Braunwald’s Heart Disease: A Textbook of Cardiovascular Medicine, 2-Volume Set

Epidemiologic Transitions......Page 16
Age of Receding Pandemics (1900-1930)......Page 18
Age of Delayed Degenerative Diseases (1965-2000)......Page 19
Current Worldwide Variations in the Global Burden of Cardiovascular Disease......Page 20
Low- and Middle-Income Countries......Page 21
Burden of Disease......Page 22
Demographic and Social Indices......Page 23
Burden of Disease......Page 24
Hypertension......Page 25
Tobacco......Page 26
Obesity......Page 27
East Asia Pacific.......Page 28
Middle East and North Africa.......Page 29
Economic Burden......Page 30
Established Cardiovascular Disease Management......Page 31
Tobacco.......Page 32
Epidemiologic Transitions......Page 33
Global Trends in Cardiovascular Disease......Page 34
Cost-Effective Solutions......Page 35
Distribution of Known Risk Factors for Heart Disease......Page 36
Disparities in Cardiovascular Care and Outcomes......Page 38
Therapy.......Page 39
Ischemic Heart Disease......Page 40
Heart Failure......Page 41
Construct of Race and Ethnicity in Medicine......Page 42
Hypertension......Page 43
Heart Failure......Page 44
Preventing and Avoiding Harm to Patients......Page 45
Addressing Refusals of and Requests for Withdrawal of Life-Sustaining Treatments......Page 46
Ensuring Appropriate Surrogate Decision Making......Page 47
Bedside Allocation of Health Care Resources......Page 48
References......Page 49
Sensitivity and Specificity (see Chaps. 14 and 17).......Page 50
Test Ordering.......Page 51
Expressions of Risk and Benefit.......Page 52
Efficacy and Effectiveness.......Page 53
Adoption of Innovation.......Page 54
Adoption of Innovation......Page 55
Decision-Making Support......Page 56
Guidelines and Quality Measures......Page 57
Retrospective Chart Review......Page 58
Prospective Data Collection......Page 59
Hospitals......Page 60
Improvement Strategies......Page 61
Guidelines and Performance Measures......Page 62
Improvement Strategies......Page 63
Constructing the Research Question......Page 64
Other Forms of Controlled Studies......Page 65
Selection of Endpoint of Clinical Trial......Page 66
During the Course of the Trial......Page 67
During the Analytic Phase of the Trial......Page 68
Future Perspectives......Page 69
Key Issues During the Trial and Measurement of the Treatment Effect......Page 70
Principles of Cell Biology and the Cell Cycle......Page 71
DNA......Page 73
From Genes to Proteins......Page 74
Principles and Techniques of Molecular Biology......Page 75
Blotting Techniques......Page 76
Genotype and the Identification of Disease-Causing Genes......Page 77
Complex Trait Analysis.......Page 78
Oligonucleotide Arrays.......Page 79
Genetic Modification of Mice to Study Human Cardiovascular Disease......Page 80
Conditional Knockout Mice......Page 81
Adenovirus.......Page 82
Molecular Basis of Genetics......Page 83
Sarcomere Protein Gene Mutations.......Page 84
Thin-Filament Proteins......Page 85
Glycogen Storage Cardiomyopathy.......Page 86
Gene Mutations Causing Dilated Cardiomyopathy......Page 87
Mutations with Conduction System Disease.......Page 88
Gene Mutations Causing Arrhythmogenic Right Ventricular Dysplasia......Page 89
Atrial and Ventricular Septal Defects.......Page 90
Noonan Syndrome.......Page 92
References......Page 93
Genetic Basis for Long-QT Syndrome.......Page 95
Genotype-Phenotype Correlates.......Page 97
Clinical Description and Manifestations.......Page 98
Common Ion Channel Polymorphisms.......Page 99
Genetic Basis of Brugada Syndrome.......Page 100
Genetic Basis of Sick Sinus Syndrome.......Page 101
Ankyrin-B Syndrome......Page 102
References......Page 103
Variability in Drug Action......Page 105
Pharmacokinetics......Page 106
Metabolism and Excretion.......Page 107
Principles of Dosage Optimization......Page 108
Dose Adjustments......Page 110
Drug Interactions......Page 111
Genetics of Variable Drug Responses......Page 112
Cardiac Stem Cells......Page 113
Cardiac Stem Cells and Myocardial Aging......Page 115
Cardiac Stem Cells and Gender......Page 116
Cardiac Stem Cells and Myocardial Diseases......Page 117
Tissue Engineering......Page 119
Exogenous Stem Cells and Tissue Engineering......Page 120
4-u1.0-B978-1-4377-0398-6..00102-5..DOCPDF.pdf......Page 0
History......Page 121
Skin.......Page 122
Extremities.......Page 123
Jugular Venous Pressure and Waveform.......Page 124
Measuring the Blood Pressure.......Page 125
Assessing the Pulses.......Page 127
First Heart Sound (S1).......Page 128
Systolic Murmurs.......Page 129
Dynamic Auscultation.......Page 131
Physical Examination.......Page 132
Third and Fourth Heart Sounds.......Page 133
Other Findings.......Page 134
Valvular Heart Disease......Page 135
Mitral Regurgitation.......Page 136
Prosthetic Heart Valves (see Fig. 66-44).......Page 137
Assessment of Arterial Pulses and Blood Pressure......Page 138
Pericardial Tamponade......Page 139
The Cardiac Dipole.......Page 140
Role of Transmission Factors.......Page 141
Precordial Leads and the Wilson Central Terminal.......Page 142
Other Lead Systems.......Page 143
Lead Vectors and Heart Vectors.......Page 144
Electrocardiographic Processing and Display Systems......Page 145
Atrial Activation.......Page 146
Heart Rate Variability.......Page 147
Mid and Late QRS Patterns.......Page 148
Sequence of Ventricular Recovery.......Page 149
Normal Variants......Page 150
Left Atrial Abnormality.......Page 151
Diagnostic Accuracy.......Page 152
Left Ventricular Hypertrophy.......Page 153
Diagnostic Criteria......Page 154
Mechanisms for Electrocardiographic Abnormalities.......Page 155
Biventricular Hypertrophy.......Page 156
Fascicular Block.......Page 157
Left Anterior Fascicular Block.......Page 158
Mechanisms for the Electrocardiographic Abnormalities.......Page 159
Clinical Significance......Page 160
Multifascicular Blocks.......Page 161
Rate-Dependent Conduction Block (Aberration).......Page 162
Repolarization (ST-T Wave) Abnormalities.......Page 163
QRS Changes.......Page 164
Evolution of Electrocardiographic Changes.......Page 165
Other Ischemic ST-T Patterns.......Page 166
Ischemic U Wave Changes......Page 167
Electrocardiographic Diagnosis of Bundle Branch Blocks and Myocardial Infarction.......Page 168
Electrocardiographic Differential Diagnosis of Ischemia and Infarction.......Page 169
Noninfarction Q Waves.......Page 170
Fragmented QRS......Page 171
T Wave Inversion.......Page 172
Calcium.......Page 173
Magnesium.......Page 174
Alternans Patterns......Page 175
Technical Errors and Artifacts......Page 176
Future Perspectives......Page 177
Myocardial Ischemia and Infarction......Page 178
Patients without Known or Suspected Cardiovascular Disease......Page 179
References......Page 181
Cardiopulmonary Exercise Testing......Page 182
Anaerobic Threshold.......Page 183
Bicycle Ergometry.......Page 184
Walk Test.......Page 185
Measurement of ST-Segment Displacement.......Page 186
Computer-Assisted Analysis.......Page 189
Pathophysiology of the Myocardial Ischemic Response......Page 190
Maximal Work Capacity.......Page 191
Diagnostic Use of Exercise Testing......Page 192
Exercise Testing in Determining Prognosis......Page 193
Silent Myocardial Ischemia.......Page 194
Acute Coronary Syndromes.......Page 195
Congestive Heart Failure.......Page 196
Evaluation of Ventricular Arrhythmias.......Page 198
Preexcitation Syndrome.......Page 199
Hypertension.......Page 200
Older Patients.......Page 201
Cardiac Transplantation and Left Ventricular Assist Devices.......Page 202
Safety and Risks of Exercise Testing......Page 203
Nonelectrocardiographic Observations......Page 204
Specific Clinical Applications......Page 205
Exercise Test Performance and Training......Page 206
Diagnosis of Obstructive Coronary Artery Disease......Page 207
Special Populations......Page 208
References......Page 212
M-Mode, Two-Dimensional, and Three-Dimensional Transthoracic Echocardiography......Page 214
Transesophageal Echocardiography......Page 217
Views of the Aorta, Pulmonary Artery, and Pulmonary Veins......Page 221
Color Flow Imaging or Color Doppler......Page 222
Tissue Doppler and Strain Imaging......Page 224
Left Ventricular Endocardial Border Enhancement and Assessment of Myocardial Perfusion......Page 226
Left Ventricular Dimensions......Page 229
Right Ventricular Dimensions......Page 231
Left Ventricular Volume......Page 232
Left Ventricular Ejection Fraction.......Page 233
Assessment of Diastolic Function......Page 234
Normal Diastolic Filling Pattern......Page 235
Grade 2 Diastolic Dysfunction or Moderate Diastolic Dysfunction......Page 236
Clinical Applications of Diastolic Function Assessment......Page 237
Coronary Artery Disease......Page 238
New Systolic Murmur: Ventricular Septal Rupture, Papillary Muscle Rupture, and Acute Outflow Obstruction.......Page 239
Evaluation of Left Ventricular Remodeling and Ischemic Mitral Regurgitation (see Chap. 57).......Page 240
Stress Echocardiography......Page 241
Diagnostic Accuracy.......Page 242
Assessment of Myocardial Viability......Page 243
Stroke Volume and Cardiac Output......Page 244
Continuity Equation (see Chap. 66)......Page 245
PISA Method......Page 246
Aortic Stenosis......Page 248
Severe Aortic Stenosis with Low Aortic Pressure Gradient.......Page 249
Mitral Stenosis......Page 250
Aortic Regurgitation......Page 251
Mitral Regurgitation......Page 252
Pulmonary Stenosis and Regurgitation......Page 253
Prosthetic Valve Evaluation (see Chap. 66)......Page 254
Infective Endocarditis......Page 258
Dilated Cardiomyopathy (see Chap. 68)......Page 259
