PRACTICAL CARDIOLOGY : evaluation and treatment of common.

Contents
Contributors
1: Chest Pain
	Definition and Scope of Problem
	Principal Causes
		History
			Cardiac
			Pericarditis
			Aortic Dissection
			Pulmonary Embolus (PE)
			Gastrointestinal Pathology
			Musculoskeletal Etiologies
	Physical Examination
	Diagnostic Testing
		Acute Coronary Syndromes
		Aortic Dissection
		Pulmonary Embolism
		Stable Angina
		Pericarditis
		Gastroesophageal Reflux Disease and Esophageal Spasm
		Musculoskeletal Disorders
		Valvular Heart Disease and Hypertrophic Cardiomyopathy
	Initial Management Scheme
	References
2: Dyspnea
	Definition
	Usual Causes
		Impaired Cardiovascular Function
		Impaired Pulmonary Function
		Altered Central Ventilatory Drive or Perception
	Keys to History
	Physical Examination
	Helpful Diagnostic Tests
		Blood Testing
			Chest Radiography
			Further Diagnostic Testing
		High Suspicion for Cardiovascular Disease
		Other Patients
			Subsequent Diagnostic Testing
			Cardiopulmonary Exercise Testing (CPET)
	When to Refer?
	Conclusion
	References
3: Palpitations
	Definitions
	Principal Causes
	Keys to the History
		Characterization of the Palpitations
		Cardiac History
		Arrhythmia History
		Family History
		Possible Endocrine Disorders
	Helpful Signs on Physical Examination
	Diagnostic Tests
		The Resting Electrocardiogram
		Echocardiography
		Exercise Testing
		24-H Ambulatory Electrocardiographic (Holter) Recording
		Event Monitor ECG
		Electrophysiologic Testing
		Implantable Loop Recorder
		Holter/Event Monitor Data: Interpretational Issues
			Arrhythmia-Symptom Correlation
			Premature Ventricular Complexes
			Sinus Tachycardia
	Management Considerations
	References
4: Edema
	Definitions
	Principles of Edema Formation (Starling Forces)
	Keys to the Clinical Evaluation
		Distribution
		Drugs Associated with Edema
		Helpful Signs on Physical Examination
		Diagnostic Tests
	Treatment
	When to Refer
	When to Admit
	References
5: Syncope
	Definition
	Principal Causes (Table 5.1)
		Neurally Mediated Syncope
		Orthostatic Syncope
		Cardiac Syncope
		Metabolic Disturbance
		Neurologic Disease
		Psychiatric Disorder
		Unexplained Etiology
	Keys to the History
		Circumstances Surrounding Onset
		Posture at the Onset of Attack
		Differentiating Syncope from Seizures
		Age at Onset
		Other Historical Clues
		Drugs
		Pregnancy
	Helpful Signs on Physical Examination
	Diagnostic Tests
	When to Admit, When to Refer, and to Whom
	Syncope and Driving
	Conclusions
	References
6: Primary Prevention of Coronary Artery Disease
	Pathobiology of Atherosclerosis
	Risk Factors and Risk Markers
	Risk Stratification
	Risk Markers
		C-Reactive Protein
		ABI
		Coronary Artery Calcium Score (CAC)
	Risk Factor Modification
		Smoking
		Lipids and Lipid Management Guidelines
		Hypertension
		Diabetes Mellitus
		Other Considerations
		Aspirin
		Postmenopausal Estrogens
	Diet and Nutrient Supplements
		Nutrition
			Vitamins
			Alcohol and Coronary Risk
	Summary
	References
7: Secondary Prevention of Coronary Artery Disease
	Introduction
	Rationale for Secondary Coronary Prevention
	Clinical Risk Stratification
	Evidence-Based Secondary Prevention Strategies (Table 7.1)
		Antiplatelet Agents
		Anticoagulants
		ß-Adrenergic Blockers
		Renin Angiotensin Aldosterone System Blockers
