Practical Cardiovascular Medicine

Cover
Title Page
Copyright Page
Contents
Preface
Abbreviations
About the Companion Website
PART 1. Coronary Artery Disease
	Chapter 1. Non-ST-Segment Elevation Acute Coronary Syndrome
		I. Definition, types of myocardial infarction, and pitfalls
		II. Clinical features, ECG, cardiac biomarkers, and echocardiography in ACS
		III. Initial approach to acute chest pain presentations and the use of conventional and high-sensitivity troponins
		IV. Management of NSTEMI
		V. General procedural management after coronary angiography: PCI, CABG, or medical therapy only
		VI. Discharge medications in NSTEMI
		VII. Prognosis
		Appendix 1. Complex angiographic disease-Moderate disease progression
		Appendix 2. Women and ACS, elderly patients and ACS, CKD
		Appendix 3. Bleeding, transfusion, patients on chronic warfarin or NOAC, gastrointestinal bleed
		Appendix 4. Antiplatelet and anticoagulant therapy
		Appendix 5. Difference between plaque rupture and plaque erosion
		Appendix 6. Spontaneous coronary artery dissection
		Appendix 7. Harmful effects of NSAIDs and cyclooxygenase-2 inhibitors in CAD
		Appendix 8. Additional ideas on the physiology of hs-troponin-Role of hs-troponin in primary prevention
		Questions and answers
	Chapter 2. ST-Segment Elevation Myocardial Infarction
		1. Definition, reperfusion, and general management
			I. Definition
			II. Timing of reperfusion
			III. ECG phases of STEMI
			IV. STEMI diagnostic tips and clinical vignettes
			V. Specific case of new or presumably new LBBB
			VI. Reperfusion strategies: fibrinolytics, primary PCI, and combined fibrinolytics?PCI
			VII. Coronary angiography and PCI later than 24 hours after presentation-role of stress testing
			VIII. Angiographic findings, PCI, and cellular reperfusion; multivessel disease in STEMI
			IX. Antithrombotic therapies in STEMI
			X. Other acute therapies
			XI. Risk stratification
			XII. LV remodeling and infarct expansion after MI
			XIII. Discharge, EF improvement, ICD
		2. Stemi Complications
			I. Cardiogenic shock
			II. Mechanical complications
			III. Recurrent infarction and ischemia
			IV. Tachyarrhythmias
			V. Bradyarrhythmias, bundle branch blocks, fascicular blocks
			VI. LV aneurysm and LV pseudoaneurysm
			VII. Pericardial complications
			VIII. LV thrombus and thromboembolic complications
			IX. Early and late mortality after STEMI
			Appendix 1. Out-of-hospital cardiac arrest: role of early coronary angiography and therapeutic hypothermia
		Questions and answers
	Chapter 3. Stable Ischemic Heart Disease and Approach to Chronic Chest Pain
		I. Causes of angina and pathophysiology of coronary flow
		II. Diagnostic approach
		III. Silent myocardial ischemia. Is there a role for screening asymptomatic patients and post-PCI patients?
		IV. Medical therapy: antiplatelet therapy
		V. Medical therapy: antianginal therapy and risk factor control
		VI. Indications for revascularization
		VII. CABG and CABG vs. medical therapy
		VIII. PCI and PCI vs medical therapy
		IX. PCI vs. CABG in multivessel and left main disease
		X. High-surgical-risk patients
		XI. Role of complete functional revascularization
		XII. Hybrid CABG?PCI
		XIII. Enhanced external counterpulsation
		XIV. Mortality in CAD
		Appendix 1. Notes on various surgical grafts
		Appendix 2. Coronary vasospasm (variant angina, Prinzmetal angina)
		Appendix 3. Microvascular endothelial dysfunction
		Appendix 4. Women with chest pain and normal coronary arteries
		Appendix 5. Diagnostic strategy for ischemia with non-obstructed coronary arteries (INOCA)
		Appendix 6. Myocardial bridging
		Appendix 7. Coronary collaterals, chronic total occlusion
		Appendix 8. Hibernation, stunning, ischemic preconditioning
		Questions and answers
PART 2. Heart Failure (Chronic and Acute Heart Failure, Specific Cardiomyopathies, and Pathophysiology)
	Chapter 4. Heart Failure
		Definition, Types, Causes, and Diagnosis of Heart Failure
		1. Definition and types of heart failure