Hypertrophic Cardiomyopathy (see Chap. 69)......Page 261
Athlete’s Heart Versus Hypertrophic Cardiomyopathy.......Page 262
Restrictive Cardiomyopathy (see Chap. 68)......Page 263
Arrhythmogenic Right Ventricular Dysplasia/Cardiomyopathy (see Chap. 68)......Page 264
Pericardial Cyst......Page 265
Pericardial Effusion and Tamponade......Page 266
Constrictive Pericarditis......Page 268
Transient Constrictive Pericarditis......Page 269
Carcinoid Disease (see Chaps. 66 and 68)......Page 270
Aortic Aneurysm......Page 271
Aortic Dissection, Intramural Hematoma, and Aortic Ulcer (see Chap. 69)......Page 272
Papillary Fibroelastoma......Page 274
Echocardiography in Atrial Fibrillation (see Chap. 40)......Page 275
Atrial Septal Defect......Page 277
Ventricular Septal Defect......Page 279
Patent Ductus Arteriosus......Page 280
Contrast Echocardiography......Page 281
Valvular Heart Disease and Endocarditis......Page 282
Atrial Fibrillation......Page 283
Echocardiography......Page 284
References......Page 290
Technical Considerations......Page 291
Image Recording and Radiation Exposure......Page 292
Cardiac Chambers and Aorta.......Page 293
Lungs and Pulmonary Vasculature.......Page 295
Normal Variations.......Page 296
Evaluating the Chest Radiograph in Heart Disease......Page 297
Lungs and Pulmonary Vasculature......Page 300
Left Atrium.......Page 301
Pulmonary Arteries.......Page 302
Aorta.......Page 303
Conclusion......Page 304
Evaluating the Chest Radiograph in Heart Disease......Page 306
Basics of Quality Control.......Page 307
SPECT Image Interpretation and Reporting......Page 308
General Principles of Interpretation and Reporting.......Page 310
Incorporating Bayesian Principles into Image Interpretation......Page 311
Lung Uptake......Page 314
Attenuation Correction Methods.......Page 316
Combined PET-CT and SPECT-CT Scanners......Page 317
CT Attenuation Correction for PET and SPECT.......Page 318
Electrocardiographically Gated Radionuclide Techniques to Assess the Physiology of Ventricular Function......Page 319
Planar Myocardial Perfusion Imaging......Page 320
Image Acquisition.......Page 321
Image Acquisition.......Page 322
PET Perfusion Tracers: Research Directions......Page 323
Assessment of Infarct Size......Page 324
Effect of a Coronary Stenosis on Coronary Blood Flow Reserve (see Chap. 52)......Page 325
Exercise Stress to Induce Coronary Hyperemia.......Page 326
Mechanism of Coronary Arteriolar Vasodilator Pharmacologic Stress......Page 327
Reversal of the Effects of Vasodilator Pharmacologic Stress.......Page 328
Dobutamine Stress to Induce Coronary Hyperemia.......Page 329
2-[18F]Fluoro-2-Deoxyglucose.......Page 330
[11C]Acetate.......Page 332
Evaluation of Diastolic Function with Radionuclide Techniques......Page 333
The Relation Between the Extent of Perfusion Defect and Natural History Outcomes......Page 334
Dynamic Assessment of Prognosis by Serial Scintigraphic Studies: A New Paradigm?......Page 335
Detecting the Presence and Extent of Coronary Artery Disease.......Page 336
Angiography as the Gold Standard.......Page 337
Sensitivity and Specificity of Myocardial Perfusion Imaging.......Page 338
Pharmacologic Stress Testing for Detection of Coronary Artery Disease.......Page 339
Imaging After Coronary Artery Bypass Surgery......Page 340
Application of Radionuclide Imaging: Answering the Clinical Questions.......Page 341
Assessment of Inducible Ischemia after Acute Myocardial Infarction......Page 342
Imaging of Ischemic Memory......Page 343
Is coronary Artery Disease the Cause of Heart Failure?......Page 344
Comparison of Imaging Techniques for Viability Assessment.......Page 345
Myocarditis (see Chap. 70).......Page 346
Imaging of the Tissue Angiotensin-Converting Enzyme Receptor System......Page 347
Assessment of the Physiology and Pathophysiology of Myocardial Blood Flow, Myocardial Metabolism, and Ventricular Function......Page 348
Disease Detection, Risk Stratification, and Clinical Decision Making......Page 349
Nuclear Cardiology......Page 350
References......Page 353
Generation of Magnetic Resonance Signal, Signal Contrast, and Image Formation......Page 354
Technical Aspects of Cardiac Magnetic Resonance Pulse Sequences......Page 355
Contrast-Enhanced Imaging......Page 356
Imaging Of Myocardial Infarction.......Page 357
Myocardial Perfusion Imaging......Page 359
Assessment of Cardiomyopathies......Page 360
Hypertrophic Cardiomyopathy.......Page 361
Arrhythmogenic Right Ventricular Cardiomyopathy.......Page 362
Cardiac Sarcoidosis.......Page 363
Iron Overload Cardiomyopathy.......Page 364
Pericardial Disease......Page 365
Anomalous Pulmonary Venous Connection.......Page 366
Cardiac Thrombi and Masses......Page 368
Magnetic Resonance Spectroscopy......Page 369
Cardiac Magnetic Resonance at 3 T......Page 370
Coronary Artery Disease......Page 371
Other Clinical Applications......Page 372
Cardiovascular Magnetic Resonance......Page 373
Reference......Page 375
Radiation Exposure......Page 376
Preparation of the Patient and Scanning Sequence......Page 377
Cardiac Computed Tomography Anatomy......Page 378
Coronary Artery Calcium Scanning......Page 379
Detection of Noncalcified Plaque......Page 382
Ventricular and Valvular Morphology and Function......Page 383
Emerging Applications......Page 387
Training and Certification......Page 388
Coronary CT Angiography......Page 392
Cardiac Computed Tomography......Page 393
References......Page 396
Indications for Diagnostic Cardiac Catheterization......Page 397
Radiation Safety.......Page 398
Catheters and Associated Equipment.......Page 399
Balloon Flotation Catheters.......Page 400
The Judkins Technique.......Page 401
Postprocedure Care.......Page 402
Transseptal Catheterization.......Page 403
Endomyocardial Biopsy.......Page 404
Percutaneous Intra-aortic Balloon Pump Insertion.......Page 405
Atrial Pressure......Page 407
Great Vessel Pressures......Page 408
Abnormal Pressure Characteristics.......Page 409
Fick Method.......Page 410
Determination of Vascular Resistance.......Page 411
Mitral Stenosis......Page 412
Calculation of Stenotic Valve Orifice Areas.......Page 413
Oximetric Method.......Page 414
Dynamic Exercise......Page 415
Pharmacologic Maneuvers......Page 416
Intracardiac Echocardiography......Page 417
Acknowledgment......Page 418
Complications Associated with Cardiac Catheterization......Page 419
Indications for Coronary Arteriography (see Guidelines for Coronary Arteriography)......Page 420
Contraindications.......Page 421
Preparation of the Patient.......Page 422
Other Catheters.......Page 423
Anticoagulants.......Page 424
Side Effects.......Page 425
Arterial Nomenclature and Extent of Disease.......Page 426
Cannulation......Page 427
Left Anterior Descending Artery.......Page 428
Right Coronary Artery.......Page 429
Saphenous Vein Grafts.......Page 431
Gastroepiploic Artery.......Page 432
Anomalous Pulmonary Origin of the Coronary Arteries (APOCA).......Page 433
Anomalous Coronary Artery from the Opposite Sinus (ACAOS).......Page 434
Coronary Artery Fistulas.......Page 435
Coronary Artery Spasm......Page 436
Lesion Complexity......Page 437
Ostial Location.......Page 439
Lesion Calcification.......Page 440
Thrombus.......Page 441
Coronary Collateral Circulation......Page 442
Quantitative Angiography......Page 443
Complications of Coronary Arteriography......Page 445
Lesion Complexity......Page 446
Coronary Arteriography in Patients with Congenital Heart Disease......Page 447
Other Uses of Coronary Arteriography......Page 448
References......Page 454
Evaluation of Atheroma Burden and Vascular Remodeling......Page 455
Clinical Indications for Intravascular Ultrasound Imaging......Page 456
Intravascular Ultrasound Assessment of Novel Antiatherosclerotic Treatments......Page 458
Future Perspectives......Page 459
Clinical Indications for Intravascular Ultrasound Imaging......Page 460
Future Perspectives......Page 461
Imaging Strategies......Page 462
Cell Trafficking: Leukocytes and Stem Cells......Page 463
Phagocytosis......Page 466
Angiogenesis......Page 467
Glucose Metabolism......Page 469
Uses for Molecular Imaging......Page 470
Biologic Processes Amenable to Molecular Targeting for Imaging......Page 471
Ultrastructure of Contractile Cells......Page 473
Titin and Length Sensing.......Page 474
Actin and Troponin Complex.......Page 475
Myosin and Molecular Basis of Muscle Contraction.......Page 476
Cross-Bridge Cycling Differs from Cardiac Contraction-Relaxation Cycle.......Page 477
Ryanodine Receptors.......Page 479
Calcium Uptake by SERCA into the Sarcoplasmic Reticulum......Page 481
Sodium-Calcium Exchanger.......Page 482
The Stimulatory G Protein Gs.......Page 483
Coupling of ALPHA1 Receptor by G Proteins.......Page 484
Cyclic Adenosine Monophosphate–Dependent Pro­tein Kinases.......Page 485
Physiologic Switch-Off and Beta-Arrestin Signaling......Page 486
Compartmentalization of cGMP.......Page 487
Other Inhibitory Signal Systems.......Page 488
Left Ventricular Contraction.......Page 489
Frank and Isovolumic Contraction.......Page 491
Wall Stress......Page 492
Force-Frequency Relationship and Optimal Heart Rate.......Page 493
Kinetic Work.......Page 494
Defects in the Contractile Function Concept.......Page 495
Ventricular Suction during Early Diastole.......Page 496
Wall Stress and Compensated Left Ventricular Hypertrophy.......Page 497
Future Perspectives......Page 498
Contractile Performance of the Heart......Page 499
Activation of the Sympathetic Nervous System.......Page 501
Activation of the Renin-Angiotensin System.......Page 503
Neurohormonal Alterations of Renal Function.......Page 504
Natriuretic Peptides.......Page 505