	Lipid Management
	Preventive Cardiology Services
	Hypertension
	Physical Activity
	Smoking Cessation
	Diet
	Weight Reduction
	Diabetes Management
	Influenza
	Psychosocial
	Hormone Replacement Therapy
	Summary
	References
8: Stable Angina
	Usual Causes
	Presenting Symptoms and Signs
	Pathophysiology
	Helpful Tests
		American College of Cardiology/American Heart Association Guideline Classification
		Electrocardiography
		Echocardiography
		Computed Tomography
		Noninvasive Stress Testing
		Cardiac Catheterization and Coronary Angiography
	Differential Diagnosis
	Complications
	Therapy
		Pharmacologic Therapy
			Anti-anginal Agents
				Nitrates
				Beta Blockers
				Calcium Channel Blockers
				Ranolazine (Ranexa)
			Antiplatelet Agents
				Aspirin
				Clopidogrel
			Lipid-Lowering Agents
				Statins
				Fibrates
			Angiotensin-Converting Enzyme Inhibitors
			Antioxidants
		Revascularization
			Coronary Artery Bypass Surgery
			Percutaneous Coronary Intervention
			Percutaneous Transluminal Coronary Angioplasty versus Coronary Artery Bypass Graft
			Stent versus Coronary Artery Bypass Graft Trials
			Percutaneous Coronary Intervention versus Coronary Artery Bypass Graft inDiabetics
		Refractory Myocardial Ischemia
			Education and Exercise
	Prognosis and Follow-Up
	References
9: Unstable Angina/Non-ST Elevation Myocardial Infarction
	Usual Causes
	Presenting Signs and Symptoms
	Helpful Tests
		Electrocardiography
		Biochemical Markers
		Noninvasive Testing
		Cardiac Catheterization
	Complications
	Differential Diagnosis
	Therapy
		General Measures
		Anti-ischemic Agents (Table 9.8)
			Nitrates
			Beta-Blockers
			Calcium Channel Blockers
		Anti-platelet Therapy (Table 9.9)
			Aspirin
			Adenosine-Diphosphate Receptor Inhibitors
			Glycoprotein IIb/IIIa Inhibitors
		Anticoagulation (Table 9.9)
			Unfractionated Heparin
			Low Molecular Weight Heparin
			Direct Thrombin Inhibitors
			Factor Xa Inhibitors
		Coronary Revascularization
	Prognosis and Follow-Up
	References
10: Acute ST Elevation Myocardial Infarction
	Usual Causes
	Presenting Symptoms and Signs
		History
		Physical Examination
	Helpful Tests
		Electrocardiography
		Cardiac Markers
		Echocardiography
	Differential Diagnosis
		Pericarditis
		Myocarditis
		Aortic Dissection
		Hypertrophic Cardiomyopathy
		Pulmonary Embolism
		Cholecystitis
		Costochondritis
	Complications
		Mechanical
			Cardiac Rupture
			Mitral Regurgitation
			Left Ventricular Failure and Cardiogenic Shock
			Right Ventricular Failure
			Left Ventricular Aneurysm
		Early Electrical Complications of Acute Myocardial Infarction
		Ischemic Complications of Acute Myocardial Infarction
		Embolic Complications of Acute Myocardial Infarction
		Pericarditis
	Therapy
		Reperfusion Therapy
		Adjunctive Pharmacotherapy
			Antiplatelet
			Anticoagulation
			Other Pharmacotherapy
		Evolving Therapy
	Prognosis
	Follow-Up
	References
11: Primary Hypertension
	Definition/Differential Diagnosis
	Usual Causes of Hypertension
		Heredity
		Environmental Factors
			Obesity
			Salt
			Stress
			Alcohol
	Helpful Tests/Presenting Symptoms and Signs
	Clinical Management
		At What Threshold Should Drug Therapy Be Initiated?
		Will Specific Antihypertensive Medications Provide CV Benefits Beyond Lowering Blood Pressure Alone?
