Encyclopedia of Heart Diseases 5
Contents 9
About the Author 17
Preface 19
Acknowledgments 21
Aging and the Heart 23
Glossary 23
I. The Size of the Problem 23
II. Effects of Aging on the Heart and Vascular System 23
A. Gross Anatomy 23
B. Histological Changes 23
C. Biochemical Changes 24
D. Electrical Conduction System 24
E. Valvular Changes 24
III. Cardiovascular Therapy in the Elderly 24
A. Thrombolytic Therapy 24
B. Percutaneous Intervention 24
C. Beta-Blocker Therapy 24
D. Calcium Antagonists 24
IV. Research Implications 25
Bibliography 25
Alcohol and the Heart 27
Glossary 27
I. Alcohol and Coronary Heart Disease 27
A. Alcohol and HDL Cholesterol 27
B. Alcohol Consumption and Hemostatic Factors 28
II. Alcohol and Hypertension 28
III. Alcohol and Heart Failure 28
IV. Alcohol and Cardiomyopathy 28
A. Susceptibility and Pathogenesis 28
B. Pathology 28
V. Alcohol and Abnormal Heart Rhythms and Abnormal Electrocardiograms 29
VI. Alcohol and Coagulation Factors and Stroke 29
VII. Type of Alcohol Consumption 29
A. Red Wine versus White Wine 29
B. French Red Wine versus German White Wine 29
VIII. Perspective 30
Bibliography 30
Altitude and Pulmonary Edema 31
Glossary 31
I. Signs and Symptoms 31
II. Mechanisms 31
III. Management 32
IV. Clinical Study 32
V. Perspective and Research Implications 32
Bibliography 33
Anatomy of the Heart and Circulation 35
Glossary 35
I. Anatomic Features 35
A. Muscle Wall/Myocardium 35
B. Pericardium 35
C. Chambers of the Heart 35
D. Coronary Arteries 41
II. Circulation of Blood 43
A. The Heart is a Simple Pump 43
B. Systemic Circulation 43
Bibliography 43
Anderson-Fabry Disease 45
Glossary 45
Bibliography 45
Anemia and the Heart 47
Glossary 47
I. Anemia And Heart Function 47
II. Clinical Studies 47
Bibliography 48
Aneurysm 49
Glossary 49
I. Abdominal Aortic Aneurysm 49
A. Pathogenesis 49
B. Signs and Symptoms 50
C. Treatment 51
D. Clinical Studies 52
II. Thoracic Aortic Aneurysm 52
A. Signs and Symptoms 52
B. Treatment 53
III. Aortic Dissection 53
A. Signs and Symptoms 53
B. Diagnostic Testing 53
C. Management 54
IV. Berry Aneurysm 54
Bibliography 54
Angina 57
Glossary 57
I. Size Of The Problem 57
II. Pathophysiology 58
A. Overview 58
B. Atheroma 59
C. Mechanism of Pain 60
III. Diagnosis 61
A. Pain Pattern 61
B. Activities that Precipitate Angina 62
IV. Disease Processes Causing Angina 62
V. Stable And Unstable Angina 63
A. Case History 63
B. Tests Required to Confirm Diagnosis 64
VI. Nondrug Treatment 64
A. Weight Reduction Effects 64
B. Exercise 66
C. Smoking 66
D. L-Arginine 66
VII. Drug Treatment 67
A. Nitrates 67
B. Beta-Blockers 69
C. Calcium Blockers (Antagonists) 72
D. Aspirin 73
E. Statins 74
F. Anti-Inflammatory Agents 74
G. Newer Agents: Nicorandil 74
H. Ranolazine 74
VIII. Hypertension 75
IX. Angina Patients With Heart Failure 75
X. Silent Ischemia 75
XI. Variant Angina (Prinzmetal's Angina) 75
XII. Unstable Angina/Acute Coronary Syndrome 76
A. Pathophysiology and Symptoms 76
B. Management 76
Bibliography 77
Angioplasty/Coronary Balloon 79
Glossary 79
I. Procedure 79
II. Indications 80
A. Stable Angina 80
B. Acute Heart Attacks 80
C. Unstable Angina and Non-ST Elevation Myocardial Infarction 80
III. Contraindications and Limitations 80
IV. Outcome of Angioplasty 81
Bibliography 82
Angiotensin-Converting Enzyme Inhibitors/Angiotensin Receptor Blockers 83
Glossary 83
I. Ace Inhibitors 83
A. Mechanism of Action 83
B. Available ACE inhibitors 84
C. Indications 84
D. Research Implications 85
E. Adverse Effects 87
F. Interactions 87
II. Angiotensin II Receptor Blockers 87
A. Mechanism of Action 87
B. Available Angiotensin Receptor Blockers 87
C. Clinical Trials 88
Bibliography 89
Antihistamines 91
Glossary 91
I. Histamine Antagonists 91
Bibliography 91
Antioxidants 93
Glossary 93
I. Statins 93
II. Vitamin E 94
A. Clinical Studies 94
III. Vitamin C 95
IV. Beta-Carotene 95
V. Mediterranean DiET 96
VI. Dietary Plant-Derived Flavonoids 96
A. Purple Grape Juice 96
VII. French Red WinE 96
VIII. Probucol 97
Bibliography 97
Antiphospholipid Antibody Syndrome 99
Glossary 99
I. Diagnosis 99
II. Management 99
Bibliography 99
Antiplatelet Agents 101
Glossary 101
I. Mechanism of Action 101
II. Indications 102
III. Available Antiplatelet Agents 102
A. Aspirin 102
B. Clopidogrel 103
C. Platelet Glycoprotein IIb/IIIa Receptor Blockers 104
Bibliography 105
Arginine and the Heart 107
Glossary 107
I. Clinical Study 107
Bibliography 107
Arrhythmias/Palpitations 109
Glossary 109
I. Origin of the Heartbeat 109
II. Palpitations, Premature Beats, and Irregular Beats 110
A. Definition 110
B. Causes 110
C. Diagnosis 111
III. Tachycardia 111
A. Sinus Tachycardia 112
B. Paroxysmal Atrial Tachycardia 112
C. Atrioventricular Nodal Reentrant Tachycardia 112
D. Atrial Fibrillation 115
E. Wolff-Parkinson-White Syndrome 115
