A Practical Approach to Cardiovascular Medicine E-Book

• Herausgeber: John Wiley & Sons
• Kategorie: Fachliteratur
• Sprache: Englisch

Seitenzahl: 512

Veröffentlichungsjahr: 2013

Beschreibung

Written, reviewed, and edited in a collaborative effort by cardiology fellows and faculty of one of the most prestigious academic centers in the country, this concise volume gives cardiology fellows the book they have long needed. Keeping coverage of the underlying pathophysiology and mechanism of disease to a minimum, the authors focus on the diagnosis and treatment of cardiac disorders. Practical and easily accessible at the time of decision making, the book relays important concepts through concise and to-the-point pearls and by utilizing algorithm charts and illustrations.

Leseprobe

Contents

Contributors

List of Abbreviations

Foreword

SECTION I Preventive Cardiology

CHAPTER 1 Prevention of Cardiovascular Disease

Prevention of Coronary Heart Disease

Smoking

Hypertension

Hyperlipidemia

Diabetes Mellitus

Specific Medications

Physical Activity

Weight Loss

Alcohol Consumption

Diet

Recommended Reading

CHAPTER 2 Dyslipidemia

Diagnosis

Risk Assessment

Treatment

Hereditary Lipid Disorders

Approach to Prevention of CAD

Recommended Reading

CHAPTER 3 Hypertension

Classification

Work-Up

Controlling BP

Causes of Resistant HTN

Hypertensive Emergency and Urgency

Recommended Reading

SECTION II Coronary Artery Disease

CHAPTER 4 Stable Angina

Etiology

Clinical Presentation

Diagnosis

Risk Stratification

Treatment

Recommended Reading

CHAPTER 5 unstable Angina and Non-ST Elevation Myocardial Infarction

Etiology

Clinical Presentation

Diagnosis (Box 5.1)

Risk Assessment (Box 5.2)

Treatment

Predischarge Risk Stratification

Revascularization

Discharge Care

Recommended Reading

CHAPTER 6 ST-Elevation Myocardial Infarction

Etiology

Clinical Presentation

Diagnosis

Treatment

Secondary Prevention after STEMI

Complications of STEMI

Recommended Reading

SECTION III Heart Failure

CHAPTER 7 Care of the Cardiomyopathic Patient

Cardiomyopathy

Diagnosis and Work-up of New-Onset CHF

Management

Recommended Reading

CHAPTER 8 Pulmonary Hypertension and Right Heart Failure

Pulmonary Hypertension

Right Heart Failure

Chronic Right Heart Failure

Recommended Reading

CHAPTER 9 Heart Transplantation

History

Indications

Contraindications

Transplant Evaluation

Cardiac Donor Selection Criteria

Donor Management

Donor and Recipient Matching

Organ Allocation and Prioritization

Surgical Technique

Immunosuppression

Infection prevention

Post-Transplant Mortality

Post-transplant Morbidities/Complications

Recommended Reading

SECTION IV Valvular and Vascular Disease

CHAPTER 10 Valvular Heart Disease

Aortic Stenosis

Aortic Regurgitation

Mitral Stenosis

Mitral Regurgitation

Tricuspid Regurgitation

Prosthetic Heart Valves

Infective Endocarditis (IE)

Recommended Reading

CHAPTER 11 Diseases of the Aorta

Acute Aortic Syndrome

Congenital Aortic Diseases

Acquired Aortic Diseases

Recommended Reading

CHAPTER 12 Peripheral Vascular Disease

Etiology

Clinical Assessment

Assessment of the Patient with Known or Suspected PAD

Therapy

Recommended Reading

SECTION V Arrhythmias and Sudden Cardiac Death

CHAPTER 13 Atrial Fibrillation and Flutter

Atrial Fibrillation

Atrial Flutter

Recommended Reading

CHAPTER 14 Supraventricular Tachycardia

Differential Diagnosis

Types of Tachyarrythmia

Management

Recommended Reading

CHAPTER 15 Ventricular Tachycardia

Diagnosis

Work-Up

VT Syndromes

Treatment

Recommended Reading

CHAPTER 16 Bradycardia

Sinus Node Dysfunction

Atrioventricular Conduction Abnormalities

Treatment

Recommended Reading

CHAPTER 17 Syncope

Differential Diagnosis

Orthostatic Hypotension (~20%)