			I. Heart failure is diagnosed clinically, not by echocardiography
			II. After HF is defined clinically, echocardiography is used to differentiate the three major types of HF
			III. Two additional types of HF
		2. Causes of heart failure
			I. Systolic HF or HF with reduced EF (HFrEF)
			II. HF with preserved EF (HFpEF)
			III. Right HF
		3. Diagnostic tests
			I. Echocardiography
			II. BNP
			III. ECG
			IV. Coronary angiography and other ischemic tests
			V. Diastolic stress testing
			VI. Endomyocardial biopsy
			VII. Cardiac MRI
		Chronic Treatment of Heart Failure
		1. Treatment of systolic heart failure
			I. Treat the underlying etiology: target BP and CAD
			II. Value of revascularization in ischemic cardiomyopathy: STICH trial
			III. Role of viability testing and ischemic testing
			IV. Drugs that affect survival in EF<40%
			V. Specifics of drugs that affect survival
			VI. Drugs that improve symptoms and morbidity
			VII. Devices
			VIII. Other therapeutic measures
			IX. Prognosis
		2. Treatment of HFpEF
		Acute Heart Failure and Acutely Decompensated Heart Failure
			I. Triggers of acute decompensation
			II. Profiles of acute HF: congestion without low cardiac output, congestion with low cardiac output
			III. Treatment of acute HF: diagnosis and treatment of triggers
			IV. Treatment of acute HF: diuretics, cardiorenal syndrome, aggressive decongestion, ultrafiltration
			V. Treatment of acute HF: vasodilators
			VI. Treatment of acute HF: IV inotropic agents
			VII. In-hospital and pre-discharge use of ACE-I/ ARB, angiotensin-neprilysin inhibition, and ƒ-blockers
			VIII. Treatment of acute HF: O2, non-invasive ventilatory support (CPAP, BiPAP), intubation
			IX. Summary: keys to the treatment of acute HF
			X. Discharge
			XI. Inability of severe HF to tolerate vasodilatation or hemodialysis
			XII. Outpatient monitoring of HF and prevention of hospitalization
			Appendix 1. Management of isolated or predominant RV failure
		Questions and answers
	Chapter 5. Additional Heart Failure Topics
		1. Specific cardiomyopathies
			I. Arrhythmia-induced cardiomyopathy
			II. Viral myocarditis
			III. Acute eosinophilic myocarditis
			IV. HIV cardiomyopathy
			V. Chagas disease
			VI. Sarcoidosis
			VII. LV non-compaction
			VIII. Takotsubo and other stress-related cardiomyopathies
			IX. Infiltrative restrictive cardiomyopathy: Amyloidosis
			X. Other infiltrative restrictive cardiomyopathies
		2. Advanced heart failure: heart transplant and ventricular assist devices
			I. Stages of HF
			II. Cardiac transplantation
			III. Left ventricular assist devices (LVADs)
		3. Pathophysiology of heart failure and hemodynamic aspects
			I. LV diastolic pressure in normal conditions and in HF (whether systolic or diastolic)
			II. Definition of afterload
			III. Cardiac output, relation to preload and afterload
			IV. LV pressure.volume relationship in systolic versus diastolic failure: therapeutic implications
			V. Optimal heart rate in HF
			VI. Mechanisms of exercise intolerance in HF
			VII. Pressure.volume loops
			VIII. Additional features of HF with preserved EF
			IX. High-output HF
		Questions and answers
PART 3. Valvular Disorders
	Chapter 6. Valvular Disorders
		1. Mitral regurgitation
			I. Mechanisms of mitral regurgitation
			II. Specifics of various causes of mitral regurgitation
			III. Assessment of MR severity
			IV. Natural history and pathophysiology of organic MR
			V. Treatment of organic (primary) MR
			VI. Treatment of secondary MR (ischemic and non-ischemic functional MR)
			VII. Treatment of acute severe MR related to acute MI
			VIII. Percutaneous mitral valve repair using the Mitraclip device (transcatheter edge-to-edge repair)
		2. Mitral stenosis
			I. Etiology and natural history
			II. Diagnosis
			III. Treatment
		3. Aortic insufficiency
			I. Etiology
			II. Pathophysiology and hemodynamics
			III. Diagnosis
			IV. Natural history and symptoms
			V. Treatment
		4. Aortic stenosis
			I. Etiology
			II. Echo and catheterization diagnosis, pitfalls, and hemodynamics