		Trials That Assess the Impact of Aggressive Blood Pressure Control
	Summary
	References
12: Approach to Secondary Hypertension
	General Clinical Approach
		Verify Accuracy of Measurements
		Determine Whether Seeming Resistant Hypertension Is Attributable to the “White Coat” Effect
		Evaluate for Pseudohypertension
		Assure Medical Adherence
	Exogenous Drug Use
	Renal Parenchymal Disease
	Renal Artery Stenosis
	Adrenal Disease
		Primary Aldosteronism
		Pheochromocytoma
		Cushing’s Syndrome
	Thyroid and Parathyroid Abnormalities
	Obstructive Sleep Apnea
	Aortic Coarctation
	Conclusions
	References
13: Heart Failure due to Left Ventricular Systolic Dysfunction
	Usual Causes
		Specific Etiologies
			Ischemia
			Infections
			Toxins
			Alcoholic Cardiomyopathy
			Athracycline and Anti-cancer Related Cardiomyopathy
			Hereditary Influences
			Idiopathic Causes
	Biologic Mechanisms and Disease Progression
		Renin-Angiotensin-Aldosterone System
		Sympathetic Nervous System
		Natriuretic Peptides
		Endothelin
		Arginine Vasopressin
	Presenting Symptoms and Signs
		New York Heart Association Classification
		American College of Cardiology/American Heart Association Stages of Heart Failure
	Clinical Features and Laboratory Tests
		History
		Physical Examination
			General Appearance
			Pulse and Blood Pressure
			Venous System
			Lungs
			Cardiac Findings
		Evaluative Testing
			Electrocardiography
			Chest Radiography
			Exercise Testing
			Echocardiography and Radionuclide Ventriculography
			Magnetic Resonance Imaging
			Coronary Arteriography and CT Angiography
			Right-Sided Heart Catheterization
			Endomyocardial Biopsy
		Laboratory Testing
	Differential Diagnosis
	Complications
	Therapy for Heart Failure due to Left Ventricular Systolic Dysfunction
		Diet and Lifestyle Issues
		Exercise
		Specific Drug Classes
			Diuretics
			Digoxin
			Renin-Angiotensin System Suppression
			Aldosterone Blockade
			Direct Vasodilators
			Sympathetic Nervous System Blockade
			Calcium Channel Antagonists
			Inotropic Therapy
		Implantable Cardiac Defibrillators
		Cardiac Resynchronization Therapy (CRT)
		Surgical Therapy
		Cardiac Transplantation
		Mechanical Circulatory Support
		Prognosis
	Follow-Up and Disease Management Systems
	Recommendations for End-of-Life Planning
	References
14: Paroxysmal Supraventricular Tachycardia
	Usual Causes and Mechanisms of Supraventricular Tachycardia
		Atrioventricular Nodal Reentrant Tachycardia
		Atrioventricular Reentrant Tachycardia (AVRT)
		Atrial Tachycardia
	Presenting Symptoms and Signs
	Helpful Diagnostic Tests and Differential Diagnosis
	Therapy
		Acute Management
		Long-Term Therapy
	References
15: Atrial Fibrillation and Atrial Flutter
	Usual Causes
	Signs and Symptoms
	Helpful Tests
	Complications
	Therapy
	Rhythm-Control Versus Rate-Control
	Prognosis
	Follow-Up
	References
16: Ventricular Tachycardia
	Usual Causes
	Presenting Symptoms and Signs
	Helpful Tests
	Differential Diagnosis
		Monomorphic Ventricular Tachycardia
		Ventricular Fibrillation
	Complications
	Therapy
		Long-Term Management
	Prognosis and Follow-Up
	References
17: Bradycardia
	Usual Causes of Bradycardia
	Presenting Symptoms and Signs
	Helpful Tests
	Differential Diagnosis
		Sinus Node Dysfunction
		Sinus Bradycardia
		Sinus Pause
		Chronotropic Incompetence
		Atrioventricular Conduction Disturbances
		First-Degree Atrioventricular Block
		Second-Degree Atrioventricular Block
		Complete Atrioventricular Block
		Escape Rhythms
	Complications
	Therapy
		Acute Management
		Long-Term Management
	Prognosis and Follow-Up
	References
18: Infective Endocarditis
	Definition
	Usual Causes
	Types of Endocarditis
		Acute Endocarditis
		Subacute Endocarditis
		Prosthetic Valve Endocarditis
