Management of Complex Cardiovascular Problems E-Book

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

Seitenzahl: 702

Veröffentlichungsjahr: 2016

Beschreibung

Patients with complex cardiovascular problems pose a special management challenge for both the specialist and the non-specialist. This book helps you approach difficult cases with the confidence to strategically map care, understand the risk profile of your patient, and make effective treatment decisions.

• Dependable and succinct content provides  high yield information for the busy cardiologist
• Take home call outs, and critical thinking boxes provide candid advice on incorporating guidelines and evidence based medicine into your practice
• New convenient pocket-sized format
• New chapter addressing cardiovascular problems in women
• Discussion of high risk factors for and strategic care mapping encourage clinical focus
• Clinical pearls offer expert advice on topical issues
• Includes emerging trends and clinical trials keeping you up to date

Leseprobe

Management of Complex Cardiovascular Problems

FOURTH EDITION

EDITED BY

Thach Nguyen, MD, FACC FSCAI

Director of Cardiovascular Research Methodist Hospital Merrillville IN 46410

Dayi Hu, MD FACC FHRS FESC

Director of the Intervention Center at Peking University People’s Hospital, President, Chinese College of Cardiovascular Physician (CCCP), Beijing, China

Shao Liang Chen MD

Professor of Cardiology Professor of Internal Medicine Deputy President, Nanjing First Hospital, Nanjing Medical University Director of Catheterization Laboratories, Nanjing First Hospital Chief of Cardiology Nanjing First Hospital Nanjing, China

Moo-Hyun Kim, MD, FACC

Associate Professor of Medicine Director, Cardiology Department Dong A University Busan, Korea

Cindy Grines, MD

Vice President Academic and Clinical Affairs, Detroit Medical Center Heart Hospital Detroit, MI

ASSOCIATE EDITOR

Faisal Latif, MD

Associate Professor of Medicine, University of Oklahoma, OKC, OK

This edition first published 2016 © 2016 by John Wiley & Sons Ltd

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Library of Congress Cataloging-in-Publication Data:

Names: Nguyen, Thach, editor. | Hu, Dayi, editor. | Chen, Shao Liang, editor. | Kim, Moo-Hyun (Cardiologist), editor. | Grines, Cindy, editor. Title: Management of complex cardiovascular problems / edited by Thach Nguyen, Dayi Hu, Shao    Liang Chen, Moo-Hyun Kim, Cindy Grines ; associate editor, Faisal Latiff. Description: Fourth edition. | Chichester, West Sussex, UK ; Hoboken, NJ : John Wiley & Sons Inc.,    2016. | Includes bibliographical references and index. Identifiers: LCCN 2015035763 (print) | LCCN 2015036342 (ebook)    | ISBN 9781118965030 (cloth) | ISBN 9781118965047 (Adobe PDF) | ISBN 9781118965054 (ePub) Subjects: | MESH: Cardiovascular Diseases--therapy. | Evidence-Based Medicine. Classification: LCC RC671 (print) | LCC RC671 (ebook) | NLM WG 120 | DDC 616.1/2--dc23 LC record available at http://lccn.loc.gov/2015035763

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

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Cover image: gettyimages.com © Janulla