			III. Low-gradient AS with aortic valve area (AVA) .1 cm2 and low EF<50%
			IV. Low-gradient AS with aortic valve area (AVA) . 1 cm2 but normal EF: paradoxical low-flow/low-gradient severe AS and normal-flow/low-gradient severe AS
			V. Pressure recovery phenomenon
			VI. Symptoms
			VII. Natural history
			VIII. AS should be differentiated from subvalvular and supravalvular AS in children or young adults
			IX. Treatment
		5. Tricuspid regurgitation and stenosis
			I. Etiology of tricuspid regurgitation
			II. Natural history of TR
			III. Treatment of TR
			IV. Tricuspid stenosis
		6. Pulmonic stenosis and regurgitation
			I. Pulmonic stenosis
			II. Pulmonic regurgitation
		7. Mixed valvular disease; radiation heart disease
			I. Mixed single-valve disease
			II. Multiple valvular involvement (combined stenosis or regurgitation of two different valves)
			III. Radiation heart disease
		8. Prosthetic valves
			I. Bioprosthesis versus mechanical prosthesis
			II. Determinants of valve degeneration and valve thrombosis; anticoagulation guidelines
			III. Particular cases: women who wish to become pregnant and dialysis patients
			IV. Echocardiographic follow-up of prosthetic valves
			V. Complications
		9. Auscultation and summary ideas
			I. Auscultation and other physical findings
			II. General ideas and workup
		Questions and answers
PART 4. Hypertrophic Cardiomyopathy
	Chapter 7. Hypertrophic Cardiomyopathy
		I. Definition and features of HCM
		II. Natural history and mortality
		III. Symptoms and ECG
		IV. Exam
		V. Invasive hemodynamic findings
		VI. Echocardiographic findings
		VII. Provocative maneuvers
		VIII. Genetic testing for diagnosis; screening of first-degree relatives
		IX. Differential diagnosis of LVOT obstruction
		X. Differential diagnosis of severe LV hypertrophy
		XI. Treatment of symptoms
		XII. Treatment: sudden cardiac death risk assessment and ICD therapy
		XIII. Athletefs heart
		Questions and answers
PART 5. Arrhythmias and Electrophysiology
	Chapter 8. Approach to Narrow and Wide QRS Complex Tachyarrhythmias
		I. The unstable patient
		II. Initial approach to any tachycardia
		III. Approach to narrow QRS complex tachycardias
		IV. Approach to wide QRS complex tachycardias
		V. Features characteristic of VT, as opposed to SVT with aberrancy
		VI. Features characteristic of SVT with pre-excitation
		VII. Role of adenosine in establishing a diagnosis
		VIII. Differential diagnosis of a wide complex tachycardia on a one-lead telemetry or Holter monitor strip
		IX. Various notes
		X. General management of SVT
		XI. Non-tachycardic wide complex rhythms
		XII. Practice ECGs of wide complex tachycardias
	Chapter 9. Ventricular Arrhythmias: Types and Management, Sudden Cardiac Death
		I. Premature ventricular complexes
		II. Ventricular tachycardia
		III. Polymorphic ventricular tachycardia
		IV. Congenital long QT syndrome (LQT)
		V. Indications for ICD implantation
		VI. VT with no obvious heart disease: VT related to subtle, overlooked cardiomyopathy
		VII. VT with no obvious heart disease: VT related to electrical disorders and channelopathies
		VIII. VT with no obvious heart disease: idiopathic outflow tract PVC or VT and idiopathic left fascicular PVC or VT
		IX. Sudden cardiac death and athletefs ECG screening
		Questions and answers
	Chapter 10. Atrial Fibrillation
		I. Predisposing factors
		II. Types of AF
		III. General therapy of AF
		IV. Management of a patient who presents with acute, symptomatic AF
		V. Peri-cardioversion anticoagulation management
		VI. Antiarrhythmic management after the acute presentation
		VII. Decisions about long-term anticoagulation, role of clopidogrel, role of triple therapy
		VIII. Special situation: atrial fibrillation and heart failure. Optimal heart rate in heart failure
		IX. Special situation: atrial fibrillation with borderline blood pressure or non-AF-related hypotension
		X. AF burden as a correlate and a driver of HF progression
		Appendix 1. Optimal heart rate and AF rate for optimal cardiac output