F. Ventricular Tachycardia 115
G. Torsades de Pointes 117
IV. Antiarrhythmic Agents 117
A. Digoxin (Lanoxin) 118
B. Beta-Blockers 118
C. Sotalol 118
D. Amiodarone 119
E. Disopyramide 120
F. Lidocaine 120
G. Mexiletine 120
H. Procainamide 120
I. Quinidine 121
V. Automatic Implantable Cardioverter Defibrillator 122
VI. Conclusion 122
Bibliography 122
Arteriosclerosis 123
Glossary 123
I. Diseases Causing Arteriosclerosis 123
A. Hypertensive Arteriosclerosis 123
B. Monckeberg's Sclerosis & mdash
C. Endarteritis Obliterans 124
D. Thromboangiitis Obliterans 124
II. Atherosclerosis 124
Bibliography 125
Artificial Heart 127
Glossary 127
I. Electric Total Artificial Heart 127
A. AbioCor 128
B. Lionheart 128
II. Left Ventricular Assist Device 129
A. Systems 129
B. Clinical Study: Rose et al. 129
C. Perspective 129
III. Is There a Logical Role for Ventricular Assist Devices? 130
IV. New Frontiers 131
Bibliography 131
Aspirin for Heart Disease 133
Glossary 133
I. Historical Review 133
A. Hippocrates, 400 BC and Beyond 133
B. Von Gerhardt, 1853 133
C. Lawerence Craven, 1953 133
D. John Vane, 1971 134
E. Lewis et al., 1983 134
F. ISIS-2, 1988 134
G. Primary Prevention, 1988 134
H. Swedish Trial, 1992 134
II. Mechanism of Action 134
III. Recognized Indications for Aspirin and Dose 135
A. Life-Saving Measures 135
B. Unstable Angina 135
C. Stable Angina 135
D. After Coronary Artery Bypass Surgery 135
E. Prevention in Normal Individuals at Risk 135
IV. Perspective 136
Bibliography 136
Atherosclerosis/Atheroma 139
Glossary 139
I. Introduction and Historical Background 139
A. Incidence 139
B. Historical 140
C. Perspective 140
II. Pathology 141
A. Definition of Atheroma and Atherosclerosis 141
B. Arteries Involved 141
III. Pathogenesis 143
A. Current Pathogenic Theories 143
B. Hydrodynamic Forces/Pulsatile Blood Flow 146
C. Arteries of Predilection 147
D. Other Risk Factors 148
IV. Vulnerable Atheromatous Plaques 149
A. Rupture of the Plaque 149
B. Superficial Erosion of the Endothelial Lining Covering the Plaque 149
C. Hemorrhage into the Plaque 149
V. Clinical Studies 149
A. Maehara et al. 149
B. Varnava et al. 149
C. ApoA Milano Nissen et al.
D. Brousseau et al. Torcetrapib 150
E. Nissen et al. Reversal Study 150
VI. Perspective and Research Implications 150
Bibliography 152
Athletes and Sudden Cardiac Death 153
Glossary 153
I. Cardiac Causes of Sudden Death in Young Athletes 154
A. Hypertrophic Cardiomyopathy 154
B. Coronary Artery Anomalies 156
C. Coronary Artery Disease 156
D. Ruptured Aorta 156
E. Aortic Stenosis 156
F. Other Causes 156
II. Sudden Death not Associated with Cardiac Disease 157
A. Commotio Cordis 157
B. Cocaine, Anabolic Steroids, and Herbal Stimulants 157
III. Athlete's Heart Versus Hypertrophic Cardiomyopathy 158
A. Differentiation 158
B. Clinical Studies 158
Bibliography 159
Atrial Fibrillation 161
Glossary 161
I. Epidemiology 162
II. Diagnosis 162
III. Causes and Research Implications 163
A. Hypertension 164
B. Heart Failure 164
C. Valvular Heart Disease 164
D. Chronic Coronary Artery Disease 164
E. Sick Sinus Syndrome 164
F. Thyrotoxicosis 165
G. Idiopathic Atrial Fibrillation 165
IV. Pathophysiology 165
V. Classification and Management 165
A. Acute Atrial Fibrillation 165
B. Paroxysmal Atrial Fibrillation 167
C. Persistent Atrial Fibrillation 169
D. Permanent Atrial Fibrillation 170
VI. Anticoagulants 170
A. Warfarin 170
B. New Anticoagulant: Ximelagatran 170
VII. Electronic Pacing 171
A. Atrial Pacing 171
B. Ablation of the AV node and Implantation of a Permanent Pacemaker 171
Bibliography 171
Atrial Septal Defect 173
Glossary 173
I. Clinical Study 173
Bibliography 174
B-Type Natriuretic Peptide 175
Glossary 175
I. Clinical Studies 175
A. Maisel et al. 175
B. Mueller et al. 175
C. Pierre-Yves et al. 176
II. Perspective 176
Bibliography 177
Beriberi Heart Disease 179
Glossary 179
I. Clinical Manifestations 179
Bibliography 179
Beta-Blockers 181
Glossary 181
I. Beta-Receptors 182
A. Beta-1 Receptors 182
B. Beta-2 Receptors 182
II. Mechanism of Action 182
III. Salutary Effects 182
IV. Indications 183
A. Angina 183
B. Acute Myocardial Infarction 183
C. Hypertension 183
D. Arrhythmias 184
E. Heart Failure 184
F. Elective Percutaneous Coronary Intervention 184
G. Dissecting Aneurysm 184
H. Mitral Regurgitation and Mitral Stenosis 184
I. Hypertrophic Cardiomyopathy 185
J. Perioperative Mortality 185
K. Marfan Syndrome 185
L. Diabetic Patients 185
M. Other Indications 185
V. Clinical Trials 185
A. Norwegian Postinfarction Timolol Trial 185
B. The American Beta-Blocker Heart Attack Trial 186
C. The CAPRICORN Study 186
D. The UKPDS Results 186
E. Implications 186
VI. Adverse Effects And Cautions 186
VII. Classification 186
VIII. Subtle Differences And Research Implications 187
IX. Individual Beta-Blockers 188
A. Acebutolol 188
B. Atenolol 188