Endothelin.......Page 506
Adrenomedullin.......Page 507
Inflammatory Mediators.......Page 508
Cardiac Myocyte Hypertrophy......Page 509
Sarcoplasmic Reticulum in the Failing Heart.......Page 510
Beta-Adrenergic Desensitization......Page 511
Autophagy.......Page 512
Cardiac Fibroblasts and Mast Cells......Page 514
Matrix Metalloproteinases.......Page 515
Alterations in the Left Ventricular Structure in Heart Failure.......Page 516
Neurohormonal Mechanisms......Page 517
Left Ventricular Remodeling......Page 518
Heart Failure Symptoms......Page 519
Other Historical Information......Page 520
Physical Examination......Page 521
Measurement of Blood Chemistry and Hematologic Variables......Page 522
Biomarkers......Page 523
Detection of Comorbidities......Page 524
Use of Imaging Modalities in the Diagnosis and Management of Patients with Heart Failure (see Chaps. 15, 17-19)......Page 525
Cardiac Imaging to Differentiate Between Ischemic and Nonischemic Causes of Heart Failure......Page 526
Summary and Future Perspectives......Page 528
Laboratory Testing, Right-Heart Catheterization, Endomyocardial Biopsy, and Exercise Testing......Page 529
Use of Imaging Modalities in Diagnosis and Management of Heart Failure......Page 530
Classification......Page 531
Congestion in Acute Heart Failure Syndromes......Page 534
Myocardial Function in Acute Heart Failure Syndromes (see Chaps. 24, 26, 28, and 30)......Page 535
Abnormalities of the Natriuretic Peptide System.......Page 536
Predictive Models of In-Hospital Mortality......Page 537
Hyponatremia.......Page 538
Blood Pressure in Response to Provocative Testing.......Page 539
Renal Function Tests......Page 540
Management of Acute Heart Failure Syndromes......Page 541
Noninvasive Ventilation.......Page 542
Diuretics (Table 27-9; see Table 28-7).......Page 543
Vasodilators (see Table 27-9).......Page 544
Nesiritide......Page 545
Inotropes with Vasodilatory Properties (Table 27-10).......Page 546
Dobutamine......Page 547
Digoxin......Page 548
Cardiogenic Pulmonary Edema.......Page 549
Treatment of Clinical and Hemodynamic Congestion.......Page 550
Phase III: Management After Discharge and During the Vulnerable Phase......Page 551
Cardiac Myosin Activators.......Page 552
Pathophysiology......Page 553
Assessment of Acute Heart Failure Syndromes......Page 554
Potential New Therapies and Future Perspectives......Page 555
Causative Factors......Page 557
Prognosis......Page 558
Biomarkers and Prognosis......Page 560
Patients at High Risk for Developing Heart Failure (Stage A).......Page 561
Defining the Appropriate Strategy......Page 563
General Measures......Page 564
Management of Fluid Status......Page 565
Loop Diuretics.......Page 566
Mechanisms of Action.......Page 567
Carbonic Anhydrase Inhibitors.......Page 568
Diuretic Treatment of Heart Failure.......Page 569
Diuretic Resistance and Management.......Page 570
Angiotensin-Converting Enzyme Inhibitors.......Page 572
Angiotensin Receptor Blockers.......Page 573
Beta-Adrenergic Receptor Blockers.......Page 574
Side Effects of Aldosterone Antagonists......Page 577
Complications of Digoxin Use......Page 578
Cancer Patients.......Page 579
Sleep-Disordered Breathing......Page 580
Disease Management......Page 581
Management of Heart Failure......Page 582
Initial Patient Evaluation......Page 583
Treatment of Patients at High Risk of Developing Heart Failure (Stage A)......Page 584
Treatment of Patients with Left Ventricular Dysfunction Who Have Not Developed Symptoms (Stage B)......Page 585
Treatment of Patients with Left Ventricular Dysfunction and Current or Prior Symptoms (Stage C)......Page 586
Treatment of Patients with Refractory End-Stage Heart Failure (Stage D)......Page 587
The Hospitalized Patient......Page 588
Special Populations and Concomitant Disorders......Page 589
End-of-Life Care......Page 590
References......Page 591
Multisite Stimulation in Cardiomyopathy Trials.......Page 592
CONTAK CD.......Page 593
Indications for Cardiac Resynchronization Therapy in Heart Failure Patients......Page 594
Multicenter Automatic Defibrillator Implantation Trial with Cardiac Resynchronization Therapy.......Page 595
Sudden Cardiac Death–Heart Failure Trial.......Page 596
Implantable Devices to Monitor Heart Failure......Page 597
Ventricular Dyssynchrony......Page 598
Implantable Devices to Monitor Heart Failure......Page 599
Clinical Features......Page 600
Obesity.......Page 601
Rarer Causes of Heart Failure with a Normal Ejection Fraction.......Page 603
The Elderly Patient with Exertional Dyspnea, Normal Ejection Fraction, and Pulmonary Hypertension.......Page 604
Doppler Echocardiographic Assessment of Diastolic Function and Filling Pressures.......Page 605
Invasive and Noninvasive Assessment of Left Ventricular Relaxation......Page 606
Evidence for Impaired Relaxation......Page 608
Invasive and Noninvasive Assessment of Left Ventricular Diastolic Stiffness.......Page 609
Vascular Dysfunction.......Page 610
Randomized Controlled Clinical Trials......Page 611
Pathophysiology......Page 613
Therapy......Page 614
Risks of Coronary Artery Bypass Grafting......Page 615
Survival Benefit.......Page 616
Mitral Valve......Page 617
Left Ventricular Reconstruction......Page 620
Passive Cardiac Support Devices......Page 621
Evaluation of the Potential Recipient......Page 622
Surgical Considerations......Page 624
Rejection......Page 625
Infection......Page 626
Renal Insufficiency.......Page 627
Functional Outcomes.......Page 628
Left Ventricular Reconstruction......Page 629
Cardiac Transplantation......Page 630
Classification and Description of Devices......Page 631
Clinical Cardiac Recovery......Page 632
Clinical Outcomes with Chronic Mechanical Assistance......Page 633
Patient Factors Influencing Outcome......Page 634
Pulmonary Function.......Page 635
Surgical Considerations......Page 636
Right Ventricular Failure......Page 637
Percutaneous Mechanical Support......Page 638
The Emerging Future of Mechanical Circulatory Support......Page 639
Long-term Management, the Total Artificial Heart, and Percutaneous Mechanical Support......Page 640
Stem and Progenitor Cells (see Chap. 11).......Page 641
Clinically Used Cell Types......Page 643
Cell Therapy in Acute Myocardial Infarction.......Page 645
Cell Therapy and Cell Mobilization Strategies in Patients with Chronic Heart Failure.......Page 647
Future Perspectives in Myocardial Repair and Regeneration.......Page 648
Gene Therapy......Page 649
Pharmacogenetics......Page 651
Metabolic Modulation......Page 653
Myocardial Regeneration......Page 655
Pharmacogenetics......Page 656
Metabolic Modulation......Page 657
Palliative Care......Page 658
Continuous Goal Assessment......Page 659
Types of Documents.......Page 660
Physical and Psychological Symptoms and Their Management......Page 661
Withdrawing and Withholding Life-Sustaining Treatment......Page 662
Care During the Last Hours......Page 663
Outcome Measures......Page 664
Assessment, Goals, and Care Planning......Page 665
Function.......Page 666
Innervation.......Page 667
Atrioventricular Node.......Page 669
Terminal Purkinje Fibers.......Page 670
Pathways of Innervation.......Page 671
Arrhythmias and the Autonomic Nervous System......Page 672
Physiology of Ion Channels......Page 673
Ion Flux Through Voltage-Gated Channels.......Page 674
Voltage-Gated Ca2+ Channels.......Page 675
Intercalated Discs......Page 676
General Considerations......Page 677
Mechanism of Phase 0.......Page 678
Upstroke of the Action Potential.......Page 679
Phase 2: Plateau......Page 681
Normal Automaticity......Page 682
Passive Membrane Electrical Properties.......Page 683
Effects of Reduced Resting Potential.......Page 684
Disorders of Impulse Formation......Page 685
Major Role of Intracellular Ca2+ Handling Abnormalities in DAD Generation.......Page 686
Long-QT Syndrome.......Page 688
Anatomic Reentry.......Page 689
Conditions for Reentry......Page 690
Spatiotemporal Organization and Focal Discharge (see Chap. 40)......Page 691
Primary Ion Channel Abnormalities in Atrial Fibrillation.......Page 692
Preexcitation Syndrome (see Chap. 39).......Page 693
Ventricular Fibrillation: Initiation and Maintenance (see Chap. 39).......Page 695
Anatomy of the Cardiac Conduction System......Page 697
Mechanisms of Arrhythmogenesis......Page 698
Physical Examination......Page 700
The Ladder Diagram......Page 702
Exercise Testing (see Chap. 14)......Page 703
Ambulatory Electrocardiographic (Holter) Recording......Page 704
Implantable Loop Recorder......Page 705
T Wave Alternans......Page 706
Upright Tilt-Table Testing......Page 708
Intraventricular Conduction Disturbance......Page 709
Sinoatrial Conduction Time.......Page 710
Tachycardia (see Chap. 39)......Page 711
Direct Cardiac Mapping: Recording Potentials Directly from the Heart......Page 712
References......Page 714
Assessment of Risk......Page 715
Clinical Competence......Page 716
Narrow- and Wide-Complex QRS Tachycardia......Page 717
Unexplained Palpitations......Page 719
Clinical Competence......Page 720
References......Page 722
Class IV......Page 723
Mechanisms of Arrhythmia Suppression (see Table 37-2).......Page 724
Pharmacogenetics (see Chap. 10).......Page 725
Proarrhythmia......Page 726
Pharmacokinetics (see Table 37-4).......Page 728
Indications.......Page 729
Indications.......Page 730
Pharmacokinetics (see Table 37-4).......Page 731
Indications.......Page 732
Beta Adrenoceptor Blocking Agents......Page 733
Pharmacokinetics (see Table 37-4).......Page 734
Hemodynamic Effects.......Page 735
Adverse Effects.......Page 736
Indications.......Page 737