		Clinical Features of Infective Endocarditis
			Symptoms
			Signs
	Helpful Tests
		Diagnosis
	Therapy
		Pharmacologic Therapy
	Prophylaxis
	References
19: Mitral Regurgitation
	Usual Causes
		Chronic Mitral Regurgitation
		Acute Mitral Regurgitation
	Presenting Symptoms and Signs
		Symptoms
		Signs
		Mitral Valve Prolapse Syndrome
	Helpful Tests
	Differential Diagnosis
	Complications
	Therapy
		Medical Therapy
		Surgical Intervention
	Prognosis
	Follow-Up
	References
20: Aortic Regurgitation
	Usual Causes
		Chronic Aortic Regurgitation
		Acute Aortic Regurgitation
	Presenting Symptoms and Signs
		Symptoms
		Signs
	Helpful Tests
	Differential Diagnosis
	Complications
	Therapy
		Medical Therapy
		Aortic Valve Replacement
	Prognosis
	Follow-Up
	References
21: Mitral Stenosis
	Usual Causes
	Presenting Signs and Symptoms
	Helpful Tests
	Differential Diagnosis
	Complications
	Therapy
		Medical Therapy
		Valvuloplasty
		Surgery
	Management Decision Making
		Asymptomatic Patients
			Very Severe Mitral Stenosis
			Severe Mitral Stenosis
		Symptomatic Patients
			Severe Mitral Stenosis
			Moderate Mitral Stenosis
			Non-rheumatic Valve Disease
	Prognosis
	References
22: Aortic Stenosis
	Definition
	Usual Causes
	Symptoms
	Signs
	Helpful Tests
		Electrocardiogram
		Chest Radiograph
		Echocardiography
		Exercise Testing
		Cardiac Catheterization
	Differential Diagnosis
		Aortic Sclerosis
		Flow Murmur of Pregnancy; Anemia; and Thyrotoxicosis
		Mitral Regurgitation
		Hypertrophic Cardiomyopathy
		Ventricular Septal Defect
	Therapy
		Lifestyle
		Pharmacologic Treatment
		Aortic Valve Replacement
		Balloon Valvuloplasty
		Percutaneous Aortic Valve Replacement
	Prognosis and Follow-Up
	References
23: Tricuspid/Pulmonary Valve Disease
	Usual Causes
		Tricuspid Valve
		Pulmonic Valve
	Presenting Symptoms and Signs
		Tricuspid Valve
		Pulmonic Valve
	Helpful Tests
	Differential Diagnosis
		Tricuspid Stenosis
		Tricuspid Regurgitation
		Pulmonic Stenosis
		Pulmonic Regurgitation
	Complications
	Therapy
		Tricuspid Stenosis
		Tricuspid Regurgitation
		Pulmonic Stenosis
		Pulmonic Regurgitation
	Prognosis and Follow-Up
		Tricuspid Valve
		Pulmonic Valve
	References
24: Acute Pericarditis/Pericardial Effusion
	Acute Pericarditis
		Definition
		Usual Causes
		Symptoms
		Signs
		Helpful Tests
			Electrocardiogram
			Chest Radiograph
			Echocardiography
			Biomarkers and Other Blood Tests
		Differential Diagnosis
			Acute Coronary Syndrome
			Acute Pleurisy
		Therapy
			Hospital Admission
			Pharmacologic Treatment
			Pericardiocentesis
			Pericardiectomy
		Clinical Course
	Pericardial Effusion
		Definition
		Usual Causes
		Symptoms
		Signs
		Helpful Tests
			Electrocardiogram
			Chest Radiograph
			Echocardiography
		Cardiac Tamponade
			Definition
		Therapy
			Needle Pericardiocentesis
			Surgical Pericardiocentesis
			Recurrent Pericardial Effusions
	References
25: Pericardial Constriction
	Usual Causes
	Presenting Symptoms and Signs
	Helpful Tests
	Differential Diagnosis
	Complications
	Therapy
	Prognosis and Follow-Up
	References
26: Abdominal Aortic Aneurysms
	Etiology and Pathogenesis
	Treatment
	Surgical Treatment
		Conventional Surgical Treatment of Intact AAA
		Conventional Surgical Treatment of Ruptured AAA
		Complications after Open Repair of AAA
		Endovascular Repair of AAA (EVAR): Intact AAA
	EVAR Versus Open Repair: Comparision of Outcomes
	Follow Up After Treatment of AAA
	Summary
	References
27: Acute Aortic Dissection
	Usual Causes
	Presenting Symptoms and Signs
	Helpful Tests
	Differential Diagnosis
	Complications
	Therapy
		Initial Medical Therapy
		Surgical Therapy
		Endovascular Therapy
	Prognosis
	Follow-Up
	References
28: Lower Extremity Ischemia
	Epidemiology and Usual Causes