C. Bisoprolol 188
D. Carvedilol 188
E. Metoprolol 188
F. Nebivolol 188
G. Others 188
Bibliography 189
Blood Clots 191
Glossary 191
I. Causes Of Blood Clots 191
II. Nondrug Treatment 192
III. Drug Treatment 192
A. Thrombolytic Agents 192
B. Antiplatelet Agents 193
C. Oral Anticoagulants (Warfarin, Coumadin) 194
D. Heparin 195
Bibliography 196
Blood Pressure 197
Glossary 197
I. Historical Review 197
A. The Beginning of Sphygmomanometry 197
B. Further Advances 197
C. Advancements Leading to Current Methods 199
II. Systolic and Diastolic Blood Pressure 200
III. Classification 200
IV. Normal Fluctuations in Blood Pressure 200
A. Marked Variability 200
B. Daytime and Nighttime Variability 201
C. White-Coat Hypertension 201
D. Pseudohypertension 201
E. Home Measurements 201
V. Finger Cuff Method of Penaz 202
VI. Technique and Pitfalls of Measurement 202
VII. Effects of High Blood Pressure 202
Bibliography 202
Brugada Syndrome 205
Glossary 205
I. Clinical Features 205
II. Perspective 206
Bibliography 206
Bundle Branch Block 207
Glossary 207
I. Right Bundle Branch Block 207
A. ECG Criteria for Diagnosis of Right Bundle Branch Block 207
B. Causes of Right Bundle Branch Block and Associations 208
C. Right Bundle Branch Block and the Left Anterior Hemiblock 208
D. Incomplete Right Bundle Branch Block 208
II. Left Bundle Branch Block 209
A. ECG Diagnostic Criteria 209
B. Causes of Left Bundle Branch Block 209
C. Prognosis 209
Bibliography 209
Caffeine and the Heart 211
Glossary 211
I. Biochemistry 211
II. Effects 212
A. Cardiovascular 212
B. Diabetes, Coffee, and the Heart 213
Bibliography 213
Calcium Antagonists 215
Glossary 215
I. Mechanism of Action 215
II. Available Calcium Antagonists 216
A. Dihydropyridines 216
B. Benzothiazepines 217
C. Phenylalkylamines 217
III. Therapeutic Benefits 218
IV. Next Generation Agents 218
Bibliography 219
Carcinoid Heart Disease 221
Glossary 221
I. Heart Damage 221
II. Diagnosis 221
III. Treatment 222
IV. Clinical Study 222
Bibliography 222
Cardiogenic Shock 223
Glossary 223
I. Causes 223
II. Pathophysiology 223
III. Management 224
IV. Perspective and Research Implications 224
Bibliography 224
Cardiomyopathy 225
Glossary 225
I. Hypertrophic Cardiomyopathy 226
A. Genetics 226
B. Macroscopic Features 226
C. Microscopic Features 226
D. Pathophysiology 229
E. Clinical Features 229
II. Sudden Death 229
A. Genotyping 229
B. Clinical Evaluation 229
C. Marked Left Ventricular Hypertrophy 229
D. Management 230
III. Dilated Cardiomyopathy 231
A. Genetics 231
B. Clinical Features 232
C. Investigations 232
D. Management 233
IV. Restrictive Cardiomyopathy 233
A. Clinical Features 233
B. Management 233
V. Specific Heart Muscle Disease 233
Bibliography 234
Cardiopulmonary Resuscitation (CPR) 237
Glossary 237
I. Causes of Loss of Consciousness 237
A. Syncope/Fainting 237
B. Seizure/Epilepsy 237
C. Stroke 237
D. Cardiac Arrest 238
II. Cardiac Arrest Rhythms 238
A. Ventricular Fibrillation/Pulseless Ventricular Tachycardia 238
B. Automated External Defibrillator 238
III. Cardiopulmonary Resuscitation 238
A. How to Recognize Cardiac Arrest 239
B. The Steps of CPR 239
C. Circulation 239
IV. Defibrillation 241
A. Errors in Defibrillation 242
V. Drugs For Cardiac Arrest 242
A. Epinephrine (Adrenaline) 242
B. Vasopressin 242
C. Amiodarone 242
D. Beta-Adrenergic Blocking Agents 242
E. Sodium Bicarbonate 243
F. Atropine 243
G. Magnesium Sulfate 243
H. Bretylium 243
VI. Perspectives And Research Implications 243
VII. Outcomes of Out-of-Hospital Cardiac Arrest 243
VIII. The Heimlich Maneuver 244
Bibliography 244
Chagas Disease 245
Glossary 245
I. Epidemiology 245
A. Transmission 245
II. Symptoms and Signs 245
A. Acute Phase 245
B. Latent and Chronic Phase 246
III. Diagnostic Investigations 247
A. Chest X-ray 247
B. Blood Tests 247
C. Echocardiography 247
IV. Management 247
A. Prevention 247
B. Medications 247
Bibliography 247
Chelation and Heart Disease 249
Glossary 249
I. Clinical Study 249
II. Perspective 249
Bibliography 250
Chemotherapy-Induced Heart Disease 251
Glossary 251
I. Chemotherapeutic Agents 251
II. Cardiac Damage from Anthracyclines 251
A. Signs and Symptoms 252
B. Management of Cardiotoxicity 252
C. Research Implications 252
III. Cyclophosphamide 253
IV. 5-Fluorouracil 253
A. Acute Cardiovascular Effects 253
Bibliography 254
Cholesterol 255
Glossary 255
I. The Magnitude of the Problem 255
II. Historical and Clinical Trials 255
A. 1900–1983 255
B. 1984 256
C. 1994 256
D. 1995 256
E. 1996 257
F. 1988 257
III. Causes of Hypercholesterolemia 257
A. Familial Hypercholesterolemia 257
B. Polygenic Hypercholesterolemia 258
C. Other Causes for Hypercholesterolemia 258
IV. Types of Cholesterol 258
A. Total Cholesterol 259
B. Low-Density Lipoprotein (Bad) Cholesterol 259
C. High-Density Lipoprotein (Good) Cholesterol 259