CONTENTS

List of Contributors

Foreword to the Third Edition

Preface

PRACTICING CARDIOLOGY IS LIKE CAR RACING AT THE INDY 500

Acknowledgements

CHAPTER 1 Hyperlipidemia

BACKGROUND

CHALLENGES

STRATEGIC MAPPING

HIGH-RISK MARKERS

INVESTIGATIONS

MANAGEMENT

MANAGEMENT OF PATIENTS NOT ON THE RECOMMENDATION LIST OF THE ACC/AHA GUIDELINES

HYPERTRYGLYCERIDEMIA

REFERENCES

CHAPTER 2 Hypertension: Implications of Current JNC 8 Guidelines on Treatment

BACKGROUND

CHALLENGES

STRATEGIC PLANNING

HIGH-RISK MARKERS

HIGH-RISK PREDICTORS

INVESTIGATIONS

MANAGEMENT

INFLUENCE OF COMORBID CONDITIONS

SECONDARY CAUSES OF HYPERTENSION

REFERENCES

CHAPTER 3 Stable Coronary Artery Disease

BACKGROUND

CHALLENGES

STRATEGIC MAPPING

RISK PROFILING

HIGH-RISK PREDICTORS

INVESTIGATIONS

FUNCTIONAL ASSESSMENT OF ISCHEMIC RISK

ANATOMICAL ASSESSMENT OF ISCHEMIC RISK

DIAGNOSIS

MANAGEMENT

REFERENCES

CHAPTER 4 Acute Coronary Syndrome

BACKGROUND

CHALLENGES

STRATEGIC MAPPING

HIGH-RISK PROFILING

HIGH-RISK PREDICTORS

INVESTIGATIONS

MANAGEMENT

SYMPTOM RELIEF AND REDUCTION OF MYOCARDIAL ISCHEMIA

MANAGEMENT OF PATIENTS WITH MAJOR CO-MORBIDITIES

SPECIAL SITUATIONS

REFERENCES

CHAPTER 5 ST Segment Elevation Myocardial Infarction

BACKGROUND

CHALLENGES

STRATEGIC MAPPING

HIGH-RISK MARKERS

HIGH-RISK PREDICTORS

INVESTIGATIONS

SMART TESTING

MANAGEMENT

COMPREHENSIVE MANAGEMENT

PREFERENTIAL MANAGEMENT

REFERENCES

CHAPTER 6 Heart Failure (Stages A, B and C)