		Appendix 2. Antiarrhythmic drug therapy
		Appendix 3. Catheter ablation of atrial fibrillation, surgical ablation, AV nodal ablation
		Appendix 4. INR follow-up in patients receiving warfarin-Non-vitamin K oral anticoagulants
		Appendix 5. Bridging anticoagulation in patients undergoing procedures
		Appendix 6. Management of elevated INR values
		Appendix 7. Left atrial appendage surgical and percutaneous closure
		Appendix 8. A common situation: AF and symptomatic pauses or bradycardia
		Appendix 9. DC cardioversion in patients with a slow ventricular response
		Appendix 10. AF occurring post-cardiac surgery and AF related to acute transient triggers
		Appendix 11. Brief asymptomatic runs of AF on device interrogation and association with stroke. Role of rhythm monitoring after cryptogenic stroke
		Questions and answers
	Chapter 11. Atrial Flutter and Atrial Tachycardia
		I. Atrial flutter
		II. Focal atrial tachycardia
		III. Multifocal atrial tachycardia (MAT) (or chaotic atrial tachycardia)
		IV. Ectopic atrial rhythm
		Questions and answers
	Chapter 12. Atrioventricular Nodal Reentrant Tachycardia, Atrioventricular Reciprocating Tachycardia, Wolff?Parkinson?White Syndrome, and Junctional Rhythms
		I. Inappropriate sinus tachycardia (IST) and postural orthostatic tachycardia syndrome (POTS)
		II. Atrioventricular nodal reentrant tachycardia (AVNRT)
		III. Atrioventricular reciprocating tachycardia (AVRT) and Wolff.Parkinson.White (WPW) syndrome
		IV. Junctional escape rhythm and accelerated junctional rhythm (or non-paroxysmal junctional tachycardia)
		Questions and answers
	Chapter 13. Bradyarrhythmias
		I. AV block
		II. Sinus node dysfunction
		III. Bundle branch blocks, bifascicular and trifascicular block
		Questions and answers
	Chapter 14. Permanent Pacemaker and Implantable Cardioverter Defibrillator
		I. Indications for permanent pacemaker implantation
		II. Types of cardiac rhythm devices
		III. Pacemaker intervals
		IV. Leads
		V. Systematic PM/ICD interrogation using the programmer
		VI. Pacemaker troubleshooting
		VII. Perioperative management of PM and ICD (during any surgery)
		VIII. Differential diagnosis and management of the patient who presents with ICD shock(s)
		IX. Evidence and guidelines supporting various pacing devices
		Appendix. Cases of PM troubleshooting
		Questions and answers
	Chapter 15. Basic Electrophysiologic Study
		I. General concepts; intracardiac electrograms
		II. AV conduction abnormalities
		III. Sinus node assessment
		IV. Ventricular vs. supraventricular tachycardia
		V. Dual AV nodal pathways
		VI. AVNRT
		VII. Accessory pathway, orthodromic AVRT, antidromic AVRT
		VIII. Atrial flutter
		IX. Inducible VT
		X. Mapping for ablation
		XI. EP electro-anatomical mapping
	Chapter 16. Action Potential Features and Propagation: Mechanisms of Arrhythmias, Antiarrhythmic Drugs
		I. Action potential
		II. Action potential propagation and mechanisms of arrhythmias
		III. General mechanism of action of antiarrhythmic agents
		IV. Modulated receptor hypothesis and use dependence
		V. Concept of concealed conduction
		VI. Specific examples of drugs
		VII. Amiodarone toxicity
		VIII. Effect on pacing thresholds and defibrillation thresholds
PART 6. Pericardial Disorders
	Chapter 17. Pericardial Disorders
		1. Acute pericarditis
			I. Causes of acute pericarditis
			II. History and physical findings
			III. ECG findings
			IV. Echocardiography
			V. Myopericarditis and perimyocarditis
			VI. Treatment
		2. Tamponade
			I. Definition
			II. Pathophysiology and hemodynamics
			III. Diagnosis: tamponade is a clinical diagnosis, not an echocardiographic diagnosis
			IV. Echocardiographic findings supporting the hemodynamic compromise of tamponade
			V. Role of hemodynamic evaluation
			VI. Special circumstances: low-pressure tamponade, tamponade with absent pulsus paradoxus, regional tamponade
			VII. Effusive.constrictive pericarditis
			VIII. Treatment of tamponade
		3. Pericardial effusion
			I. Causes of a pericardial effusion with or without tamponade
