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Loading...Mayo Clinic Cardiology – Concise Textbook
FOURTH EDITION
Editors-in-Chief
Joseph G. Murphy, MD
Margaret A. Lloyd, MD
Associate Editors
Peter A. Brady, MB, ChB, MD
Lyle J. Olson, MD
Raymond C. Shields, MD
Contributors xv
Section I Fundamentals of Cardiovascular Disease 1
Chapter 1 Cardiovascular Examination 3
Clarence Shub, MD
Chapter 2 Applied Anatomy of the Heart and
Great Vessels 20
Joseph G. Murphy, MD, and R. Scott Wright, MD
Chapter 3 Evidence-Based Medicine and Statistics in
Cardiology 44
Charanjit S. Rihal, MD
Chapter 4 Noncardiac Surgery in Patients With
Heart Disease 49
J. Wells Askew III, MD, and Clarence Shub, MD
Chapter 5 Essential Molecular Biology of Cardiovascular
Diseases 58
Cindy W. Tom, MD, and
Robert D. Simari, MD
Section II Noninvasive Imaging 69
Chapter 6 Restrictions on Drivers and Aircraft Pilots With
Cardiac Disease 71
Stephen L. Kopecky, MD
Chapter 7 Principles of Echocardiography 77
Teresa S. M. Tsang, MD
Chapter 8 Stress Echocardiography 100
Patricia A. Pellikka, MD
Chapter 9 Transesophageal Echocardiography 106
Sarinya Puwanant, MD, Lawrence J. Sinak, MD,
and Krishnaswamy Chandrasekaran, MD
Chapter 10 Nuclear Imaging 120
J. Wells Askew III, MD, and Todd D. Miller, MD
Chapter 11 Positron Emission Tomography 130
Panithaya Chareonthaitawee, MD
Chapter 12 Cardiovascular Computed Tomography and
Magnetic Resonance Imaging 139
Thomas C. Gerber, MD, PhD, and
Eric M. Walser, MD
Chapter 13 Cardiac Radiography 159
Jerome F. Breen, MD, Mark J. Callahan, MD,
and Margaret A. Lloyd, MD
Chapter 14 Atlas of Congenital Heart Defects 177
Sabrina D. Phillips, MD, and Frank Cetta Jr, MD
Chapter 15 Cardiopulmonary Exercise Testing in Clinical
Medicine 185
Thomas G. Allison, PhD, MPH
Chapter 16 Stress Test Selection 197
Thomas G. Allison, PhD, MPH
Section III Electrophysiology 203
Chapter 17 Electrocardiographic Diagnoses: Criteria and
Definitions of Abnormalities 205
Stephen C. Hammill, MD
Chapter 18 Cardiac Cellular Electrophysiology 239
Hon-Chi Lee, MD, PhD
Chapter 19 Indications for Invasive and Noninvasive
Electrophysiologic Testing 250
Barry A. Boilson, MD, and
Peter A. Brady, MB, ChB, MD
Chapter 20 Heritable Cardiomyopathies and Channelopathies:
Clinical Presentations, Genetics, and Implications
of Genetic Testing 257
J. Martijn Bos, MD, PhD, and
Michael J. Ackerman, MD, PhD
Chapter 21 Pediatric Arrhythmias 266
Bryan C. Cannon, MD
Chapter 22 Atrial Fibrillation and Flutter 270
Peter A. Brady, MB, ChB, MD
Contentsxii Contents
Chapter 23 Supraventricular Tachycardia 281
Joseph J. Gard, MD, Ammar Habib, MD,
and Samuel J. Asirvatham, MD
Chapter 24 Ventricular Tachycardia and Ectopy 289
Thomas M. Munger, MD
Chapter 25 Arrhythmias in Congenital Heart Disease 302
Christopher J. McLeod MB, ChB, PhD, and
Peter A. Brady, MB, ChB, MD
Chapter 26 Evaluation and Management of Pregnancy Associated
Arrhythmias 307
Peter A. Brady, MB, ChB, MD
Chapter 27 Syncope: Diagnosis and Treatment 313
Win-Kuang Shen, MD
Chapter 28 Pacemakers 324
Yong-Mei Cha, MD, and David L. Hayes, MD
Chapter 29 Cardiac Resynchronization Therapy 334
Grace Lin, MD, and David L. Hayes, MD
Chapter 30 Implantable Cardioverter-Defibrillator
Troubleshooting 339
Barry A. Boilson, MD, and Margaret A. Lloyd, MD
Chapter 31 Implantable Cardioverter-Defibrillator Trials and
Prevention of Sudden Cardiac Death 349
Margaret A. Lloyd, MD, and
Bernard J. Gersh, MB, ChB, DPhil
Chapter 32 Heart Disease in Athletes 357
Stephen C. Hammill, MD
Chapter 33 Autonomic Function Testing 359
K. L. Venkatachalam, MD
Chapter 34 Antiarrhythmic Drugs 363
Peter A. Brady, MB, ChB, MD
Chapter 35 Intracardiac Electrophysiology Tracings 372
Malini Madhavan, MBBS,
Christopher J. McLeod MB, ChB, PhD,
Douglas L. Packer, MD, and
Samuel J. Asirvatham, MD
Section IV Valvular Heart Disease 383
Chapter 36 Valvular Stenosis 385
Rick A. Nishimura, MD
Chapter 37 Valvular Regurgitation 393
Rick A. Nishimura, MD
Chapter 38 Rheumatic Heart Disease 403
Andrew G. Moore, MD
Chapter 39 Carcinoid and Drug-Related Heart Disease 409
Heidi M. Connolly, MD, and
Patricia A. Pellikka, MD
Chapter 40 Prosthetic Heart Valves 416
Martha A. Grogan, MD, and
Fletcher A. Miller Jr, MD
Chapter 41 Surgery for Cardiac Valve Disease 425
Rakesh M. Suri, MD, DPhil, and
Thomas A. Orszulak, MD
Chapter 42 Pathogenesis of Valvular Heart Disease 435
Nalini M. Rajamannan, MD, and
Joseph G. Murphy, MD
Chapter 43 Epidemiology of Valvular Heart Diseases 442
Vuyisile T. Nkomo, MD, MPH
Section V Aorta and Peripheral Vascular Disease 445
Chapter 44 Peripheral Vascular Disease 447
Peter C. Spittell, MD
Chapter 45 Cerebrovascular Disease and Carotid
Artery Stenting 455
Peter C. Spittell, MD, and David R. Holmes Jr, MD
Chapter 46 The Aorta 460
Peter C. Spittell, MD
Chapter 47 Renal Artery Disease 470
Verghese Mathew, MD
Chapter 48 Pathophysiology of Arterial Thrombosis 475
Robert D. McBane, MD, and
Waldemar E. Wysokinski, MD, PhD
Chapter 49 Treatment and Prevention of Arterial
Thrombosis 484
Robert D. McBane, MD, and
Waldemar E. Wysokinski, MD, PhD
Chapter 50 Venous and Lymphatic Disorders 500
Raymond C. Shields, MD
Chapter 51 Vasculitis 506
Paul W. Wennberg, MD
Chapter 52 Marfan Syndrome 514
Naser M. Ammash, MD, and Heidi M. Connolly, MD
Section VI Coronary Artery Disease Risk Factors 523
Chapter 53 Coronary Artery Disease Epidemiology 525
Thomas G. Allison, PhD, MPH
Chapter 54 Metabolic Syndrome 531
Thomas G. Allison, PhD, MPHContents xiii
Chapter 55 Pathogenesis of Atherosclerosis 537
Joseph L. Blackshear, MD, and Birgit Kantor, MD
Chapter 56 Dyslipidemia 551
Joseph G. Murphy, MD, Thomas
G. Allison, PhD, MPH, and R. Scott Wright, MD
Chapter 57 Lipid-Lowering Clinical Trials and Medications 558
Joseph G. Murphy, MD, R. Scott Wright, MD,
and Thomas G. Allison, PhD, MPH
Chapter 58 Novel Biomarkers of Coronary Artery
Disease Risk 571
Iftikhar J. Kullo, MD, FACC, FAHA
Chapter 59 Diabetes and Coronary Artery Disease 574
Robert L. Frye, MD, and David R. Holmes Jr, MD
Chapter 60 Hypertension 578
Adrian J. B. Brady, BSc, MD, R. Scott Wright, MD,
and Joseph G. Murphy, MD
Chapter 61 Stroke and Cardiovascular Disease 591
Joseph G. Murphy, MD, and
Margaret A. Lloyd, MD
Chapter 62 Heart Disease in Women 595
Patricia J. M. Best, MD, and
Sharonne N. Hayes, MD
Chapter 63 Heart Disease in the Elderly 603
Imran S. Syed, MD, Joseph G. Murphy, MD, and
R. Scott Wright, MD
Section VII Myocardial Infarction 607
Chapter 64 Cardiac Biomarkers 609
Brian P. Shapiro, MD, Luciano Babuin, MD, PhD,
and Allan S. Jaffe, MD
Chapter 65 Acute Coronary Syndromes 615
R. Scott Wright, MD, Stephen L. Kopecky, MD,
and Joseph G. Murphy, MD
Chapter 66 Chronic Stable Angina 627
Kalkidan G. Bishu, MD, and
Frank V. Brozovich, MD, PhD
Chapter 67 Right Ventricular Infarction 637
Joseph G. Murphy, MD, and R. Scott Wright, MD
Chapter 68 Adjunctive Therapy in Acute Myocardial
Infarction 641
R. Scott Wright, MD, Imran S. Syed, MD, and
Joseph G. Murphy, MD
Chapter 69 Arrhythmia Complications of Acute Myocardial
Infarction 652
Joseph G. Murphy, MD, and Margaret A. Lloyd, MD
Chapter 70 Mechanical Complications of Acute Myocardial
Infarction 657
Joseph G. Murphy, MD, and Margaret A. Lloyd, MD
Chapter 71 Cardiogenic Shock 665
Joseph G. Murphy, MD
Chapter 72 Reperfusion Strategies for ST-Elevation
Myocardial Infarction 672
Joseph G. Murphy, MD
Chapter 73 Cardiac Emergencies 682
Joseph G. Murphy, MD, Barry A. Boilson, MD,
and Margaret A. Lloyd, MD
Chapter 74 Risk Stratification After Myocardial Infarction 690
Randal J. Thomas, MD, MS
Chapter 75 Cardiac Rehabilitation 695
Thomas G. Allison, PhD, MPH
Chapter 76 Coronary Artery Bypass Surgery 701
Thoralf M. Sundt III, MD
Section VIII Diseases of the Heart, Pericardium, and
Pulmonary Circulation 707
Chapter 77 Pericardial Diseases 709
Rowlens M. Melduni, MD
Chapter 78 Pulmonary Embolism 725
Vivek Iyer, MD
Chapter 79 Pulmonary Hypertension 735
Rachel J. Le, MD, and
Garvan C. Kane, MD, PhD
Chapter 80 Pregnancy and the Heart 752
Heidi M. Connolly, MD
Chapter 81 Adult Congenital Heart Disease 761
Naser M. Ammash, MD, and
Carole A. Warnes, MD
Chapter 82 HIV Infection and the Heart 773
Joseph G. Murphy, MD, and
Zelalem Temesgen, MD
Chapter 83 Infective Endocarditis 777
Nandan S. Anavekar, MB, BCh, M. Rizwan Sohail,
MD, and Joseph G. Murphy, MD
Chapter 84 Systemic Disease and the Heart 797
Grace Lin, MD, Marian T. McEvoy, MD,
and Joseph G. Murphy, MD
Chapter 85 Cardiac Tumors 807
Joseph G. Murphy, MD, and R. Scott Wright, MDxiv Contents
Chapter 86 Sleep Apnea and Cardiac Disease 812
Tomas Kara, MD, PhD, Tomas Konecny, MD,
and Virend Somers, MD, PhD
Chapter 87 Cardiovascular Trauma 820
Joseph G. Murphy, MD, and R. Scott Wright, MD
Chapter 88 Acute Brain Injury and the Heart 824
Nandan S. Anavekar, MB, BCh,
Sarinya Puwanant, MD, and
Krishnaswamy Chandrasekaran, MD
Chapter 89 Noncardiac Anesthesia in Patients With
Cardiovascular Disease 830
Laurence C. Torsher, MD
Section IX Cardiomyopathy and Heart Failure 837
Chapter 90 Reflex and Humoral Control of the Circulation 839
Alfredo L. Clavell, MD
Chapter 91 Systolic Heart Function 843
Wayne L. Miller, MD, PhD, and Lyle J. Olson, MD
Chapter 92 Heart Failure With Preserved Ejection Fraction 850
Barry A. Borlaug, MD
Chapter 93 Heart Failure: Diagnosis and Evaluation 858
Richard J. Rodeheffer, MD, and
Margaret M. Redfi eld, MD
Chapter 94 Right Ventricular Failure and Cor Pulmonale 864
Robert P. Frantz, MD, and Joseph G. Murphy, MD
Chapter 95 Pharmacologic Therapy of Systolic Ventricular
Dysfunction and Heart Failure 869
Richard J. Rodeheffer, MD, and
Margaret M. Redfi eld, MD
Chapter 96 Mechanical Ventricular Assist Devices 874
John A. Schirger, MD, Soon J. Park, MD, and
Sudhir S. Kushwaha, MD
Chapter 97 Myocarditis 877
Leslie T. Cooper Jr, MD, and Lori A. Blauwet, MD
Chapter 98 Dilated Cardiomyopathy 888
Horng H. Chen, MD, BCH, and
Sanjay Dandamudi, MD
Chapter 99 Restrictive Cardiomyopathy 892
Sudhir S. Kushwaha, MD
Chapter 100 Hypertrophic Cardiomyopathy 898
Steve R. Ommen, MD
Chapter 101 Cardiac Transplantation 908
Barry A. Boilson, MD, Richard C. Daly, MD,
and Sudhir S. Kushwaha, MD
Section X Invasive/Interventional Cardiology 919
Chapter 102 Diagnostic Cardiac Angiography 921
André C. Lapeyre III, MD
Chapter 103 Coronary Artery Physiology and Intracoronary
Imaging 953
Abhiram Prasad, MD
Chapter 104 Principles of Myocardial Revascularization in
Interventional Cardiology 966
Joseph G. Murphy, MD, Gregory W. Barsness, MD,
and Rajiv Gulati, MD
Chapter 105 Percutaneous Treatment of Structural
Heart Disease 971
Margaret A. Lloyd, MD, Joseph G. Murphy, MD,
and Charanjit S. Rihal, MD
Chapter 106 Catheter Closure of Intracardiac Shunts 977
Guy S. Reeder, MD
Chapter 107 Invasive Hemodynamics 984
Rick A. Nishimura, MD
Chapter 108 Atlas of Hemodynamic Tracings 995
Rick A. Nishimura, MD, and
Joseph G. Murphy, MD
Section XI Appendix 1023
Chapter 109 Preparing for Cardiology Examinations 1025
Joseph G. Murphy, MD, and
Margaret A. Lloyd, MD
Chapter 110 Principles of Coronary Stenting 1035
Joseph G. Murphy, MD, Gregory
W. Barsness, MD, and Rajiv Gulati, MD
Chapter 111 Endomyocardial Biopsy 1041
Joseph G. Murphy, MD, Robert P. Frantz, MD,
and Leslie T. Cooper Jr, MD
Credit Lines 1047
Index 1059
1059
Index
Abdominal aorta
aneurysms of, 451, 464f, 550
applied anatomy, 35–36, 35f
atherosclerosis prevalence, 537, 549f
Doppler recording, 91f
grade 4 ulcerocalcific disease, 469f
Marfan syndrome, 519
MRA/CTA evaluation, 156–157
penetrating aortic ulcer, 467, 469f
postoperative CV care, 520
type III aortic dissection, 465f
Abdominal aortic aneurysm (AAA)
atherosclerotic AAA, 36
complications of, 461
CTA findings, 150
elective surgical/endovascular treatment,
461–463
iliac artery aneurysm association, 451
imaging studies, 460, 461f, 464f
inferior vena cava and, 21
lack of symptoms, 460–461
medical management, 461
MRA findings, 147f
repair of, and perioperative hypertension, 55
Abdominojugular (hepatojugular) reflux
sign, 5
Abnormal automaticity, 246
Abnormal chordae tendineae, 393
Absolute risk reduction (in measures of
effect), 45
ACAS (asymptomatic carotid atherosclerosis)
study, 457
Accelerated idioventricular rhythm, 248t, 653
Accelerated junctional tachycardia
(nonparoxysmal), 248t
Accelerated junctional tachycardias, 246
Accessory-pathway mediated tachycardia
(APMT), 266–267
treatment options, 286–287
ACCF/AHA (American College of
Cardiology Foundation/American
Heart Association)
CAD assessment guidelines, 53, 53b
perioperative guidelines algorithm, 49, 50
stress test recommendations, 52b
ACCORD study, 576, 577
Acquired AV node dysfunction, 302
Acquired sinus node dysfunction, 302
Acromegaly, 4t, 798
Action potentials, regional variations
atria, 245
AV node, 245–246
sinus node, 245
ventricles, 246
ACTIVE A clinical trial, 487t
ACTIVE W clinical trial, 487t
Acute arterial occlusion, 450
Acute brain injury
autonomic nervous system anatomy, 823f
cardiac complications
of encephalomyelitis, 827
of head trauma, 826
cardiac innervation
parasympathetic, 822
sympathetic, 822, 824
CV complications, cerebrovascular
accident
cardiac biomarkers, 825
electrocardiographic abnormalities,
824–825, 824f
neurogenic left ventricular
dysfunction, 825
subarachnoid hemorrhage, 825–826,
825f, 826f–827f
manifestations in seizures
electroconvulsive therapy, 827
epileptic seizures, 826–827
Acute coronary syndromes (ACS). See also
unstable angina
atrial fibrillation, 271
CAD likelihood, significance, 616t
clinical assessment, initial, 617–618
clopidogrel use, 487
with aspirin, 489
clopidogrel with aspirin, 489
coronary artery calcification, 141
CURE trial, 487
endothelial dysfunction, plaque
formation, 914
GP IIb/IIIa inhibitor use, 1039
initial clinical assessment, 617–618
lipid-lowering therapy, 546
low-molecular-weight heparin, 494b
MI classification, 616
MI postoperative surveillance, 56
NSTEMI syndromes, 492
nuclear imaging, 129
plaque rupture, apparent
thromboembolism, 617f
PROVE-IT trial, 546–547
PURSUIT trial, 492
stress SPECT testing, 129
UA/NSTEMI management principles,
619–626
unfractionated heparin, 493
Page numbers followed by “f“ denote figures; those followed by “t“ denote tables; those followed by “b“ denote boxes.1060 Index
Acute coronary syndromes (ACS) (cont.)