STAGE A: ASYMPTOMATIC HEART FAILURE RISK FACTORS

BACKGROUND

CHALLENGES

STRATEGIC MAPPING

HIGH-RISK MARKERS

HIGH-RISK PREDICTORS

INVESTIGATIONS

SMART TESTING

MANAGEMENT

STAGE B: ASYMPTOMATIC LEFT VENTRICULAR REMODELING

BACKGROUND

CHALLENGES

STRATEGIC MAPPING

HIGH-RISK MARKERS

HIGH-RISK PREDICTORS

MANAGEMENT

STAGE C: HEART FAILURE

BACKGROUND

CHALLENGES

STRATEGIC MAPPING

HIGH-RISK MARKERS

HIGH-RISK PREDICTORS

INVESTIGATIONS

SMART TESTING

MANAGEMENT

REFERENCES

CHAPTER 7 Acute Decompensated and Chronic Stage D Heart Failure

NEW UNDERSTANDINGS

STRATEGIC MAPPING

HIGH-RISK MARKERS

HIGH-RISK PREDICTORS

INVESTIGATIONS

SMART TESTING

DIAGNOSES

MANAGEMENT

SYSTEM-BASED PRACTICE: DISCHARGE

SYSTEM-BASED PRACTICE: EARLY AND RECURRENT READMISSION

ADVANCED (STAGE D) HEART FAILURE

REFERENCES

CHAPTER 8 Atrial Fibrillation

BACKGROUND

CHALLENGES

STRATEGIC MAPPING

HIGH-RISK MARKERS

HIGH-RISK PREDICTORS

INVESTIGATIONS

SMART TESTING

ACUTE MANAGEMENT

CHRONIC MANAGEMENT

INVASIVE MANAGEMENT

MANAGEMENT OF COMPLEX PROBLEMS OR HIGH-RISK PATIENT SUBSETS

REFERENCES

CHAPTER 9 Ventricular Tachycardia

BACKGROUND

CHALLENGES

STRATEGIC MAPPING

HIGH-RISK PROFILING

HIGH-RISK PREDICTORS

SMART TESTING

DIAGNOSES

MANAGEMENT

REFERENCES

CHAPTER 10 Syncope

BACKGROUND

CHALLENGES

STRATEGIC MAPPING

HIGH-RISK MARKERS

HIGH-RISK PREDICTORS

INVESTIGATIONS

WORKING DIAGNOSES

SMART TESTING

MANAGEMENT

REFERENCES

CHAPTER 11 Aortic Stenosis

BACKGROUND

CHALLENGES

HIGH-RISK MARKERS

HIGH-RISK PREDICTORS

INVESTIGATIONS

SMART TESTING

MANAGEMENT

REFERENCES

CHAPTER 12 Mitral Regurgitation

BACKGROUND

CHALLENGES

STRATEGIC MAPPING

HIGH-RISK MARKERS

HIGH-RISK PREDICTORS

INVESTIGATIONS

PRIMARY MITRAL REGURGITATION

SECONDARY MITRAL REGURGITATION

ACUTE MITRAL REGURGITATION

REFERENCES

CHAPTER 13 Cardiovascular Problems in Elderly Patients

BACKGROUND

CHALLENGES

STRATEGIC MAPPING

HIGH-RISK MARKERS

HIGH-RISK PREDICTORS

INVESTIGATIONS

SMART TESTING

MANAGEMENT

REFERENCES

CHAPTER 14 Cardiovascular Problems in Women

BACKGROUND

CHALLENGES

HIGH-RISK MARKERS

STRATEGIC MAPPING

INVESTIGATIONS

SMART TESTING

INVASIVE TESTING

MANAGEMENT

REFERENCES

Index

EULA

List of Tables

Chapter 1

Table 1.1

Table 1.2

Table 1.3

Table 1.4

Table 1.5

Table 1.6

Table 1.7

Table 1.8

Table 1.9

Table 1.10

Table 1.11

Table 1.12

Chapter 2

Table 2.1

Chapter 3

Table 3.1

Table 3.2

Table 3.3

Table 3.4

Table 3.5

Table 3.6

Table 3.7

Table 3.8

Table 3.9

Chapter 4

Table 4.1

Table 4.2

Table 4.3

Table 4.4

Chapter 5

Table 5.1

Table 5.2

Table 5.3

Table 5.4

Table 5.5

Table 5.6

Table 5.7

Table 5.8

Table 5.9

Table 5.10

Table 5.11