Work-up

Criteria for Hospital Admission

Treatment

Recommended Reading

SECTION VI Cardiovacular Disease in Special Populations

CHAPTER 18 Congenital Heart Disease

Fundamental Underlying Principle

Common Congenital Lesions

Patients Who Most Benefit from Surgical Repair

Eisenmenger’s Syndrome

Imaging a Patient with Suspected Congenital Heart Disease

Most Commonly Encountered Surgical Corrections

Complications Relevant to Adults

Recommended Reading

CHAPTER 19 Cardiology Consultation and Management of Perioperative Complications

Preoperative Cardiac Evaluation

Risk Stratification of Cardiac Events

Stepwise Approach to Perioperative Cardiac Evaluation

Recommended Reading

CHAPTER 20 Management of Pre- and Post-Cardiac Surgery Patients

Preoperative Assessment for Cardiac Surgery

Preoperative Anticoagulation

Postoperative Assessment

Postoperative Complications

Recommended Reading

SECTION VII Specialized Testing and Therapeutics

CHAPTER 21 Adult Advanced Cardiac Life Support

Overview of Sudden Cardiac Arrest and Resuscitation

Management of Symptomatic Bradycardia and Tachycardia

Ethical Considerations

Recommended Reading

CHAPTER 22 ECG Interpretation

Checklist

Lead Placement

Recommended Reading

CHAPTER 23 Transthoracic and Transesophageal Echocardiography

Doppler Echocardiography

Transesophageal Echocardiocardiography

Recommended Reading

CHAPTER 24 Noninvasive Stress Testing

Estimating Pretest Probability

Exercise Testing

Recommended Reading

CHAPTER 25 Cardiac MRI and CT

Cardiac MRI

Cardiac CT

Recommended Reading

CHAPTER 26 Clinical Cardiac Hemodynamics

Pulmonary Artery Catheter

Hemodynamic Measurements

Recommended Reading

CHAPTER 27 Percutaneous Interventions

Preparing a Patient for Angiography

Procedure

Anticoagulation

Postprocedure Care

Intra-Aortic Balloon Pump (IABP) Counterpulsation

Complications

Peripheral Interventions

Recommended Reading

CHAPTER 28 Pacemakers and ICD Troubleshooting

Pacemaker Fundamentals

Pacemaker Troubleshooting

ICD Function

Recommended Reading

CHAPTER 29 Introduction to Electrophysiology Studies

Measurement of Baseline Conduction Intervals

Sinus Node Function

AV Node Function

Atrial Programmed Stimulation

Ventricular Programmed Stimulation

Induction of Arrhythimas

Recommended Reading

Index

To my mother, Masoumeh Toti, for her continuous support and love.

and

To my mentor, Irv Weissman, for being a true role model and a source of inspiration. [R.A.]

To my wife Mabel, for bringing so much love and joy to my life. [M.P.]

To my wonderful wife Gloria and to my beautiful daughters Catherine and Margaret.

and

To the memory of my loving parents Lillian and Samuel. [P.W.]

Reza Ardehali

Marco Perez

Paul Wang

This edition first published 2011 © 2011 by Blackwell Publishing Ltd

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Library of Congress Cataloging-in-Publication Data

A practical approach to cardiovascular medicine / edited by Reza Ardehali, Marco Perez, Paul Wang.

p.; cm.

Includes bibliographical references and index.

ISBN 978-1-4051-8039-9 (pbk.: alk. paper) 1. Heart–Diseases–Handbooks, manuals, etc. 2. Cardiology–Handbooks, manuals, etc. I. Ardehali, Reza.

II. Perez, Marco, M.D. III. Wang, Paul, Ph.D. [DNLM: 1. Cardiovascular Diseases–diagnosis. 2. Cardiovascular Diseases–therapy.