Electrophysiologic Actions (see Tables 37-1, 37-2, 37-3, and 37-5).......Page 738
Indications.......Page 739
Digoxin......Page 740
Technique.......Page 741
Indications.......Page 742
Ablation Therapy for Cardiac Arrhythmias......Page 743
Location of Pathways.......Page 744
Ablation Site.......Page 745
Slow Pathway Ablation.......Page 746
Radiofrequency Catheter Ablation of Arrhythmias Related to the Sinus Node.......Page 747
Reentrant Atrial Tachycardia.......Page 748
Radiofrequency Catheter Ablation of Atrial Flutter (see Chap. 39).......Page 749
Radiofrequency Catheter Ablation of Ventricular Tachycardia.......Page 751
Location and Ablation.......Page 752
Indications......Page 753
Chemical Ablation.......Page 754
Surgical Techniques.......Page 755
Pharmacologic Therapy......Page 756
Electrotherapy......Page 757
Strength-Duration Relationship.......Page 758
Rationale for Cardiac Resynchronization Therapy.......Page 759
Intracardiac Electrogram......Page 761
Blanking and Refractory Periods.......Page 762
Sensing Thresholds.......Page 763
VT/VF Detection......Page 764
Confirmation, Redetection, and Episode Termination.......Page 765
Atrial Inhibited Pacing (AAI)......Page 766
Dual-Chamber Pacing and Sensing with Inhibition and Tracking (DDD)......Page 767
Antitachycardia Pacing......Page 768
Failure to Pace.......Page 769
Pacing at A Rate Not Consistent with the Programmed Rate.......Page 770
Oversensing......Page 771
Approach to the Patient Experiencing an ICD Shock......Page 772
Failure to Respond to Resynchronization Pacing......Page 774
Lead-Related Complications......Page 775
Follow-up......Page 776
Complications......Page 777
Acute Myocardial Infarction......Page 778
Carotid Sinus Syndrome and Neurocardiogenic Syncope......Page 779
Selection of Pacemakers......Page 780
Implantable Cardioverter-Defibrillator Therapy......Page 781
Personal and Public Safety Issues......Page 782
References......Page 783
Electrocardiographic Recognition.......Page 784
Premature Atrial Complexes......Page 787
Electrocardiographic Recognition.......Page 788
Atrial Fibrillation......Page 789
Electrocardiographic Recognition.......Page 790
Clinical Features.......Page 791
Tachycardias Involving the AV Junction......Page 793
Electrophysiologic Features.......Page 795
Prevention of Recurrences......Page 797
Electrocardiographic Recognition.......Page 798
Diagnosis of Accessory Pathways.......Page 799
Variants......Page 800
Accessory Pathway Conduction.......Page 803
Clinical Features.......Page 805
Summary of Electrocardiographic Diagnosis of Supraventricular Tachycardias......Page 808
Clinical Features.......Page 809
Electrocardiographic Recognition.......Page 811
Differentiation Between Ventricular and Supraventricular Tachycardia......Page 812
Electrophysiologic Features.......Page 813
Acute Management of Sustained Ventricular Tachycardia......Page 814
Long-Term Therapy for Prevention of Recurrences......Page 816
Arrhythmogenic Right Ventricular Cardiomyopathy.......Page 817
Brugada Syndrome.......Page 818
Electrocardiographic Recognition.......Page 819
Electrocardiographic Recognition.......Page 820
Short-QT Syndrome......Page 822
Outflow Tract Tachycardias.......Page 823
Bidirectional Ventricular Tachycardia......Page 824
Electrocardiographic Recognition.......Page 825
Electrocardiographic Recognition.......Page 826
Sinus Pause or Sinus Arrest.......Page 827
Wandering Pacemaker.......Page 828
Management.......Page 829
Electrocardiographic Recognition.......Page 830
First-Degree AV Block......Page 831
Second-Degree AV Block......Page 832
Differentiation of Type I from Type II AV Block......Page 833
Third-Degree (Complete) AV Block......Page 834
Classification.......Page 835
Supraventricular Arrhythmias......Page 836
Atrioventricular Block (Heart Block)......Page 837
Classification of Atrial Fibrillation......Page 838
Clinical Features......Page 840
Risk Stratification......Page 841
Low-Molecular-Weight Heparin......Page 842
Acute Management of Atrial Fibrillation......Page 843
Pharmacologic Rate Control......Page 844
Implanted Atrial Defibrillator......Page 845
Conventional Radiofrequency Catheter Ablation.......Page 846
Newer Ablation Tools.......Page 847
Wolff-Parkinson-White Syndrome (see Chaps. 37 and 39)......Page 848
Epidemiology......Page 849
Specific Clinical Syndromes......Page 850
Cardioversion of Atrial Fibrillation (Table 40G-3)......Page 851
Hypertrophic Cardiomyopathy......Page 852
References......Page 857
Definitions......Page 858
Incidence and the Population Burden of Sudden Cardiac Death......Page 859
Biologic and Clinical Time-Dependent Risk.......Page 860
General Profile of Sudden Cardiac Death Risk (see Chaps. 7 to 9).......Page 861
Ventricular Arrhythmias in Chronic Ischemic Heart Disease (see Chaps. 39 and 57).......Page 864
Mechanical Obstruction to Coronary Arteries.......Page 865
Ventricular Hypertrophy and Hypertrophic Cardiomyopathy (see Chaps. 69 and 83)......Page 867
Inflammatory, Infiltrative, Neoplastic, and Degenerative Diseases of the Heart.......Page 868
Congenital Heart Disease.......Page 869
Long-QT Syndromes (see Chaps. 9 and 35 to 39).......Page 870
Brugada Syndrome (see Chaps. 35 and 39).......Page 871
Other Causes and Circumstances Associated with Sudden Death......Page 872
Myocardium.......Page 873
Acute Ischemia and Initiation of Lethal Arrhythmias.......Page 874
Transition from Myocardial Instability to Lethal Arrhythmias.......Page 875
Onset of the Terminal Event......Page 876
Progression to Biologic Death......Page 877
Exercise Testing.......Page 878
Impact of Tiered Response Systems.......Page 879
Initial Assessment and Basic Life Support......Page 881
Concept of Cardiocerebral Resuscitation.......Page 882
Early Defibrillation by First Responders......Page 883
Defibrillation-Cardioversion.......Page 884
Bradyarrhythmic and Asystolic Arrest; Pulseless Electrical Activity.......Page 885
Cardiac Arrest Among in-Hospital Patients with Noncardiac Abnormalities.......Page 886
General Care.......Page 887
Ambulatory Monitoring (see Chap. 36).......Page 888
Catheter Ablation Therapy.......Page 890
Primary Prevention of SCD in Patients with Advanced Heart Disease.......Page 891
Primary Prevention in Patients with Less Advanced Common Heart Diseases or Uncommon Diseases.......Page 892
Sudden Death and Public Safety......Page 893
Epidemiology......Page 894
Clinical Characteristics of the Patient with Cardiac Arrest......Page 895
Prevention of Cardiac Arrest and Sudden Cardiac Death......Page 896
Sudden Death and Public Safety......Page 897
Classification......Page 898
Reflex-Mediated Syncope......Page 899
Cardiac Causes of Syncope......Page 900
History, Physical Examination, and Carotid Sinus Massage......Page 901
Blood Tests.......Page 902
Event Recorders.......Page 903
Electrophysiologic Testing......Page 904
Approach to the Evaluation of Patients with Syncope......Page 905
Management of Patients......Page 906
Future Perspectives......Page 907
References......Page 908
Endothelial Cells.......Page 909
Intima.......Page 911
Leukocyte Recruitment......Page 912
Focality of Lesion Formation......Page 915
Innate and Adaptive Immunity: Mechanisms of Inflammation in Atherogenesis......Page 916
Smooth Muscle Cell Death During Atherogenesis......Page 917
Arterial Stenoses and Their Clinical Implications......Page 918
Plaque Rupture and Thrombosis......Page 919
Thrombosis due to Superficial Erosion of Plaques......Page 920
Diffuse and Systemic Nature of Plaque Vulnerability and Inflammation in Atherogenesis......Page 921
Accelerated Arteriosclerosis After Transplantation......Page 922
Aneurysmal Disease......Page 923
Infection and Atherosclerosis......Page 924
Infection in Atherosclerosis......Page 925
Smoking......Page 926
Hypertension......Page 927
Hyperlipidemia and Elevated Low-Density Lipoprotein Cholesterol......Page 929
Triglyceride-Rich Lipoproteins and Cardiovascular Risk......Page 930
Metabolic Syndrome, Insulin Resistance, and Diabetes......Page 931
Exercise, Weight Loss, and Obesity......Page 933
High-Sensitivity C-Reactive Protein......Page 934
Other Markers of Inflammation......Page 938
Lipoprotein(a)......Page 939
Direct Plaque Imaging......Page 940
Novel Approaches to Global Risk Detection......Page 941
Moving Toward Evidence-Based Guidelines......Page 942
Hypertension......Page 943
Exercise, Weight Loss, and Obesity......Page 944
Future Directions: Direct Plaque Imaging......Page 945
Moving Toward Evidence-Based Guidelines......Page 946
Prevalence......Page 947
Genetic Determinants (see Chap. 8).......Page 948
Isolated Systolic Hypertension in Older Adults.......Page 949
Long-Term Sympathetic Regulation of Blood Pressure.......Page 950
Endothelial Cell Dysfunction.......Page 951
Receptor-Mediated Actions of Angiotensin II.......Page 952
Pressure Overload Hypertrophy......Page 953
White Coat Hypertension.......Page 955
Definition of High Risk......Page 956
Renal Parenchymal Disease (see Chap. 93)......Page 957
Renovascular Hypertension......Page 958
Management.......Page 959
Diagnosis.......Page 960
Therapy.......Page 961
Oral Contraceptive Use......Page 962
Chronic Hypertension.......Page 963
Pathophysiology......Page 964
Pathophysiology of Hypertension......Page 965
Complications of Hypertension......Page 966
Systolic Pressure in Older Patients......Page 967
Lifestyle Modifications......Page 968
Weight Reduction.......Page 969
Other Modalities.......Page 970
General Guidelines......Page 971
Choice of Initial Drug.......Page 972
Clinical Effects.......Page 973
Hyperuricemia......Page 974
Guanethidine.......Page 975
Mechanism of Action......Page 976
Mechanisms of Action......Page 977