Chapter 6

Table 6.1

Table 6.2

Table 6.3

Table 6.4

Table 6.5

Table 6.6

Table 6.7

Table 6.8

Table 6.9

Table 6.10

Table 6.11

Chapter 7

Table 7.1

Table 7.2

Table 7.3

Table 7.4

Table 7.5

Table 7.6

Table 7.7

Table 7.8

Table 7.9

Table 7.10

Table 7.11

Table 7.12

Table 7.13

Chapter 8

Table 8.1

Table 8.2

Table 8.3

Table 8.4

Table 8.5

Table 8.6

Table 8.7

Table 8.8

Table 8.9

Table 8.10

Table 8.11

Chapter 9

Table 9.1

Table 9.2

Table 9.3

Table 9.4

Table 9.5

Table 9.6

Table 9.7

Table 9.8

Chapter 10

Table 10.1

Table 10.2

Table 10.3

Table 10.4

Table 10.5

Table 10.6

Table 10.7

Table 10.8

Table 10.9

Table 10.10

Table 10.11

Chapter 11

Table 11.1

Table 11.2

Table 11.3

Table 11.4

Table 11.5

Table 11.6

Chapter 12

Table 12.1

Table 12.2

Table 12.3

Table 12.4

Table 12.5

Table 12.6

Table 12.7

Table 12.8

Table 12.9

Table 12.10

Table 12.11

Chapter 13

Table 13.1

Table 13.2

Chapter 14

Table 14.1

Table 14.2

Table 14.3

Table 14.4

Table 14.5

Table 14.6

Table 14.7

Table 14.8

Table 14.9

Table 14.10

List of Illustrations

Chapter 1

Figure 1.1

Schema for selection of patients to be treated for hyperlipidemia (adapted from Stone et al [1]).

Chapter 7

Figure 7.1

EKG before the index emergency room visit.

Figure 7.2

EKG on the index visit (diffuse T waves inversion in all leads V1-V6, I and AvL).

Figure 7.3

EKG 3 months later (The T waves changes reversed to normal upright).

Chapter 8

Figure 8.1

Strategy for management of atrial fibrillation.

(CI: contraindication; LAA: left atrial appendage; BB: beta-blocker; CCB: non-dihydropyridine receptor calcium channel blockers; AAD: anti-arrhythmic drugs.

Chapter 10

Figure 10.1

Tilt training (Standing training). Source: Benditt 2009 [50]. Reproduced with permission of Elsevier.

Figure 10.2

Physical maneuvers to counter an imminent vasovagal or orthostatic faint. Source: Benditt 2009 [50]. Reproduced with permission of Elsevier.

Chapter 12

Figure 12.1

Proximal isovelocity surface area (PISA) approximation for effective orifice area (EROA) and regurgitant volume (RV). (A) Schematic of PISA calculation. (B) Transesophageal interrogation of the regurgitant jet and measurement of the radius (r) of flow convergence. (C) Measurement of MR peak velocity (PkVreg) and velocity time integral (MR-VTI). (D) Calculation for the EROA and RV based on measured values for this case. Based on the calculations, the patient has severe MR. Note that this example used the highest values, given the atrial fibrillation, there may be a need for averaging several beats. Source: Zoghbi 2003. Reproduced with permission of Oxford University Press. Chapter 12, Reference [5].