D. Very-Low-Density Lipoprotein 262
V. Blood Tests 262
A. Total Cholesterol 262
B. Blood LDL Cholesterol Levels 262
C. HDL Cholesterol Blood Level 263
V1. Coronary Artery Disease Risk 263
A. Based on LDL Cholesterol 263
B. Estimated 10-Year Risk for Men and Women/the Framingham Point Scores 263
C. Based on the Total Cholesterol to HDL Cholesterol Ratio 264
VII. Diets and Cholesterol 264
A. Saturated Fats and Cholesterol 264
B. Polyunsaturates and Linolenic Acid 264
C. Nuts and Cholesterol and Risk 265
D. General Advice on Diets 265
VIII. Cholesterol-Lowering Drugs 266
A. HMC-CoA Reductase Inhibitors (Statins) 266
B. Cholesterol Absorption Inhibitors 267
C. Resins 267
D. Fibrates 267
E. Niacin (Nicotinic Acid) 267
F. Combination Therapy 267
Bibliography 268
Coenzyme Q10 269
Glossary 269
I. Actions 269
II. Clinical Study 269
III. Prospective and Research Implications 271
Bibliography 271
Congenital Heart Disease 273
Glossary 273
I. Incidence and Classification 273
II. Ventricular Septal Defect 274
A. Clinical Features 274
B. Clinical Study, Gabriel et al. 275
C. Perspective 275
III. Patent Ductus Arteriosus 275
A. Clinical Features 276
B. Treatment 276
IV. Aortic Stenosis 276
V. Bicuspid Aortic Valve 276
A. Management and Research Implications 276
VI. Coarctation of the Aorta 276
VII. Other Congenital Anomalies 277
A. Coronary Artery Anomalies in Adults 277
VIII. Congenital Cyanotic Heart Disease 278
A. Tetralogy of Fallot 278
IX. Pregnancy and Congenital Heart Disease 280
A. Research Implications 280
B. Teratogens 280
Bibliography 283
Contraception and Cardiovascular Disease 285
Glossary 285
I. Oral Contraceptives 285
A. Risks 285
B. Perspective 286
Bibliography 287
Coronary Artery Bypass Surgery 289
Glossary 289
I. The Coronary Arteries 289
II. Indications 290
A. Stable Angina 290
B. Unstable Angina 290
C. Left Main Coronary Artery Disease 290
D. Diabetes Mellitus 290
III. Types of Grafts 290
A. Saphenous Vein 290
B. Internal Mammary Artery 291
C. Radial Artery 291
D. Robotic Bypass Surgery 291
IV. Outcomes 292
A. Survival 292
B. Prolongation of Life 292
C. Symptomatic Relief 293
D. Other Factors Affecting Mortality and Morbidity 293
V. Complications 293
A. Acute Myocardial Infarction 293
B. Heart Failure 293
C. Atrial Fibrillation and Other Arrhythmias 294
D. Neurologic 294
E. Bleeding 294
F. Infection 294
G. Hypertension 294
VI. Surgery in the Elderly 294
A. Octogenarian Study 294
VII. Contraindications 295
VIII. Medications 295
A. Perioperative 295
B. Postoperative Maintenance 295
C. Other Advice 295
IX. Coronary Bypass Surgery Versus PCI 296
A. Drug-Eluting Stents 296
B. Coronary Artery Bypass Surgery 296
C. Clinical Study: The SOS Investigators 296
Bibliography 297
C-Reactive Protein and the Heart 299
Glossary 299
I. A Marker of Risk 299
II. Clinical Studies 300
A. Ridker et al. 300
B. Study by Labarrere et al. 301
C. Study by Danesh et al. 301
III. Perspective and Research Implications 301
Bibliography 302
Cytochrome P-450 303
Glossary 303
I. Definition and Nomenclature 303
II. Functions 303
III. P-450s Regulation 305
IV. P-450s and Cardiovascular Drug Interactions 305
A. Statins 305
B. Beta-Adrenergic Blocking Agents 307
Bibliography 307
Deep Vein Thrombosis 309
Glossary 309
I. Incidence and Location 309
A. Incidence 309
B. Location 309
II. Pathogenesis of Deep Vein Thrombosis 309
A. Immobilization 309
B. Coagulation Factors 310
C. Predisposing Factors 310
III. Diagnostic Features 310
A. Symptoms and Signs 310
B. Diagnostic Testing 310
IV. Management 311
A. Heparin 311
B. Prophylaxis 311
Bibliography 312
Depression and the Heart 313
I. Pathophysiologic Mechanisms 313
II. Drug Management 313
Bibliography 314
Diabetes and Cardiovascular Disease 315
Glossary 315
I. Size of The Problem 315
A. Incidence 315
B. Diabetic Distress 316
II. Clinical Features and Complication of Type 2 Diabetes 316
A. Symptoms of Type 2 Diabetes 316
B. Diagnosis 316
C. Features 317
III. Pathogenesis of Type 2 Diabetes and Research Implications 317
A. Insulin Secretion 317
B. Underlying Mechanisms 319
C. Effects of Insulin 320
D. Mechanisms of Vascular Abnormalities in Diabetes Mellitus 320
E. Dyslipidemia 320
F. Defect in Fibrinolysis and Thrombosis 321
G. Genetic Abnormalities 321
IV. Maturity Onset Diabetes of the Young 321
V. Management of Type 2 Diabetes 321
A. Drugs 321
VI. Hyperglycemic Hyperosmolar Coma 323
VII. Dyslipidemia in Type 2 Diabetes 323
A. Characteristics 323
B. Management of Dyslipidemia 323
VIII. Clinical Studies, Type 2 Diabetes 324
A. Tuomilehto et al. 324
B. Cho et al. 324
IX. Coffee Consumption and Risk of Type 2 Diabetes 324
A. van Dam et al. 324
X. Insulin Resistance 325
A. Abbasi et al. 325
B. Other Studies 325
XI. Type 1 Diabetes 325
A. Pathogenesis and Epidemiology 325
B. Pathologic Features 326
C. Symptoms, Signs, and Complications 327