			II. Management of asymptomatic effusions and role of pericardiocentesis
			III. Note on postoperative pericardial effusions (after cardiac surgery)
			IV. Note on uremic pericardial effusion
		4. Constrictive pericarditis
			I. Causes
			II. Pathophysiology and hemodynamics
			III. Hemodynamic findings in constrictive pericarditis and differential diagnosis of constrictive pericarditis: restrictive cardiomyopathy, decompensated RV failure, COPD
			IV. Practical performance of a hemodynamic study when constrictive pericarditis is suspected
			V. Echocardiographic features of constrictive pericarditis, and differentiation between constrictive pericarditis and restrictive cardiomyopathy
			VI. Physical exam, ECG findings, BNP, pericardial thickness (CT/MRI)
			VII. Transient constrictive pericarditis
			VIII. Treatment
			IX. Hemodynamic case analysis
		Questions and answers
PART 7. Congenital Heart Disease
	Chapter 18. Congenital Heart Disease
		1. Acyanotic congenital heart disease
			I. Atrial septal defect (ASD)
			II. Patent foramen ovale (PFO)
			III. Ventricular septal defect (VSD)
			IV. Patent ductus arteriosus (PDA)
			V. Coarctation of the aorta
			VI. Other anomalies
		2. Cyanotic congenital heart disease
			I. Pulmonary hypertension secondary to shunt
			II. Tetralogy of Fallot
			III. Ebstein anomaly
		3. More complex cyanotic congenital heart disease and shunt procedures
			I. Functionally single ventricle and Fontan procedure
			II. Transposition of great arteries (TGA)
			III. Other anomalies
		Questions and answers
PART 8. Peripheral Arterial Disease
	Chapter 19. Peripheral Arterial Disease
		1. Lower extremity peripheral arterial disease
			I. Clinical tips
			II. Clinical classification of PAD: critical limb ischemia, acute limb ischemia, atheroembolization
			III. Diagnosis of PAD
			IV. Medical therapy of PAD
			V. Revascularization for PAD
			VI. Notes on the technical aspects of surgical and percutaneous therapies
			VII. Management of acute limb ischemia
			VIII. Management of lower extremity ulcers
		2. Carotid disease
			I. Assessment of carotid stenosis
			II. Medical therapy of carotid stenosis
			III. Revascularization of asymptomatic carotid stenosis
			IV. Revascularization of symptomatic carotid stenosis
			V. Main risks of CEA and carotid stenting
			VI. CEA versus carotid stenting
			VII. Carotid disease in a patient undergoing CABG
			VIII. Subtotal and total carotid occlusions
		3. Renal artery stenosis
			I. Forms of renal artery stenosis
			II. Screening and indications to revascularize renal artery stenosis
			III. Notes
		Questions and answers
	Chapter 20. Aortic Diseases
		I. Aortic dissection
		II. Thoracic aortic aneurysm
		III. Abdominal aortic aneurysm
PART 9. Other Cardiovascular Disease States
	Chapter 21. Pulmonary Embolism and Deep Vein Thrombosis
		1. Pulmonary embolism
			I. Presentation of pulmonary embolism and risk factors
			II. Probability of PE
			III. Initial workup
			IV. Specific PE workup
			V. Submassive or intermediate-high risk PE, pulmonary hypertension, and thrombolysis
			VI. PE and chronic pulmonary hypertension
			VII. Acute treatment of PE
			VIII. Duration of anticoagulation
			IX. Thrombophilias
			X. PE prognosis and long-term follow-up
		2. Deep vein thrombosis
			I. Types
			II. Diagnosis
			III. Treatment
		3. Immune heparin-induced thrombocytopenia
			I. Incidence
			II. Diagnosis
			III. Treatment
		Questions and answers
	Chapter 22. Shock and Fluid Responsiveness
		1. Shock
			I. Shock definition and mechanisms
			II. Goals of shock treatment
			III. Immediate management of any shock
			IV. Sepsis and septic shock
			V. Cardiogenic shock
		2. Fluid Responsiveness
			Appendix. Hemodynamic equations, transfusion, and miscellaneous concepts
		Questions and answers
	Chapter 23. Hypertension
		1. Hypertension
			I. Definition
			II. ACC and ESC targets of therapy and rationale
			III. Treatment of hypertension: timing, first-line drugs, compelling indications for specific drugs