Figure 12.2

Multi-planar assessment of estimated regurgitant orifice area (EROA) using 3-dimensional (3D) Doppler. (A and B) Systolic long-axis views are optimized to visualize the MR (MR) jet. The largest systolic proximal isovelocity surface area (PISA) is used to adjust the short-axis plane (blue line) to obtain an

en face

view of the base of the PISA (C and D). (E) The color Doppler baseline is adjusted to 39.6 cm/s. (F) Multiple orthogonal view can be generated (C and D, red planes) to obtain the largest 2-dimensional PFCR. The radius, length, and width measurements are shown (A and D) and the longest PISA radius is shown (F). Source: Thavendiranathan et al. 2012. Reproduced with permission of Elsevier. Chapter 12, Reference [28].

Figure 12.3

Percutaneous mitral clipping of the mitral valve using the MitraClip ® and associated clip delivery system (CDS) (Abbott Vascular, Santa Clara, CA). (A) Alfieri surgical technique performed to create a double orifice mitral valve and reduce regurgitation. (B) Trans-septal access, optimization and orientating a MitraClip with the middle scallops of the anterior and posterior leaflets, A2 and P2 respectively. (C) Successful grasping of the leaflet edges to complete an edge-to-edge repair.

Guide

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Preface

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List of Contributors

NABEEL ALI, MD

Xavier University School of Medicine, Aruba

HY TAT AN

MS Class of 2020 Tan Tao University School of Medicine

Tan Duc E-City, Duc Hoa – Long An Vietnam

KHALID NUMAN AL AZZA, MD

Jordan University of Science and Technology

Irbid, Jordan

AMAN M. AMANULLAH, MD, PhD, FACC, FAHA

Clinical Professor of Medicine

Sidney Kimmel Medical College of Thomas Jefferson University

Section Chief, Noninvasive Cardiology, Albert Einstein Medical Center

Philadelphia, PA 19141

AMSA ARSHAD, MD

Xavier University School of Medicine, Aruba

NISA ARSHAD, MD

Xavier University School of Medicine, Aruba

Christopher M. Bianco, MD

Cardiology Fellow

The Brody School of Medicine at East Carolina University

Greenville, NC

THOMAS BUMP, MD

Clinical Associate Professor, University of Chicago

Clinical Assistant Professor, University of Illinois at Chicago

Chicago, IL

PATRICK T. CAMPBELL, MD

Advanced Heart Failure Fellow

Section of Cardiomyopathy & Heart Transplantation

Ochsner Heart and Vascular Center, New Orleans

Mihail G. Chelu, MD, PhD, FHRS

Assistant Professor University of Utah School of Medicine

Electrophysiology Division Salt Lake City, UT

SHAO LIANG CHEN, MD, PhD, FACC

Professor of Cardiology

Professor of Internal Medicine

Deputy President, Nanjing First Hospital, Nanjing Medical University

Director of Catheterization Laboratories, Nanjing First Hospital

Chief of Cardiology, Nanjing First Hospital

Nanjing, China

NGUYEN DUC CONG, MD, PhD

Professor of Medicine

Director of Thong Nhat Hospital

Director of Geriatric Department of Pham Ngoc Thach Medical University

Vice Director of Geriatric Department, The University of Medicine and Pharmacy

Vice Director Department of Internal Medicine, School of Medicine, the National University of Hochiminh City, Hochiminh City, Vietnam

VIJAY DAVE, MD

Director of Medical Education

St Mary Medical Center Hobart, IN

HO THUONG DUNG, MD, PhD, FSCAI

Vice Director of Thong Nhat Hospital, HCM City

Vice Chairman of Interventional Cardiology Association of HCM City

Hochiminh City, Vietnam

MARVIN H. ENG, MD

Structural Heart Disease Fellowship Director

Center for Structural Heart Disease, Division of Cardiology

Henry Ford Health System, Detroit, MI

DANIEL FORMAN, MD

Professor of Medicine, University of Pittsburgh

Chair, Geriatric Cardiology Section, University of Pittsburgh Medical Center

Director, Cardiac Rehabilitation, VA Pittsburgh Healthcare System

Pittsburgh, PA

RUNLIN GAO, MD, FACC, FESC, FSCAI

Professor of Medicine

Member, Chinese Academy of Medical Sciences

Chief Cardiologist, Fuwai Hospital Beijing, China

C. MICHAEL GIBSON, MD

Director, TIMI Data Coordinating Center; and Associate Professor

Harvard Medical School; and Chief of Clinical Research, Cardiovascular

Division, Beth Israel Deaconess Medical Center, Boston, MA

CINDY GRINES MD

Vice President Academic and Clinical Affairs, Detroit Medical Center Heart Hospital