3. Cardiology–methods. WG 120]

RC669.15.P727 2011

616.1’2–dc22

2010047389

A catalogue record for this book is available from the British Library.

This book is published in the following electronic formats: ePDF 9781444393873; Wiley Online Library 9781444393897; ePub 9781444393880

1 2011

Contributors

Amin Al-Ahmad MD

Department of Internal Medicine

Division of Cardiology

Stanford University School of Medicine

Stanford, CA, USA

Jesus Almendral MD

Department of Internal Medicine

Division of Cardiology

Stanford University School of Medicine

Stanford, CA, USA

Reza Ardehali MD PhD

Department of Internal Medicine

Division of Cardiology

Stanford University School of Medicine

Stanford, CA, USA

Euan Ashley MRCP DPhil

Department of Internal Medicine

Division of Cardiology

Stanford University School of Medicine

Stanford, CA, USA

Ramin Beygui MD

Department of Internal Medicine

Division of Cardiology

Stanford University School of Medicine

Stanford, CA, USA

John Cooke MD PhD

Department of Internal Medicine

Division of Cardiology

Stanford University School of Medicine

Stanford, CA, USA

William F. Fearon MD

Department of Internal Medicine

Division of Cardiology

Stanford University School of Medicine

Stanford, CA, USA

Michael Fowler MB FRCP

Department of Internal Medicine

Division of Cardiology

Stanford University School of Medicine

Stanford, CA, USA

Karen Friday MD

Department of Internal Medicine

Division of Cardiology

Stanford University School of Medicine

Stanford, CA, USA

Victor F. Froelicher MD

Department of Internal Medicine

Division of Cardiology

Stanford University School of Medicine

Stanford, CA, USA

Anurag Gupta MD

Department of Internal Medicine

Division of Cardiology

Stanford University School of Medicine

Stanford, CA, USA

Mohammad Haghdoost MD

Department of General Surgery

Stanford University School of Medicine

Stanford, CA, USA

Shahriar Heidary MD

Department of Internal Medicine

Division of Cardiology

Stanford University School of Medicine

Stanford, CA, USA

Micheal Ho MD

Department of Internal Medicine

Division of Cardiology

Stanford University School of Medicine

Stanford, CA, USA

Henry Hsia MD

Department of Internal Medicine

Division of Cardiology

Stanford University School of Medicine

Stanford, CA, USA

Jeffrey Hsing MD

Department of Internal Medicine

Division of Cardiology

Stanford University School of Medicine

Stanford, CA, USA

Sharon Hunt MD

Department of Internal Medicine

Division of Cardiology

Stanford University School of Medicine

Stanford, CA, USA

Arvindh Kanagasundram MD

Department of Internal Medicine

Division of Cardiology

Stanford University School of Medicine

Stanford, CA, USA

Chandra Katikireddy MD

Department of Internal Medicine

Division of Cardiology

Stanford University School of Medicine

Stanford, CA, USA

Richard Lafayette MD

Department of Internal Medicine

Division of Nephrology

Stanford University School of Medicine

Stanford, CA, USA

David P. Lee MD

Department of Internal Medicine

Division of Cardiology

Stanford University School of Medicine

Stanford, CA, USA

Nicholas J. Leeper MD

Department of Internal Medicine

Division of Cardiology

Stanford University School of Medicine

Stanford, CA, USA

Joshua Lehrer MD

Department of Internal Medicine

Division of Cardiology

Stanford University School of Medicine

Stanford, CA, USA

David Liang MD PhD

Department of Internal Medicine

Division of Cardiology

Stanford University School of Medicine

Stanford, CA, USA

Ronald Lo MD

Department of Internal Medicine

Division of Cardiology

Stanford University School of Medicine

Stanford, CA, USA

Robert Maranda MD

Department of Internal Medicine

Division of Cardiology

Stanford University School of Medicine

Stanford, CA, USA

Michael V. McConnell MD

Department of Internal Medicine

Division of Cardiology

Stanford University School of Medicine

Stanford, CA, USA

Azar Mehdizadeh MD

Department of Internal Medicine

Division of Cardiology

Stanford University School of Medicine

Stanford, CA, USA

Aiden O’Loughlin MBBS

Department of Internal Medicine

Division of Cardiology

Stanford University School of Medicine

Stanford, CA, USA

Shirley Park MD

Department of Internal Medicine

Division of Cardiology

Stanford University School of Medicine

Stanford, CA, USA

Marco Perez MD

Department of Internal Medicine

Division of Cardiology

Stanford University School of Medicine

Stanford, CA, USA

Stanley G. Rockson MD

Department of Internal Medicine

Division of Cardiology

Stanford University School of Medicine

Stanford, CA, USA

Karim Sallam MD

Department of Internal Medicine

Stanford University School of Medicine

Stanford, CA, USA

Ingela Schnittger MD