			IV. Resistant hypertension
			V. Secondary hypertension
			VI. Peripheral vs. central aortic pressure: therapeutic implications
			VII. First-line antihypertensive drugs
			VIII. Second-line antihypertensive drugs
			IX. Orthostatic hypotension and extremely labile HTN
		2. Acute severe hypertension: hypertensive emergencies and urgencies
			I. Definitions
			II. Treatment of hypertensive emergencies
			III. Treatment of hypertensive urgencies
			IV. Specific situations
		Questions and answers
	Chapter 24. Dyslipidemia
		I. Indications for therapy
		II. Notes on LDL, HDL, and triglycerides
		III. Drugs: LDL-lowering drugs
		IV. Drugs: TG/HDL-treating drugs and lifestyle modification
		V. Metabolic syndrome
		VI. Diabetes and cardioprotective diabetic drugs
		VII. Elevated hs-CRP (high-sensitivity C-reactive protein test) ≥2 mg/l
		VIII. Chronic kidney disease
		IX. Causes of dyslipidemia to consider
		X. Side effects of specific drugs: muscle and liver intolerance with statins, fibrates, and niacin
		XI. Aspirin is ineffective in primary prevention
		Questions and answers
	Chapter 25. Pulmonary Hypertension
		I. Definition
		II. Categories of PH
		III. Two tips in the evaluation of PH
		IV. Hypoxemia in patients with PH
		V. Diagnosis: echocardiography; right and left heart catheterization
		VI. Treatment
		Questions and answers
	Chapter 26. Syncope
		I. Neurally mediated syncope (reflex syncope)
		II. Orthostatic hypotension and postural orthostatic tachycardia syndrome
		III. Cardiac syncope
		IV. Other causes of syncope
		V. Syncope mimic: seizure
		VI. Clinical clues
		VII. Diagnostic evaluation of syncope
		VIII. Tilt table testing
		IX. Indications for hospitalization
		X. Treatment of vasovagal syncope, orthostatic hypotension, and POTS
		Questions and answers
	Chapter 27. Chest Pain, Dyspnea, Palpitations
		1. Chest Pain
			I. Causes
			II. Features
			III. Management of chronic chest pain
			IV. Management of acute chest pain
		2. Acute Dyspnea
			I. Causes
			II. Notes
			III. Management
		3. Palpitations
			I. Causes
			II. Diagnosis
	Chapter 28. Infective Endocarditis and Cardiac Rhythm Device Infections
		1. Infective endocarditis
			I. Clinical diagnosis
			II. Echocardiography: timing and indications
			III. Organisms
			IV. Morphology
			V. Anatomical complications
			VI. Indications for valvular surgery and special situations
		2. Cardiac rhythm device infections
			I. Organisms and mechanisms of infection
			II. Diagnosis
			III. Diagnosis in patients with bacteremia but no local or TEE signs of infection
			IV. Management
	Chapter 29. Preoperative Cardiac Evaluation
		I. Steps in preoperative evaluation
		II. Surgical risk: surgeryfs risk and patientfs risk
		III. CARP and DECREASE V trials
		IV. Only the highest-risk coronary patients require revascularization preoperatively
		V. Preoperative percutaneous revascularization
		VI. Surgery that needs to be performed soon after stent placement
		VII. Preoperative Ÿ?-blocker therapy
		VIII. Other interventions that improve outcomes
		IX. Severe valvular disease
		X. Perioperative hypertension
		XI. Preoperative management of patients with pacemakers or ICDs
		Questions and answers
	Chapter 30. Miscellaneous Cardiac Topics: Cardiac Masses and Tumors, Pregnancy, HIV and Heart Disease, Cocaine and the Heart, Chemotherapy and Heart Disease, Chest X-Ray
		1. Cardiac masses
			I. Differential diagnosis of a cardiac mass
			II. Cardiac tumors; focus on atrial myxoma
		2. Pregnancy and heart disease
			I. High-risk cardiac conditions during which pregnancy is better avoided
			II. Cardiac conditions that are usually well tolerated during pregnancy, but in which careful cardiac evaluation and clinical and echo follow-up are warranted
			III. Cardiac indications for cesarean section
			IV. Mechanical prosthetic valves in pregnancy: anticoagulation management
			V. Peripartum cardiomyopathy
			VI. Cardiovascular drugs during pregnancy
			VII. Arrhythmias during pregnancy
			VIII. MI and pregnancy