	Presenting Symptoms and Signs
	Helpful Tests
	Therapy
		Risk Factor Modification/Medical Therapy
			Exercise Rehabilitation
			Smoking Cessation
			Weight Loss
			Glycemic Control
			Treatment of Hyperlipidemia
			Hypertension Control
			Correction of Hyperhomocystinemia
		Pharmacotherapy for Claudication
			Cilostazol
			Pentoxifylline
		Agents Under Investigation
			Carnitine
			l-Arginine
		Surgical and Endovascular Therapy
	Prognosis/Outcomes
	Follow-Up
	References
29: Pulmonary Embolism
	Epidemiology and Usual Causes
	Presenting Signs and Symptoms
		Clinical Model
		D-Dimer
		Clinical Model and D-Dimer
	Imaging Studies
		Contrast-Enhanced Spiral Computed Tomography (CT)
		Ventilation/Perfusion Lung Scanning
		Lower Extremity Studies
		Pulmonary Angiography
		Magnetic Resonance Imaging
		Echocardiography and Biomarkers
		Nonspecific Tests
	A Recommended Diagnostic Algorithm
		Alternative or Additional Testing
		Special Circumstances
	Differential Diagnosis
	Therapy
		Low Molecular Weight Heparin (LMWH)
		Unfractionated Heparin (UFH)
		Oral Anticoagulants
		Novel Oral Anticoagulant Drugs
		Thrombolytic Agents
		Inferior Vena Caval Interruption
			Inferior Cava Interruption
		Pulmonary Embolectomy and Transvenous Catheter Extraction
	Prevention of Venous Thromboembolism
	Recurrence
	References
30: Pulmonary Hypertension
	Introduction
	Common Signs and Symptoms in PH
	Classification of PH and Associated Triggers
	Algorithm for Assessment and Diagnosis of PH
	Testing to Determinate Appropriate Diagnosis in PH
		Electrocardiogram
		Chest Radiograph
		Echocardiography
		Right Heart Catheterization (RHC)
		Computed Tomography and the Ventilation/Perfusion Lung Scan
		Cardiac Magnetic Resonance (CMR)
		Serologic and Hepatic Function Studies
		Pulmonary Function Studies (PFTs) and Arterial Blood Gas Measurements
		Functional Capacity Assessment
		Lung Biopsy
	Pulmonary Arterial Hypertension
		Therapy for Pulmonary Arterial Hypertension
		Endothelin Antagonists (ERA)
		Phosphodiesterase-5 Inhibitors (PDE5)
		Soluble Guanylate Cyclase (sGC) Stimulator
		Prostacyclins
		Combination Therapy for Pulmonary Artery Hypertension
		Treatment of Refractory Pulmonary Artery Hypertension
	References
31: Simple Congenital Cardiac Lesions
	Atrial Septal Defect
	Presenting Symptoms and Signs
	Helpful Tests
		Differential Diagnosis
	Complications
	Therapy
	Prognosis and Follow-Up
	Ventricular Septal Defect
	Presenting Symptoms and Signs
	Helpful Tests
	Differential Diagnosis
	Complications
		Therapy
	Prognosis and Follow-Up
	Coarctation of the Aorta
		Presenting Symptoms and Signs
		Helpful Tests
		Differential Diagnosis
		Complications
		Therapy
		Prognosis and Follow-Up
	Patent Ductus Arteriosus
		Presenting Symptoms and Signs
		Helpful Tests
		Differential Diagnosis
		Complications
		Therapy
		Prognosis and Follow-Up
	References
32: Complex Congenital Lesions
	Tetralogy of Fallot
	Presenting Symptoms and Signs
	Helpful Tests
	Differential Diagnosis
	Complications
	Therapy
	Prognosis and Follow-Up
	Transposition of the Great Arteries
	Presenting Symptoms and Signs
		Senning and Mustard Procedures
		Arterial Switch Procedures
	Helpful Tests
		Senning and Mustard Procedures
		Arterial Switch Procedures
	Differential Diagnosis
	Complications
	Therapy
	Prognosis and Follow-Up
	Single Ventricle Lesions and the Fontan Procedure
	Presenting Symptoms and Signs
	Helpful Tests
	Differential Diagnosis
	Complications
	Therapy
	Prognosis and Follow-Up
	References
33: Perioperative Evaluation and Management of Patients Undergoing Noncardiac Surgery
	Definitions of Urgency and Risk
	Risk Prediction
	Assessing Perioperative Cardiac Risk for Patients Undergoing Noncardiac Surgery [4, 8]
		Is Noncardiac Surgery Emergently Required?