Department of Internal Medicine

Division of Cardiology

Stanford University School of Medicine

Stanford, CA, USA

Maulik Shah MD

Department of Internal Medicine

Division of Cardiology

Stanford University School of Medicine

Stanford, CA, USA

Farheen Shirazi MD

Department of Internal Medicine

Division of Cardiology

Stanford University School of Medicine

Stanford, CA, USA

Yen Tibayan MD

Department of Internal Medicine

Division of Cardiology

Stanford University School of Medicine

Stanford, CA, USA

Paul Wang PhD

Department of Internal Medicine

Division of Cardiology

Stanford University School of Medicine

Stanford, CA, USA

Matthew T. Wheeler MD PhD

Department of Internal Medicine

Division of Cardiology

Stanford University School of Medicine

Stanford, CA, USA

Andrew Wilson MBBS PhD

Department of Internal Medicine

Division of Cardiology

Stanford University School of Medicine

Stanford, CA, USA

Christopher Woods MD PhD

Department of Internal Medicine

Division of Cardiology

Stanford University School of Medicine

Stanford, CA, USA

Alan Yeung MD

Department of Internal Medicine

Division of Cardiology

Stanford University School of Medicine

Stanford, CA, USA

Patrick Yue MD

Department of Internal Medicine

Division of Cardiology

Stanford University School of Medicine

Stanford, CA, USA

Roham T. Zamanian MD

Department of Internal Medicine

Division of Pulmonary and Critical Care

Stanford University School of Medicine

Stanford, CA, USA

Paul Zei MD PhD

Department of Internal Medicine

Division of Cardiology

Stanford University School of Medicine

Stanford, CA, USA

List of Abbreviations

6MWT

6-min walk test

AAA

abdominal aortic aneurysm

ABG

arterial blood gases

ABI

ankle brachial index

ABPM

ambulatory blood pressure monitoring

ACC

American College of Cardiology

ACE-I

angiotensin-converting enzyme inhibitor

ACR

acute cellular rejection

ACS

acute coronary syndromes

ADA

American Diabetes Association

AF

atrial fibrillation

AHA

American Heart Association

AI

aortic insufficiency

AIVR

accelerated idioventricular rhythm

AMR

antibody-mediated rejection

AR

aortic regurgitation

ARB

angiotensin receptor II blocker

ARVC

arrhythmogenic right ventricular cardiomyopathy

ARVD

arrhythmogenic right ventricular dysplasia

AS

aortic stenosis

ASA

aspirin

ASD

atrial septal defect

AV

atrioventricular

AVRT

atrioventricular re-entrant tachycardia

AVNRT

atrioventricular nodal re-entrant tachycardia

AVR

atrial valve replacement

BBB

bundle branch block

BMI

body mass index

BMP

basic metabolic panel

BMS

bare metal stent

BNP

brain natriuretic protein

BP

blood pressure

CABG

coronary artery bypass graft

CAD

coronary artery disease

CAV

cardiac allograft vasculopathy

CBC

complete blood count

CCA

common carotid artery

CCB

calcium channel blocker

CCU

coronary care unit

CHB

complete heart block

CHD

coronary heart disease

CHF

congestive heart failure

CMV

cytomegalovirus

CNI

calcineurin inhibitor

CNS

central nervous system

COPD

chronic obstructive pulmonary disease

CPB

cardiopulmonary bypass

CPR

cardiopulmonary resuscitation

CRI

chronic renal insufficiency

CRP

C-reactive protein

CRT

cardiac resynchronization therapy

CT

computed tomography

CVA

cerebrovascular accident

CVD

cardiovascular disease

CVP

central venous pressure

CVVH

continuous venovenous hemofiltration

CXR

chest X-ray

DBP

dystolic blood pressure

DCC

direct current cardioversion

DES

drug-eluting stent

DM

diabetes mellitus

EBCT

electron beam computed tomography

ECG

electrocardiography

ECMO

extracorporeal membrane oxygenation

EF

ejection fraction

ESD

end-systolic diameter

ESR

erythrocyte sedimentation ratio

ETT

exercise treadmill test

FT4

free thyroxine

FVC

forced vital capacity

FEV1

forced expiratory volume in 1s

GFR

glomerular filtration rate

GI

gastrointestinal

GP

glycoprotein

HCM

hypertrophic cardiomyopathy

HDL

high-density lipoprotein

HE

hypertensive emergency

HJR

hepatojugular reflex

HIV

human immunodeficiency virus

HOCM

hypertrophic obstructive cardiomyopathy

HR

heart rate

HSVC

high superior vena cava

HTN

hypertension

HU

hypertensive urgency

IABP

intra-aortic balloon pump

ICD

implantable cardioverter defibrillator

ICU

intensive care unit

IE

infective endocarditis

IL

interleukin

IVC

inferior vena cava

IVCD

intraventricular conduction defect

IVUS

intravascular ultrasound

JVP

jugular venous pressure

LA

left atrium

LAD

left anterior descending artery

LAP

left atrial pressure

LBBB

left bundle branch block

LDL

low-density lipoprotein

LFT

liver function test

LHF

left heart failure

LIMA

left internal mammary artery

LMWH

low-molecular-weight heparin

lp(a)