unstable coronary syndromes,
pathophysiology, 616–617
venous thromboembolism, 500
Acute heart failure
aortic regurgitation, 16
cardiac injury, 822
dyspnea presence, 48, 873
evaluation of, 863
giant cell myocarditis, 861
ivabradine BEAUTIFUL trial, 633
systolic ventricular dysfunction
treatment, 873
Acute inferior-posterior-lateral myocardial
infarction, 227f
Acute mitral regurgitation, 396, 662,
663f, 664f
Acute mitral valve regurgitation, 437
Acute myocardial infarction. See also acute
myocardial infarction, adjunctive
therapy; acute myocardial infarction,
arrhythmia complications
atherosclerotic plaque distribution, 40
AV block, second-degree, Mobitz
type I, 214f
driving restrictions and, 72t
echocardiographic evaluation, 93, 93b
EP testing contraindication, 251b
pericarditis in, 716–717
perioperative, 55
SHOCK Trial data, 46
surgical risk factors, 50, 51b
temporary pacing for, 325
Acute myocardial infarction, adjunctive
therapy
aldosterone antagonists, 648t
diabetes mellitus management, 647, 649
ED/prehospital setting, 642f
aspirin, 641–642, 643f, 648t
beta-blockers, 643f, 644, 648t
heparin, 643–644, 648t
morphine, 642–643, 648t
nitroglycerin, 644, 648t
oxygen, 642, 648t
P2Y
12 antiplatelet therapy, 644–645
renin-angiotensin-aldosterone antagonist
therapy, 645, 646f, 647
effect on mortality, 643f
lifestyle risk factor management, 649, 651
Mayo Clinic risk score, 642t
statins/lipid-lowering therapies, 647, 648t
thirty-day mortality risk, 643f
TIMI risk score, 642t
Acute myocardial infarction, arrhythmia
complications
asystole, electromagnetic dissociation, 653
electrical storm, 653
other ECG findings, 654
post-MI conduction disturbances
AV block, mechanisms, significance, 655
bundle branch block, 655
first-degree heart block, 654
intraventricular block, 655
second-degree AV block, 654–655
third-degree heart block, 655
reperfusion arrhythmias, 653
supraventricular arrhythmias, 652
temporary pacing, pre-infarct period, 653t
T-wave alternans, 653
ventricular arrhythmias, 653
Acute myocardial infarction, mechanical
complications
acute mitral regurgitation, 662–663
cardiogenic shock, 657–658
hemodynamic classification, 657
hemodynamic monitoring, 658
LV mural thrombus, 663–664, 664f
papillary muscle rupture, 663f, 664f
pericardial effusion and pericarditis, 663
posteromedial mitral papillary muscle
rupture, 664f
postinfarction syndrome (Dressler
syndrome), 663
RV infarction, 5, 637–640, 652,
657–662
Acute pericarditis
causes, 710–712
diagnostic evaluation, 712
differential diagnosis, 235, 628
ECG evaluation, 205
with PR-segment depression, 228f
ST-segment, T-wave abnormalities,
206, 227, 464
transient constrictive phase, 713
treatment, 712–713
Acute rejection (cardiac transplantation), 912
Acute rheumatic fever
clinical features, 404, 804–805
epidemiology, 403
Jones criteria, 404b
pathogenesis, 403–404
WHO criteria, 404b
Acute ST-segment elevation myocardial
infarction, 53
ACUTE study, of cardioversion, 108
Addison disease, 166, 799
Adenosine, 100
adverse effects, 123
contraindications, 100
indications for use, 126t
mechanism of action, 122–123
pharmacologic stress test, 100, 122, 144
during pregnancy, 308
Adenosine-sensitive ventricular tachycardia,
297–298, 298–300
ADONIS clinical trial, 368, 369f
ADP-receptor antagonists, 486–489. See also
thienopyridines
AFCAPS/TexCAPS trial, 564
African Americans
CAD rates, 526, 574
diabetes mellitus rate, 574, 575t
high blood pressure rates, 580
stroke rate, 455
AIM-HIGH study, 536, 561, 577
Aircraft pilots with cardiac disease. See
drivers and aircraft pilots with cardiac
disease, restrictions on
Aldosterone antagonists, 648t, 871. See also
spironolactone
Alpha-adrenergic blockers, 585
Alpha level, in studies, 45, 46
Amantadine, 316b
Ambrisentan, 749
American College of Cardiology Foundation
Quality Strategic Directions
Committee Appropriateness Criteria
Working Group, 77
American College of Emergency
Physicians, 77
American Heart Association/American
College of Cardiology
absence of statin recommendation, 435
anorexigen management guidelines, 413
cardiac CT, MRI statements, 140
family history, genetic markers
guidelines, 573
invasive EP testing criteria, 250
novel plasma biomarkers guidelines, 572
pacemaker implantation guidelines, 324
VO
2 max recommendations, 196
wide complex tachycardia, monomorphic
VT, polymorphic VT
management, 289
American Indian/Alaska natives
diabetes mellitus rates, 575t
American Society of Echocardiography, 77
American Society of Nuclear Cardiology, 77
Amiloride, 585, 586
Amiodarone, 267, 276, 276t, 294, 310,
367–368
Andersen-Tawil syndrome, 244, 265
Anderson-Fabry disease, 145
Aneurysms
abdominal aortic aneurysm, 21, 55, 147f,
150, 451, 460–463
atherosclerotic abdominal aortic
aneurysm, 36
atherosclerotic aneurysms, 550
predisposing factors, 450–451
Angina pectoris
CMV approval/disapproval and, 74t
driving restrictions and, 72t
unstable/severe, Canadian
class III or IV, 51b
Angiography. See also computed tomography
angiography
ARVC/ACM diagnosis, 261t
coronary angiography
acute coronary syndromes, 129
catheter-based, 141, 147, 152
coronary CT angiography, 139, 141–143,
150f, 448
invasive, 133
magnetic resonance angiogram,
149f, 385, 448, 449f
multivessel CAD image, 125f
preoperative, perioperative, 53–54,
53b, 103
revascularization, 200f
peripheral vascular disease diagnosis, 448,
450–452
popliteal artery entrapment, 452
radionuclide angiography, 127, 198, 400
stenosis of right common iliac artery, 450f
syncope evaluation, 317
ventricular tachycardia diagnosis, 291
Angiosarcoma, 715, 807, 808b, 809, 811
Angiotensin-converting enzyme (ACE)
inhibitors, 56
for acute MI, 645–646
for heart failure in women, 601
for HFpEF, 856
for hypertension, 583
for peripheral arterial disease, 449
for sudden death prophylaxis, 294
syncope evaluation, 315Index 1061
for systolic ventricular dysfunction,
869–870
Angiotensin receptor blockers (ARBs)
for acute myocardial infarction, 647
for ARVC, 250
for diastolic ventricular dysfunction, 605
for hypertension, 583
for Marfan syndrome, 518, 521
for syncope, 315
for systolic ventricular dysfunction, 870
VALIANT trial, 647
Ankylosing spondylitis, 4t
Anomalous pulmonary venous connection,
21–22
Anterior myocardial infarction, 325
Antiarrhythmic drugs (AADs), 363–371.
See also antiarrhythmic drugs
(AADs), specific agents
adjuvant therapy for DCCV facilitation, 275
classifications, 363
clinical trials, 367–371, 369f
effects on reentrant circuits, 363
for IART, 304
in-hospital vs outpatient initiation, 371
suppressive therapy, 276
syncope and, 316
Antiarrhythmic drugs (AADs), specific agents
adenosine (unclassified), 370
class I agents
disopyramide (class IA), 276t, 309, 365
flecainide (class IC), 267, 276t,
309–310, 366
lidocaine (class IB), 365–366
mexiletine (class IB), 297, 366
monitoring of agents, 364
phenytoin (class IB), 366
proarrhythmic effects, 364
procainamide (class IA), 365
propafenone (class IC), 366–367
quinidine (class IA), 309, 364–365
use-dependent action phenomenon, 363
class III agents
amiodarone, 267, 276, 294, 310,
367–368
dofetilide, 276f, 369–370
dronedarone, 276, 368
ibutilide, 275, 370
sotalol, 243, 260, 267, 274t, 276t, 293f,
304, 368–369
Anticoagulation therapy
atrial arrhythmias, 304
AV junction ablation complications, 280
cardioversion and, 108, 275
driving restrictions, 74t
in heart failure, 872–873
indications for ECG use, 78t
invasive EP testing risks, 254
oral anticoagulation approach, 56, 275, 278
for postoperative AF, 277
in pregnancy, 310
stroke risk prevention, 593
Antidepressant medications, 316b
Antidromic reciprocating tachycardia, 290b
Antihistamines, 248t, 262, 682, 922
Antiphospholipid syndrome, 501, 504, 592t
Antiplatelet agents
ADP-receptor antagonists: thienopyridines,
486–489, 486b, 487t
clopidogrel, 486–489, 487t
prasugrel, 489
ticagrelor, 489
ticlopidine, 486
COX inhibitors: aspirin, 484–486, 485b
GpIIb-IIIa inhibitors, 489–492
Antiproliferative agents, 537, 747, 911,
1035, 1036. See also azathioprine;
mycophenolate
Antithrombin III deficiency, 502
Aorta, applied anatomy, 35f
abdominal aorta, 35–36
aortic arch, 34–35
ascending aorta, 34–35
congenital heart disease
aortic arch congenital abnormalities, 36
aortopulmonary window, 36
coarctation of the aorta, 36
ductus arteriosus, 36
descending thoracic aorta, 35
Aortic aneurysms
abdominal aortic aneurysm, 21, 55, 147f,
150, 451, 460–463, 461f, 464f
atherosclerotic abdominal aortic
aneurysm, 36
MRA/CTA evaluation, 152
sudden death from, 290b
Aortic arch congenital abnormalities, 36
Aortic atheroembolism, 460
Aortic atheromatous disease, 593
Aortic dissection, 461–463
acute aortic regurgitation from, 33, 437
acute arterial occlusion from, 450
aortic arch and, 35
AR murmur from, 16
ascending aorta disease and, 399
cardiac arrest from, 311
classification, clinical features, 463
coarctation of the aorta and, 36
CTA of type III, 154f
diagnostic imaging, 93, 106, 107t, 464,
465f, 466
etiology of, 463
hypertrophic obstructive cardiomyopathy
and, 6
laboratory tests, 463–464
pharmacologic therapy, 467, 468b
pleural effusion complication, 95f
syncope and, 315b
systolic murmur from, 15
TEE evaluation, 106, 107t
Aortic incompetence, 7, 8b, 658, 801, 822,
1026, 1027, 1031
Aortic intramural hematoma, 468–469
Aortic root angiography, 400, 929–930, 993
Aortic root dilatation, 4t, 8b, 33–34, 67t, 400,
437, 516f
Aortic rupture, incomplete, 469
Aortic stenosis, 6, 12, 25, 34f, 54, 435.
See also severe aortic stenosis;
supravalvular aortic stenosis; valvular
aortic stenosis; valvular stenosis
aortic sclerosis comparison, 12
aortic valve replacement
recommendation, 388t
CMV approval/disapproval and, 75t
commercial driving risks, 75t
in congenital heart disease, 65–66
congenital valvular aortic stenosis, 8b
continuous murmurs in, 18
controversial management issues, 388–389
definition, causes, 385
echocardiographic evaluation, 89e, 90, 90f
fourth heart sounds in, 11–12
in hypertrophic cardiomyopathy, 6, 257
LV pressure overload from, 25
natural history, treatment, 388
noninvasive imaging evaluation, 90, 90f
palpable A- wave from, 3
pulsus parvus in, 6
right atrial enlargement finding, 164f
severe aortic stenosis, 6, 10, 12, 54, 88f, 90,
386–388
severity determination, 387t
subvalvular aortic stenosis, 385–386,
902, 932f
sudden death from, 290b, 358
surgery, indications for, 427
third heart sounds in, 11
transmitted murmurs in, 6
in valvular heart disease, 54
Aortic ulcer, penetrating, 467–468
Aortic valve
applied anatomy, 32–33, 33f
indications for surgery, 425, 426f–427f,
428
valvular heart disease, pathogenesis,
435–437
Aortic valve regurgitation, 16
causes, 398–399
ascending aorta diseases, 399
intrinsic valvular disease, 398–399
clinical syndrome of, 399–400
CMV approval/disapproval and, 75t
echocardiographic evaluation, 91, 91f
evaluation of, 400
natural history, treatment, 400–402
pathophysiology, 399
surgery, indications for, 425, 427
Aortic valve sclerosis, 435
Aortic valvuloplasty, 437, 605, 758, 971
Aortoiliac disease, 448, 450
Apixaban, 493
ARBITER-6 study, 567–568
Argatroban, 493, 504, 835
Arrhythmias, 54–55. See also acute
myocardial infarction, arrhythmia
complications; pediatric arrhythmias;
pregnancy-associated arrhythmias;
tachyarrhythmias; ventricular
arrhythmias
acquired LQTS and, 262t
AV bundle and, 41–42
AV interactions, ECG diagnosis, 206, 212
AV node and, 41
Brugada syndrome and, 264
clinical risk factor assessments, 51
conduction disturbances and, 54–55
in congenital heart disease, 302–306
anomalies, complexes, 305–306
associations, 302–304, 303t
decompensated CHF, 51b
driving ability evaluation, 73, 75t
EP testing evaluation, 250
exercise testing evaluation, 197
fetal arrhythmias, 309, 312
HCM and, 257–258
involving DADs, 248
mechanisms, 247f1062 Index
Arrhythmias (cont.)