Professor of Medicine, Wayne State University School of Medicine, Detroit MI

RAJIV GOSWAMI DO

Assistant Professor of Medicine, Baylor College of Medicine

Ben Taub Hospital, Houston, Texas

NGUYEN LAN HIEU, MD, PhD

Vice director, Heart Center

Hanoi Medical University Hospital

Hanoi, Vietnam

BAO V. HO, MD, MSC

New York Institute of Technology, College of Osteopathic Medicine

Old Westbury, NY

DAYI HU, MD, FACC, FESC

Director of the Heart Center at Peking University People's Hospital, Beijing China

President of the China Heart Federation Beijing China

PHAM MANH HUNG, PhD, MD, FACC, FESC

Associate Professor, Hanoi Medical University

Secretary General, Vietnam National Heart Association

Director, Cardiac Catheterization Laboratories Vietnam National Heart Institute

Hanoi, Vietnam

PHAM NHU HUNG, MD, PhD, FACC, FASCC

Consultant of Cardiology and Electrophysiology

Director of Electrophysiology Laboratories, Hanoi Heart Hospital

Hanoi, Vietnam

PHAN NAM HUNG, MD

General Secretary, the Internal Medicine Society of Vietnam

Vice Chief, Cardiovascular Medicine Department, Binh Dinh General Hospital

Qui Nhon, Vietnam

AN HUYNH

MS Class of 2019, Tan Tao University School of Medicine

Tan Duc E-City, Duc Hoa – Long An Vietnam

HUNG D. HUYNH

Senior Research Associate, Community Healthcare System, St Mary

Medical Center, Hobart, IN; and Webmaster, Riverside, CA

KIM N. HUYNH

Honor Student, Miss Hall's School

Vice President, International Student Alliance

Pittsfield, MA

KAHROBA JAHAN MD

Division of Cardiology, Sarver Heart Center

Banner University Medical Center South Campus

University of Arizona, Tucson, AZ

Deepak Joshi, MD

Cardiology Fellow

The Brody School of Medicine at East Carolina University

Greenville, NC

MOO-HYUN KIM, MD, FACC, FSCAI

Director, Global Clinical Trial Center

Professor, Dept. of Cardiology, Dong-A University Hospital

Busan, Korea

NEAL KLEIMAN MD

Professor, Department of Medicine

Weill Cornell Medical College of Cornell University

Director, Applied Platelet Physiology Lab

Director, Cardiac Catheterization Laboratories

Houston Methodist DeBakey Heart & Vascular Center

Houston, TX

SELIM R. KRIM, MD

Staff, Section of Cardiomyopathy & Heart Transplantation

Ochsner Heart and Vascular Center, New Orleans LA

FAISAL LATIF, MD, FACC, FSCAI

Associate Professor of Medicine

Associate Program Director, Cardiology Fellowship Program

University of Oklahoma Health Sciences Center

Director, Cardiac Catheterization Laboratories

VA Medical Center, Oklahoma City, OK

SORIN LAZAR, MD

Electrophysiologist

Methodist Hospital, Merrillville, IN

DAN D. LE, MD

Cardiology Fellow

The Brody School of Medicine at East Carolina University

Greenville, NC

TRONG HA LE

MS Class of 2019 Tan Tao University School of Medicine

Tan Duc E-City, Duc Hoa – Long An Vietnam

KWAN S. LEE, MD FACC FSCAI

Medical Director of Cardiology

Director Cardiac Catheterization Laboratory

Banner University Medical Center South Campus

Sarver Heart Center, Banner University Medical Center South Campus

University of Arizona Tucson, AZ

XIAN KAI LI, MD, PhD

Cardiology Department

Shanghai Tenth People's Hospital of Tongji University

Shanghai, China

TUNG DINH MAI, DO

Resident, Department of Internal Medicine

Detroit Medical Center – Sinai Grace Hospital

Wayne State University – School of Medicine, Detroit, Michigan

Clinical faculty, Department of Medicine

Michigan State University – College of Osteopathic Medicine

East Lansing, Michigan

ARAVINDA NANJUNDAPPA, FACC, FSCAI, RVT

Professor of Medicine and Surgery

Director of TAVR Program

West Virginia University, Charleston, WV

CHISALU NCHEKWUBE, MD

Internal Medicine Residency Program

Department of Internal Medicine

University of Illinois Hospital and Health Sciences System

Chicago, IL

RAJASEKHAR NEKKANTI, MD FACC FASE CCDS

Associate Professor of Medicine

Program Director, Cardiology Fellowship Program

Director, Continuing Medical Education-Cardiovascular Series

East Carolina Heart Institute

The Brody School of Medicine at East Carolina University

Director, Echocardiography Laboratories

East Carolina Heart Institute at Vidant Medical Center

Greenville, NC

Tam Ngo, MD

Resident in ophthalmology

University of Medicine and Pharmacy, Ho Chi Minh City, Viet Nam

LAN NGUYEN, MD

Universidad Autonóma de Guadalajara

Guadalajara, MX

NGUYEN PHUC NGUYEN, MD

Cardiology Department

St Mary Medical Center, Hobart, IN

NGOC-QUANG NGUYEN, MD, Phd, FASCC, FSCAI

Department of Cardiology, Hanoi Medical University

Head of Coronary Care Unit (C7), Vietnam National Heart Institute

Bach Mai Hospital, Hanoi, Vietnam

QUANG TUAN NGUYEN, MD, PhD, FACC, FSCAI

CEO, Hanoi Heart Hospital

Medical Director, Hanoi Heart Hospital

Associate professor, Hanoi Medical University

President, Vietnam Interventional Cardiology Society

President, Hanoi Heart Association, Hanoi, Vietnam

THACH NGUYEN, MD, FACC, FSCAI

Deputy Editor-in-chief, Interventional Cardiology Grand Rounds, NYC, NY, and Associate-editor-in-chief, Journal of Geriatric Cardiology, Beijing, China; and Editorial Consultant, Journal of Interventional Cardiology; Hoboken, NJ, and Chinese Medical Journal, Beijing, China, and Honorary Professor of Medicine, Hanoi Medical University, and Vietnam Heart Institute, Hanoi, Vietnam, and Capital University of Medical Sciences, Beijing, China; and The Institute of Geriatric Cardiology, 301 Hospital of the Chinese People's Liberation Army, Beijing, China; and Friendship Hospital, Beijing, and the Tenth People's Hospital, Shanghai, China, and Visiting Professor, Nanjing First Hospital, Nanjing Medical University, Nanjing, China; and Clinical Assistant Professor of Medicine, Indiana University Northwest, IN, USA, Director of cardiovascular research Methodist hospital, Merrillville, IN; and Director of Cardiology, Community Healthcare System, St Mary Medical Center, Hobart, IN, USA