D. Management 327
E. Perspective 327
Bibliography 328
Diets and Heart Disease 329
Glossary 329
I. Diets 329
A. Controversial Diets 329
B. Recommended Diets 329
II. Trans Fatty Acids And Coronary Artery Disease 330
A. Clinical Study: Oomen et al. 331
B. Zutphen Elderly Study 331
C. Effect on Blood Lipids 331
D. Foods Containing Trans Fatty Acids 332
III. Diet-Drug Valvulopathy 332
A. Anorectic Agents 332
B. Perspective and Research Implications 333
IV. Fish Oils 333
Bibliography 333
Diuretics 335
Glossary 335
I. Indications 335
A. Hypertension 335
B. Heart Failure 335
C. Edema Caused by Kidney or Liver Disease 335
II. Renal Physiology 336
III. Individual Diuretics 337
A. Thiazides 337
B. Loop Diuretics — Furosemide 338
C. Aldosterone Antagonists/Potassium-Sparing Diuretics 339
Bibliography 340
Down Syndrome 341
Glossary 341
I. Genetics 341
II. Incidence of Congenital Heart Malformations 341
Bibliography 341
Dyslipidemia 343
Glossary 343
I. Lipoproteins 343
A. Size 343
B. Function 343
C. Types 343
D. Abnormalities 345
E. Drug Management 346
Bibliography 348
Echocardiography 349
Glossary 349
I. Historical 349
A. W. D. Keidel 349
B. Inge Edler and Helmut Hertz 349
C. Jack Reid, John Wild, and Claude Joyner 349
D. Harvey Feigenbaum 349
E. Recent Era 350
II. Instrumentation 350
III. Echocardiographic Examination 350
A. Echocardiographic Window 350
B. Transthoracic Echocardiogram 351
C. Transesophageal Echocardiogram 351
IV. Clinical Applications 351
A. Valvular Heart Disease 351
B. Thrombi 351
C. Congenital Heart Disease 352
D. Coronary Artery Disease 352
E. Heart Failure 352
F. Other Clinical Indications 354
V. Research Implications 354
VI. New Frontiers 355
A. Transthoracic Visualization of the Coronary Artery 355
B. Handheld Instruments 355
Bibliography 355
Effects of Smoking and Heart Disease 357
Glossary 357
I. Effects of components of cigarette smoke 357
A. Nicotine 358
B. Carbon Monoxide 358
C. Tar fraction 359
II. Cigarette Smoke and Atherosclerosis 359
A. Nitric Oxide and Vasodilatory Function 359
B. Oxidation of LDL Cholesterol 359
C. Genetic Predisposition 359
D. Platelet Dysfunction and Thrombotic Factors 359
III. Recent Epidemiologic Study 359
IV. Anginal chest pain and impotence 359
A. Anginal Pain 359
B. Impotence 360
V. Habituation and Cessation 360
A. Habituation 360
B. How to Stop 360
C. Effect of Cessation 360
Bibliography 360
Electrocardiography 363
Glossary 363
I. Historical 363
A. Early Timeline 363
B. Einthoven 363
C. Sir Thomas Lewis 364
II. General Applications 364
III. The Normal Electrocardiogram 365
IV. Diagnosis of Specific Conditions 365
A. Acute Myocardial Infarction 365
B. Hypertrophy of the Heart 368
C. Electrical Conduction Defects 368
D. Arrhythmia 369
V. Recent Discoveries 371
A. Microvolt T-wave Alternans 371
B. Clinical Study: NIH Study 371
Bibliography 371
Embryology 375
Glossary 375
I. Development of the Heart 375
Bibliography 379
Endocarditis 381
Glossary 381
I. Definition and Sites of Infection 381
II. Diagnosis 381
III. Therapy 382
IV. Prevention 382
A. Case History I 383
B. Case History II 383
Bibliography 383
Endocrine Disorders and the Heart 385
Glossary 385
I. Acromegaly 385
A. Clinical Features 385
B. Management 385
II. Thyroid Diseases 386
A. Thyrotoxicosis 386
B. Hypothyroidism (Myxedema) 386
III. Adrenal Disorders 386
A. Cushing's Syndrome 386
B. Hyperaldosteronism 387
C. Pheochromocytoma 387
Bibliography 387
Erectile Dysfunction and the Heart 389
Glossary 389
I. Mechanism of Erectile Dysfunction 389
A. Physiology of Penile Erection 389
II. Causes of Erectile Dysfunction 391
A. Cardiovascular Disease 391
B. Diabetes 391
C. Other Causes 391
III. Management 391
A. Phosphodiesterase Inhibitors 391
B. Sildenafil 392
C. Valdenafil and Tadalafil 394
Bibliography 395
Exercise and the Heart 397
Glossary 397
I. Benefits Of Exercise 397
II. Aerobic Exercise 398
A. Cardiopulmonary Physiology 398
B. Effect of Exercise 399
C. Caloric Costs of Work 399
D. Cardiovascular Conditioning --- Training Effect 400
E. Physiologic Hypertrophy 402
III. Isometric, Static Exercise 402
IV. Weight Reduction and Exercise 403
V. Effects on Blood Pressure and Atheroma 403
VI. Effects on Blood 404
A. Plasma Lipoprotein Cholesterol 404
B. Other Effects 404
VII. Clinical Studies Of Exercise And Heart Disease 405
A. San Francisco Longshoremen 405
B. London Bus Drivers 405
C. University Alumni 405
D. Australian Study 405
E. Tanasescu et al. 406
F. Albert et al. 406
G. Frolkis et al. 406
H. Vigorous Exercise and Risk 406
I. Perspective 407
VIII. Injuries During Jogging 407
IX. How to Start an Exercise Program 407
A. General Advice 407
B. Heart Rate Maximum and Training Range 408
X. Exercise Stress Test 409
XI. Conclusion 410
Bibliography 410
Gene Therapy 413
Glossary 413
I. Strategies 413
II. Clinical Application 414