obstructive sleep apnea and, 816
post-cardiac transplantation, 912–913
ryanodine receptors and, 243
stress echocardiography evaluation, 100
supernormal excitability and, 246
underlying cause treatment, 71
in women, 601–602
Arrhythmogenesis mechanisms
abnormal rhythm conduction
reentry, 248
abnormal rhythm generation
abnormal automaticity, 246
delayed afterdepolarizations, 248
early afterdepolarizations, 247–248
triggered activity, 246–247
Arrhythmogenic right ventricular dysplasia
(ARVD), 289
SCD in athletes, 357, 358
sudden death from, 290b
VT in, 295–296
Arrhythmogenic right ventricular myopathy
(ARVC)
clinical presentation, 260, 868
EMB diagnosis, 1044
genetic basic/genotype-phenotype
correlations of, 261–262
revised task force criteria, 261t
SCD/indications for ICD, 260
Arrhythmogenic RV dysplasia, 891
Arterial pulse
carotid pulse abnormalities, 6–7
femoral pulse abnormalities, 7
Arterial thrombosis
clopidogrel use for, 64
heparin-induced thrombocytopenia
and, 452
Arterial thrombosis, pathophysiology of,
475–483
anticoagulant system, 477–478
coagulation factor activation, 475,
476f, 477
contact activation (intrinsic) pathway, 480
endothelium, 475
fibrinogen, 481fi
brinolytic system, 478
new paradigm of, 482–483
old paradigm of, 481–482
platelets, 478–480
thrombus propagation, 477
tissue factor (extrinsic) pathway, 480
von Willebrand factor, 480–481
Arterial thrombosis, treatment and prevention,
484–499
fibrinolytic agents, 497–498
heparinoids
fondaparinux, 495–496, 496f
heparin-induced thrombocytopenia,
494–495
low-molecular-weight heparin, 493–494
unfractionated heparin, 493
platelet inhibitors
ADP-receptor antagonists:
thienopyridines, 486–489, 486b, 487t
COX inhibitors: aspirin, 484–486, 485b
GpIIb-IIIa inhibitors, 489–492
phosphodiesterase inhibitors, 489
thrombin inhibitors
apixaban, 493
argatroban, 493
bivalirudin, 492, 492b
dabigatran etexilate, 493
lepirudin, 492, 492b
rivaroxaban, 493
ximelagatran, 493
warfarin, 496–497, 496b, 497f
Artifactual tachycardia, 290b
ASCOT-LLA trial, 563f, 564
Aspergillus infective endocarditis, 784f
Aspirin
adjunctive
for MI, 641–642, 643f
for STEMI, 679
for erythromelalgia, 454
for peripheral arterial disease, 449
for sudden death prophylaxis, 294
ASSENT-3 clinical trial, 490
ASTEROID trial, 567
ASTRAL trial, 473–474
ASTRONOMER clinical trial, 437
Asystole and electromechanical
dissociation, 653
Atenolol, 309, 311, 468b, 518, 589, 624t,
683, 757
ATHENA clinical trial, 368
Atherosclerosis
abdominal aorta, fatty streaks, 549f
ACAS study, 457
aortic arch aneurysms, 35
aortic atherosclerosis, 16, 460
aortic valve disease association, 435
arterial remodeling, 543
aspirin treatment, 486
cardiac risk factors, 50, 66, 480, 503, 529,
538–541
carotid artery disease association,
455–456
carotid pulse pressure association, 6, 7
cigarettes smoking implications, 541
claudication from, 448t
coronary artery calcification process, 140
coronary artery cross sections, 538f
diabetes mellitus implications, 539–541
diffuse atherosclerosis, 7
early processes, 541, 542f, 543, 545f
endothelium reaction, 541
foam cells in, 542f
histologic typology, contents, 544
hypertension implications, 539
LDL-C implications, 539, 541, 542f
obstructive sleep apnea and, 815–816
peripheral arterial disease association, 447
plaque stabilization, regression,
546–548, 550
platelet activation physiology, 548f
risk factors, 552
role of Lp(a) lipoprotein, 551
smooth muscle cell proliferation, 538f
statin trials, comparative, 548t
stenotic plaque, 544f, 545f, 547f
sudden death from, 290b
sudden death risks, 290b
in Takayasu arteritis, 509f, 510
TEE evaluation, 117f
thoracic aortic aneurysms from, 460
thrombosis, 545–546
vaso vasorum, angiogenesis,
neovascularization, 543–544, 543f
vulnerability, plaque rupture, 544–545,
545f, 546f, 547f
Atherosclerotic abdominal aortic
aneurysm, 36
Atherosclerotic aneurysms, 550
Athletes and heart disease, 357–358
athletes vs. nonathletes, 357
causes of sudden death, 257, 260, 262
CPX testing, 185, 195t, 197, 202
determination of athletic eligibility,
357–358
diastolic dysfunction evaluation, 86f
endurance athletes, 187, 188
screening for SCD risks, 358f
Atorvastatin, 436, 440f, 546, 547f, 548, 559,
564–569, 647, 776
A to Z statin trial, 548t, 567, 647
Atria, applied anatomy, 22–24
atrial septal defect, 24
atrial septum, 22–23
comparison of, 23–24
left atrium, 23
right atrium, 22
Atrial arrhythmias
cardiac action potentials and, 245
cardioversion of, 275
congenital tachycardia and, 303
lipomatous hypertrophy of the atrial
septum in, 41
from Mustard/Senning procedures, 306
sudden death from, 290b
Atrial ectopic tachycardia (AET), 267
Atrial fibrillation, 248t
cardiac associations, 271b
classification of, 272
clinical importance, 270
clinical presentation, 271–272, 304
epidemiology of, 270
EP testing risk, 255b
first episode, evaluation and management,
272–273
heart failure, 873
IART comparison, 304
modulating factors, 271f
noncardiac associations, 271b
nonpharmacologic management, 279–280
obstructive sleep apnea and, 817
pathophysiology of, 270
post-MI, 652
progression of, 273f
rate control agents and control, 275
rhythm vs. rate control, 273, 275
in women, 601
Atrial flutter, 248t, 268, 272t
classification of, 272
clinical importance, 270
common associations
congestive heart failure, 270–271
hypertension, 270
hypertrophic cardiomyopathy, 271
myocardial infarction, ischemia, 271
preexcitation syndromes, 271
thyrotoxicosis, 271
epidemiology of, 270
first episode, evaluation and management,
272–273
isthmus-dependent, 303–304
nonpharmacologic management, 279–280
pathophysiology of, 270Index 1063
postoperative atrial flutter, 275, 276–277
preexcited atrial flutter, 276, 277f
rate control agents and control, 275
recurrence after successful DCCV, 275
rhythm vs. rate control, 273, 275
risk factors for stroke, 277–278
anticoagulants, 278
thromboembolic complication prevention,
277–278
Atrial myxoma, 507b
Atrial rhythms
ECG diagnoses, 205–206
ECG score sheet diagnosis, 207, 208f–210f,
209–210
Atrial septal aneurysm, 8, 96, 145f, 977,
979f, 981f
Atrial septal defect, 167f, 170f, 177f. See also
primum atrial septal defect; secundum
atrial septa defect
abnormal jugular venous pulse waves, 6b
advanced carcinoid syndrome, 438
amyl nitrate/vasopressors, effects, 16t
anomalous venous connection, 22
in arrhythmias, 305
clinical clues, general examination, 4t
congenital absence of the pericardium, 710
cryptogenic stroke, 593
cryptogenic stroke and, 593
described, 305
driving restrictions, 66
Ebstein anomaly of the tricuspid valve, 303
ECG diagnosis, 207
ejection clicks, 8b
familial atrial septa defects, 66
left-to-right shunts, 738b
percutaneous atrial septal occlusion
devices, 978f, 978t
right ventricular infarction, 639
septal occluder device treatment, 176
sinus venosus atrial septal defect, 22, 98f,
119f, 763
S
2 splitting, 9f
TEE evaluation, 97, 98f, 107t
Atrial septostomy, 749
Atrial switch (dextrotransposition of the great
arteries), 178f, 179f
Atrial tachyarrhythmias, postoperative, 54
Atrial tachycardia, 248t
treatment options, 287–288
Atrioventricular block
acquired AV block, 302, 324
arrhythmia association, 262t
atrial flutter with, 268
atrial tachycardia with, 206
in children, 268–269
congenital AV block, 302, 303t
EP testing evaluation, 253b
first degree, 72t, 231, 267
high-grade, 51b, 126, 126t, 253,
281, 373
infrahisian, 373, 375f
localizing the site of, 373
Mobitz type I, 72t
Mobitz type II, 72t, 212, 251
second-degree, 251, 268–269, 324
suprahisian, 372, 374f
third-degree, 212, 251, 269, 325
Atrioventricular conduction system
disease, 315b
Atrioventricular node reentrant tachycardia
(AVNRT), 267, 281–282, 284f
coronary sinus EGMs and, 377–379
treatment options, 286
Atrioventricular valves, applied anatomy
chordae tendineae, 28
papillary muscles, 28
valve annulus, 28
valve leaflets, 28
Atropine, 100–101, 212, 246, 299, 317, 360,
834, 922
Attenuation correction in PET, 130
Austin Flint murmur, 17
Automatic tachyarrhythmias, 246
Autonomic function testing, 359–362
biochemical tests
plasma norepinephrine levels, 362
cardiology-related anatomy, physiology,
359
pharmacologic tests
atropine, 360
carotid sinus massage, 360
isoproterenol, 360
norepinephrine, 360
quantitative sudomotor axon reflex
test, 361
sudomotor, 360–361
thermoregulatory sweat test, 360–361,
360f–361f
physiologic tests
carotid sinus massage, 360
head-up tilt test, 359–360
AV conduction abnormalities
ECG diagnoses, 206
ECG score sheet diagnosis, 212–213
AVERT trial, 565–566
AV fistula formation, EP testing risk, 255b
AVID ICD for SCD prevention trial
(1997), 351t
AV junctional rhythms
ECG diagnoses, 206
ECG score sheet diagnosis, 210
AV nodal blocking agents. See also
adenosine; beta-blockers; digoxin;
diltiazem; verapamil
for arrhythmias during pregnancy, 308–309
AV reciprocating tachycardia (AVRT), 286
Azathioprine, 508, 883, 908, 911–912,
915, 1041
Bacterial endocarditis, 507b
BARI 2D trial, 576
BARI trial, 970
Basal cell carcinoma, 507b
Beals syndrome (congenital contractural
arachnodactyly), 517
Becker muscular dystrophy, 64, 797
Behçet syndrome, 507t, 510, 786, 801
BENESTENT trial, 964
Benign coronary artery anomalies, 923
Beta-adrenergic blockers
for atrial tachycardia, 287
for heart failure, 871
for hypertension, 583–584
interactions, side-effects, 569t
for tachycardia, 286
Beta-blockers. See also bisoprolol; esmolol;
metoprolol; metoprolol succinate;
propranolol
for acute myocardial infarction,
643f, 644, 649
adverse effects, 55, 309
for APMT, 267
for ARVC, 258
assessment for need, 49, 56
for atrial fibrillation, atrial flutter, 275
for atrial tachyarrhythmias, 54
for CPVT, 264–265
driving guidelines, 74t
for erythromelalgia, 454
for familial channelopathy syndromes, 297
for HCM, 258, 904–905
for hypertension, 56
intravenous administration, 56
for long QTS syndrome, 262, 263
for Marfan syndrome, 517
for perioperative ischemia, 55
during pregnancy, 309
for PVCs, 301
for sudden death prophylaxis, 294
syncope evaluation, 315
for systolic ventricular dysfunction, heart
failure, 871, 872t
BHAT ICD for SCD prevention trial
(1982), 352t
Bicuspid aortic valve
aortic arch anomalies, 152
aortic regurgitation, 91
aortic stenosis, 385, 386b
benign coronary artery anomalies, 923
coarctation of the aorta, 153f
congenital absence of the pericardium, 710
congenital bicuspid aortic valve, 8b, 33, 34,
36, 517, 761, 763
driving restrictions, 75t
in pregnancy, 755
systolic ejection clicks, 8, 400
TEE evaluation, 111f
thoracic aortic aneurysms from, 460
Bisoprolol, 309t, 584, 871, 872t, 883
Bivalirudin, 452, 458, 492, 492b, 494, 620, 835
Blood pressure. See also hypertension
African Americans, 580
atherosclerosis risk factors, 552
cardiac emergencies, 688
carotid sinus stimulation for lowering,
586–587
carotid sinus stimulation treatment,
586–587
discrepancies between arms, arms
and legs, 5b
examination reading, 3
JNC 7 blood pressure staging, 578, 579t
measurement, 579–580
Mexican Americans, 580
National High Blood Pressure Education
Program, 588
role of cardiovascular reflexes, 839
self-measurement (HBPM), 580
stroke risk, 580f, 591
supravalvular aortic stenosis
discrepancy, 5b
whites, 580
BNP. See brain natriuretic peptide
Board examination. See cardiovascular
examination
Body weight. See also cardiopulmonary
exercise testing1064 Index
Body weight (cont.)
FDA prasugrel warning and, 489
influence on VO
2, 186–187
low-molecular-weight heparin and, 494
Bosentan, 748f, 749, 867
Bradyarrhythmias
acute brain injury, 822
CAD risk factor, 546
cardiac rehabilitation criteria, 695
causes of, 246
CPX interpretation, 188
diagnosis/management, 251b
EP testing indications, 251b
Guillain-Barré syndrome, 798
limit influence of, 54
obstructive sleep apnea, 812, 816
QT prolongation, 316b
RV infarction complication, 639
sudden death risk, 872
Bradycardias
acquired bradycardia, 302
acquired LQTS association, 262t
cardiac syncope, 315
congenital bradycardia, 302
driving restrictions, 72t
ECG diagnosis, 205
management of, 303
medication-induced, 123
pacemaker bradycardia, 231f
preoperative management issues, 55
SCD risk factor, 290b
sinus bradycardia, 207, 231, 238, 268
sudden death from, 290b
torsades de pointes risk factor, 276
in utero, 42
Bradycardia-tachycardia syndrome, 268
Brain natriuretic peptide (BNP)
acute heart failure, 873
chronic stable angina, 629f
congestive heart failure, 1034
ECG evaluation, 78t
evaluation for, 47t
increased levels, causes, 841b
pulmonary hypertension algorithm, 750f
right ventricular pressure overload, 746
ventricular dysfunction prognosis, 861t
Breathing Not Properly Multinational Study,
47–48
British Pacing and Electrophysiology Group
Generic Code, 325
Broad-QRS tachycardia, 254
Brugada syndrome
asymptomatic, 297
clinical presentation, 264
driving restrictions, 75t
genetic basis/genotype-phenotype
correlations, 263t, 264
polymorphic VT rhythms in, 289
SCD from, 290b
SCD in athletes, 357, 358
sudden death from, 290b
syncope evaluation, 315
Buerger disease (thromboangiitis obliterans),
451–452, 451f, 451t
Bundle branch reentry ventricular tachycardia,
294–295, 296f
CABG Patch Trial, ICD for SCD prevention
(1997), 353t, 355
CADILLAC clinical trial, 490
Calcific aortic valve disease
cardiovascular risk factors, 436b
genetic component, 435
mechanism of development, 436f
osteoblast regulatory pathways, 437b
prospective clinical trials, 436–437
risk factors/CAD comparison, 443
statin studies, 439t
statin treatment, 435–436
Calcineurin inhibitors, 910–911, 915–916.
See also cyclosporine; tacrolimus
Calcium channel, L-type, 243, 263t, 264, 600
Calcium channel blockers, 54, 56. See also
diltiazem; nifedipine; verapamil
for atrial fibrillation, atrial flutter, 275
for atrial tachyarrhythmias, 54
for atrial tachycardia, 287
for HCM, 904–905
for hypertension, 584–585
for Marfan syndrome, 518
for pulmonary hypertension, 747
for PVCs, 301
syncope evaluation, 315
for systolic ventricular dysfunction, heart
failure, 871
for tachycardia, 286
T-type, 244
CAMIAT clinical trial, 353t, 367
Candesartan, 647, 856, 870
CAPRIE clinical trial, 487t
Carcinoid heart disease, 409–415
adenomas, 393
advanced tricuspid valve disease, 411f
anesthetic management, 412–413
carcinoid tumors
cardiac involvement, 409–410
diagnosis, 409
systemic, regional therapy for, 409
carcinoid valvular disease, pathology, 411
diagnosis, 409, 410
echocardiographic features, 410–411
mitral leaflet abnormalities from, 393
pulmonary stenosis, incompetence in, 32
pulmonary valve involvement, 412f
schematic illustration, 410f
surgical management of, 411–412
tricuspid regurgitation in, 92
tricuspid stenosis in, 29
tricuspid valve, gross pathologic
specimen, 412f
valve prosthesis choices, 412
valvular incompetence in, 29
Carcinoid syndrome, 4t, 17, 409–413,
438, 441
Cardiac allograft vasculopathy (CAV),
911, 913–916, 918
Cardiac arrest, and hypoxic-ischemic brain
injury, 592
Cardiac chambers, applied anatomy
atria, 21–25
ventricles, 25–28
Cardiac channelopathy-susceptibility genes,
263t. See also long QT syndrome
Cardiac conduction system, applied
anatomy, 42f
atrioventricular bundle, 41–43
atrioventricular node, 41
bundle branches, 43
innervation, 43
internodal tracts, 41
sinus node, 40
Cardiac emergencies
acute coronary syndromes, 685–687
AF/AFL, rapid ventricular response,
683–684
aortic dissection, 687
beta-blocker toxicity, overdose, 688
blood pressure management, 688
calcium channel blocker toxicity, overdose,
688–689
digoxin toxicity, overdose, 688
hyperkalemia, 688
hypertensive emergencies, 687
multifocal atrial tachycardia, 685
pacemaker-mediated tachycardia, 685
paroxysmal SV tachycardia, 684
pericardial tamponade, 688
polymorphic ventricular tachycardia,
682–683
pulmonary edema, 687
pulmonary thromboembolism, 688
reciprocating tachycardia, Wolff-Parkinson
syndrome, 684–685
right ventricular ischemia,
infarction, 687
Cardiac magnetic resonance imaging (MRI).