TUAN D. NGUYEN, DO

Candidate, Class of 2017

New York Institute of Technology, College of Osteopathic Medicine

Old Westbury, NY

ALI OTO, MD, FESC, FACC, FHRS

Professor of Cardiology

Chairman, Department of Cardiology,

MHG, Memorial Ankara Hospital

Ankara, Turkey

PHAN DINH PHONG, MD, PhD

Head of Training Center

Vietnam National Heart Institute

Bach Mai Hospital, Hanoi, Vietnam

DUANE PINTO, MD FACC FSCAI

Associate Professor of Medicine, Harvard Medical School

Director, General Cardiology Fellowship Program

Director, Cardiac Intensive Care Unit, Beth Israel Deaconess Medical Center

Boston MA

GIANLUCA RIGATELLI, MD, PhD, EBIR, FACP, FACC, FESC, FSCAI

Cardiovascular Diagnosis and Endoluminal Interventions Unit

Rovigo, General Hospital, Rovigo, Italy

MICHAEL RINALDI, MD

Interventional Cardiology and Vascular Medicine

Director, Clinical Research, Sanger Heart and Vascular Institute

Professor of Medicine, Carolinas HealthCare System

Charlotte, NC

MADHUR ROBERTS, MD

Cardiovascular Fellow, PGY 6

University of Tennessee Medical Center

Knoxville, TN

AINOL SHAREHA SAHAR, MD FACC FSCAI FNHAM SCIM

Senior Consultant Cardiologist

Deputy Head, Department of Cardiology

Penang General Hospital

Penang Malaysia

SARA SHAH

Honor Student, Munster High School

National Society of High School Scholar

Delegate, the Congress of Future Medical Leaders

2015 Nominee, National Youth Leadership Forum in Medicine

EVGENY SHLYAKHTO, MD, PhD, FESC, FACC

President, Russian Society of Cardiology

Director, Federal Almazov Heart Blood Endocrinology Centre

St Petersburg, Russian Federation

UDHO THADANI, MD, MRCP, FRCPC, FACC, FAHA

Professor Emeritus of Medicine University of Oklahoma Health Sciences Center

Consultant Cardiologist Oklahoma University Medical Center and VA Medical Center

Oklahoma City, OK

LÊ HOÀNG ĐÚ'C TOÀN

MS Class of 2019 Tan Tao University School of Medicine

Tan Duc E-City, Duc Hoa – Long An Vietnam

LÊ THỊ NGỌC TRÂM

MS Class of 2019, Tan Tao University School of Medicine

Tan Duc E-City, Duc Hoa – Long An Vietnam

HAU TRAN, MD, DO

New York Institute of Technology, College of Osteopathic Medicine

Old Westbury, NY

PHILLIP TRAN, DO

Cardiology fellow

Mercy Medical Center – North IA

HUÝNH THỊ THU TRÚC

MS Class of 2019 Tan Tao University School of Medicine

Tan Duc E-City, Duc Hoa – Long An Vietnam

VIEN THANH TRUONG, MD

Resident in Internal Medicine

Junior Lecturer, Internal Medicine Department

Pham Ngoc Thach University of Medicine, Ho Chi Minh City, Vietnam

M. HARIS U. USMAN, MD, MS

Interventional Cardiology Fellow

Detroit Medical Center, Wayne State University

Detroit MI

HECTOR O. VENTURA, MD, FACC, FACP

Director, Section of Cardiomyopathy & Heart Transplantation

Ochsner Heart and Vascular Center, New Orleans

New Orleans, LA

VÕ MINH VIỆT

MS Class of 2019 Tan Tao University School of Medicine

Tan Duc E-City, Duc Hoa – Long An Vietnam

YIDONG WEI, MD, FACC

Professor, Chief, Department of Cardiology

Shanghai Tenth People's Hospital of Tongji University

Shanghai, China

NANETTE K. WENGER, MD, MACC, MACP, FAHA

Professor of Medicine (Cardiology) Emeritus

Emory University School of Medicine

Consultant, Emory Heart and Vascular Center

Atlanta, GA

BO XU, MBBS

Director, Catheterization Laboratory

Fu Wai Hospital, National Center for Cardiovascular Diseases

Beijing, China

HAN YALING, MD, FACC, FESC

Academician of Chinese Academy of Engineering

President, Institute of Cardiovascular Medicine of PLA

Director, Department of Cardiology

General Hospital of Shenyang Military Region

Shenyang, Liaoning China

Foreword to the Third Edition

The modern cardiologist is confronted with a bewildering amount of new information. At last count there were more than one hundred cardiology journals. Many cardiology textbooks, covering every aspect of the field and dozens of symposia are published each year. The major cardiovascular centers all have their ‘in house’ publications, which emphasize their local accomplishments. In addition, industry bombards cardiologists with many reviews, each placing the sponsor's project and trial in the best light.

What the practicing cardiologist really needs is a text that emphasizes unbiased, up to date information and that places this information into an appropriate context. The third edition of Management of Complex Cardiovascular Problems, carefully edited by Dr. Nguyen, does precisely this.

Particularly new, reader friendly, features are the boxes of ‘Take Home Messages’ [Action Points in the Fourth Edition] which give succinct summaries of each chapter, together with Critical Thinking (new concepts); Evidence-Based Medicine (the key results of important clinical trials); and Clinical Pearls (advice from master clinicians).

This unique format provides busy cardiologists with an approach to deal with information overload and will thereby enhance the quality of care delivered to the cardiac patient. Thus, Dr. Thach Nguyen and his talented authors have again provided us with important ammunition for the war against heart disease. This fine book describes clearly some of the most difficult problems that cardiovascular specialists face, and it provides enormously helpful directions in dealing with them. This eminently readable book should be equally valuable to practicing cardiologists in the front lines of the battle against the global scourge of cardiovascular disease and to trainees in the field.

Eugene Braunwald, M.D.

Boston, Massachusetts

Preface

PRACTICING CARDIOLOGY IS LIKE CAR RACING AT THE INDY 500

When driving to work, do you drive in the fast lane? When using the internet, do you use a shortcut to open a new window? For short and quick communication, do you text or pick up the phone? In 2016, do cardiologists still work with 20th century mentality or do they see and work through a 21st century lens or Google Glass? In this fourth edition of Management of Complex Cardiovascular Problems, the authors and editors offer new strategic views and tactical maps similar to the ones used in car racing; they are presented, however, with the wit of a young broker in the middle of the New York Stock Exchange pit.