III. Clinical Trials 416
A. The Euroinject 416
B. Study in Patients with Disabling Intermittent Claudication 416
C. Adenovirus Gene Therapy Trial (AGENT)Trial 416
D. Small Trials 416
E. Initial Study 416
IV. Adverse Outcomes 416
A. Progression of Atherosclerosis 416
B. Other Effects 417
Bibliography 417
Heart Attacks 419
Glossary 419
I. Perspective 420
II. Causes and Pathophysiology 420
III. Door-to-Needle Time 422
IV. Symptoms 422
A. Type of Pain 422
B. The Location of the Pain 423
C. Severity and Duration of the Pain 424
D. Warning Attacks 425
E. Associated Symptoms 425
F. Clinical Example 427
V. Physical Signs 427
VI. Mimics of a Heart Attack 427
A. Indigestion and Stomach Problems 428
B. Reflux Esophagitis and Hiatus Hernia 428
C. Esophageal Spasm 428
D. Lung Infections 429
E. Pericarditis 429
F. Chest Wall Pain 429
G. Arm Pain, Tingling, and Numbness 429
VII. Ambulance Transport 429
A. What to do Before the Ambulance Arrives 429
B. Mobile Coronary Care Ambulance 430
VIII. What to Expect in the Hospital 431
A. Coronary Care Units 432
IX. Diagnostic Tests 433
A. Electrocardiogram 433
B. Blood Tests/Cardiac Enzymes 434
C. Echocardiography 435
X. Specific Management 435
A. Pain 435
B. Strategies to Reduce Morbidity and Mortality 437
XI. Clinical Trials 439
A. Meta-Analysis 439
B. Danami-2, Andersen et al. 439
C. Prague-2 439
D. Captim 439
XII. Non-St Elevation Myocardial Infarction 439
A. Diagnosis 439
B. Management 440
XIII. Complications of Myocardial Infarction 440
A. Arrhythmias 440
B. Heart Failure 441
C. Right Ventricular Infarction 441
D. Risk Assessment for Long-Term Outcome 442
XIV. Heart Attack and Emotional Impact 442
XV. Depression and Anxiety 442
XVI. Diet After a Heart Attack 443
XVII. Rehabilitation, Retirement, and Travel 443
A. Don'ts 444
XVIII. Retirement and Travel 445
A. Retirement 445
B. Travel 445
XIX. Sexual Activities 445
A. Don'ts 446
B. Suggestions 446
XX. Beta-Blockers 446
XXI. Eplerenone (Inspra) 448
XXII. Case History of a Heart Patient 448
XXIII. Risk Factors and Prevention 449
XXIV. Heart Attack Prevention Diet 450
A. Do Not Use the Following Foods 450
B. Use the Following Foods Sparingly and in Small Amounts 450
C. Use the Following Recommended Foods 450
Bibliography 451
Heart Failure 455
Glossary 455
I. Incidence and Pathogenesis 455
II. Basic Causes Of Heart Failure 456
A. Coronary Artery Disease 456
B. Hypertension 457
C. Valvular Heart Disease 457
D. Cardiomyopathy 457
E. Right Heart Failure 457
III. Precipitating Factors 457
IV. Pathophysiology 458
A. Nature's Defense Mechanisms 458
B. Relevant Definitions 459
V. Symptoms And Signs 459
A. Symptoms 459
B. Physical Signs 460
VI. Diagnosis 460
A. Chest X-Ray 460
B. B-Type Natriuretic Peptide 460
C. Echocardiogram 460
VII. Drug Treatment 460
A. Digitalis (Digoxin) 460
B. Digitoxin 461
C. ACE Inhibitors and Angiotensin Receptor Blockers 462
D. Angiotensin receptor blockers 463
E. Diuretics 464
F. Nitrates 464
G. Beta-Blockers 464
H. Aldosterone Antagonists 465
I. Resynchronization 465
J. Transplantation and the Artificial Heart 466
VIII. Nondrug Therapy 466
A. Advice on Drugs, Salt, Diet, Potassium, Alcohol, and Exercise 466
IX. What To Expect In The Hospital And On Discharge 467
Bibliography 468
Hemochromatosis 471
Glossary 471
I. Incidence 471
II. Genetics And Iron Overload 471
III. Clinical Complications 472
A. Myocardial Damage Mechanisms 472
B. Symptoms and Signs 473
C. Diagnosis 473
IV. Management 473
Bibliography 473
Herbal, Dietary Supplements, and Cardiovascular Disease 475
Glossary 475
I. Historical 475
II. Consumption and Regulation 475
III. Benefits, Adverse Effects, and Drug Interactions 476
A. Danshen (Salvia miltiorrhiza) 476
B. Ephedra sinica (Ma Huang) 476
C. Ginkgo 477
D. Garlic (Allium sativum) 478
E. Ginger (Zingiber officinale) 479
F. Ginseng (Panax ginseng) 479
G. Feverfew (Tanacetum parthenium) 479
H. Gugulipid (Commiphora mukul) 480
I. Hawthorn (Crataegus Species) 480
J. Horse Chestnut Seed (Aesculus hippocastanum) 480
L. Kava (Piper methysticum) 481
M. l-Arginine 481
N. Linoleic Acid 481
O. Licorice 481
P. St. John's Wort 481
Q. Yohimbine (Pausinystalia yohimbe) 481
R. Other Natural Products 482
IV. Substances Used by Athletes 482
Bibliography 483
HIV and the Heart 485
Glossary 485
I. Incidence 485
II. Cardiac Complications Of Aids 485
A. Pericardial Effusion 485
B. Myocarditis and Left ventricular Systolic Dysfunction 486
C. Other Complications 486
Bibliography 486
Homocysteine and Cardiovascular Disease 487
Glossary 487
I. Homocysteine Metabolism 487
II. Homocysteine And Vascular Disease 487
III. Clinical Studies 487
A. Willems et al. 487
B. Schnyder et al. 488
IV. Conditions Causing Hyperhomocystinemia 488
A. Medical Conditions 488
B. Medications 488
C. Lifestyle Behaviors 488
V. Screening 488