See also magnetic resonance imaging
clinical uses
cardiac stenosis, 884
coronal artery calcium scanning,
140–141
myocarditis evaluation, 879, 881
ventricular structure, function
assessment, 743
description, 143
exercise cardiac MRI, 144
inappropriate use, 79b
proposed myocarditis criteria, 881b
risk factors, 881–882
usefulness of, 143–144
Cardiac PET radiopharmaceuticals
nitrogen-13 ammonia, 131–132, 132f, 133f,
134f, 136f, 137f
PET metabolic tracers, 132–133
PET perfusion tracers, 131
rubidium 82, 131f, 132, 133f, 134f
Cardiac radiography, 159–176. See also
cardiac radiography, pulmonary
vasculature
aortic disease, 170, 172, 172f, 173f
cardiac masses, 170, 171f
implanted cardiovascular devices
septal occluder devices, 176, 176f
transcatheter aortic valve implants,
175f, 176
valves, 162f, 174f, 175–176, 175f
ventricular assist devices, 175f, 176f
pericardial disease
normal pericardium, 168
pericardial calcification, 169, 170f
pericardial defects, 169–170, 171f
pericardial effusion, 169
pulmonary vasculature
decreased pulmonary blood flow,
166, 168f
increased pulmonary blood flow,
166, 167fIndex 1065
increased resistance to pulmonary blood
flow, 166–167
normal pulmonary blood flow, 165–166
pulmonary arterial hypertension,
167–168, 169f, 170f
pulmonary venous hypertension,
167, 168f
silhouette and chamber size, 160f–162f
generalized cardiac enlargement,
160–161, 163f
heart size, 160
lateral projection, 159–160
left atrial enlargement, 161–162, 163f
left ventricular enlargement, 163, 164f
posteroanterior projection, 159
right atrial enlargement, 164–165, 165f
right ventricular enlargement, 165
Cardiac radiography, pulmonary vasculature
normal pulmonary blood flow, 165–166
pulmonary arterial hypertension, 167–168,
169f, 170f
pulmonary venous hypertension, 167, 168f
Cardiac rehabilitation (CR)
definition, 695–696
historical perspective, 696
post-CPX mortality data, 194f
post-MI, 691
VO
2 max long-term survival prediction, 192
WHO definition, 695–696
Cardiac resynchronization therapy (CRT),
325, 355
benefits from, 851t, 873
cardiomyopathy and heart failure,
872–873
clinical trials, 334, 335t–336t
defined, 334
ECG use indication, 78t
goal of, 325
implantation technique, 337
indications for, 334
left anterior oblique cross-sectional
view, 337f
posteroanterior chest radiographs, 338f
responders/prediction of response, 337–338
systolic dysfunction approach, 870t
Cardiac sarcoidosis, 801f, 881, 884, 884f,
890, 894, 894f
Cardiac sarcomas
angiosarcoma, 715, 807, 808b, 809, 811
Kaposi sarcoma, 773, 775, 811
Cardiac tamponade, 5, 6b
aortic dissection association, 717
causes, 20–21
hemodynamics of, 713–714
invasive EP testing risks, 255b
jugular vein clues, 6b
M-mode, 2D features, 94
pericardial effusion and, 169, 713–716
pericardial tamponade, 688
sudden death from, 290b
“Swinging Heart“ in, 94f
syncope and, 315b
treatment of, 715
Cardiac transplantation, 53b
allograft rejection management,
1043–1044, 1045b
antibody-mediated rejection, 914f
bedside right heart catheterization, 997
CAD CPX assessment, 197
cardiogenic shock, orthopedic
transplantation, 670
cell-mediated rejection, 913f
Chagas cardiomyopathy, 886
complications, early (post-transplant)
acute rejection, 912
arrhythmia, 912–913
hyperacute rejection, 912
primary graft failure, 912
complications, late (post-transplant)
cardiac allograft vasculopathy, 911,
913–916, 918
chronic kidney disease, 915–916
infection, 916
lymphoproliferative disease, 917f
malignancy, 916–917
contraindications, 909b
current demographics and outcomes, 918
DCM patient consideration, 877, 889, 891
donor and recipient matching, 908–910
driving restrictions, 72t, 73t
ECG evaluation, 881
endomyocardial biopsy evaluation, 882
heart failure, 861, 862t, 863
immunosuppression methods, 910–912
indications for, 908, 909b
ISHLT data, 912, 915, 916, 918
LVAD and, 874–875
myocarditis treatment, 883
operative details, 910
biatrial anastomosis, 910f–911f
bicaval anastomosis, 910f–911f
pulmonary hypertension eligibility, 751
restrictive cardiomyopathy from, 893b
TEE application, 108t, 110, 835
Cardiac troponin, 259, 259t, 609–610,
610t, 612f
Cardiac tumors
carcinoid heart disease, 811, 811f
cardiac myxomas, 807
cardiac sarcomas
angiosarcoma, 715, 807, 808b, 809, 811
Kaposi sarcoma, 773, 775, 811
cardioembolic stroke and, 592t
familial cardiac tumors, 807–808
lipomatous hypertrophy of the atrial
septum, 808–809
mesothelioma of the AV node, 809
metastatic cardiac tumors
AIDS, 811
melanoma, 810f
neoplastic pericarditis, 811, 811t
papillary fibroelastoma, 809
presentation of, 807
TEE assessment, 106, 110, 116
Cardiac valve disease surgery, 425–434
aortic regurgitation, indications, 425, 427
aortic valve stenosis, indications, 427
minimally invasive robotic surgery,
432–434, 433f
mitral regurgitation, indications, 427, 429f
mitral stenosis, indications, 428, 432f
reoperation, 434
suture reconstruction, 433f
thoracoscopic approach, 432
triangular resection, 433f, 434f
tricuspid valve, 429
valve choice, 429–431
Cardiac valves, applied anatomy
aortic valve, 32–33
atrioventricular valves, 28
fibrous cardiac skeleton, 33–34
mitral valve, 29–31
pulmonary valve, 32
semilunar valves, 31–32
tricuspid valve, 28–29
Cardiogenic shock, 46, 657–658
accompanying inflammatory state, 670
acute aortic regurgitation, 401
acute myocardial infarction, 106, 657–658
beta blocker therapy, 644
bundle branch block, 655
causes, 106, 665
circulatory assist devices, 669–670
coronary angiography and
revascularization, 668–669
coronary angiography risks, 922
diagnosis of, 666
failed treatment in, 670
hypertension in, 1028
implantable cardioverter defibrillator, 355b
incidence/mortality, 665
predictors of, 665–666
inotropic/vasopressor agents, 669
Killip classification, 619t
management
acute pulmonary edema, 667
angiography, 667
cardiogenic shock, 667–668
general issues, 670
hypovolemia, 667
intra-aortic balloon pump, 667
invasive monitoring, 667
myocardial infarction, 604
noncardiogenic shock vs., 997
refractory cardiogenic shock, 909b
reperfusion strategy for STEMI, 679–680
RV infarction and, 666–667
SHOCK clinical trial, 669–670
Cardiomyopathies. See also dilated
cardiomyopathy; hypertrophic
cardiomyopathy; restrictive
cardiomyopathy
cardiomyopathy-associated PVCs, 301t
cardiomyopathy mutants, 67
diabetic cardiomyopathy, 575
hypertrophic cardiomyopathy, 93
hypertrophic obstructive cardiomyopathy
and, 6
idiopathic dilated cardiomyopathy, 145
infiltrative cardiomyopathy, 613, 722
inflammatory cardiomyopathy, 891
ischemic cardiomyopathy, 355b, 891
metabolic cardiomyopathy, 891
stress-induced cardiomyopathy, 891
tachycardia-induced cardiomyopathy, 272
valvular cardiomyopathy, 891
Cardiomyopathy-associated premature
ventricular contractions, 301t
Cardiopulmonary exercise testing (CPX),
185–196
CCI codes in CPX laboratories, 185
conventional ECG vs., 187–188
cycle ergometer exercise tests vs., 188
dyspnea on exertion: case study, 194–195,
194b, 194f, 195f
historical background, 185
interpretation, 188–1891066 Index
Cardiopulmonary exercise testing (cont.)
prognosis based on VO2 max, 192, 194
ranges for VO2 max, 195–196
sample CPX tests: case studies, 189–192,
189b, 189f, 189t, 190f, 191b, 191f,
191t, 192f, 192t
test instrumentation, 186f
uses, 188
VO
2 to cardiac output, relationship,
185–187, 186f
Cardiovascular examination
abnormalities on palpation of precordium,
3, 5
angiographic images, important, 1027
aortograms/ventriculograms, clinical clues,
1026
arterial pulse, 6–7
blood pressure, 3
Board overview, 1025
cardiac murmurs, 12, 13f, 14–18, 15t,
16b, 16t
cardiovascular disease, physical signs
acute mitral regurgitation, 1030
acute pericarditis, 1029
acute pulmonary hypertension, 1030
aortic regurgitation, 1031
aortic stenosis, 1031
atrial septal defect, 1032
cardiac tamponade, 1029
chronic pulmonary hypertension, 1030
Eisenmenger syndrome (right-to-left
shunt), 1032
hypertrophic cardiomyopathy, 1032
infective endocarditis, 1029–1030
left ventricular failure, 1028
mitral regurgitation (chronic), 1030
mitral stenosis, 1030
mitral valve prolapse, 1030
murmurs (named murmurs), 1032–1033
patent ductus arteriosus, 1032
pulmonary regurgitation, 1032
pulmonary stenosis, 1031–1032
right ventricular failure, 1028–1029
tetralogy of Fallot, 1032
tricuspid regurgitation, 1031
tricuspid stenosis, 1031
ventricular septal defect, 1032
clinical clues to abnormalities, 4t
ECG tracing diagnosis, clinical clues
arrhythmias, 1026
chest pain, 1026
healthy patients, 1026
metabolic ECGs, 1025–1026
postoperative patients, 1026
echocardiographic images, important, 1027
electrophysiologic/pacemaker tracings,
important, 1027
general appearance, 3
heart sounds, 7–12
jugular veins, 5
physical signs, important
apex beat palpation, 1027
arterial pulses, 1027
auscultation, 1027
JVP, 1027
topics on typical examinations
arrhythmias, 1034
arteritis, 1033
congestive heart failure, 1034
coronary artery anomalies, 1033
coronary artery disease, 1033
hypertrophic cardiomyopathy,
1033–1034
MI, mechanical complications, 1033
MR/CT imaging, 1033
pulmonary hypertension, 1034
stress testing, 1033
valvular heart disease, 1033
Cardiovascular reflexes
blood pressure regulation, 839
inferior infarctions, 654
lesions, influences of, 359
Cardiovascular Risk Stratification
Pyramid, 571f
Cardiovascular trauma
aorta and great vessels, 823
blunt cardiac injury, 820
cardiac lesions, 165, 405, 408, 754, 755b,
761, 821b
damage to intracardiac structures, 822–823
diagnosis of injury, 821–822
electrical injury to the heart, 823
fatal hemopericardium, 821f
medical cardiac injury, 821
motor vehicle accidents, 821f, 823, 823f
myocardial contusion, 611t, 658, 820,
821–822, 821b
penetrating cardiac injury, 820
pericardial injury, 820
traumatic lesions, 821b
treatment of injury, 822
Cardioversion. See also direct-current
cardioversion
abnormalities diagnosed with TEE,
108, 108t
ACUTE study of, 108
anticoagulation and, 275
for AVRT, 286
CARDS trial, 564
CARE-HF clinical trial (for CRT), 336t, 338
CARE trial, 565, 566
CARGO study, 912
Carotid artery disease, 454–459
ACAS study, 457
angiographic evaluation, 456
asymptomatic AAA, 461
CAD risk factor, 552
carotid endarterectomy treatment, 456
carotid sinus massage contraindication, 316
causes of stroke, 455–456
cephalic arteries, spontaneous
dissection, 459
cerebral embolism, 459
extracranial carotid artery disease, 456
noninvasive imaging evaluation, 456
stroke risks, 455
Veterans Administration study, 456–457
Carotid artery stenting
adjunctive therapy, 458
clinical trials, 458–459
procedural goals, 457–458
Carotid atherosclerosis, 6–7, 447,
455–456, 457
Carotid endarterectomy treatment
benefits of, 456
carotid artery stenting, 457–459
computed tomographic angiogram, 472f
limitations of, 457
with medical therapy, 456–457
risk stratification, 50b, 831t
risk factors, 457
Carotid pulse
abnormalities, 6–7, 6b
jugular vein pulse comparison, 6t
Carotid sinus massage, 376f
description, 360
noninvasive EP testing algorithm,
255f, 256
pacemaker-mediated-tachycardia, 685
paroxysmal supraventricular
tachycardia, 684
RVOT VT treatment choice, 300
in syncope, 316, 359
Carotid sinus stimulation, for lowering blood
pressure, 586–587
CASCADE, ICD for SCD prevention trial
(1993), 351t
CASH, ICD for SCD prevention trial
(1993), 351t
CASS trials, 968
CAST, ICD for SCD prevention trial
(1991), 352t
Catecholaminergic polymorphic ventricular
tachycardia (CPVT), 290b
clinical presentation, 264–265
genetic basis/genotype-phenotype
correlations, 265
Catheter ablation
accessory pathway-related
tachycardias, 287
acquired tachycardia, 303–304
atrial flutter, atrial fibrillation,
270, 272, 280
congenital tachycardia, 303
direct current method, 292
for IART, 304
pediatric patients
atrial ectopic tachycardia, 267
junctional ectopic tachycardia, 268
supraventricular tachycardia, 267
ventricular tachycardia, 291
Catheter-based artery embolization, 409
CCP trial, 692t
Cellular electrophysiology, 239–249
action potentials, regional variations
atria, 245
AV node, 245–246
sinus node, 245
ventricles, 246
arrhythmogenesis mechanisms
abnormal rhythm conduction,
248–249
abnormal rhythm generation,
246–248
calcium channel
L-type, 243, 263t, 264
T-type, 244
electrogenic membrane pumps,
exchangers, 244
gap junction channels, 241–242
G protein-gated Kir channel, 243–244
hyperpolarization-activated cyclic
nucleotide gated channel, 244
ion channels
and cardiac action potential, 240–244
structure and function, 239–240
normal rhythm generation, conduction, 246Index 1067
potassium channel, 242, 243, 263,
263t, 296
ryanodine receptors, 240–244
sodium channel, 241, 263, 263t, 264, 297
strong Kir channel, 244
Central sleep apnea (CSA)
acute/chronic effects, 817
CVD association, 817–818
treatment, 818–819
Cerebral embolism, 459, 592
Cerebral hemorrhage, 455, 687, 798. See also
intracerebral hemorrhage
Cerebral thromboembolism, 592
Cerebrovascular disease
CAD risk factor, 566
cardiac transplant contraindications, 909b
carotid artery stenting and, 455–459
cryptogenic stroke, 593
evaluation for, 50, 52b, 315
hypercholesterolemia,
hyperhomocysteinemia, 67t
hypertension risks, 449
ischemic heart disease surgery risks, 833b
risk index, 51b
Chagas disease, 62, 145, 774, 879t, 883, 890,
1042b
Chamber size/wall thickness assessments
left atrial size, 82, 82f, 83f
LV size, 79f, 82
LV thickness, 82, 82e
right ventricular size, right atrial size, right
ventricular wall thickness, 82–83
Channelopathies, 248t
CHARISMA trial, 449, 487t
Chest pain
acute coronary syndromes, 615
acute myocardial infarction and, 93
acute myocardial ischemia, 617
acute pericarditis, 711
amyloidosis, 1043
angina pectoris, 627
aortic dissection, 467f
aortic valve disease, 425
ASTEROID trial, 567
atherosclerosis, 539
CAD evaluation, 197, 616t
Chagas cardiomyopathy, 887t
cocaine use, 804
congenital absence of the pericardium, 709
coronary calcification, 141
dobutamine contraindication, 123
ECG evaluation, 78b, 93, 93b, 226f, 617
failed thrombosis, 659
heart failure, 861, 862t
hypersensitivity myocarditis, 886t
hypertrophic cardiomyopathy, 257
infective endocarditis, 782
Marfan syndrome, 519
mitral valve prolapse, 397–398
morphine sulfate (IV) treatment, 642
MRA/CTA imaging, 152
myocardial perfusion imaging, 129
myocardial reperfusion, 675, 677
myocarditis, 879
noncardiac causes, 963b
normal coronary arteries and, 962–963
PCI-related delay and STEMI, 673
pericardial cyst, 710
postoperative patients, 1026
in pregnancy, 758
pulmonary embolism, 727, 728f
pulmonary hypertension, 735
pulmonary stenosis, 764
pulmonary toxicity, 367
reperfusion arrhythmias, 653
sex differences and bias, 595, 597, 600
syncope, 315
TEE evaluation, 110f
CHF-STAT clinical trial (1995), 352t, 368
Children. See also pediatric arrhythmias
accessory-pathway mediated tachycardia,
266–267
atrial ectopic tachycardia, 267
atrial flutter, 268, 272t
atrioventricular node reentrant
tachycardia, 267
junctional ectopic tachycardia, 267–268
long QT syndrome, 269
normal resting heart rates, 268t
second-degree AV block, 268–269
sinus node dysfunction, 268
third-degree AV block, 269
ventricular arrhythmias, 268
Chloroquine, 316b
Cholesterol. See also dyslipidemia;
high density lipoprotein;
hypercholesterolemia; lipid-lowering
clinical trials and medications; low
density lipoprotein cholesterol;
National Cholesterol Education
Program; statins
ASTRONOMER trial, 437
as CAD risk factor, 529, 529f, 538, 540,
552, 559, 572, 616t
cholesterol emboli, 456b, 507b, 922t
daily intake guidelines, 558
NCEP LDL-C level recommendation, 528
reverse cholesterol transport, 541, 550
transient ischemic attack, 456b
Chronic coronary artery disease
stress SPECT evaluation
diagnostic assessment, 127–128
post-revascularization assessment, 129
prognostic assessment, 128
Chronic kidney disease
chronic angina management, 632
C-reactive protein measures, 541
hypertension guidelines, 539, 584f,
587t, 605
indications of, 473–474
post-cardiac transplantation, 915–916
SHARP trial, 568
in women, 597b, 599
Chronic mitral regurgitation, 396, 437–438
Chronic pernio, 454
Chronic stable angina
activities of daily living, 53
assessment methods, 628t
coronary risk factor reduction, 630–631
differential diagnosis, 628
invasive diagnostic testing, 630
medical management
antianginal, anti-ischemic therapy,
632–633
aspirin therapy, 485b
beta-adrenergic receptor blockers, 633
calcium channel blockers, 633
nonrecommended treatments, 633
vasculoprotective agents, MI
prevention, 632
noninvasive diagnostic testing,
629–630
nonmedical antianginal interventions
CABG surgery, 634–635
enhanced external counterpulsation,
633–634
myocardial revascularization, 634
percutaneous coronary intervention,
634–645
spinal cord stimulation, 633
pathophysiology, 616–617, 628–629
physical examination, 627–628, 628t
prognosis, risk stratification, 630
signs and symptoms, 627
Chronic thromboembolic pulmonary
hypertension (CTEPH),
733–734, 737b
Churg-Strauss syndrome, 507t, 511, 511b,
511f, 801
CIDS, ICD for SCD prevention trial
(1993), 351t
Cigarette smoking. See tobacco use
Cilostazol, 449–450
Circumflex coronary artery, 33, 38–39
anatomy, 144f, 220, 923, 925f,
926f, 947f
anomalies, 924f, 949f, 1027
distal, 915f, 946f
dominance, 923, 969
primary PCI in STEMI, 672, 674
RV infarction, 637
CLARITY clinical trial, 487t
Claudication
consequences of, 187
intermittent claudication, 447, 448
exercise training for, 449
medical management, 448–450
noncritical claudication, 447
in peripheral arterial vascular
disease, 447
pseudoclaudication, 447
true vs. pseudoclaudication, 448t
Clinical setting, in evidence-based
medicine, 44
Clonidine, 55–56, 453, 687, 831, 834t
Clopidogrel
adjunctive, for acute MI, 645
with aspirin, 278, 458, 486
clinical trials, 449, 486–489, 487t
for peripheral arterial disease, 449
post-coronary interventions, 53, 64
CLOSURE I clinical trial, 977
Coarctation of the aorta, 36, 178f, 179f, 765,
766f, 777
Cogan syndrome, 510
Coincidence detection in PET, 130
Commercial motor vehicle (CMV)
certification, conditions for approval,
disapproval, 71, 73, 74t–76t
COMMIT clinical trial, 487t
Committee on Vascular Lesions of the
Council on Arteriosclerosis of the
American Heart Association, 544
Commotio cordis, 290b, 357
COMPANION clinical trial (for CRT), 336t,
338, 350
Complex regional pain syndrome, 507b1068 Index
Computed tomography (CT), 139–158.