Mechanism of Action......Page 978
Mechanisms of Action......Page 979
Hypertension in Older Persons.......Page 980
Coronary Artery Disease......Page 981
Therapy for Hypertensive Crises......Page 982
Pharmacologic Therapy......Page 983
Initial Evaluation......Page 984
Drug Therapy......Page 985
References......Page 986
Lipoproteins, Apolipoproteins, Receptors, and Processing Enzymes......Page 987
Intestinal Pathway (Chylomicrons to Chylomicron Remnants).......Page 990
Low-Density Lipoproteins.......Page 991
High-Density Lipoprotein and Reverse Cholesterol Transport.......Page 993
Familial Defective apo B.......Page 994
Familial Hypertriglyceridemia (Type IV Hyperlipoproteinemia).......Page 995
Familial Combined Hyperlipidemia.......Page 996
Metabolic Causes.......Page 997
Bile Acid–Binding Resins......Page 998
Fibric Acid Derivatives (Fibrates)......Page 999
Cholesteryl Ester Transfer Protein Inhibitors......Page 1000
Secondary Prevention and Acute Coronary Syndromes......Page 1001
Acute Coronary Syndromes.......Page 1002
Fibrates.......Page 1003
Approach to the Treatment of Lipoprotein Disorders......Page 1004
Treatment of Combined Lipoprotein Disorders......Page 1005
Lipoprotein Transport System and Lipoprotein Disorders......Page 1006
Future Perspectives......Page 1007
Dietary Fiber.......Page 1008
Types of Fat.......Page 1009
Polyunsaturated Fatty Acids......Page 1011
Foods......Page 1012
Dairy Products......Page 1013
Other Minerals......Page 1015
Energy Balance......Page 1016
Individual-Based Strategies.......Page 1017
Macronutrients......Page 1019
Foods......Page 1020
Further Considerations......Page 1021
Types of Evidence About Risk Factors......Page 1022
Risk Predictors and Risk Reducers......Page 1023
Assessing Individual Risk.......Page 1024
Classification of Interventions for Modifiable Risk Factors......Page 1025
Class 1 Interventions......Page 1026
Guidelines and Recommendations.......Page 1027
Guidelines and Treatment.......Page 1028
Prevalence.......Page 1029
Guidelines and Treatment.......Page 1030
Beta-Adrenergic Receptor Blockers.......Page 1031
Angiotensin-Converting Enzyme Inhibitors.......Page 1032
Benefits of Treatment.......Page 1033
Prevalence.......Page 1034
Benefit of Intervention.......Page 1035
Guidelines and Treatment.......Page 1036
Alcohol.......Page 1037
Recommendations.......Page 1038
Recommendations.......Page 1039
Step 1.......Page 1040
Special Populations (see Chaps. 80 and 81).......Page 1042
Future Challenges......Page 1043
Blood Pressure Control......Page 1045
Physical Activity......Page 1046
Implementation of Preventive Interventions......Page 1047
Ventilatory Threshold......Page 1048
Angina Pectoris......Page 1049
Cardiac Rehabilitation in Patients After PCI......Page 1050
Program Structure......Page 1051
Other Components of Comprehensive Cardiac Rehabilitation......Page 1052
References......Page 1053
Acupuncture.......Page 1054
Herbal Medicine......Page 1055
Acupuncture and Acupressure......Page 1056
Herbal Medicine......Page 1057
Hypercholesterolemia......Page 1058
Diabetes......Page 1059
Coronary Autoregulation.......Page 1060
Nitric Oxide (Endothelium-Derived Relaxing Factor)......Page 1061
Determinants of Coronary Vascular Resistance......Page 1063
Structure and Function of the Coronary Microcirculation.......Page 1064
Flow-Mediated Resistance Artery Control.......Page 1065
Adenosine......Page 1066
Sympathetic Innervation......Page 1067
Paracrine Vasoactive Mediators and Coronary Vasospasm.......Page 1068
Stenosis Pressure-Flow Relationship......Page 1069
Concept of Maximal Perfusion and Coronary Reserve......Page 1070
Relative Flow Reserve.......Page 1072
Advantages and Limitations of Coronary Flow Reserve Measurements.......Page 1073
Left Ventricular Hypertrophy.......Page 1074
Coronary Collateral Circulation......Page 1075
Regulation of Collateral Resistance......Page 1076
Reversible Ischemia and Perfusion-Contraction Matching......Page 1077
Myocardial Preconditioning and Postconditioning.......Page 1078
Chronic Hibernating Myocardium.......Page 1079
Cell Survival and Antiapoptotic Program in Response to Repetitive Is­chemia.......Page 1081
Successful Adaptation Versus Degeneration in Hibernating Myocardium.......Page 1082
Future Perspectives......Page 1083
Metabolic and Functional Consequence of Ischemia......Page 1085
Pericardial Disease......Page 1087
Gastrointestinal Conditions......Page 1088
Electrocardiography (see Chap. 13).......Page 1089
Other Markers.......Page 1090
Immediate Management......Page 1091
Imaging Tests.......Page 1095
Immediate Management......Page 1096
Limitations of Current Therapy......Page 1098
Pathology......Page 1099
Gross Pathology.......Page 1101
Coronary Anatomy and Location of Infarction.......Page 1103
Right Ventricular Infarction.......Page 1104
Nonatherosclerotic Causes of Acute Myocardial Infarction.......Page 1105
Systolic Function.......Page 1106
Infarct Expansion.......Page 1108
Reduction of Affinity of Hemoglobin for Oxygen.......Page 1109
Hemostatic Markers.......Page 1110
Differential Diagnosis.......Page 1111
Jugular Venous Pulse.......Page 1112
Serum Markers of Cardiac Damage.......Page 1113
Troponin Versus CK-MB.......Page 1114
Hematologic Findings.......Page 1116
Electrocardiography.......Page 1117
Roentgenography......Page 1118
Electrocardiography.......Page 1119
Pathophysiology......Page 1120
Clinical Features......Page 1121
Emergency Medical Services Systems.......Page 1122
Management in the Emergency Department......Page 1124
Control of Cardiac Pain......Page 1126
Dynamic Nature of Infarction......Page 1127
Routine Measures for Infarct Size Limitation......Page 1128
General Concepts.......Page 1129
Fibrinolysis......Page 1130
TIMI Frame Count......Page 1131
Effect of Fibrinolytic Therapy on Mortality.......Page 1132
Other Fibrinolytic Agents.......Page 1133
Complications of Fibrinolytic Therapy.......Page 1135
Choice of Agent......Page 1136
Selection of Reperfusion Strategy......Page 1137
Hirudin and Bivalirudin......Page 1139
Anticoagulation with Fibrinolysis.......Page 1140
Antiplatelet Therapy.......Page 1141
Combination Pharmacologic Reperfusion......Page 1142
Recommendations for Antiplatelet Therapy......Page 1143
Coronary Care Units......Page 1144
Physical Activity......Page 1145
Recommendations......Page 1146
Inhibitors of the Renin-Angiotensin-Aldosterone System (RAAS).......Page 1147
Nitrate Preparations and Mode of Administration......Page 1149
Magnesium......Page 1150
Need for Invasive Monitoring.......Page 1151
Hemodynamic Subsets......Page 1152
Therapeutic Implications.......Page 1153
Digitalis.......Page 1154
Diagnosis.......Page 1155
Recommendations.......Page 1156
Treatment.......Page 1157
Clinical Characteristics......Page 1158
Rupture of a Papillary Muscle.......Page 1160
Surgical Treatment.......Page 1161
Ventricular Premature Depolarizations.......Page 1162
Management......Page 1163
Second-Degree Atrioventricular Block......Page 1164
Complete (Third-Degree) Atrioventricular Block......Page 1165
Sinus Tachycardia.......Page 1166
Management......Page 1167
Pericarditis......Page 1168
Management.......Page 1169
Risk Stratification After STEMI......Page 1170
Initial Presentation.......Page 1171
Electrical Instability......Page 1172
Treating Depression.......Page 1173
Anticoagulants.......Page 1174
Emerging Therapies......Page 1176
Emergency Department Management......Page 1178
Reperfusion Therapy......Page 1179
Hemodynamic Disturbances......Page 1180
Other Complications......Page 1181
Initial Recognition and Evaluation in the Emergency Department......Page 1182
Complications Following Stemi......Page 1184
Convalescence, Discharge, and Post–Myocardial Infarction Care......Page 1186
References......Page 1188
Platelet Activation and Aggregation......Page 1189
Continuous Electrocardiographic Monitoring.......Page 1190
Noninvasive Testing......Page 1191
Clinical Classification......Page 1192
Natural History.......Page 1193
C-Reactive Protein and Other Markers of Inflammation (see Chaps. 44 and 49)......Page 1194
Combined Risk Assessment Scores......Page 1195
Aspirin (ASA)......Page 1196
Thienopyridines......Page 1197
Clopidogrel.......Page 1198
Prasugrel.......Page 1199
Risk Stratification to Target GP IIb/IIIa Inhibitors......Page 1200
Low-Molecular-Weight Heparin......Page 1201
Oral Anticoagulation.......Page 1202
Treatment Strategies and Interventions......Page 1203
Lipid-Lowering Therapy.......Page 1204
Long-Term Secondary Prevention After UA/NSTEMI (see Chap. 49)......Page 1205
Prinzmetal Variant Angina......Page 1206
Acetylcholine.......Page 1207
Management......Page 1208
Management......Page 1209
Prinzmetal Variant Angina......Page 1211
Hospital Care......Page 1212
Hospital Discharge and Posthospital Discharge Care......Page 1214
References......Page 1220
Characteristics of Angina.......Page 1221
Esophageal Disorders.......Page 1222
Fixed-Threshold Compared With Variable-Threshold Angina.......Page 1223
Biochemical Tests.......Page 1224
Noninvasive Stress Testing.......Page 1225
Identification of Patients at High Risk.......Page 1226
Catheterization and Coronary Arteriography......Page 1227
Exercise Electrocardiography......Page 1228
Limitations of Angiography.......Page 1229
Cigarette Smoking......Page 1230
Low level of HDL Cholesterol.......Page 1231
Clopidogrel.......Page 1232
Angiotensin-Converting Enzyme Inhibitors and Angiotensin Receptor Blockers.......Page 1233
Antithrombotic Effects.......Page 1234
Nitroglycerin Tablets......Page 1235
Beta-Adrenergic Blocking Agents.......Page 1236
Genetic Polymorphisms.......Page 1237