A. American Heart Association Recommendation 489
B. European International Task Force Recommendation 489
C. Canadian Task Force Recommendation 489
D. Normal and Abnormal Homocysteine Levels 489
VI. Management Of Hyperhomocystinemia 489
A. Folic Acid Intake 489
VI1. Benefits Of Decreasing Homocysteine Levels 489
VII1. Clinical Studies 489
A. The Recent FACIT Trial Lange et al.
B. Toole et al.: The Vitamin Intervention for Stroke Prevention (VISP) Randomized Controlled Trial 490
Bibliography 490
Hypertension 491
Glossary 491
I. Measurement of Blood Pressure 491
II. How High Is High? 493
A. Old convention, 1930–1996 493
B. New Convention, 2003 493
III. Causes Of Hypertension 493
A. Primary (Essential) Hypertension 493
B. Secondary Hypertension 494
C. Malignant Hypertension 495
IV. Pathogenesis of Primary Essential Hypertension 496
A. Salt Hypothesis 496
B. Other Hypotheses 497
V. Complications 498
A. Effects on Arteries and Heart 498
B. Stroke 499
C. Kidney Damage 499
VI. Symptoms 499
VII. Investigations 499
VIII. Nondrug Treatment 500
A. Sodium (Salt) Restriction 500
B. Weight Reduction 501
C. Stress 501
D. Exercise 501
E. Alcohol 502
F. Coffee and Smoking 502
IX. Drug Treatment 502
A. Number of Drugs Available 502
B. Choice of Antihypertensive Agent for Patients Without Coexisting Disease 504
C. Therapy for Patients with Coexisting Diseases or Target Organ Damage 504
D. Individual Antihypertensive Agents 505
Bibliography 512
Hypertrophy of the Heart 515
Glossary 515
I. Pathophysiology 515
A. Compensatory Hypertrophy 515
B. Angiotensin II 516
C. RNA 516
D. Mitochondria Mass and Function 517
E. Other Factors 517
II. Causes And Complications of Heart Hypertrophy 517
A. Causes 517
B. Complications 517
III. Diagnosis 517
A. Clinical study: Verdecchia et al. 519
IV. Prevention And Management 519
A. Alpha-Blockers 520
B. ACE Inhibitors 520
C. Beta-Adrenergic Blockers 520
D. Calcium Antagonists 520
E. Diuretics 520
F. Aldosterone Receptor Blocking Agents 520
Bibliography 521
Kawasaki Heart Disease 523
Glossary 523
I. Clinical Features 523
II. Diagnosis 523
III. Causation 523
IV. Management 524
A. Intravenous Gamma Globulin Therapy 524
B. Aspirin 524
C. Corticosteroids 524
Bibliography 524
Miscellaneous Disorders 527
I. Marfan Syndrome 527
A. Diagnostic Symptoms and Physical Signs 527
B. Management 527
II. Cor Pulmonale 527
A. Causes 528
B. Diagnosis 528
C. Management 528
III. Ehlers-Danlos Syndrome 528
IV. Noonan Syndrome 528
V. Ebstein's Anomaly 529
VI. Turner Syndrome 529
VII. Fetal Alcohol Syndrome 529
VIII. Holt-Oram Syndrome 529
IX. Paget& rsquo
X. Ankylosing Spondylitis 529
XI. Rubella Syndrome 529
XII. Pseudoxanthoma Elasticum 529
XIII. Myotonic Muscular Dystrophy 530
XIV. Takayasu 530
A. Cardiovascular Lesions 530
B. Management 530
XV. Lupus Erythematosus 530
XVI. Sarcoidosis 531
XVII. Syphilis 531
XVIII. Atrial Myxoma 531
Bibliography 531
Murmurs and Heart Disease 533
Glossary 533
I. Clinical Cases 533
A. Questions Posed 533
B. Answers 533
II. Clinical Diagnosis of Heart Murmurs 534
A. Diagnostic Clues 534
B. Classification 535
III. Investigative Tests 536
Bibliography 536
Nonsteroidal Anti-Inflammatory Drugs 537
Glossary 537
I. Adverse Cardiovascular Effects 537
A. Effects on Prostacyclin 538
B. Effect on Atherothrombosis 538
C. Increased Viral Load 538
D. Hypertension and Heart Failure 539
E. Caution 539
Bibliography 539
Obesity and Heart Disease 541
Glossary 541
I. Incidence and Definitions 541
A. Metabolic syndrome 541
B. Metropolitan Height and Weight Tables 541
II. Effects on the Cardiovascular System 543
A. Coronary Heart Disease 543
B. Heart Failure 543
C. Hypertension 543
III. Management 543
A. Weight Reduction Diet 543
IV. Clinical Studies Of Diets 545
A. The Atkins-Type Diet 545
B. A Low-Carbohydrate Diet Compared with a Low-Fat Diet 546
C. Recommendations 546
Bibliography 546
Pacemakers 547
Glossary 547
I. Historical 547
II. Complete Heart Block 548
A. Pathophysiology 548
B. Causes of Complete Heart Block — Third Degree AV block 549
C. Diagnosis 550
III. Second Degree AV Block 550
IV. Sinus Node Dysfunction 550
V. Permanent Pacemakers 551
A. Types of Pacemakers 551
B. Electrical Safety 552
C. Complications 552
D. Temporary Pacing 553
VI. What a Pacemaker will not do 554
VII. Activities 554
Bibliography 554
Patent Foramen Ovale 555
Glossary 555
I. Developmental Features 555
II. Clinical Features and Investigations 557
III. Proof of Pfo Involvement in Stroke 557
A. Clinical Study: Martin Braun et al. 559
IV. Perspective and Research Implications 559
Bibliography 559
Pericarditis and Myocarditis 561
Glossary 561
I. Pericarditis 561
A. Causes 561
B. Diagnosis 561
C. Viral Pericarditis 562
D. Cardiac Tamponade 562
E. Constrictive Pericarditis 562
II. Myocarditis 563
A. Causes 563
B. Symptoms and Signs 563
C. Management 563
Bibliography 563