See also computed tomography
angiography; magnetic resonance
angiography; magnetic resonance
imaging (MRI); vascular computed
tomography
clinical use of
coronary artery calcium scanning,
140–141
coronary CTA, 140t, 141–142,
141–143, 142t
patent foramen ovale (PFO), 140f
thoracic aorta dissection evaluation, 96
thoracic aortic aneurysm evaluation, 460
thrombus, LV, LA, 141f
Computed tomography angiography (CTA),
140t, 141–143, 142t
specific indications
abdominal aorta, 155f, 156
aortic arch, thoracic aorta, 152, 154f
aortic arch branches, 151f, 152
cardiovascular risk, prognosis, 198
central venous structures, 151f, 152
mesenteric ischemia, 156–157
pulmonary arteries, 152
renal artery stenosis, 156, 156f–157f
technique of, 152
vs. magnetic resonance angiography,
148, 150, 152
Conduction disturbances
acute myocardial infarction, 325
anterior myocardial infarction, 325
arrhythmias and, 54
cardiac complications, head trauma, 826
dilated cardiomyopathy, 889
inferior myocardial infarction, 325
intermodal tracts, 41
intraventricular, 206, 213
post-MI, 654
prosthetic valve endocarditis, 788
restrictive cardiomyopathy, 895
Confidence intervals (defined), 45–46
Congenital bicuspid aortic valve disease,
8b, 33, 34, 36, 517, 761, 763
Congenital cleft of the anterior mitral
leaflet, 393
Congenital contractural arachnodactyly (Beals
syndrome), 517
Congenital heart defects, atlas images
adult, repaired Tetralogy of Fallot, 182f
atrial septal defect, 177f
atrial switch (dextrotransposition of the
great arteries), 178f, 179f
coarctation of aorta, 178f, 179f
corrected levotransposition of the great
arteries, 181
Ebstein anomaly, 178f
Eisenmenger syndrome, 178f
infant, unrepaired Tetralogy of Fallot,
181f, 182f
large patent ductus arteriosus, 183f–184f
right coronary artery fistula to SVC, 184f
Scimitar syndrome, 177f
severe pulmonary valve regurgitation
after previous pulmonary conduit
implantation, 183f
Congenital heart disease. See also congenital
heart disease, in adults
aorta-related
aortic arch congenital abnormalities, 36
aortopulmonary window, 36
coarctation of the aorta, 36
ductus arteriosus, 36
arrhythmias in, 302–306
common associations, 303t
pathophysiology, 301–304
risk assessment, SCD, 305
cardiac MRI evaluation, 143
CMV approval/disapproval and, 75t
driving restrictions and, 73t
Marfan syndrome, 65–66
supravalvular aortic stenosis, 65–66
ventricle-related
double-outlet right ventricle, 27
tetralogy of Fallot, 27
transposition of great arteries, 27
truncus arteriosus, 27
ventricular septal defect, 12, 14–15,
26–27
VT with, 295
Congenital heart disease, in adults. See also
atrial septal defect; coarctation of the
aorta; Eisenmenger syndrome; patent
ductus arteriosus; primum atrial septal
defect; secundum atrial septal defect;
Tetralogy of Fallot
cyanotic heart disease, 769
Eisenmenger syndrome, 770–772
the Fontan procedure, 770
great arteries
congenitally corrected transposition,
768–769
transposition of, 770
pulmonary atresia with VSD, 770
single ventricle, 770
tricuspid atresia, 770
truncus arteriosus, 770
Congenital long QT syndrome, 248t
Congenitally corrected transposition of the
great arteries, 768–769
Congenital valvular aortic stenosis, 8b
Congestive heart failure (CHF). See also acute
heart failure; heart failure
acquired LQTS, 262t
atrial fibrillation and flutter, 269, 270–271,
271b, 275, 594t
bundle branch block, 655
cardiac resynchronization therapy, 325, 334
cardiac risk index, 51b
cardiogenic shock management, 667
cardiovascular reflexes, 839
cellular electrophysiology, 241–244
CHADS2 stroke risk component, 280t
cilostazol contraindications, 449
clinical trials, 356, 370f, 371
deep venous thrombosis, 727
diabetes mellitus, 575
dilated cardiomyopathy, 64
dipyridamole cautions, 489
driving restrictions, 72t, 73t, 75t
driving restrictions and, 73t
ECG evaluation, 94
in elderly people, 605
elevated troponin levels, 611t
Framingham Criteria for Diagnosis
of CHF, 856
“hepatojugular“ reflux sign, 5
HIV-negative treatment, 774
infective endocarditis, 781
ischemia cardiomyopathy, 525
junctional ectopic tachycardia, 267
mechanical ventricular assist devices,
874–876
mitral stenosis, 17
nuclear imaging evaluation, 129
obstructive sleep apnea, 815f, 816–817
obstructive sleep apnea and, 816–817
pediatric arrhythmias, 269
PEP-CHF study, 856
polyarteritis nodosa, 511
postoperative CHF, 50
pregnancy treatment, 754, 755b, 756–757
pulsus alternans, 6–7
reflex/humoral control of circulation,
839, 841b
renal artery disease detection, 470, 474
reperfusion arrhythmias, 653
rheumatic heart disease, 403, 407–408
right-sided, 4t
surgical risk factors, 51b
syncope, 317b
Takayasu arteritis, 509
in women, 595
Constrictive pericarditis, 3, 6b
BNP in, 721
causes of, 718b
clinical features, 717–718
composite of flow velocities, 721f
computed tomogram, 141f
differential diagnosis, 638, 659
ECG evaluation, 78, 720
hemodynamic findings in, 721–722
jugular vein clues, 5, 6b
M-mode/2D features, 95–96, 720f
noncalcific, 717f
palpation of the apex, 3
pericardial calcification, 169, 170f,
718, 719f
pericardial knock, 11
pericardial thickness in, 720f, 721, 722f
post-CABG, 718f
pulsus paradoxus from, 7b
schema of Doppler velocities, 95f
signs and symptoms, 718b
CONTAK-CD clinical trial (for CRT),
335t, 338
Continuous wave Doppler echocardiography,
81, 81b, 81f, 89–91, 92f, 93, 501
Contrast echocardiography, assessments
chamber size, wall thickness, 79f–80f,
82–83, 82e
hemodynamic, 85, 85e, 87t–88t, 88,
88e–90e
ventricular function, 83–85, 83e, 84f, 85f
CORAL trial, 474
Coronary artery, 921–923
anatomy
coronary arteries, 923
dominance, 923
anomalies
benign, 923
clinically significant, 923–924
fistula, 924
Coronary artery bypass graft (CABG)
ACE inhibitors, 632
aortic valve replacement in AS,
recommendations, 388tIndex 1069
CABG Patch Trial, 354f, 355, 355b–356b
CAD epidemiology, men vs. women, 529
calcium channel blockers, 633
diabetes mellitus, 576
driving restrictions, 74t
intraoperative management
conduit choice, 703–704
mitral regurgitation, 704
on-pump/off-pump surgery, 702–703
JUPITER trial, 564–565
mitral valve surgery and, 663
myocardial infarction association, 613b,
616, 618t
myocardial revascularization, 634, 635
patient selection for, 635
PCI vs., 635, 669
postoperative atrial fibrillation, 276
postoperative management
hemodynamic factors, 704–705
postoperative bleeding, 705–706
pulmonary function, 705
sternal wound, 705
weaning patients from inotropic
drops, 706
preoperative assessment, 701
preoperative management, 701–702
relative mortality risk, 702t
Scandinavian Simvastatin Survivor
Study, 565
SHOCK trial, 669
statins/cardiovascular mortality, 631
trials of ICD therapy, 353t
WOSCOP study, 564
Coronary artery calcium scanning, 140–141
Coronary artery disease (CAD), 526f, 527f.
See also chronic coronary artery
disease; circumflex coronary artery
aspirin therapy for, 485
atrial fibrillation association,
270, 271b, 280t
Cardiovascular Risk Stratification
Pyramid, 571f
carotid artery disease in, 455
coronary angiography evaluation, 388
CPX evaluation, 194f, 195t
diabetes mellitus and, 574–577
dyslipidemia risk factors, 552, 553f
epidemiology, men vs. women, 529
family history, genetic markers, 572–573
HIV disease and, 775–776
hyperlipidemia risks, 66
in-hospital vs. out-hospital death
trends, 528f
leptin, influence in, 575
MADIT II trial, 355
mitral systolic murmurs, 13f
multivessel image, 125f
natural history, pathophysiology, 525
noncardiac surgical considerations, 53, 53b
novel biomarkers of risk, 572f, 572t, 573t
ACC/AHA guidelines, 572
clinical utility, 571–572
family history, genetic markers, 572–573
obstructive sleep apnea and, 815–816
peripheral vascular disease in, 447
PET, diagnosis and prognosis, 133,
135–136
prevalence, incidence, trends,
525–526, 527f
RAS detection, 470
risk factors, 526–527, 529b
role of Lp(a) lipoprotein, 554
serum cholesterol deciles, 529f
stress echocardiography evaluation,
100, 103
stress SPECT evaluation, 127–128, 128t
stress testing for diagnosis
ACCF/AHA recommendations, 51b
advantages/limitations of modalities,
198–199, 199t
choice of appropriate modality, 199–201
noncardiac surgery evaluation, 53
pretest probability, 52b, 197–198
standard test techniques, 133, 198
syncope association, 317
TEE evaluation, 460
U.S. death rates, 528f
ventricular tachycardia and, 310
Coronary artery physiology
altered physiology
nonobstructive disease, 956–957
obstructive disease, 956, 957f
overload states, 957
intracoronary Doppler measurements
chest pain, normal coronary arteries,
962–963, 963b, 963f
coronary flow reserve, 962
coronary interventions, 963–964
Doppler technology, 961
indeterminate coronary stenoses, 962
intracoronary pressure measures
coronary interventions, 965
indeterminate coronary stenoses, 965
myocardial FFR, 956t, 964
pressure guidewires, 964
intravascular ultrasonography, 958f
catheter technology, 957–958
clinical utility, 959
coronary intervention, 960–961
image recognition, 959, 959f
indeterminate coronary stenoses,
959–960, 960f
normal physiology
autoregulation of blood flow, 954–955,
955f
blood flow regulation, 953–954, 954f
coronary flow reserve, 955, 956t
diastolic pressure-time index, 954
endothelial function, 955–956, 957b
myocardial oxygen consumption, 953
myocardial sinusoids, 954, 955f
novel imaging modalities, 961, 962f
Coronary artery trauma, 255b
Coronary circulation, applied anatomy, 37f
cardiac lymphatics, 40
circumflex coronary artery, 38–39
collateral circulation, 39–40
conduction system blood supply, 39
coronary veins, 40
left anterior descending coronary artery,
37–38
left main coronary artery, 36–37
right coronary artery, 36
Coronary sinus atrial septal defect, 24
Coronary sinus electrograms (EGMs),
377–379
Coronary stenting principles, 1035–1040
bare metal stents (BMSs), 1036–1037
complications, 1037–1038
drug-eluting stents, 1036
EPISTENT trial, 490
ESPRIT trial, 492
GP IIb/IIIa inhibitor use, 1039
infection possibilities, 791
PCI guidelines, recommendations, 1037
post-implantation pharmacologic treatment,
53, 486b, 488, 645, 674, 831
preoperative risk reduction, 54
saphenous vein graft, expanded
stents, 1036f
stent thrombosis, 1039
antiplatelet prevention strategy, 1039
surgery, post-stenting, 1036–1037
Cor pulmonale
acute cor pulmonale, 207, 234
causes of, 726
ECG evaluation, 865
presentation, 864
pulsus paradoxus, 714
Cor triatriatum sinistrum, 22
CPX. See cardiopulmonary exercise testing
C-reactive protein
acute rheumatic fever diagnosis, 404b
AIRGENE study/MI survivors, 481
atherosclerosis marker, 541
atrial fibrillation modulation, 271f
CAD risk factors, 529, 554–555, 572t
calcific aortic valve disease risks, 436
large vessel arteritis diagnosis, 509
metabolic syndrome risk factors, 533, 534f
Takayasu arteritis diagnosis, 509
Creatine kinase (CK), 559, 562, 610, 612f
CREDO clinical trial, 487t
CREST study, 458
CRT responders, 337–338
Cryptogenic stroke, 593
Culture-negative endocarditis, 785, 786b
CURE clinical trial, 487t
Cushing syndrome, 555, 587t, 798,
798f, 841b
Cutaneous lymphoma, 507b
Cyanotic heart disease, 769, 771
Cycle ergometer exercise tests, 188
Cyclosporine, 367, 453, 508, 559, 569t, 748,
883, 911–912, 915, 1041
Dabigatran etexilate, 278, 493, 593
DAD-dependent arrhythmias, 298
Dalteparin, 643
DART trial, 558
DEBATE II trial, 963–964
Decompensated congestive heart failure, 51b
Deep vein thrombosis (DVT)
anticoagulation management, 730
bleeding risks, 731
chronic thromboembolic pulmonary
hypertension, 733
diagnosis of, 727
direct thrombin inhibitors, 731
fondaparinux prophylaxis, 496
heparin-induced thrombocytopenia, 494
LMWH prophylaxis, 494
lower extremity, 725, 726
spontaneous DVT, 726
symptoms, 500–501
ultrasonography evaluation, 195, 502f