lipoprotein a

LPA

left pulmonary artery

LSVC

low superior vena cava

LV

left ventricular

LVD

left ventricular dysfunction

LVEDP

left ventricular end-diastolic pressure

LVEDV

left ventricular end-diastolic volume

LVEF

left ventricular ejection fraction

LVH

left ventricular hypertrophy

LVOT

left ventricular outflow tract

MAOI

monoamine oxidase inhibitor

MAP

mean arterial pressure

MET

metabolic equivalent

MI

myocardial infarction

MMF

mycophenolate mofetil

MPA

main pulmonary artery

MR

mitral regurgitation

MRI

magnetic resonance imaging

MRSA

methicillin-resistant

Staphylococcus aureus

MV

mitral valve

MVP

mitral valve prolapse

MVR

mitral valve replacement

NRT

nicotine replacement therapy

NSAID

nonsteroidal anti-inflammatory drug

NSVT

nonsustained ventricular tachycardia

NTG

nitroglycerin

NYHA

New York Heart Association

OTC

over the counter

PAC

premature atrial contraction

PAD

peripheral artery disease

PAH

pulmonary artery hypertension

PAP

pulmonary artery pressure

PASP

pulmonary artery systolic pressure

PAWP

pulmonary artery wedge pressure

PCA

patient-controlled anesthesia

PCH

pulmonary capillary hemangiomatosis

PCI

percutaneous coronary intervention

PCN

penicillin

PCP

phenylcyclidine

PCWP

pulmonary capillary wedge pressure

PDA

patent ductus arteriosus

PE

pulmonary embolism

PEA

pulseless electrical activity

PEEP

positive end-expiratory pressure

PFO

patent foramen ovale

PFT

pulmonary function test

PHT

pressure half-time

PHTN

portal hypertension

PMBV

percutaneous mitral balloon valvotomy

PND

paroxysmal nocturnal dyspnea

PPAR

peroxisome proliferator-activated receptor

PPM

permanent pacemaker

PRA

panel reactive antibody

PS

pulmonic stenosis

PTCA

percutaneous transluminal coronary angioplasty

PTLD

post-transplant lymphoproliferative disorder

PVC

premature ventricular contraction

PVD

premature ventricular depolarization

PVOD

pulmonary veno-occlusive disease

PVR

pulmonary vascular resistance

RA

right atrium

RAD

right axis deviation

RAE

right atrial enlargement

RAP

right atrial pressure

RCA

right coronary artery

RCT

randomized controlled trial

RF

regurgitant fraction

RHF

right heart failure

RPA

right pulmonary artery

RV

right ventricular

RVAD

right ventricular assist device

RVEDP

right ventricular end-diastolic pressure

RVH

right ventricular hypertrophy

RVOT

right ventricular outflow tract

RVSP

right ventricular systolic pressure

SAM

systolic anterior motion

SBP

systolic blood pressure

SCD

sudden cardiac death

SLE

systemic lupus erythematosus

SOB

shortness of breath

SPEP

serum protein electrophoretic pattern

STEMI

ST elevation myocardial infarction

SVC

superior vena cava

SVG

saphenous vein graft

SVR

systemic vascular resistance

SVT

supraventricular tachycardia

TB

tuberculosis

TC

total cholesterol

TEE

transesophageal echocardiogram

TFT

thyroid function test

TG

triglyceride

TGA

transposition of great arteries

TIMI

thrombolysis in myocardial infarction

TLI

total lymphoid irradiation

TnI

troponin I

TOF

tetralogy of Fallot

TR

tricuspid regurgitation

TSH

thyroid stimulating hormone