			IX. Hypertension and pregnancy
		3. HIV and heart disease
			I. Pericardial disease
			II. HIV cardiomyopathy
			III. Pulmonary hypertension
			IV. CAD
		4. Cocaine and the heart
			I. Myocardial ischemia
			II. Other cardiac complications of cocaine
		5. Chemotherapy and heart disease
			I. Cardiomyopathy
			II. Myocardial ischemia
			III. Atrial fibrillation
		6. Chest X-ray
			I. Chest X-ray in heart failure
			II. Various forms of cardiomegaly
			III. Left atrial enlargement; aortic dilatation
			IV. Lateral chest X-ray
			V. Chest X-ray in congenital heart disease
		Questions and answers
PART 10. Cardiac Tests: Electrocardiography, Echocardiography, and Stress Testing
	Chapter 31. Electrocardiography
		I. Overview of ECG leads and QRS morphology
		II. Stepwise approach to ECG interpretation
		III. Rhythm and rate
		IV. QRS axis in the limb leads and normal QRS progression in the precordial leads
		V. P wave: analyze P wave in leads II and V1 for atrial enlargement, and analyze PR interval
		VI. Height of QRS: LVH, RVH
		VII. Width of QRS. Conduction abnormalities: bundle brunch blocks
		VIII. Conduction abnormalities: fascicular blocks
		IX. Low QRS voltage and electrical alternans
		X. Assessment of ischemia and infarction: Q waves
		XI. Assessment of ischemia: ST-segment depression and T-wave inversion
		XII. Assessment of ischemia: differential diagnosis of ST-segment elevation
		XIII. Assessment of ischemia: large or tall T wave
		XIV. QT analysis and U wave
		XV. Electrolyte abnormalities, digitalis effect and digitalis toxicity, hypothermia, PE, poor precordial R-wave progression
		XVI. Approach to tachyarrhythmias
		XVII. Approach to bradyarrhythmias: AV block
		XVIII. Abnormal automatic rhythms that are not tachycardic
		XIX. Electrode misplacement
		Appendix 1. Supplement on STEMI and Q-wave MI: phases and localization
		Appendix 2. Spread of electrical depolarization in various disease states using vector illustration
		Questions and answers
	Chapter 32. Echocardiography
		1. General echocardiography
			I. The five major echocardiographic views and the myocardial wall segments
			II. Global echo assessment of cardiac function and structure
			III. Doppler and assessment of valvular regurgitation and stenosis
			IV. Summary of features characterizing severe valvular regurgitation and stenosis
			V. M-mode echocardiography
			VI. Pericardial effusion
			VII. Echocardiographic determination of LV filling pressure and diastolic function
			VIII. Additional echocardiographic hemodynamics
			IX. Prosthetic valves
			X. Brief note on Doppler physics and echo artifacts
		2. Transesophageal echocardiography (TEE) views
			Appendix. Note on LV mechanics and myocardial tissue strain
	Chapter 33. Stress Testing, Nuclear Imaging, Coronary CT Angiography, cardiac MRI, cardiopulmonary exercise testing
		I. Indications for stress testing
		II. Contraindications to all stress testing modalities
		III. Stress testing modalities
		IV. Diagnostic yields and pitfalls of stress ECG and stress imaging
		V. Mechanisms of various stress modalities
		VI. Nuclear stress imaging
		VII. Coronary CT angiography and coronary calcium scoring
		VIII. Cardiac MRI: summary of applications and findings
		IX. Cardiopulmonary exercise testing (CPET)
PART 11 Cardiac Tests: Invasive Coronary and Cardiac Procedures
	Chapter 34. Angiographic Views: Coronary Arteries and Grafts, Left Ventricle, Aorta, Coronary Anomalies, Peripheral Arteries, Carotid Arteries
		I. Right coronary artery
		II. Left coronary artery
		III. Coronary angiography views. Recognize the angle of a view: LAO vs. RAO, cranial vs. caudal
		IV. Coronary angiography views. General ideas: cranial vs. caudal views
		V. Coronary angiography views. General ideas: foreshortening and identifying branches
		VI. Left coronary views
		VII. Right coronary views
		VIII. Improve the angiographic view in case of vessel overlap or foreshortening: effects of changing the angulation, effects of respiration, and vertical vs. horizontal heart