When confronting a cardiac problem, the first strategy is to identify the challenges. How long is the race? Where are there dangerous turns? Which slippery slope could dump the best and most promising rider? If this vital information is available ahead of the game, the practicing cardiologists could program their brain, rewire the shortcuts, and reserve enough adrenaline needed for the run.

The second strategy when examining a patient is to risk profile the patient thereby discriminating the sickest from the less sick. By doing so, more resources, time, and manpower could be allocated for the small number of patients who need it the most without compromising quality of care for the entire group.

Then the authors and editors would offer a strategic map which prioritizes the process of investigation and management. Which is the straight line to the target (direct tests to confirm a clinical diagnosis)? How does one rule out the most important differential diagnoses? Which option offers the best cost and time effective (most fuel efficient) treatment? At the same time, signposts warning of imminent risks or end of danger zones are positioned in strategic locations dotting the horizons. Signs predicting the near future (or prognostic factors) are also prominently posted. Metrics which monitor the progress (follow-up) and evaluate the performance of the operators (practicing cardiologists) are positioned on large billboards or LED screens along the track. All of these signs are transparently posted for the practicing cardiologists without a paternalistic overtone.

Instead of arguing for a preferred solution to a particular problem, the authors and editors provide raw data in the form of abstracts detailing important randomized clinical trials; this enables the practicing cardiologist readers to scrutinize the main results and understand their differences. By so doing, they are able to intelligently select the best between multiple options. There is no need to spoonfeed readers with digested and regurgitated data. The numbers speak for themselves. However, the editors and authors do give practical pearls (which are shortcuts in real life) in order to cut time and cost.

Information is provided by the writers and editors utilizing short paragraphs so that readers will be able to store them in their short-term memory and analyze them before storing them in different compartments of their long-term memories. The strategy is to tailor these messages for today's cardiologists who may be overbooked, impatient, and/or hyperactive.

To all of our readers: The authors and editors of this book have shared many of your trials and tribulations. We have experienced the many sleepless nights. We labor every day in the hospital, at the patient's bedside, like yourself. We too have felt the need for the practical advices found in this book; indeed, that is why we have written them. We are, like all of you, our colleagues, both experienced and beginners, young and old, men and women; there are no divisions of class, age, sex, or race here. This book is not written from an ivory tower perspective – we aim to practice what we preach. Although much practical information and suggestions are given, we have also written from our subjective experience and from our hearts. After all, there is much drama and many ups and downs occurring daily on every cardiac floor in every healthcare facility across the globe. Hopefully, the outcome of our care and treatment will always be a happy and beneficial one for the patients. The bottom line is that we practice cardiology to the best of our ability in a responsible manner that is both cost-effective and time-effective and provides excellent patient-centered care. We are all equal in our quest of striving for the best management and clinical success.

That is the goal of this handbook. To give you, the cardiologist (racing car driver), the tools, the data, and the resources that you need to successfully navigate the race to the finishing line.

Acknowledgements

For the completion of this book, we owe much to our teachers, friends, colleagues, families, staff and patients. I (TNN) am indebted to Dr Eugene Braunwald, who wrote the foreword of the first to the third editions, for his invaluable encouragement, very kind words and advices. My deepest appreciation goes to my fellow editors and contributors and to my family, with the dedicated support of Huang Weitao, NNG CN; my parents Sau N. Nguyen (+ 2012) and Hanh T.H. Tran, and my family in Irvine CA and La Porte IN, especially Robert Luscomb Jr, Le Cong Dinh JD, Lê Gia Long and Lê Trung Húng, SGN, VN; Dr Huynh Duong Hung, Webmaster Riverside CA; Professor Bui Duy Tam, SFO, Lê Hoàng Đú'c Toàn, Võ Minh Viêt, Hu***nh Tr**ng Ân, Lê Tr**ng Hà, Hu**nh Th** Thu Trúc, Lê Th** Ng**c Trâm, Hy Tat An, Hoàng Quôc B**o, Truyên Thiên Tâ´n Trí Tài of Tan Tao University School of Medicine, Long An, Vietnam; special assistance was given by Cindy Macko at the Library of St Mary Medical Center, Hobart, IN and Yin Rong-Xiu at the Institute of Cardiovascular Disease, Capital University of Medical Sciences, Beijing, China. Above all, we are indebted to our patients – the purpose of our care, the source of our quests, the inspiration of our daily work. To them we give our heartfelt thanks.

CHAPTER 1Hyperlipidemia

Vien T. Truong, Kim N. Huynh, Tam Ngo, Sara Shah, Hau Van Tran, Chisalu Nchekwube, Nabeel Ali and Faisal Latif