Antiatherogenic Action.......Page 1238
Nifedipine.......Page 1239
Verapamil.......Page 1240
Ranolazine.......Page 1242
Metabolic Agents*.......Page 1243
Approach to Patients with Chronic Stable Angina.......Page 1244
Significance of Coronary Lesions and Other Anatomic Considerations......Page 1245
Risks of the Procedure......Page 1246
Comparisons between Percutaneous Coronary Intervention and Medical Therapy.......Page 1247
Patient Selection.......Page 1248
Outcomes in Minimally Invasive Coronary Artery Bypass Grafting.......Page 1250
Patient Selection.......Page 1251
Relief of Angina......Page 1252
Patients with Depressed Left Ventricular Function.......Page 1253
Women......Page 1254
Patients Requiring Reoperation.......Page 1255
Choosing Among Percutaneous Coronary Inter­vention, Coronary Artery Bypass Grafting, and Medical Therapy.......Page 1256
Multivessel Disease......Page 1258
Transmyocardial Laser Revascularization......Page 1259
Prognosis.......Page 1260
Prognosis.......Page 1261
Ischemic Cardiomyopathy.......Page 1262
Left Ventricular Aneurysmectomy.......Page 1263
Connective Tissue Disorders.......Page 1264
References......Page 1265
Stress Imaging Studies......Page 1269
Specific Patient Subsets......Page 1270
Noninvasive Tests for Ischemia......Page 1273
Coronary Angiography......Page 1274
Pharmacologic Therapy......Page 1276
Risk Reduction......Page 1277
Revascularization......Page 1278
Patient Follow-Up......Page 1279
References......Page 1280
Indications for Percutaneous Coronary Intervention......Page 1281
Extent of Jeopardized Myocardium.......Page 1282
Underlying Cardiac Function.......Page 1283
Associated Medical Comorbidities.......Page 1285
Vascular Access Complications......Page 1287
Coronary Atherectomy......Page 1288
Embolic Protection Devices......Page 1289
Coronary Stents......Page 1290
Sirolimus-Eluting Stents.......Page 1291
Thienopyridine Derivatives.......Page 1293
Low-Molecular-Weight Heparin (see Chap. 87).......Page 1294
Myocardial Infarction......Page 1295
Angiographic Complications......Page 1296
Late Clinical Outcomes.......Page 1297
Indications for Percutaneous Coronary Intervention......Page 1298
Coronary Devices......Page 1299
Outcomes After Percutaneous Coronary Intervention......Page 1300
Clinical Presentation......Page 1301
Guidelines for Training......Page 1305
References......Page 1311
Atrial Septal Defect......Page 1312
Paravalvular Leak......Page 1313
Septal Ablation......Page 1314
Aortic Balloon Valvotomy......Page 1315
Mitral Valve Repair......Page 1316
Aortic Valve Implantation......Page 1317
Aortic Balloon Valvotomy......Page 1318
Aortic Valve Implantation......Page 1319
Microscopic Structure.......Page 1320
Pathogenesis.......Page 1321
Computed Tomography......Page 1322
Medical Therapy......Page 1323
Thoracic Aortic Aneurysms......Page 1324
Genetically Triggered Thoracic Aortic Aneurysm Diseases......Page 1325
Diagnosis.......Page 1326
Natural History.......Page 1327
Descending Thoracic Aneurysms.......Page 1328
Endovascular Repair of Thoracic Aneurysms.......Page 1329
Classification.......Page 1330
Causes and Pathogenesis.......Page 1331
Physical Findings.......Page 1332
Laboratory Findings.......Page 1334
Computed Tomography......Page 1335
Selecting an Imaging Modality......Page 1336
Blood Pressure Reduction......Page 1337
Definitive Therapy......Page 1338
Surgical Management......Page 1339
Type B Aortic Dissection.......Page 1340
Long-Term Therapy and Follow-Up.......Page 1341
Aortic Intramural Hematoma......Page 1343
Penetrating Atherosclerotic Ulcer......Page 1344
Bacterial Infections of the Aorta......Page 1345
Future Perspectives......Page 1346
Aortic Dissection......Page 1347
Primary Tumors of the Aorta......Page 1348
Risk Factors for Peripheral Artery Disease (see Chap. 44)......Page 1349
Factors Regulating Blood Supply (see Chap. 52)......Page 1350
Symptoms......Page 1351
Segmental Pressure Measurement......Page 1353
Pulse Volume Recording......Page 1354
Magnetic Resonance Angiography......Page 1355
Contrast Angiography......Page 1356
Prognosis......Page 1357
Treatment of Diabetes (see Chap. 64)......Page 1358
Antiplatelet Therapy (see Chap. 87)......Page 1359
Pharmacotherapy......Page 1360
Exercise Rehabilitation (see Chaps. 50 and 83)......Page 1361
Clinical Presentation......Page 1362
Treatment......Page 1363
Pathogenesis......Page 1364
Atheroembolism......Page 1365
Clinical Presentation......Page 1366
Clinical Presentation......Page 1367
Treatment......Page 1368
Artheroembolism......Page 1369
Secondary Prevention.......Page 1370
Secondary Prevention.......Page 1371
Primary Prevention.......Page 1372
Primary Prevention.......Page 1373
Secondary Prevention.......Page 1374
Intravenous Recombinant Tissue Plasminogen Activator......Page 1375
Anticoagulation and Antiplatelet Therapy.......Page 1376
Stroke after Percutaneous Coronary Intervention and Thrombolytic Treatment for Myocardial Infarction......Page 1377
Management of Acute Ischemic Stroke......Page 1378
Atherosclerotic Lower Extremity Disease......Page 1379
Treatment......Page 1380
Treatment......Page 1381
Treatment......Page 1383
Renal Artery Stenosis.......Page 1385
Patient Selection......Page 1388
Unilateral Renal Artery Stenosis and Nephropathy......Page 1390
Diagnosis......Page 1391
Treatment......Page 1392
Carotid Artery Disease.......Page 1394
Surgical Treatment......Page 1395
Catheter-Based Treatment......Page 1396
Treatment......Page 1398
Percutaneous Treatment......Page 1399
Atherosclerotic Lower Extremity Disease......Page 1400
Carotid and Vertebral Disease......Page 1401
Obstructive Venous Disease......Page 1402
Mechanistic Considerations Linking Diabetes and Atherosclerosis......Page 1403
Prevention of Coronary Heart Disease and Its Complications in the Setting of Diabetes......Page 1405
Fibric Acid Derivatives (Fibrates).......Page 1406
Angiotensin II Receptor Blockers.......Page 1407
Aspirin Therapy......Page 1408
Sulfonylureas.......Page 1409
Thiazolidinediones.......Page 1410
Cardiovascular Effects of Intensive Glucose Control Strategies......Page 1411
Glucose-Insulin-Potassium Therapy......Page 1412
Targeted Glucose Control......Page 1413
Glycoprotein IIb/IIIa Blockers......Page 1414
Perioperative Glucose Control......Page 1415
Ischemic Heart Disease and Hypertension.......Page 1416
Modulation of the Renin-Angiotensin-Aldosterone System.......Page 1417
General......Page 1418
Acute Coronary Syndromes and Cardiac Surgery......Page 1419
Heart Failure......Page 1420
Adult Patient.......Page 1421
Environmental.......Page 1422
Ventriculoarterial Connections.......Page 1423
Fetal Circulatory Pathways.......Page 1424
Adult.......Page 1425
Hematologic......Page 1426
Pulmonary Hypertension......Page 1427
Cardiac Catheterization.......Page 1428
Atrial Arrhythmias.......Page 1429
Williams Syndrome.......Page 1430
Criteria for Shunt Vascularity (see Fig. 16-14).......Page 1431
Segmental Approach to Echocardiography in Congenital Heart Disease.......Page 1432
Echocardiography in the Neonate and Infant.......Page 1433
Before Cardioversion.......Page 1434
Therapeutic Catheterization.......Page 1435
Adults......Page 1436
Surgery......Page 1437
Morphology.......Page 1438
Down Syndrome......Page 1439
Natural History.......Page 1440
Cardiac Catheterization.......Page 1441
Full-Term Infants, Children, and Adults......Page 1442
Follow-Up.......Page 1443
Reproductive Issues.......Page 1444
After Surgery, Palliated......Page 1445
Repaired......Page 1446
Electrocardiography.......Page 1447
Definition.......Page 1448
Pathophysiology.......Page 1449
Clinical Features.......Page 1450
Arrhythmia (see Chap. 39)......Page 1451
Arrhythmias......Page 1452
Echocardiography (Fig. 65-22).......Page 1453
Definition and Natural History.......Page 1454
Atrial Switch......Page 1455
Indications for Reintervention.......Page 1456
Arterial Switch and Rastelli Procedure......Page 1457
Indications for Intervention and Reintervention.......Page 1458
Clinical Features.......Page 1459
Natural History.......Page 1460
Interventional Options.......Page 1461
Intervention.......Page 1462
Long-term Complications......Page 1463
Complex Coarctation......Page 1464
Anomalous Origin of a Right Subclavian Artery.......Page 1465
Neonatal Presentation.......Page 1466
Complex Subaortic Stenosis.......Page 1467
Follow-Up.......Page 1468
Clinical Features.......Page 1469
Clinical Features.......Page 1470
Interventional Options and Outcomes.......Page 1471
Electrocardiography.......Page 1472
Management Options and Outcomes.......Page 1473
Clinical Features.......Page 1474
Anatomy and Embryology......Page 1475
Cyanotic Heart Disease......Page 1476
Valvular and Vascular Conditions......Page 1477
Calcific Aortic Valve Disease......Page 1478
Pathophysiology.......Page 1479
Ischemia.......Page 1481
Symptoms......Page 1482
Physical Examination.......Page 1483
Asymptomatic Patients.......Page 1484
Hemodynamic Progression......Page 1485
Adults.......Page 1486
Results.......Page 1487
Valvular Disease......Page 1488
Pathophysiology......Page 1489
Myocardial Ischemia.......Page 1490
Echocardiography.......Page 1491
Natural History of Chronic Aortic Regurgitation.......Page 1493
Medical Treatment.......Page 1494
Indications for Operation......Page 1495
Acute Aortic Regurgitation.......Page 1497
Radiography.......Page 1498
Disease Course.......Page 1499
Cause.......Page 1500
Left Ventricular Function.......Page 1501
Auscultation.......Page 1502
Radiography.......Page 1503
Systemic Embolism.......Page 1504
Percutaneous Balloon Mitral Valvotomy.......Page 1505
Closed Mitral Valvotomy.......Page 1506