upper extremity, 726–7271070 Index
Defective tensor apparatus, 393–394
DEFINITE, ICD for SCD prevention trial
(2004), 350
Delayed afterdepolarizations (DADs), 248
Delayed myocardial enhancement (DME)
MRI evaluation, 144–145, 146f
Deoxyribonucleic acid (DNA)
amplification by bacterial cloning, 61f
analysis of protein interactions, 62
analyzing fragments of, 61–62
binding of sequences, 60
cleaver DNA with restriction enzymes, 65f
manipulating fragments of, 60–61
polymerase chain reaction, 62, 64f
polymorphisms and mutations, 64
recombinant DNA technology, 66–67
sequencing, 62
Southern blotting analysis, 62
structure of, 58, 59f
Western blotting analysis, 62
Diabetes mellitus, 51b, 54, 315b. See also
type 2 diabetes mellitus
cardiac risk factor, 539–541
coronary artery disease and, 574–577
demographic date, U.S., 575t
dyslipidemia risk factors, 551–552, 570
with femoral artery disease, 448
foot care management, 449
hypertension in, 589
INTERHEART study, 527, 554
limb loss risks, 450
lipoprotein metabolism, 554
management, in acute MI, 647, 649
stroke risks, 455
Diabetic cardiomyopathy, 575
Diagnostic cardiac angiography, 921–952
angiographic views, 925, 925f–926f
anomalies, 924f
benign, 923, 924t
clinically significant, 923–924, 924t
fistula, 184f, 924, 924t, 952f
left coronary artery, 952f
aortic dissection, 951f
aortic injection, 934f, 937f, 948f
aortic root angiography, 400, 929–930, 993
aortogram, 933f
apical ballooning syndrome, 951f
calcific pericarditis, 950f
catheter-based, 141, 147, 152
complications, 922t
major, 921–922
minor, 922
pseudocomplications, 922
rare (less than 1%), 922
constrictive pericarditis, 938f
contraindications to, 921
coronary angiography
complications of, 921–923
indications for, 921
coronary artery anatomy, 923–925, 923f
coronary artery lesions
aneurysms, 926
stenoses, 925
coronary CT angiography, 139, 141–143,
150f, 448
dextrocardia, 935f
dominant right coronary artery, 949t
ectasia/aneurysmal disease, 945f
indications for, 921
invasive, 133
left anterior descending coronary artery,
946f, 947f, 948f
left circumflex coronary artery, 949t
left main coronary injection, 945f
lesions
aneurysms, 928
stenoses, 925, 927f
limitations of, 926–927
magnetic resonance angiogram, 149f, 385,
448, 449f
MI-associated ventriculoseptal defect, 942f
multivessel CAD image, 125f
normal vessels, 939f
percutaneous transluminal coronary
angioplasty, 939f
preoperative, perioperative,
53–54, 53b, 103
pulmonary angiogram, 934f
pulmonary hemorrhage, 950f
radiation safety, 930–931
revascularization, 200f
right coronary artery, 938f, 939f, 940f,
941f, 949f
saphenous vein graft, 938f, 944f, 945f, 946f
structure sizing, 930
tilting disk mechanical valve, 941f
ventriculography
aortic regurgitation, 993
Chagas cardiomyopathy, 886
ejection fraction, 848
left, 397, 668, 701, 927–929, 932f, 934f,
935f, 936f, 942f–944f
limitations, 993
mitral regurgitation, 397, 992, 993
right, 929, 936f
uncommon abnormalities,
928f–930f, 929
DIAMOND clinical trial (1997), 352t, 370
Diastolic dysfunction
amyloidosis, 799
antiarrhythmic drugs, 365
atrial fibrillation, 271b, 278f
atrial fibrillation association, 271b
BNP levels, constrictive pericarditis, 721
bypass patients, postoperative
management, 705
congestive heart failure, 605
dilated cardiomyopathy, 888, 890t
function assessment, 84, 86f
HCM evaluation, 260, 898, 906
HFpEF, 850, 851, 851t, 852f, 853–856
hypereosinophilic syndrome, 803
hypertensive patients, 580
left ventricle, 900
pulmonary hypertension, 737b
renal failure, 803
restrictive cardiomyopathy, 897
right ventricle failure, 864–865
stress echocardiography evaluation, 105
valvular heart disease, 386
Diastolic murmurs
aortic regurgitation, 16
Austin Flint murmur, 17
continuous murmurs, 18
mid-diastolic flow murmurs, 18
mitral stenosis, 17
pulmonary regurgitation, 17
tricuspid stenosis, 17
Diet and lifestyle modifications
acquired LQTS, 262t
for acute myocardial infarction, 649, 651
CAD epidemiology, men vs. women, 529
chronic heart failure, 863
chronic stable angina, 631
DART trial, 558
diabetes mellitus, 576
exercise training, 448–449, 456, 581,
632, 857
HFpEF, 854
HIV infection, 776
hypercholesterolemia, 556
hypertension, 581, 582, 583t
for hypertension, 582
hypertriglyceridemia, 557
low in fat diet, 559
Lyon Diet Heart Study, 558
Mediterranean diet, 558, 957
metabolic syndrome, 535–536
Moradabad Heart Study, 558
myocardial infarction, 691
polymeal strategy, 559
pregnancy, 754
DIGAMI trial, 575
Digoxin, 73, 198, 199, 267, 271–272, 275
during pregnancy, 309
RADIANCE trial, 869–870
syncope evaluation, 315
for tachycardia, 286
Dilated cardiomyopathy (DCM), 64–65, 289
acquired LQTS, 262t
anticoagulation, long-term, 872
cardiogenic shock, 670
cardiomyopathies, characteristics
clinical presentation, 889
diagnostic characteristics, 890
dilated cardiomyopathy, 889
etiologies, 889
genetics, 889
pathological features, 889–890
prognosis, survival, 890
treatments, 890–891
catecholamine-induced secondary DCM, 4t
DEFINITE trial, 350
definition, classifications, 64–65, 888
driving restrictions, 74t
Friedrich ataxia, 797
hemochromatosis, 802
HIV infection, 774
idiopathic DCM, 75t, 145, 774
ischemic DCM, 355b
left ventricle volume overload, 25, 163,
848, 848b
mitral regurgitation, 438
myocardial infarction, 847
nonischemic DCM, 355b, 394, 859
specific cardiomyopathies
arrhythmogenic RV dysplasia, 891
hypertensive cardiomyopathy, 891
inflammatory cardiomyopathy, 891
ischemic cardiomyopathy, 355b, 891
metabolic cardiomyopathy, 891
muscular dystrophies, 797, 798, 891
neuromuscular disorders, 891
peripheral cardiomyopathy, 891
stress-induced cardiomyopathy, 891
valvular cardiomyopathy, 891
sudden death from, 290bIndex 1071
sudden death risk, 290b
systolic ventricular dysfunction, 859
Diltiazem, 274t, 275, 277, 309, 369, 449, 585,
633, 683–684, 747, 871
DINAMIT, ICD for SCD prevention trial
(2004), 350
Dipyridamole, 100, 122–123, 126t, 127,
133, 489
Direct-current cardioversion (DCCV), 272,
275, 293f
adjuvant AAD therapy for facilitation, 275
post-DCCV AF recurrence, 275
Direct thrombin inhibitors, 731
Disopyramide, 276t, 309, 365, 904–905
Diuretics
acromegaly, 798–799
cardiogenic shock, 847t
chronic stable angina, 631
contraindications, 688, 904
coronary artery disease, 536
diabetes mellitus, 577
elderly patients, 605
heart failure, 872
HFpEF, 857
hypertension, 582, 585, 588
interactions, 569t, 582
myocarditis, 883
nonobstructive HCM, 906
pregnancy, 408, 589, 756–757
proarrhythmia, 368–369
restrictive cardiomyopathy, 856
right ventricular failure, 747
RV failure with PAH, 867
syncope evaluation, 315, 315b
systolic ventricular dysfunction, 869
Dobutamine echocardiography, 52–53
Dobutamine pharmacologic stress
cardiography, 52–53, 100–101, 103,
104f, 122–123, 126t
Dofetilide, 276f, 276t, 369–370
Doppler echocardiography
aortic stenosis evaluation, 90, 385, 387, 436
cerebral syncope pattern, 360
coarctation of the aorta evaluation, 765–766
constriction vs. restriction diagnosis,
96, 724
constrictive hemodynamic conditions, 713
description/mechanics, 77, 81, 81f, 88
diastolic dysfunction evaluation, 900
distal cardiomyopathy evaluation, 888
HCM evaluation, 903–904
heart failure evaluation, 859
HFpEF evaluation, 854t
HIV infection, 775
mitral stenosis evaluation, 90
mitral valve gradient evaluation, 390
pregnancy evaluation, 753
prosthetic valve assessment, 92
pulmonary hypertension evaluation, 740
restrictive cardiomyopathy evaluation, 895
supravalvular aortic stenosis
evaluation, 385
Double-impulse carotid arterial pulse, 6b
Double-outlet right ventricle, 27
Down syndrome, 4t
Dressler syndrome (postinfarction syndrome),
663, 717, 718b
Drivers and aircraft pilots with cardiac
disease, restrictions on, 71–76
commercial driver certification, 71, 73
commercial motor vehicle certification,
conditions for approval, disapproval,
74t–76t
driving restrictions, waiting periods,
72t–73t
FAA medical certification, 73, 76
noncommercial licensure, 71
Dronedarone (Multaq), 276
Droperidol, 316b, 682, 834t
Drug-induced orthostatic hypotension, 315b
Drug-related heart disease, 413–415. See also
valvular heart diseases
anorexigens, 413, 414f
ergot alkaloids, 413–414
pergolide, 414–415
Duchenne type muscular dystrophy, 4t, 64
Dynamic LVOTO (left ventricular outflow
tract obstruction), 258
Dyslipidemia, 551–557. See also high density
lipoprotein; hypercholesterolemia;
hypertriglyceridemia; lipid-lowering
clinical trials and medications; low
density lipoprotein; statins
advanced testing recommendations, 551
atherogenic dyslipidemia, 550
central obesity with, 531
classification of lipid levels, 552t
diabetes mellitus with, 531, 552
Framingham risk score, 555t
goals, treatment strategies, 551–552, 552t,
553f, 555–557
HDL-C, influential factors, 557t
hyperlipidemia, secondary causes, 555t
LDL-C, goals for, 556
lipoprotein metabolism
diabetes mellitus, 554
high density lipoprotein, 553
LDL subtractions, 552–553
Lp(a) lipoprotein, 553–554
metabolic syndrome, 554
novel CV risk factors
C-reactive protein, 554–555
homocysteine, 555
LP-PLA, 555
OSA and ischemic heart disease, 555
special populations
diabetic patients, 570
elderly patients, 569–570
women with heart disease, 569
Dyspnea
acute-onset, 152
adenosine/dipyridamole effects, 123
atrial septal defect, 167f
Breathing Not Properly Multinational
Study, 47–48
driving/airline pilot restrictions, 73t
on exertion: CPX case study, 187, 194–195,
194b, 194f, 195f
indication for echocardiography, 78t
preoperative testing evaluation, 52b
Early afterdepolarizations (EADs), 247–248
Ebstein anomaly, 178f, 266
chest radiography, 767–768
ECG evaluation, 767
evaluation and management, 768
physical examination, 767
in tricuspid valve regurgitation, 441
in ventricular arrhythmias, 303
Echocardiography principles, 77–99.
See also echocardiography principles,
evaluation of specific disorders; stress
echocardiography; transesophageal
echocardiography
appropriate indications for use, 78b
contrast echocardiography, 82
Doppler echocardiography, 77, 81, 81b,
81f, 89–91, 92f, 93
inappropriate indications for use, 79b
M-mode and 2-dimensional
echocardiography, 77, 79f, 83e
stress echocardiography, 52, 53, 82,
100–105, 128
thoracic aorta, 95f, 96
uncertain indications for use, 78b
Echocardiography principles, evaluation of
specific disorders
acute myocarditis, 881
adenosine-sensitive VT, 298
aortic regurgitation, 91, 91f
aortic stenosis, 89e, 90, 90f
chest pain, acute MI, 93, 93b
ergot alkaloid valvular disease, 413
hypertrophic cardiomyopathy, 93
infective endocarditis, 93–94, 93f
mitral regurgitation, 91, 397
mitral stenosis, 89e, 90, 92b
pericardial disease
constrictive pericarditis, 95–96, 95f
effusion, 94, 94f
tamponade, 94, 94f
prosthetic valves, 92–93
rheumatic heart disease, 442–443
source of embolus, 96–97, 96f
tricuspid regurgitation, 92
Ectopic atrial tachycardias, 246, 290b
Edema
alveolar edema, 167
in DVT, 500–501
interstitial edema, 167, 168f
lower extremity edema, 504
in mitral regurgitation, 394
myocardial edema, 40
in postthrombotic syndrome, 502
pulmonary edema, 57, 399
in RAS, 470, 473
regional edema, clinical features, 504t
from venous compression, 452
Ehlers-Danlos syndrome, type IV, 517
Eisenmenger syndrome
amyl nitrates/vasopressors, effects, 16
chest radiography, 771
clinical clues, 4t, 770–772
development of, 738, 763
differential diagnosis, 771
ECG evaluation, 771
evaluation and management, 771–772
physical examination, 771
pregnancy contraindication, 754
pulmonary artery enlargement, 170f, 178f
pulmonary hypertension and, 739
VSD and, 764
Ejection clicks, causes, 8b
Elderly people, heart diseases, 603–606
aortic valve degeneration, 31
arterial pulse in, 6–7
arterial thrombosis, 491, 4971072 Index
Elderly people, heart diseases (cont.)