		Does the Patient Have Acute Coronary Syndrome?
		What Is the Perioperative Risk of MACE?
		Is Further Testing Required If the Risk of MACE Is Elevated (>1%)?
			Functional Capacity
		Is Non-invasive Cardiac Testing Necessary?
			Evidence Based Indications for Non-invasive Cardiac Testing in Perioperative Assessment
				Electrocardiogram
				Echocardiogram
				Exercise Testing
			Pharmacologic Stress Test
			Myocardial Perfusion Imaging
			Dobutamine Stress Echocardiography
			Preoperative Coronary Angiography for Risk Stratification
		Is There a Benefit for Preoperative Coronary Revascularization
			Timing of Elective Noncardiac Surgery in Patients with PCI
		What Additional Preoperative, Intraoperative, and Postoperative Risk Modification Strategies?
			Role of Medical Therapy
				Beta Adrenergic Antagonists
				Alpha-2 Adrenergic Agonists
				HMG-CoA Reductase Inhibitors (Statins)
				Calcium Channel Blockers
				Angiotensin-Converting Enzyme (ACE) Inhibitors
				Antiplatelet Agents
				Oral Anticoagulant Agents
			Other Strategies for Reducing Perioperative Risk
				Anesthetic Strategies and IntraoperativeManagement
				Perioperative Anemia Management
			Monitoring for Perioperative Myocardial Infarction
	Noncardiac Surgery in Patients with Specific Cardiovascular Conditions
		Valvular Heart Disease
		Arrhythmias and Conduction Defect
		Cardiac Implantable Electronic Devices
		Congestive Heart Failure and Left Ventricular Dysfunction
		Pulmonary Hypertension
		Hypertrophic Cardiomyopathy
		Congenital Heart Disease
	References
34: Complementary and Alternative Medicine
	Classification of Complementary And Alternative Medical Therapies
		Alternative Medical Systems
		Mind-Body Interventions
		Manipulative and Body-Based Methods
		Energy Therapies
		Biologically Based Treatments
	Acupuncture
	Herbal Remedies
		Garlic
		Soy Protein
		Cholestin (Red Rice Yeast)
		Guggulipid (Guggul Gum)
		Ginkgo Biloba
		Hawthorn (Crataegus)
		Ginger
		Curcumin (Turmeric)
		Arjuna
		Grape Seed Extract
		Green Tea
		Spirulina
		Raw Cacao
		Camu Camu
	Orthomolecular Therapies
		Coenzyme Q-10 (Ubiquinone)
		Vitamin D
		Vitamin K2
		Vitamin E
		Vitamin C
		Vitamin A and Carotenoids
		Lutein
		Folic Acid
		Astaxanthin
		Magnesium
		Probiotics
	Chelation Therapy
	Fish Oil
	Adverse Effects of Herbal Supplements and Orthomolecular Therapies Commonly Used in Cardiovascular Cases
	Conclusion
	References
35: Cardio-Oncology
	Cardiotoxicity from Cancer Treatment Drugs
	Cardiomyopathy and Heart Failure
		Anthracycline/Anthraquinolones
		Tyrosine Kinase Inhibitors
		Alkylating Agents
		Monoclonal Antibody Tyrosine Kinase Inhibitors
	Myocardial Ischemia
		Antimetabolites
		Antimicrotubule Agents
	Hypertension
		Monoclonal Antibody Based Tyrosine Kinase Inhibitor
		Small Molecule Tyrosine Kinase Inhibitor
		Alkylating Agents
	Hypotension
		Cytokines
		Miscellaneous
		Monoclonal Antibody
	Arrhythmias
	QTc Prolongation
	References
Index