Open Valvotomy.......Page 1507
Mitral Valve Replacement......Page 1508
Calcification.......Page 1509
Involvement of the Papillary Muscles.......Page 1510
Left Ventricular Compensation......Page 1511
Normal or Reduced Compliance.......Page 1512
Auscultation.......Page 1513
Radiography.......Page 1514
Disease Course......Page 1515
Surgical Treatment......Page 1516
Mitral Valve Repair Versus Replacement.......Page 1517
Asymptomatic Patients......Page 1518
Acute Mitral Regurgitation.......Page 1519
Pathology......Page 1520
Dynamic Auscultation.......Page 1521
Electrocardiography.......Page 1522
Disease Course.......Page 1523
Pathophysiology.......Page 1524
Management.......Page 1525
Causes and Pathology.......Page 1526
Echocardiography......Page 1527
Pulmonic Stenosis......Page 1528
Clinical Presentation.......Page 1529
Mitral Stenosis and Aortic Valve Disease.......Page 1530
Mechanical Prostheses......Page 1531
Stented Bioprosthetic Valves.......Page 1533
Stentless Bioprosthetic Valves.......Page 1534
Hemodynamics of Valve Replacements.......Page 1535
Pregnancy......Page 1536
Aortic Stenosis......Page 1537
Bicuspid Aortic Valve......Page 1538
Mitral Valve Prolapse......Page 1539
Aortic Stenosis......Page 1540
Cardiac Catheterization......Page 1541
Aortic Regurgitation......Page 1542
Management......Page 1543
Intraoperative Assessment......Page 1545
Patients with Prosthetic Heart Valves......Page 1546
Evaluation and Management of Coronary Artery Disease in Patients with Valvular Heart Disease......Page 1547
References......Page 1548
Adults.......Page 1550
Microbiology.......Page 1551
Pathology.......Page 1552
Enterococci......Page 1553
Pathogenesis......Page 1554
Conversion of Nonbacterial Thrombotic Endocarditis to Infective Endocarditis......Page 1555
Clinical Features......Page 1556
Diagnosis......Page 1557
Establishing the Microbial Cause......Page 1558
Antimicrobial Therapy for Specific Organisms......Page 1559
Streptococcus Pyogenes, Streptococcus Pneumoniae, and Group B, C, and G Streptococci.......Page 1560
Enterococci......Page 1561
Staphylococcal Prosthetic Valve Endocarditis.......Page 1562
Monitoring Therapy for Endocarditis.......Page 1563
Left-Sided S. aureus Endocarditis.......Page 1564
Mycotic Aneurysms and Septic Arteritis.......Page 1565
Chemoprophylaxis.......Page 1566
Pathogenesis, Clinical Features, Diagnosis......Page 1567
Prevention......Page 1568
Acknowledgment......Page 1569
References......Page 1570
Specific Causes.......Page 1571
Natural History......Page 1573
Histologic Examination.......Page 1574
Tachycardia-Induced Cardiomyopathy.......Page 1575
Inflammatory and Infectious Myocarditis.......Page 1576
Noninvasive Evaluation.......Page 1577
Biopsy.......Page 1578
Cardiac Catheterization and Endomyocardial Biopsy.......Page 1579
Laboratory Studies......Page 1580
Restrictive Cardiomyopathy.......Page 1581
Management......Page 1582
Fabry Disease......Page 1583
Clinical Manifestations.......Page 1584
Management.......Page 1585
Endomyocardial Fibrosis......Page 1586
Biventricular Endomyocardial Fibrosis.......Page 1587
Presenting Symptoms and Natural History......Page 1588
Diagnosis......Page 1589
Dilated Cardiomyopathy......Page 1590
Carcinoid Heart Disease and Arrhythmogenic Right Ventricular Dysplasia/Cardiomyopathy......Page 1591
Left Ventricular Hypertrophy (see Chaps. 15 and 18)......Page 1592
Histopathology......Page 1594
Left Ventricular Outflow Obstruction......Page 1595
Family Screening Strategies......Page 1596
Gender and Race......Page 1598
Heart Failure......Page 1599
Risk Stratification and Sudden Death......Page 1600
Atrial Fibrillation (see Fig. 69-12)......Page 1601
Alcohol Septal Ablation (see Chap. 59)......Page 1602
Future Directions......Page 1603
Management......Page 1604
Dilated Cardiomyopathy (see Chap. 68)......Page 1605
Specific Etiologic Agents......Page 1606
Influenza.......Page 1607
Trichinosis.......Page 1608
Pathophysiology......Page 1609
Innate Immunity (see Fig. 70-2)......Page 1610
Acquired Immunity......Page 1611
Diagnostic Approaches......Page 1612
Laboratory Testing......Page 1613
Histologic Evaluation.......Page 1614
Image-Guided Biopsies.......Page 1615
Prognosis......Page 1616
Immunosuppression......Page 1617
Immune Modulation......Page 1618
Pathophysiology......Page 1619
Clinical Presentation and Diagnosis......Page 1620
Pathophysiology......Page 1621
Acute Phase......Page 1624
Antitrypanosomal Drug Treatment......Page 1625
Pathophysiology......Page 1626
Clinical Manifestations and Management......Page 1627
Pathogenesis.......Page 1628
Prognosis.......Page 1630
Monitoring and Therapy.......Page 1631
Infective Endocarditis......Page 1632
Pulmonary Hypertension......Page 1633
Long-QT Interval......Page 1634
Monitoring Recommendations......Page 1635
Perinatal Transmission and Vertically Transmitted HIV Infection......Page 1637
Effects of Ethanol on Organ Function......Page 1638
Coronary Artery Disease......Page 1639
Arrhythmias......Page 1640
Cocaine-Related Myocardial Ischemia and Infarction......Page 1641
Arrhythmias......Page 1643
Serotonin Agonists......Page 1644
Arsenic......Page 1645
Serotonin Agonists......Page 1646
Environmental Exposures......Page 1647
Embolic Phenomena......Page 1648
Diagnostic Approach......Page 1649
Myxomas......Page 1650
Papillary Tumors of the Heart Valves......Page 1651
Hemangiomas and Lymphangiomas......Page 1654
Angiosarcomas......Page 1655
Leiomyosarcomas......Page 1656
Management of Primary Cardiac Tumors......Page 1657
Clinical Presentation......Page 1658
Malignant Tumors......Page 1659
Management of Primary Cardiac Tumors......Page 1660
Anatomy and Physiology of the Pericardium......Page 1661
History and Differential Diagnosis......Page 1662
Hemogram.......Page 1663
Natural History and Management......Page 1664
Pathophysiology and Hemodynamics......Page 1665
Clinical Presentation......Page 1666
Chest Radiography (see Chap. 16).......Page 1667
Echocardiography (see Chap. 15).......Page 1668
Other Imaging Modalities.......Page 1669
Effusions with Actual or Threatened Tamponade.......Page 1670
Etiology......Page 1671
Physical Examination......Page 1672
Computed Tomography and Cardiac Magnetic Resonance.......Page 1673
Differentiation of Constrictive Pericarditis from Restrictive Cardiomyopathy......Page 1674
Effusive-Constrictive Pericarditis......Page 1675
Etiology and Pathophysiology.......Page 1676
Etiology and Pathophysiology.......Page 1677
Radiation-Induced Pericarditis......Page 1678
Systemic Lupus Erythematosus.......Page 1679
Acute Pericarditis......Page 1680
Specific Causes of Pericardial Disease......Page 1681
Clinical Presentation and Pathophysiology......Page 1682
Treatment......Page 1683
Causes......Page 1684
Iatrogenic Cardiac Injury......Page 1685
Electrical Injury......Page 1686
Metabolic Cardiac Injury and Burns......Page 1687
Late Sequelae......Page 1688
Pulmonary Embolism......Page 1689
Epidemiology......Page 1690
Diagnosis......Page 1691
Massive Pulmonary Embolism.......Page 1692
Chest Computed Tomography.......Page 1694
Lung Scanning.......Page 1695
Risk Stratification......Page 1696
Unfractionated Heparin.......Page 1697
Dosing and Monitoring of Warfarin.......Page 1698
Provoked VTE (Including Cancer)......Page 1699
Fibrinolysis.......Page 1700
Massive Pulmonary Embolism.......Page 1701
Prevention......Page 1702
Epidemiology......Page 1703
Management......Page 1704
Prevention......Page 1705
Exercise.......Page 1706
Pathobiology of Pulmonary Arterial Hypertension......Page 1707
Vascular Proliferation.......Page 1708
Cellular Pathology of Pulmonary Arterial Hypertension......Page 1709
Role of Genetics in Pulmonary Arterial Hypertension......Page 1710
History......Page 1711
Laboratory Tests.......Page 1712
Chest Radiography.......Page 1713
Cardiac Magnetic Resonance Imaging.......Page 1714
Vasodilator Testing.......Page 1715
Natural History and Symptoms......Page 1716
Principles of Vasodilator Drug Treatment of Pulmonary Arterial Hypertension......Page 1717
Prostacyclins......Page 1718
Endothelin Receptor Blockers......Page 1719
Pulmonary Arterial Hypertension Associated with Congenital Heart Disease.......Page 1720
Pathology.......Page 1721
Treatment.......Page 1722
Interstitial Lung Diseases.......Page 1723
Pulmonary Hypertension Caused by Chronic Thromboembolic Disease......Page 1724
Treatment.......Page 1725
Sarcoidosis.......Page 1726
Clinical Assessment of the Patient......Page 1727
Pulmonary Hypertension with Uncertain or Multifactorial Mechanisms......Page 1728
Pathophysiologic Mechanisms Linking Obstructive Sleep Apnea to Cardiovascular Disease.......Page 1729
Obstructive Sleep Apnea and Cardiovascular Disease Associations and Outcomes.......Page 1730
Definition and Physiology.......Page 1731
Central Sleep Apnea and Cardiovascular Disease Associations and Outcomes.......Page 1732
Other Therapies.......Page 1733
Central Sleep Apnea......Page 1734
Sleep Apnea Therapy......Page 1735
Demographics and Epidemiology......Page 1736
Pathophysiology......Page 1737
Medication Therapy: Modifications for the Older Patient......Page 1738
Renal Clearance (see Chap. 93).......Page 1739
Adverse Drug Events and Drug Interactions......Page 1740
Pharmacokinetic Interactions.......Page 1741
Inappropriate Prescribing in the Elderly......Page 1742
Medicare D......Page 1743
Additional Considerations in the Older Patient with Hypertension.......Page 1744
Current Controversies.......Page 1745
Testing for Ischemia (see Chap. 53)......Page 1746
Revascularization (see Chaps. 57 and 58)......Page 1747
Current Issues in Revascularization of the Elderly.......Page 1748