atrial arrhythmias, 275
atrial fibrillation, 270, 603–604
bradycardias, 604
cardiac drugs for, 605–606
congestive heart failure, 605
coronary artery disease, 526, 597, 604
exercise ECG testing, 198
heart sounds, 11–12
hypertension, 539, 605
hypertrophic cardiopathy, 26
idiopathic ventricular tachycardia, 297
lipid management, 563f, 565, 569–570,
604–605
mitral annular dilation, 28
myocardial infarction, 604
noncardiac surgery risk stratification, 50b
pacemakers, 324
resistant hypertension, 586
stress testing, 103, 128, 604
supraventricular tachycardia, 281
syncope, 303–304
type 2 diabetes, 574
valvular heart disease, 386, 388, 605
Electrical storm, 653, 682
Electrocardiographic (ECG) diagnoses,
205–238
CPX vs. conventional exercise ECG,
187–188
ECG diagnoses
acute myocarditis, 879, 881
atrial rhythms, 205–206, 207f–210f
AV conduction abnormalities, 206
AV interactions in arrhythmias, 206
AV junctional rhythms, 206
bradycardias, 205
cardiac injury, intracardiac shunts, 822
cardiac transplantation, 881
congestive heart failure (CHF), 94
constrictive pericarditis, 78, 720
cor pulmonale, 865
Ebstein anomaly, 767
Eisenmenger syndrome, 771
general features, 205
hypertension, 78t, 100, 101f, 103–104
infective endocarditis, 78t, 93–94, 93f
intraventricular conduction
disturbances, 206
left ventricular (LV) systolic function,
83, 84f, 93, 724
mitral regurgitation, 397
pacemaker function, rhythm, 206
P-wave abnormalities, 206
QRS voltage/Axis abnormalities, 206
ST-, T-, U-wave abnormalities, 206
suggested/probable clinical
disorders, 207
transmural MI, 206
ventricular hypertrophy, 206
ventricular rhythms, 206, 212f
examination strategy, 205
metabolic ECGs, 1025–1026
recommendations for, 51b
score sheet diagnosis
atrial rhythms, 207, 208f–210f,
209–210
AV conduction abnormalities, 212–213,
213f–216f
AV interactions in arrhythmias, 212
AV junctional rhythms, 210
general features, 207, 207f–208f
intraventricular conduction disturbances,
213–214, 217f–220f
pacemaker function, rhythm, 229,
230f–231f, 231
P-wave abnormalities, 214
QRS voltage/axis abnormalities,
214, 217–218, 221f
ST-, T-, U-wave abnormalities, 223,
227–229, 228f–230f
suggested/probable clinical disorders,
221f, 231–232, 232f–237f,
234–235, 238
transmural MI, 218f–219f, 221, 223,
224f–225f
ventricular hypertrophy, 218–219, 221,
221f–222f
ventricular rhythms, 210–211, 211f–212f
systematic evaluation on ECG tracing, 205
tracing diagnosis, clinical clues
arrhythmias, 1026
chest pain, 1026
healthy patients, 1026
metabolic ECGs, 1025–1026
postoperative patients, 1026
Electrograms (EGMS)
atrial EGMs, 375, 380
coronary sinus EGMs, 377–379
His bundle EGMs, 379
ICD appropriate therapy delivery, 341
ICD inappropriate therapy delivery,
341–342
intracardiac EGMs, 251, 372–382
intracardiac electrograms, 251, 381f, 1025
local (near-field), 339
ventricular EGMs, 372
Electrophysiologic (EP) testing. See also
intracardiac electrophysiology tracings
AV nodal function indications, 253b
contraindications to, 251b
driving restrictions, waiting periods, 72t
goals of, 250
indications for, 251b
invasive EP testing, 250
noninvasive EP testing, 255–256,
255f, 256b
positive HUP response interpretation, 256
programmed electrical stimulation
for suspected bradyarrhythmia,
250–253
for suspected tachyarrhythmia, 253–254
syncope evaluation, 317–319
EMIAT clinical trial (1997), 353t, 367
Endocardial disease, and HIV, 775
Endocardial (thrombus) lesions, 821b
Endomyocardial biopsy (EMB)
amyloidosis, 893, 1043, 1045f
ARVC/ACM, 261t
ARVC/D, 1044
cardiac allograft rejection, 1043–1044
cardiac MRI guidance, 882
cardiac sarcoidosis, 894, 894f
with solitary granuloma, 1044f
cardiovascular trauma from, 820
CARGO study, 912
complications, 1045t
eosinophilic restrictive
cardiomyopathy, 894
heart failure recommendations, 862t
hemochromatosis, 1043, 1044f
immunocompromised patients, 1044
left ventricle, 26, 1045
medical cardiac injury from, 821
myocarditis, 877, 879t
acute lymphocytic myocarditis,
1041–1042
acute myocarditis, 882–883
Aspergillus myocarditis, 1045f
eosinophilic myocarditis, 1042, 1044f
giant cell myocarditis, 1042, 1044f
hypersensitivity myocarditis, 1042
lymphocytic myocarditis, 861
sarcoid myocarditis, 1042
patients vaccinated for smallpox, 1044
polymyositis/dermatomyositis, 800
restrictive vs. constrictive pericarditis, 897t
right ventricle, 24, 25, 882f
complications, 1045
risk factors, 1045t
role of (ACC/AHA/ESC Statement), 1043t
technique of, 1044–1045
transesophageal ECG, 108t, 110
treatable disease list, 1042b
tricuspid valve regurgitation, 441
Endothelial dysfunction
atrial fibrillation modulation, 271f, 278f
CAD/diabetes mellitus, 574
CAD risk biomarkers, 572t, 611
cardiac allograft vasculopathy, 913–915
causes, 525, 540
congestive heart failure, 816
coronary angiograms, 963f
coronary angiography, 921
described, 955, 956–957
Fabry disease, 799
HFpEF, 854, 855f
HIV infection, 774, 776
hypertrophic cardiomyopathy, 902
Marfan syndrome, 514
microvascular dysfunction and, 600
nitrate therapy, 632
nitroglycerin therapy, 644
obstructive sleep apnea, 814, 815
paradoxical vasoconstriction, 963
statin agents, 647
syndrome X, 962
women vs. men, 600b
Endothelin receptor antagonists
ambrisentan, 749, 867
bosentan, 748, 867
Enoxaparin, 490–491, 496, 622f, 643–644,
678, 731
Eosinophilic myocarditis, 511f, 885, 887b,
1042b, 1044f
EPIC clinical trial, 490
EPILOG clinical trial, 490
EPISTENT clinical trial, 490
Epoprostenol sodium, 747
Equilibrium radionuclide angiography
(MUGA), 127, 127f
Ergot alkaloids, and valvular heart disease,
413–414
Erythromelalgia, 454
Erythromycin (macrolides), 243, 296, 316b,
365, 408, 559, 569t, 682
Esmolol, 275, 277b, 309t, 468b, 624t, 683
ESPIRIT clinical trial, 492Index 1073
ESPS-1 trial, 489
ESPS-2 trial, 489
ESVEM, ICD for SCD prevention trial
(1993), 351t
EURIDIS clinical trial, 368, 369f
European Coronary Surgery Study, 968
European Society of Cardiology, 255, 260
Event rate (in measures of effect), 45
Everolimus, 911–912, 915, 1036
Evidence-based medicine
clinical setting, 44
defined, 44
diagnostic tests, 46
disease, therapeutic outcomes
alpha-level, beta-level, 45
confidence intervals, 45–46
measures of effect, 45
null hypothesis, 45
prevalence, incidence, 44–45
patient-physician factors, 44
predictive values, 46–48
scientific evidence, 44
statistics in cardiology, 44
Examination. see cardiovascular examination
Exercise cardiac MRI, 143–144
Exercise myocardial perfusion imaging,
198–199
Exercise stress echocardiography, 198
Exercise training
for HFpEF, 857
for hypertension, 581
for peripheral vascular disease, 448–449
for reducing coronary risk factors, 632
Extracranial carotid artery disease, 456
Fabry disease, 67t, 799, 856t, 893
Factor V Leiden mutation, 502–503
Fainting. See vasovagal syncope
FAME trial, 965
Familial aortopathy, 460
Familial channelopathy syndromes,
296–297
Familial hypercholesterolemia, 66, 67t, 562
Familial thoracic aortic aneurysm, 517
Familial thrombophilia, 502–503
FDG myocardial metabolic tracer, 130–133,
136–137, 136f, 140t
Fenfluramine, 413, 441
Fetal arrhythmias, 309, 312
Fibrinogen
CAD risk factor, 572t
description, 481
platelet aggregation, 477f
platelet storage granules, 479b
Fibrinolytic therapy, 498, 599, 643, 677, 693
Fibrinolytic Therapy Trialists‘ Collaborative
Group, 677
Fibrous cardiac skeleton, 33–34
Fibrous pericardium, 20
Fick method of cardiac output measurement,
388, 984–985, 992, 996–997
FIELD trial, 536, 636
First-degree heart block, 654
First heart sound (S1), 7, 7b
First-pass radionuclide angiography, 127
Flecainide, 267, 276t, 309–310, 366
Fondaparinux, 495–496, 496f, 504, 620, 622f
Fontan procedure, 306
Fourth heart sound (S4), 11–12
Framingham Criteria for Diagnosis of
Congestive Heart Failure, 856
Framingham Heart Study, 50, 527, 528,
534f, 555t
Frank-Starling mechanism, 394f, 395, 395f,
399
FREEDOM trial, 576
Friedreich ataxia, 4t, 797
Fungal infective endocarditis, 785
Fusion beats, 211, 289, 291b
Gadolinium contrast agent (for MRI),
130, 139, 144–145, 152
GAIN trial, 567
Gamma camera, 121
GAS (group A streptococcal) pharyngitis, 442
Gated SPECT, 122, 122e
Gene expression basics, 58, 59f
Gene function basics, 58
General appearing (physical examination
reading), 3
Gene structure basics, 58
Gene therapies for cardiovascular disease,
67–68
Genetic structure basics, 58
GESICA clinical trial (1994), 352t, 368
Gestational hypertension, 588–589
Giant cell arteritis, 507, 507t, 508–509
Giant cell myocarditis (GCM), 861, 862t,
883, 883f, 884f
GISSI trial, 678
GISSI-2 trial, 678
Global cerebral hypoperfusion, 255
GpIIb-IIIa inhibitors, 489–492
abciximab, 490–491, 490b
eptifibatide, 491–492, 491b
tirofiban, 491, 491b
Great arteries
applied anatomy
aorta, 34–36
pulmonary arteries, 34
click production, reasons for, 8, 10
dextrotransposition, 180f, 181f
hypertrophic cardiomyopathy, 26
stenoses, 152
transposition of
congenitally corrected, 302, 768 –769
corrected, 269
L-transposition, 269
Mustang and Senning procedures,
306, 770
transverse sinus location, 20
ventricular septal defect, 26–27
Great veins, applied anatomy
anomalous venous connection, 21–22
congenital anomalies, 21
cor triatriatum sinistrum, 22
inferior vena cava, 21
superior vena cava, 21
systemic veins, 21f
Guillain-Barré syndrome, 798
GUSTAVO IV-ACS clinical trial, 490
GUSTO-IIB angiographic substudy trial, 679
GUSTO-III trial, 679
GUSTO-I trial, 679
GUSTO-STEMI trial, 692t
Haloperidol, 316b, 682
HCM. See hypertrophic cardiomyopathy
Head-up tilt test (HUT), 359
age-variable response, 256b
contraindications to, 256b
indications for, 256b
reasons for performing, 359
supine testing and, 362
Heart and great vessels, applied anatomy,
20–43
cardiac chambers
atria, 22–24
ventricles, 25–28
cardiac conduction system
atrioventricular bundle, 41–43
atrioventricular node, 41
bundle branches, 43
innervation, 43
internodal tracts, 41
sinus node, 40
cardiac valves
aortic valve, 32–33
atrioventricular valves, 28
fibrous cardiac skeleton, 33–34
mitral valve, 29–31
pulmonary valve, 32
semilunar valves, 31–32
tricuspid valve, 28–29
coronary circulation, 37f
circumflex coronary artery, 38–39
collateral circulation, 39–40
conduction system blood supply, 39
coronary veins, 40
left anterior descending coronary artery,
37–38, 38f
left main coronary artery, 36–37
right coronary artery, 36
great arteries
aorta, 34–36, 35f
pulmonary artery, 34
great veins
anomalous venous connection,
21–22
congenital anomalies, 21
cor triatriatum sinistrum, 22
inferior vena cava, 21
superior vena cava, 21
systemic veins, 21f
mediastinum, 20–43
pericardium, 20–21
Heart failure. See also acute heart failure;
congestive heart failure; heart failure
with preserved ejection fraction
ACC/AHA heart failure
stages, 859t
acute heart failure evaluation, 863
associated/systemic conditions, 863
BNP evaluation, 47t
clinical monitoring, 863, 863t
clinical presentation, 860, 862t
defined, 858
diastolic ventricular dysfunction,
causes, 860
epidemiology of, 858
evaluation of, 860–861, 860t, 862t, 863
natural history of, 859, 859f, 860t,
861f, 862t
with reduced ejection fraction, 858
systolic ventricular dysfunction, causes,
859–860, 862t
in women, 600–6011074 Index
Heart failure with preserved ejection fraction
(HFpEF)
ALLHAT study, 857
CHARM-Preserved trial, 857
clinical features, 854
diagnosis, 854–856, 855t, 856t
epidemiology, 850–851
OPTIMIZE-HF registry, 857–858
pathophysiology
age-associated aortic stiffness, 854
chronotropic incompetence, 854
diastolic dysfunction, 851, 852f, 853
exercise-related inadequate arterial
vasodilation, 854
PEP-CHF study, 856
phosphodiesterase type 5 inhibitors
for, 751
preserved vs. reduced ejection
fraction, 851t
SENIORS trial, 857
treatment, pharmacologic, 856–857
Heart Protection Study, 566
Heart sounds
causes of ejection clicks, 8b
first heart sound (S1), 7
fourth heart sound (S4), 11–12
mid-to-late nonejection clicks, 8
opening snap, 10–11
second heart sound (S2), 8–10
systolic ejection clicks, 7–8
third heart sound (S3), 1b, 11
Heart transplant. See cardiac transplantation
Hemodynamic assessment (contrast
echocardiography), 87t–88t, 88, 90f
advantages, 421
aortic stenosis, 991
constrictive pericarditis, 722
mitral stenosis, 990
modified Bernoulli equation derivation,
85, 88, 88f
pregnancy, 753
preoperative assessment, 55
proximal isovelocity surface area (PISA)
method, 89, 89e, 89f
RV infarction, 638
valvular stenosis, 387
variables (list), 85, 85e
Hemodynamics, invasive. See invasive
hemodynamics
Hemodynamic tracings, atlas of
aortic stenosis, 1004f, 1006f–1007f
Carabello sign, 1005f
low-output, low-grade, 1005f–1006f
with normal LV function, 1000f
aortic stenosis with normal LV function,
1000f
apex beat cardiogram, 1000f
arterial pulses, 995
artifact, 1014f, 1015f
bifid pulse in aortic regurgitation with
aortic stenosis, 996f
coarctation of the aorta, 1003f
constrictive pericarditis
dissociation of intrathoracic, intracardiac
pressures, 1017f
hemodynamic tracings, 1018f
restrictive filling, 1019f
ventricular discordance, 1019f
ventricular interdependence, 1018f
constrictive pericarditis, restrictive
cardiomyopathy, 1016, 1016t, 1017t
dicrotic pulse, 997t
dynamic LV outflow tract gradient, effect of
pacing on, 1013f
exercise, effect of, 1012f
hypertrophic obstructive
cardiomyopathy, 1013f
Brockenbrough sign, 1014f
spike-and-dome pattern, 996f
“triple-ripple“ apical impulse, 1001f
intra-aortic balloon counterpulsation, 1016f
left ventricular aneurysm, 1001f
mitral stenosis, 1007f, 1008f–1009f, 1012f
severe mitral stenosis, 1008f
normal carotid arterial pulse, 996f
pacemaker syndrome, 1003f
pericardial tamponade
pulsus paradoxus, electrical
alternans, 1002f
right atrial pressure, 999f
pulmonary capillary wedge pressure
cv wave, 999f
left atrial pressure, right atrial
pressure, 998f
variations, during spontaneous
breathing, 1002f
pulmonary hypertension, 1010f–1011f
pulmonic stenosis, 1009f–1010f
restrictive cardiomyopathy, 1016, 1017t,
1021f
right atrial pressure, constrictive
pericarditis, 999f
right atrial pressure, giant a wave, 998f
right heart catheterization, 995–997
severe calcific aortic stenosis, 996f
severe mitral regurgitation, 1001f, 1002f
steep and tall rapid filling (RF) wave, 1000f
systemic amyloidosis, 1020f
ventricular interdependence, absence of,
1020f, 1021f
Hemorrhagic pericarditis, 821b
Henoch-Sch?nlein purpura, 511–512
Heparin. See also low-molecular-weight
heparin
acute myocardial infarction, adjunctive
therapy, 643–644, 648t
percutaneous coronary intervention,
643–644
venous thromboembolism, 493b
Heparin-induced thrombocytopenia,
452, 492b, 494, 503–504
Heparinoids. See fondaparinux;
low-molecular-weight heparin;
unfractionated heparin
Hepatojugular (abdominojugular)
reflux sign, 5
Hereditary hemorrhagic telangiectasia
(Osler-Weber-Rendu disease), 4t
HERS trial (RCT), 44
HFpEF. See heart failure with preserved
ejection fraction
High-density lipoprotein (HDL-C)
description, 553
factors influencing, 557t
levels/risk factors, 551–552
role in metabolic syndrome, 555
High-grade atrioventricular block, 51b
High-risk operations (described), 50, 50b
His bundle electrograms (EGMs), 372–373,
376, 379–380
HIV infection and the heart
cardiac tumors, 775
coronary artery disease, 775–776
endocardial disease, 775
lactic acidosis and HIV drugs, 776
long-QT syndrome, 776
myocarditis, cardiomyopathy,
774, 886–887
pericarditis, 773–774
pulmonary hypertension, 736–737,
737b, 775
pulmonary vascular disease, 775
secondary vasculitis, 507t
serologic assessment, 508
thromboembolism, 775
HIV myocarditis, 774, 886–887
Holt-Oram syndrome, 4t
Homocysteine. See also
hyperhomocysteinemia
CAD risk factors, 66, 555
described, 555
Homocystinuria, 66, 517
Humoral systems, local and circulating
vasoconstrictor, antinatriuretic, mitogenic
systems
endothelin system, 841, 842
renin-angiotensin-aldosterone system,
842, 842t
sympathetic nervous system, 841–842
vasodilatory, natriuretic, antimitogenic
systems
endothelium-derived relaxing factor,
839–840–841
natriuretic peptides, 839–840, 841b
Hydralazine, 504, 585, 718b, 756b, 867, 870t
Hyperacute rejection (cardiac
transplantation), 912
Hypercholesterolemia. See also dyslipidemia;
lipid-lowering clinical trials and
medications
CAD risk factor, 550
calcific aortic valve disease, 436f
dietary/statin management, 559
familial hypercholesterolemia, 66
genetic causes, 67t
strengthening clinical characteristics, 197
treatment/survival rates, 556
Hyperdynamic carotid pulse, 6, 6t
Hyperhomocysteinemia
acquired/inherited causes, 503
atherosclerosis risk factor, 66, 541
calcific aortic valve disease, 436b
genetic causes of, 67t
Marfan syndrome, 517
risk factors for, 503
screening, in VTE, 503
Hypersensitivity myocarditis, 511f, 885, 887b
Hypersensitivity vasculitis, 511
Hypertension, 578–590. See also blood
pressure
in aneurysmal disease, 450
aneurysms from, 450, 460
in aortic regurgitation, 16
in atheroembolism, 460
in atherosclerotic CV disease, 470, 552
atrial fibrillation association, 271b
atrial flutter association, 270Index 1075
baseline patient investigations, 580–581
blood pressure measurement, 579–580
blood pressure staging, 578, 579t
cardiac risk factor, 538–539
CMV approval/disapproval and, 74t
in congestive heart failure, 5
CPX evaluation, 195t
C-reactive protein in, 541
definition, 578
in descending thoracic aorta aneurysms, 35
diet drugs and, 413
driving restrictions, 73t, 74t
ECG evaluation, 78t
in elderly people, 539, 605
in endometrial dysfunction, 525
essential hypertension, 74t
femoral pulse abnormalities, 7
in HCM, 257
intracranial hemorrhage from, 498
J-shaped treatment curve, 585
left ventricular enlargement, 163
lifestyle modification treatment, 582
malignant hypertension, 591
in Marfan syndrome, 519
mitral annulus calcification in, 393
in mitral stenosis, 389
obstructive sleep apnea and, 815
palpable A wave and, 3
peripheral arterial disease risk factor, 449
pharmacologic treatment, 582–585
in pregnancy, 408, 521, 588–589
prevention, primary, 581–582
pulmonary arterial hypertension, 167–168
pulmonary hypertension, 4t, 5, 6b, 8b,
10–12, 25, 34
pulmonary venous hypertension, 163f, 167,
168f, 421
radial/femoral pulse palpation, 7
renovascular hypertension, 474
resistant hypertension, 585–587, 585t, 586f
in rheumatic heart disease, 408
risk factors, 50, 445, 552, 579f
secondary hypertension, 470, 578, 586,
587–588
in secondary pulmonary regurgitation, 441
stress ECG evaluation, 100, 101f, 103–104
strokes and, 455, 592
sudden cardiac death risks, 290b, 305b
in SVC syndrome, 502
systemic hypertension, 3, 10
urgencies and emergencies, 589
U.S./global demographics, 578–579, 579f
in ventricular septal defect, 8b, 10–12
Hypertensive cardiomyopathy, 891
Hypertensive encephalopathy, 591–592
Hypertriglyceridemia, 540–541, 555t, 557t,
561–562, 570, 577
Hypertrophic cardiomyopathy (HCM)
atrial flutter association, 271
atrial septum thickness, 23
cardiac MRI evaluation, 143, 145
causes of, 65
characteristics, 26, 30, 31
clinical management
physical examination, 902–903
presentation, diagnosis, 257–258,
901–902
CMV approval/disapproval and, 75t
definition, 898
double-impulse carotid arterial pulse, 6b
driving ability association, 73, 75t
driving restrictions and, 73t
echocardiographic evaluation, 78t, 79t, 93,
103–104, 257–258
Doppler, 904
two-dimensional, 903–904
general examination, 4t
genetic etiology, 63–64, 898
genotype-phenotype correlations,
258–260, 899
intraoperative TEE evaluation, 108–109
nonobstructive HCM, 902, 904
management, 906
obstructive HCM, management
alcohol septal ablation, 905
beta-blockers, 904–905
calcium channel blockers, 905
disopyramide, 905
dual-chamber pacing, 905–906, 905f
general principles, 904
invasive therapy criteria, 905t
surgery, 904t, 905
obstructive sleep apnea and, 817
pacing for, 325
pathologic/morphologic features, 898–899
pathophysiology
arrhythmias, 901
autonomic dysfunction, 901
diastolic dysfunction, 900
LVT obstruction, mitral regurgitation,
900–901
SCD in athletes, 357, 358
stress echocardiography evaluation, 103
sudden death risk assessment,
258, 259–260, 906–907, 906f
syncope and, 315b
VT in, 295–296
Hypertrophic obstructive cardiomyopathy,
6b, 12, 54
Hypokalemia, 248t
Hypomagnesemia, 248t
Hypoxia, 248t
Hypoxic-ischemic brain injury, 592
Ibutilide, 275, 370
IDEAL trial, 548t, 566
Idiopathic dilated cardiomyopathy, 75t, 145,
774, 888
Idiopathic dilated pulmonary artery, 8b
Idiopathic left ventricular cardiomyopathy,
357
Idiopathic polymorphic ventricular
tachycardia, 299f
Idiopathic ventricular fibrillation, 357
Idiopathic ventricular tachycardia, 310
Iliac artery aneurysm, 451
Iloprost, inhaled, 748
IMAC trial, 883
IMPACT-II clinical trial, 491
Impedance plethysmography and stain-gauge
outflow plethysmography, 501
Implantable cardioverter-defibrillators (ICDs).