Pulmonary Arterial Hypertension 565
Glossary 565
I. Pulmonary Hypertension 565
A. Causes and Risk Factors 565
B. Symptoms and Physical Signs 565
C. Laboratory Studies 566
II. Primary Pulmonary Hypertension 567
A. Diagnosis 567
B. Risk Factors and Pathogenesis 567
C. Therapy 568
Bibliography 569
Pulmonary Embolism 571
Glossary 571
I. Incidence 571
II. Pathogenesis 571
III. Pathophysiology 571
IV. Diagnosis 572
V. Investigations 572
A. Arterial Blood Gas Analysis 572
B. Elisa 572
C. Electrocardiogram 573
D. Lung Scan 573
E. Venous Ultrasonography 573
F. Pulmonary Angiogram 573
VI. Management 573
Bibliography 573
Race and Cardiovascular Disease 575
Glossary 575
I. Hypertension 575
A. Epidemiology 575
B. Target Organ Damage 575
C. Role of Obesity 576
D. Management of Hypertension 576
II. Heart Failure 576
A. Management 576
III. Coronary Artery Disease and Stroke 578
A. African-Americans 578
B. Heart Disease in Asian Indians 578
C. Other Ethnic Groups 579
Bibliography 579
Sleep and the Heart 581
Glossary 581
I. Effects of Normal Sleep on the Cardiovascular System 581
II. Sleep Apneas 581
A. Obstructive Sleep Apnea 582
B. Central Sleep Apnea 582
III. Sleep Apnea and Heart Failure 582
A. Atrial Pacing in Sleep Apnea 584
IV. Sleep Apnea and Hypertension 585
V. Sleep Apnea and Arrhythmias 585
Bibliography 585
Stents 587
Glossary 587
I. A Major Advance 587
II. Restenosis 587
III. Drug-Eluting Stents 588
A. Sirolimus-Eluting Stents 588
B. Paclitaxel-Eluting Stent 589
C. New Agents 589
A. Long-Term Studies 589
B. Other Drugs to Prevent Restenosis 590
Bibliography 590
Stress and Heart Disease 591
Glossary 591
I. Effects on the Cardiovascular System 591
A. Stress and Sports 593
B. The Symptoms and Signs of Stress 593
C. How to Handle Stress 594
D. Conclusion 594
II. Type a Behavior 594
Bibliography 595
Stroke/Cerebrovascular Accident 597
Glossary 597
I. Incidence 597
II. Types Of Cerebrovascular Accidents 597
III. Cerebral Infarction/Ischemic Stroke 598
A. Causation 598
B. Symptoms and Signs 598
IV. Transient Ischemic Attack 599
A. Symptoms and Signs 599
B. Outcome Following TIA 599
C. Management 599
V. Intracranial Hemorrhage 600
VI. Subarachnoid Hemorrhage 600
Bibliography 600
Syncope 603
Glossary 603
I. Definition and Incidence 603
II. Causes 603
A. Reflex-Mediated Syncope 603
B. Orthostatic 605
C. Cardiovascular 605
III. Diagnostic Evaluation 606
A. Detailed History and Physical Examination 606
B. Electrocardiography and Holter Monitoring 606
C. Event Recorders 607
D. Echocardiography 607
E. Electrophysiologic Testing 608
F. Stress Test 608
G. Tilt-Table Testing 608
IV. Management 608
A. Neurally Mediated Syncope 608
B. Orthostatic Syncope 608
C. Transient Ischemic Attack 608
D. Cardiac Causes 609
E. Unexplained Syncope 609
Bibliography 610
Tests for Heart Diseases 611
Glossary 611
I. Electrocardiogram 611
II. Exercise Treadmill Stress Test 611
III. Chest X-Ray 612
IV. Echocardiogram 612
V. Holter Monitor 612
VI. Nuclear Scans 612
VII. Coronary Arteriography/Cardiac Catheterization 613
A. Historical 613
B. Technique for Cardiac Catheterization Coronary Arteriography 613
C. Indications 614
VIII. Coronary Calcium Evaluation 615
A. Electron Beam Tomography 615
IX. Cardiovascular Magnetic Resonance Imaging/Magnetic Resonance Angiography 615
A. Clinical Study: Kim et al. 616
Bibliography 616
Thyroid Heart Disease 619
Glossary 619
I. High Thyroid (Hyperthyroidism) 619
A. Symptoms 619
B. Physical Signs 619
C. Treatment 619
II. Low Thyroid (Hypothyroidism) 619
A. Symptoms and Signs 619
B. Treatment 620
III. Amiodarone-Induced Thyroid Dysfunction 620
Bibliography 620
Valve Diseases 621
Glossary 621
I. Murmurs 621
II. Causes and Consequences of Valve Disease 621
A. Causes 621
B. Consequences 622
III. Rheumatic Fever 622
A. Types of Valve Damage 622
B. Prevention of Rheumatic Fever 623
IV. Specific Valve Lesions 623
A. Mitral Stenosis 623
B. Mitral Regurgitation 624
C. Aortic Stenosis 624
D. Aortic Regurgitation 625
E. Mitral Valve Prolapse 626
V. Prosthetic Valve Choice 626
A. Mechanical Prostheses 626
B. Tissue Prostheses 626
Bibliography 628
Ventricular Fibrillation 629
Glossary 629
I. Clinical Features 629
II. Genesis and Causes 629
A. Genesis 629
B. Causes 629
C. Other Causes 630
III. Management 630
Bibliography 630
Women and Heart Disease 631
Glossary 631
I. Relevant Statistics and Perspectives 631
II. Recognized Differences in Women and Men 632
A. Atypical Chest Pain versus Angina 632
B. Innovative Technology 633
C. Acute Myocardial Infarction 633
D. Dyslipidemia 633
III. Hormone Therapy 633
A. Premenopausal Protection 633
B. Clinical Studies 634
IV. Pregnancy and Heart Disease 634
A. Hypertension 635
B. Valvular Heart Disease 636
C. Arrhythmias 636
D. Peripartum Cardiomyopathy 636
Bibliography 636
Appendix A 639
Appendix B 641
Glossary 643
Index 649