathy, 211

Questions and answers, 221

References, 222

PART 5. Arrhythmias and Electrophysiology, 225

8. Approach to Narrow and Wide QRS Complex Tachyarrhythmias, 225

Questions and answers: Practice ECGs of wide complex tachycardias, 235

Further reading, 241

9. Ventricular Arrhythmias: Types and Management, Sudden Cardiac Death, 242

Questions and answers, 254

References, 256

Further reading, 257

10. Atrial Fibrillation, 258

Appendix 1. Antiarrhythmic drug therapy (indications and examples), 265

Appendix 2. Catheter ablation of atrial fibrillation, surgical ablation, AV nodal ablation, 267

Appendix 3. INR follow-up in patients receiving warfarin; new anticoagulants, 268

Appendix 4. Bridging anticoagulation in patients undergoing procedures and receiving warfarin, 270

Appendix 5. Management of elevated INR values, 270

Appendix 6. A common special situation: AF and symptomatic pauses (sinus or AF pauses) or bradycardia, 271

Appendix 7. DC cardioversion in patients with a slow ventricular response, 271

Appendix 8. AF occurring post-cardiac surgery and AF related to acute transient triggers, 271

Appendix 9. Brief asymptomatic runs of AF seen on telemetry or device interrogation, 272

Questions and answers, 272

References, 274

Further reading, 277

11. Atrial Flutter and Atrial Tachycardia, 278

Questions and answers, 285

References, 287

Further reading, 287

12. Atrioventricular Nodal Reentrant Tachycardia, Atrioventricular Reciprocating Tachycardia, Wolff-Parkinson-White Syndrome, and Junctional Rhythms, 288

Questions and answers, 301

Further reading, 302

13. Bradyarrhythmias, 304

Questions and answers, 317

References, 319

14. Permanent Pacemaker and Implantable Cardioverter Defibrillator, 320

Questions and answers: Cases of PM troubleshooting, 338

References, 344

15. Basic Electrophysiologic Study, 346

Further reading, 357

16. Action Potential Features and Propagation: Mechanisms of Arrhythmias, Antiarrhythmic Drugs, 358

Further reading, 365

PART 6. Pericardial Disorders, 367

17. Pericardial Disorders, 367

1. Acute pericarditis, 368

2. Tamponade, 370

3. Pericardial effusion, 373

4. Constrictive pericarditis, 376

Questions and answers, 384

References, 386

Further reading, 387

PART 7. Congenital Heart Disease, 389

18. Congenital Heart Disease, 389

1. Acyanotic congenital heart disease, 389

2. Cyanotic congenital heart disease, 398

3. More complex cyanotic congenital heart disease and shunt procedures, 401

Questions and answers, 404

References, 407

PART 8. Peripheral Arterial Disease, 409

19. Peripheral Arterial Disease, 409

1. Lower extremity peripheral arterial disease, 409

2. Carotid disease, 418

3. Renal artery stenosis, 421

Questions and answers, 422

References, 425

20. Aortic Diseases, 428

References, 437

PART 9. Other Cardiovascular Disease States, 439

21. Pulmonary Embolism and Deep Vein Thrombosis, 439

1. Pulmonary embolism, 439

2. Deep vein thrombosis, 445

3. Immune heparin-induced thrombocytopenia, 446

Questions and answers, 447

References, 447

22. Shock and Fluid Responsiveness, 449

1. Shock, 449

2. Fluid responsiveness, 452

Appendix. Hemodynamic equations, transfusion, and miscellaneous concepts, 454

References, 455

23. Hypertension, 456

1. Hypertension, 456

2. Hypertensive urgencies and emergencies, 465

Questions and answers, 467

References, 469

24. D yslipidemia, 472

Questions and answers, 476

References, 477

25. Pulmonary Hypertension, 479

Questions and answers, 484

References, 486

26. Syncope, 488

Questions and answers, 495

References, 497

27. Chest Pain, Dyspnea, Palpitations, 499

1. Chest pain, 499

2. Acute dyspnea, 502

3. Palpitations, 504

References, 505

28. Infective Endocarditis and Cardiac Rhythm Device Infections, 507

1. Infective endocarditis, 507

2. Cardiac rhythm device infections, 511

References, 513

29. Preoperative Cardiac Evaluation, 514

Questions and answers, 518

References, 519

30. Miscellaneous Cardiac Topics: Cardiac Masses and Tumors, Pregnancy, HIV and Heart Disease, Cocaine and the Heart, Chemotherapy and Heart Disease, Chest X-Ray, 521

1. Cardiac masses, 522

2. Pregnancy and heart disease, 523

3. HIV and heart disease, 527

4. Cocaine and the heart, 527

5. Chemotherapy and heart disease, 528

6. Chest X-ray, 529

Questions and answers, 532

References, 534

PART 10. Cardiac Tests: Electrocardiography, Echocardiography, and Stress Testing, 537

31. Electrocardiography, 537

Appendix 1. Supplement on STEMI and Q-wave MI: phases and localization, 589

Appendix 2. Spread of electrical depolarization in various disease states using vector illustration, 594

Questions and answers, 595

References, 598

Further reading, 601

32. Echocardiography, 602

1. General echocardiography, 602

2. Transesophageal echocardiography (TEE) views, 639

Further reading, 648

33. Stress Testing, Nuclear Imaging, Coronary CT Angiography, 649

Appendix 1. Mechanisms of various stress modalities, 656

Appendix 2. Nuclear stress imaging, 657

Appendix 3. Coronary CT angiography, 660

References, 663

Further reading, 664

PART 11. Cardiac Tests: Invasive Coronary and Cardiac Procedures, 665

34. Angiographic Views: Coronary Arteries and Grafts, Left Ventricle, Aorta, Coronary Anomalies, Peripheral Arteries, Carotid Arteries, 665

Questions and answers, 697

Further reading, 699

35. Cardiac Catheterization Techniques, Tips, and Tricks, 700

36. Hemodynamics, 720

Appendix 1. Advanced hemodynamic calculation: a case of shunt with pulmonary hypertension, 737

Questions and answers: Additional hemodynamic cases, 738

References, 740

37. Intracoronary Imaging, 741

1. Intravascular ultrasound (IVUS), 741

2. Optical coherence tomography (OCT), 749

References, 751

Further reading, 751

38. Percutaneous Coronary Interventions and Complications, Intra-Aortic Balloon Pump, Ventricular Assist Devices, and Fractional Flow Reserve, 752

Questions and answers, 770

Further reading, 773

Index, 775