TTE

transthoracic echocardiography

TV

tricuspid valve

TVR

target vessel revascularization

TWI

T-wave inversion

UFH

unfractionated heparin

UPEP

urine protein electrophoretic pattern

VAD

ventricular assist device

VLDL

very-low-density lipoprotein

VPB

ventricular premature beat

VSD

ventricular septal defect

VT

ventricular tachycardia

WBC

white blood cell

WHO

World Health Organization

WPW

Wolff–Parkinson–White

Foreword

Medical knowledge is increasing at an unprecedented rate and physicians in training are expected to master a large body of knowledge that can seem overwhelming. While many refer to textbooks and the Internet for updates in diagnostic methods, new therapies, and clinical trials addressing medical issues, a practical handbook that can be used even at the bedside is what prompted the design of this book. This cardiology handbook emphasizes evidence-based medicine in an up-to-date, practical, reader-friendly context, and addresses an unmet need in an era of information overload.

This book was originally designed with the need of a cardiology fellow trainee in mind. A major strength of this handbook relates to its editors and authors: it was primarily written and edited by cardiology fellows who know both about how busy the service can be and what information is needed for effective patient care. We believe that this book can serve as practical guide not only to cardiology fellows in training, but also to a wider audience that includes other trainees in medicine, surgery, and anesthesiology, as well as practicing internists and cardiologists. The practical format of this book includes boxes and flowcharts (for diagnosis and treatment), evidence-based practice (landscape trials) and clinical pearls (succinct advice from master clinicians). The dedication and commitment to patient care of the authors and editors are evident in the quality of the final product. We are confident that this book can be used by many physicians with the goal of improved patient care.

For more than five decades, Stanford has been a leader in cardiovascular care, research and education. From the first heart-lung transplant to innovative intracoronary devices to basic research on cardiac development, Stanford has contributed enormously to the advancement of cardiovascular therapy. Its programs in cardiology and cardiothoracic surgery have trained hundreds of experts, who have gone on to become leaders in their fields. This book has grown out of the Stanford Cardiology tradition of giving its fellows a pivotal role in patient care and educating colleagues and peers. Each chapter is written by a fellow in training with direct supervision of a member of the Stanford faculty. The book holds true to the core values of our institution: patient care, research, and education.

Alan C. Yeung, MD

Robert C. Robbins, MD

Li Ka Shing Professor of Medicine

Professor and Chairman, Cardiothoracic

Chief, Cardiovascular Medicine

Surgery

(Clinical)

Director, Cardiovascular Institute

Stanford University School of Medicine

Stanford University School of Medicine

SECTION I

Preventive Cardiology

CHAPTER 1

Prevention of Cardiovascular Disease