Invasive Strategies......Page 1749
Transient Ischemic Attack......Page 1750
Prevention......Page 1751
Surgical and Endovascular Approaches......Page 1752
Treatment140-142.......Page 1753
Heart Failure (see Chaps. 25 to 30)......Page 1754
Heart Failure with Decreased Systolic Function (Systolic Heart Failure) (see Chap. 28).......Page 1755
Heart Failure with Normal or Preserved Left Ventricular Ejection Fraction (Diastolic Heart Failure).......Page 1756
Arrhythmias......Page 1757
Ventricular Arrhythmias......Page 1758
Management......Page 1759
Aortic Regurgitation......Page 1760
Future Directions......Page 1761
Hypertension......Page 1762
Carotid Artery Disease and Stroke......Page 1763
Arrhythmias......Page 1764
Scope of the Problem......Page 1766
Hypertension (see Chaps. 45 and 46).......Page 1767
Global Assessment of Risk Factors for Coronary Heart Disease (see Chap. 44)......Page 1768
Women in Clinical Research (see Chaps. 6 and 44).......Page 1769
Practice Guidelines to Codify Treatment Recommendations.......Page 1770
Invasive Management and Revascularization......Page 1772
Bleeding with Antithrombotic Therapy......Page 1773
Heart Failure (see Chaps. 26 to 30)......Page 1774
Peripheral Arterial Disease (see Chap. 61)......Page 1775
Specific Risk Factors in Women......Page 1776
Heart Failure in Women......Page 1777
Peripheral Arterial Disease in Women......Page 1778
During Pregnancy......Page 1779
Transthoracic Echocardiography.......Page 1780
Atrial Septal Defect.......Page 1781
Cyanotic Heart Disease.......Page 1782
Pulmonary Hypertension (see Chap. 78)......Page 1783
Unfractionated Heparin......Page 1784
Peripartum Cardiomyopathy.......Page 1785
Hypertension (see Chaps. 45 and 46)......Page 1786
Cardiovascular Drug Therapy (see Chap. 10)......Page 1787
Tubal Sterilization......Page 1788
Atrial Fibrillation......Page 1789
Supraventricular Tachycardias......Page 1790
Anticoagulation......Page 1791
References......Page 1792
Physical Activity, Exercise, and Sports......Page 1793
Risks of Exercise......Page 1794
Exercise Prescription for Health and Fitness......Page 1796
Athletes......Page 1797
Cardiomyopathy......Page 1799
Future Perspectives......Page 1800
Exercise and Cardiovascular Disease......Page 1801
Advanced Age and Gender......Page 1802
Reoperation.......Page 1803
Preoperative Drug Therapy......Page 1804
Pulmonary Disease......Page 1805
Preoperative Risk Calculation......Page 1806
The “Normal” Postoperative Convalescence......Page 1807
Postoperative Laboratory Values......Page 1808
Hypotension and Low Cardiac Output.......Page 1809
Postoperative Hypertension.......Page 1810
Atrial Fibrillation......Page 1811
Postoperative Pulmonary Morbidity......Page 1812
Postoperative Bleeding......Page 1813
Cognitive Dysfunction.......Page 1814
Reducing Risk of Postoperative Stroke and Encephalopathy.......Page 1815
Postoperative Wound Infection......Page 1816
Preoperative Risk Analysis......Page 1817
Postoperative Morbidity......Page 1818
Ischemic Heart Disease......Page 1820
Valvular Heart Disease......Page 1821
Arrhythmias......Page 1822
Decision to Undergo Diagnostic Testing......Page 1823
Tests to Improve Identification and Definition of Cardiovascular Disease......Page 1824
Intraoperative Hemodynamics and Myocardial Ischemia......Page 1826
Surveillance and Implications of Perioperative Cardiac Complications......Page 1827
Surgical Revascularization......Page 1828
Beta-Adrenergic Blocking Agents.......Page 1829
Nitroglycerin.......Page 1831
Anesthesia and Postoperative Management......Page 1832
Risk Reduction Interventions......Page 1833
References......Page 1837
Cardiovascular Manifestations of Acromegaly......Page 1838
Adrenocorticotropic Hormone and Cortisol......Page 1839
Cushing Disease......Page 1840
Treatment.......Page 1841
Thyroid Gland......Page 1842
Cellular Mechanisms of Thyroid Hormone Action on the Heart......Page 1843
Hemodynamic Alterations in Thyroid Disease......Page 1844
Atrial Fibrillation.......Page 1845
Heart Failure in Thyroid Disease.......Page 1846
Diagnosis.......Page 1847
Amiodarone and Thyroid Function (see Chap. 37)......Page 1848
Changes in Thyroid Hormone Metabolism That Accompany Cardiac Disease......Page 1849
Future Perspectives......Page 1850
Thyroid Disease......Page 1851
Pheochromocytoma......Page 1852
Platelet Inhibition.......Page 1853
Adhesion.......Page 1854
Coagulation......Page 1855
Fibrin Formation.......Page 1856
Mechanism of Action of Tissue Plasminogen Activator.......Page 1857
Arterial Thrombosis......Page 1858
Factor V Leiden......Page 1859
Surgery and Immobilization......Page 1860
Sex Hormone Therapy......Page 1861
Mechanism of Action......Page 1862
Indications......Page 1863
Side Effects.......Page 1864
Anticoagulants......Page 1865
Pharmacology of Heparin......Page 1866
Thrombocytopenia.......Page 1867
Pharmacology of Low-Molecular-Weight Heparin......Page 1868
Lepirudin.......Page 1869
Pharmacology of Warfarin.......Page 1870
Dosing......Page 1871
New Oral Anticoagulants......Page 1872
Alteplase.......Page 1873
Conclusions and Future Directions......Page 1874
Anticoagulants......Page 1875
Fibrinolytic Drugs......Page 1876
Pathobiology......Page 1877
Jones Criteria (Fig. 88-2)......Page 1878
Carditis......Page 1879
Arthritis......Page 1880
Treatment......Page 1881
Carditis.......Page 1882
Epidemiology......Page 1883
Treatment......Page 1884
Pathogenesis.......Page 1885
Treatment.......Page 1886
Pathogenesis.......Page 1887
Pathogenesis.......Page 1888
Clinical Features.......Page 1889
Differential Diagnosis.......Page 1890
Treatment.......Page 1891
Clinical Features.......Page 1892
Treatment.......Page 1893
Clinical Features.......Page 1894
Treatment.......Page 1895
Clinical Features.......Page 1896
Sarcoidosis......Page 1897
Treatment.......Page 1898
Nonsteroidal Anti-Inflammatory Drugs and the Risk of Cardiovascular Disease......Page 1899
Sarcoidosis......Page 1900
Cardiac Tamponade.......Page 1902
Causative Factors.......Page 1903
Ischemic Heart Disease......Page 1904
Taxanes.......Page 1905
Alkylating Agents and Antimetabolites.......Page 1906
Targeted Therapeutics......Page 1907
HER2 Receptor and Its Antagonists: Trastuzumab, Lapatinib, and Pertuzumab......Page 1908
Epidermal Growth Factor Receptor Antagonists......Page 1909
Coronary Artery Disease.......Page 1910
Cardiovascular Complications of Cancer Therapeutic Agents......Page 1911
Cardiovascular Complications of Radiation Therapy......Page 1912
Psychological and Psychiatric Conditions in the Cardiac Patient......Page 1913
Mental Stress......Page 1914
Work Stress......Page 1915
General Stress......Page 1916
Anxiety......Page 1917
Tricyclic Antidepressants.......Page 1918
Selective Serotonin Reuptake Inhibitors.......Page 1919
Antipsychotics......Page 1920
Medications with Other Actions.......Page 1921
Exercise......Page 1922
Chronic Stress......Page 1923
Alternative Medicines, Herbs, and Supplements......Page 1924
Cardiovascular Manifestations.......Page 1925
Arrhythmias......Page 1926
Treatment and Prognosis.......Page 1927
Echocardiography.......Page 1928
Treatment and Prognosis.......Page 1929
Clinical Presentation.......Page 1930
Treatment and Prognosis.......Page 1932
Clinical Presentation.......Page 1933
Treatment and Prognosis.......Page 1934
Cardiovascular Manifestations.......Page 1935
Clinical Presentation.......Page 1936
Cardiovascular Manifestations.......Page 1937
Clinical Presentation.......Page 1938
Cardiovascular Manifestations.......Page 1939
Future Perspectives......Page 1940
Acute Cerebrovascular Disease......Page 1942
Chronic Kidney Disease as a Cardiovascular Risk State......Page 1943
Implications of Anemia Caused by Chronic Kidney Disease......Page 1944
Prevention of Contrast-Induced Acute Kidney Injury (see Chap. 20)......Page 1946
Acceleration of Vascular Calcification......Page 1949
Diagnosis in Patients with Chronic Kidney Disease......Page 1950
Treatment in Patients with Renal Dysfunction......Page 1951
Complicating Heart Failure......Page 1952
Consultative Approach to the Hemodialysis Patient......Page 1954
Summary......Page 1955
Percutaneous Coronary Interventions and Contrast-Induced Acute Kidney Injury......Page 1956
Consultative Approach to the Hemodialysis Patient......Page 1957
Cardiopulmonary Baroreceptors......Page 1958
Orthostatics......Page 1959
Heart Rate Recovery.......Page 1960
Diagnosis and Therapy.......Page 1961
Orthostatic Intolerance......Page 1962
Neurally Mediated Syncope......Page 1963
Norepinephrine Transporter Deficiency......Page 1964
Right Coronary Thrombolysis......Page 1965
Disorders of Increased Sympathetic Outflow......Page 1966
Congestive Heart Failure......Page 1967
Pheochromocytoma......Page 1968
Autonomic Dysregulation......Page 1969
Future Perspectives......Page 1970
Dedication......Page 1971
Preface to the Ninth Edition......Page 1972
Look for these other titles in the Braunwald’s Heart Disease Family......Page 1974
Institution and Company Codes......Page 1975
Contributors......Page 1976
A......Page 1978
B......Page 1985
C......Page 1987
D......Page 1995
E......Page 1997
G......Page 2002
H......Page 2003
I......Page 2008
L......Page 2009
M......Page 2010
N......Page 2015
P......Page 2017
R......Page 2022
S......Page 2024
T......Page 2027
V......Page 2030
W......Page 2032
Z......Page 2033
Front Matter......Page 1
Copyright......Page 2
Dedication......Page 3
Dedication......Page 4
Contributors......Page 6
Preface to the Ninth Edition......Page 13
Preface—Adapted from the First Edition......Page 15
Acknowledgments......Page 5
Look for these other titles in the Braunwald’s Heart Disease Family......Page 2034