		IX. Saphenous venous graft views
		X. LIMA-to-LAD or LIMA-to-diagonal views
		XI. Left ventriculography
		XII. Aortography for assessment of aortic insufficiency
		XIII. Coronary anomalies
		XIV. Lower extremity angiography
		XV. Carotid angiography
		Questions and answers
	Chapter 35. Cardiac Catheterization Techniques, Tips, and Tricks
		I. View for the engagement of the native coronary arteries: RAO vs. LAO
		II. Design of the Judkins and Amplatz catheters
		III. Engagement of the RCA
		IV. How to gauge the level of the RCA origin in relation to the aortic valve level
		V. What is the most common cause of failure to engage the RCA? What is the next step?
		VI. Tiger or JR4 catheter engages the conus branch. What is the next step?
		VII. Left coronary artery engagement: general tips
		VIII. Management of a JL catheter that is sub-selectively engaged in the LAD or LCx
		IX. Specific maneuvers for the Amplatz left catheter
		X. If you feel that no torque is getting transmitted, what is the next step?
		XI. Appropriate guide catheters for left coronary interventions
		XII. Appropriate guide catheters for RCA interventions
		XIII. Selective engagement of SVGs: general tips
		XIV. Specific torque maneuvers for engaging the SVGs
		XV. Appropriate catheters for engaging SVGs
		XVI. Engagement of the left internal mammary artery graft
		XVII. Left ventricular catheterization
		XVIII. Engagement of anomalous coronary arteries
		XIX. Specific tips for coronary engagement using a radial approach
		XX. Damping and ventricularization of the aortic waveform upon coronary engagement, and role of side-hole catheters
		XXI. Technique of right heart catheterization
	Chapter 36. Hemodynamics
		I. Right heart catheter
		II. Overview of pressure tracings: differences between atrial, ventricular, and arterial tracings
		III. RA pressure abnormalities
		IV. Pulmonary capillary wedge pressure (PCWP) abnormalities
		V. LVEDP
		VI. Cardiac output and vascular resistances
		VII. Shunt evaluation
		VIII. Valvular disorders: overview of pressure gradients and valve area calculation
		IX. Dynamic LVOT obstruction
		X. Pericardial disorders: tamponade and constrictive pericarditis
		XI. Exercise hemodynamics
		XII. Additional hemodynamic caveats in AF
		Appendix 1. Advanced hemodynamic calculation: a case of shunt with pulmonary hypertension
		Questions and answers: Additional hemodynamic cases
	Chapter 37. Intracoronary Imaging
		1. Intravascular ultrasound (IVUS)
			I. Image basics
			II. Plaque types
			III. Basic IVUS measurements
			IV. Interpretation of how a severe stenosis may look mild angiographically, yet severe by IVUS; significance of lesion haziness
			V. Endpoints of stenting
			VI. Assessment of lesion significance by IVUS
			VII. Assessment of left main by IVUS
		2. Optical coherence tomography (OCT)
	Chapter 38. Percutaneous Coronary Interventions and Complications, Intra-Aortic Balloon Pump, Ventricular Assist Devices, and Fractional Flow Reserve
		I. Major coronary interventional devices
		II. Stent thrombosis, restenosis, and neoatherosclerosis
		III. Peri-PCI antithrombotic therapy
		IV. Complex lesion subsets
		V. Sheath management
		VI. Post-PCI mortality and coronary complications
		VII. Femoral access complications
		VIII. Renal, stroke, and atheroembolic complications
		IX. Intra-aortic balloon pump (IABP) or intra-aortic balloon counterpulsation
		X. Percutaneous LV assist device: Impella and TandemHeart
		XI. Extracorporeal membrane oxygenation (ECMO)
		XII. Fractional flow reserve (FFR)
		Questions and answers
Appendix: General review questions
	1. Questions
		I. NSTEMI and STEMI
		II. Stable CAD
		III. Heart failure and cardiomyopathies
		IV. Valvular disorders
		V. Arrhythmias
		VI. Congenital heart disease
		VII. Peripheral arterial disease-Pulmonary embolism-Pulmonary hypertension
		VIII. Hypertension and syncope
		IX. Pregnancy-Chemotherapy and heart disease-Miscellaneous
		X. ECG
		XI. Echocardiography
		XII. Additional hemodynamics
		XIII. Percutaneous coronary intervention and shock
		XIV. Radiation in the cardiac catheterization laboratory
	2. Answers
Index
EULA