See also cardiac resynchronization
therapy; implantable cardioverter
defibrillators (ICD), clinical trials;
implantable cardioverter defibrillators
(ICD), troubleshooting; pacemakers
Brugada syndrome and, 264
in children, for atrial flutter, 268
driving restrictions, 72t, 75t
EP evaluation, 250, 251b, 254, 255, 258,
259–260
for familial channelopathy syndromes, 297
HCM risk stratification, 258
indications for in ARVC, 260
lead placement, near- and far-field
EGMs, 340f
long QT syndrome and, 262
sudden death risk, 268, 295t
summary of coverage for (2005),
355b–356b
syncope and implantation, 322
VT and, 291, 294–295, 297
Implantable cardioverter-defibrillators (ICDs),
clinical trials, 349–356
AVID trial (1997), 351t
BHAT trial (1982), 352t
CABG Patch Trial (1997), 353t, 355
CAMIAT trial (1997), 353t
CASCADE trial (1993), 351t
CASH trial (1993), 351t
CAST trial (1991), 352t
CHF-STAT trial (1995), 352t
CIDS trial (1993), 351t
COMPANION trial (2004), 350
DEFINITE trial (2004), 350
DIAMOND trial (1997), 352t
DINAMIT (2004), 350
EMIAT trial (1997), 353t
ESVEM trial (1993), 351t
GESICA trial (1994), 352t
inclusion criteria, 350t
IRIS trial (2009), 349, 353t
MADIT II trial (2002), 355
MADIT trial (1996), 352t
MUSTT trial (1999), 353t
SCD-HeFT trial (2005), 349–350,
353t, 354f
SWORD trial (1996), 352t
Wever et al trial (1995), 351t
Implantable cardioverter-defibrillators (ICDs),
troubleshooting, 339–348
antitachycardia pacing failure, 347f
appropriate therapy delivery, 341,
341f–342f
data interpretation algorithm,
340–341, 340f
failure of SVT discrimination, 342f–343f
far-field signals, 339
inappropriate therapy delivery,
discriminators, 341–342, 342f, 344,
344f–345f
insufficient shock energy delivery, 347f
local EGMs (near-field EGMs), 339
marker channels, 339
morphology discrimination success,
343f–344f
ventricular arrhythmia detection
failure, 346f
ventricular arrhythmias, failures in
delivering appropriate therapy,
344, 346f, 347
Implantable loop recorders, 316, 319, 321t
Inappropriate sinus tachycardia, 248t
Incomplete aortic rupture, 469
Infective endocarditis, 393, 592t
acute aortic regurgitation, 16, 4371076 Index
Infective endocarditis (cont.)
acute mitral regurgitation, 396, 437
aortic regurgitation, 399, 401
in Austin Flint murmur, 17
brain abscesses, 780f
cardioembolic strokes, 592t
cardiovascular device-related infections
CIED infection, 788–789, 790f
coronary artery stents, 791
intra-aortic balloon pumps, 792
left ventricular-assist devices, 789, 791
nonvalvular device-related
infections, 791t
vascular closure devices, 792
clinical manifestations, 781–782, 781f
complications, 106, 108, 108t
congenitally bicuspid aortic valves,
33–34
diagnostic criteria, 783, 783b, 784f
diagnostic investigations
ancillary blood tests, 782, 782t
finding the organism, 782
imaging, 782–783, 783b
ECG evaluation, 78t, 93–94, 93f
echocardiographic evaluation, 93–94, 93f
epidemiology, 777–778
extracardiac pathologic findings, 778t
heterograft valves, 417
in HIV patients, 775
left-sided infective endocarditis,
785–786, 786b
microbiology
Aspergillus infective endocarditis, 784f
culture-negative endocarditis,
785, 786b
enterococcal organisms, 784
fungi, 785
gram-negative bacilli, 784
HACEK organisms, 784–785
intravenous drug users, 785
staphylococcal organisms, 784
streptococcal organisms, 783–784
mitral leaflets and, 30
mitral valve involvement, 778f
native valve endocarditis, 784, 786b
organ system manifestations
central nervous system, 780, 780f
heart, 778–779
kidney, 779–780, 779f
lung, 780
mycotic aneurysms, 780
skin, mucous membranes, 780
spleen, 780
pathogenesis, 778, 778f
pre-dental procedure prophylaxis, 762b
in pregnancy, 733b
prophylaxis for, 788, 789b, 791t
prosthetic valve endocarditis, 783, 787, 788b
right-sided infective endocarditis, 786b
TEE evaluation, 106
therapeutic approach
medical therapy, 786
surgical therapy, 786–787, 788b
valve regurgitation, 393
valve-ring abscess, 787–789
Inferior vena cava syndrome, 21, 22
Infiltrative cardiomyopathy, 613, 722
Infiltrative diseases of the heart, 289
Inflammatory cardiomyopathy, 891
Infra-Hisian block, 251–252, 253f, 254b,
655, 1027
Infranodal conduction system disease, 253f
Inhaled iloprost, 748
Innocent systolic murmurs, 15–16
Insect venom, 507b
INTERHEART study, 527, 554
INTERMACS criteria, for LVAD
consideration, 875–876
Intermediate-risk operations (described),
50, 50b
International Society and Federation of
Cardiology, 260
Intra-atrial reentry tachycardia (IART),
303–304
Intracardiac electrograms (EGMS),
251, 381f, 1025
Intracardiac electrophysiology tracings,
251, 372–382
antegrade conduction recognition, through
accessory pathway, 379–380, 382
atrial/ventricular EGMs identification,
372–373
catheter displays and tracings, 372
coronary sinus EGMs, AV reentrant
tachycardia, 377–379
dual AV node physiology, 375–377, 378f
His bundle EGMs, 372–373, 376,
379–380
induction of AV reentrant tachycardia,
375–377
infrahisian atrioventricular block,
373, 375f
localization of AV block site, 373
normal EGM sequence, 373f
sinus node dysfunction, syncope evaluation,
373–375
sinus node function testing, 376f
suprahisian atrioventricular block,
372, 373, 374f
tachycardia analysis, 375
tracing analysis approach, 372–373
wide complex tachycardia, 375, 377f, 379,
379f, 381f
Intracardiac shunts. See also intracardiac
shunts, catheter closure
arterial desaturation evaluation, 990
carcinoid heart disease, 802
cardiac injury, ECG identification, 822
causes of, 738b, 987–988
contrast echocardiography indication, 82
detection methods, 988
Eisenmenger physiology from, 771
infective endocarditis from, 781
left-to-right shunts
dye curves and, 989–990, 989f
and oxygen saturation measurement,
988–989, 989t
pulmonary hypertension from, 738b
low-dose aspirin therapy, 760
mid-diastolic flow murmurs from, 18
schematic depiction, 988f
third-degree AV block, epicardial pacing
system, 269
Intracardiac shunts, catheter closure
ASD or PFO, complications of closure
air embolism, 981, 981t
arrhythmia, 981, 981t
cardiac perforation, 979, 981, 981t
device erosion, fracture, 982–983981t
device malfunction, 979
incomplete closure, 981
malposition, device embolization,
979, 981t
thrombus formation, 981
TIA or stroke, 981–982
vascular complications, 981t
ASD or PFO, devices for closure of,
977–979
atrial septal aneurysm, 8, 96, 145f, 977,
979f, 981f
clinical trials, 977
intracardiac echocardiography, 978, 979f
percutaneous atrial septal occlusion
devices, 978f, 978t
percutaneous closure of VSD, 983
TEE, preprocedural, 977, 978
Intracerebral hemorrhage (ICH), 593,
780, 786, 826. See also cerebral
hemorrhage
Intraoperative transthoracic echocardiography
(TEE), 107t, 108, 110, 115f, 116f
Intravascular ultrasonography (IVUS)
aorta/peripheral vascular disease, 458
CAD assessment, 550
catheter technology, 957–958
clinical utility, 959
coronary intervention, 960–961
endothelial dysfunction assessment, 956
functions of, 630, 926–927
GAIN trial, 567
image recognition, 959
indeterminate coronary stenoses,
959–960
limitations, 957
REVERSAL trial, 598
Intraventricular conduction disturbances
ECG diagnoses, 206
ECG score sheet diagnosis, 213–214
INTRO-AMI clinical trial, 492
Invasive hemodynamics. See also intracardiac
shunts; intracardiac shunts, catheter
closure
cardiac output
Doppler flow velocity method,
985–986
Fick method, 388, 984–985, 992,
996–997
indicator dilution method, 984, 985
intracardiac shunts, 987–990, 988f,
989f, 989t
pressures and resistance
normal values, 986t
pressures, 986, 987f
resistance, 986–987
regurgitant valvular lesions
injections of contrast media,
992–993, 993t
regurgitant fractions, 993–994
stenotic valvular lesions
aortic stenosis, hemodynamic
assessment, 991–992, 992f, 993f
mitral stenosis, hemodynamic
assessment, 990–991, 990f, 991F
Ion channels
and cardiac action potential, 240–244
structure and function, 239–240
ISAR-CHOICE clinical trial, 488Index 1077
ISAR-REACT clinical trial, 488
Ischemic cardiomyopathy, 355b, 891
Ischemic stroke, 110, 277, 279f, 488, 493,
539, 559, 577, 592
ISHLT data, in cardiac transplantation,
912, 915, 916, 918
ISIS–2 trial, 678
Isoproterenol, 254, 256, 293f, 299, 317, 359,
360, 682, 904
Isosorbide dinitrate, 632, 644, 871
Itraconazole, 316b, 569t, 682
JAK2 mutations, 503
JNC 7 blood pressure staging, 578, 579t
Joint National Committee on Prevention,
Detection, Evaluation, and Treatment
of High Blood Pressure (Seventh
Report), 519
Jugular veins
abnormal pulse waves, 6b
arrhythmias, 1034
carotid pulse comparison, 6t
constrictive pericarditis, 717
great veins, anatomy, 21
hepatojugular reflux sign, 5
IVC filer insertion, 731
percutaneous VSD closure, 982f
temporary pacing, 333
timing of pulse waves, 5b
vascular ultrasonography identification, 1045
Junctional ectopic tachycardia (JET),
267–268
Junctional tachycardia, 74t, 209, 246, 248t,
271, 283, 290b, 306
JUPITER trial, 564–565
Kaposi sarcoma, 773, 775, 811
Kawasaki disease, 510
K+ channel blockers, 248t
KCNJ2-mediated Andersen-Tawil
syndrome, 265
Kearns-Sayre syndrome, 65, 67t, 269,
425, 798
Ketoconazole, 316b, 449, 682, 748, 798
Lactation (pregnancy-associated
arrhythmias), 307
Large vessel arteritis
Takayasu arteritis, 460, 462f, 507t, 508,
509–510
temporal (giant cell) arteritis, 507, 507t,
508–509
Left cardiac sympathetic denervation
therapy, 265
Left-sided infective endocarditis,
785–786, 786b
Left ventricular assist devices (LVADs),
870, 874–876
Left ventricular mural thrombus,
663–664, 664f
Left ventricular (LV) systolic contraction
cellular aspects
contraction mechanics, 845, 845f
excitation, contraction coupling, 843,
844f, 845
microanatomy, 843
determinants, intact LV
afterload, 845–846, 846f, 847t
contractility, 846, 847f
heart rate, 846–847, 847b
LV hypertrophy, 848, 848b
myocardial infarction, 847, 848b
preload, 845, 846f, 847t
Left ventricular (LV) systolic function
aortic stenosis differentiation, 90
in CAD, 53, 133
coronary artery bypass, 136f
ECG assessment, 83, 84f, 93, 724
ECT study, 827
mitral valve replacement for, 408
PET MPI assessment, 136
physiologic measures
ejection fraction, 848, 848b
maximal elastance, 848, 849f
post-revascularization improvements, 137
in valvular heart disease, 54, 386,
389, 408
Left ventriculography
cardiac catheterization, 397
cardiogenic shock, 668
contraindications to, 927–928
ejection fraction, 928
indications for, 927
mitral regurgitation, 397, 928–929,
992, 993
right ventriculography, 928, 929
technique, 927
uncommon abnormalities, 929
wall motion, 928
Leg ulcers, 504, 505f
Lentigines (LEOPARD syndrome), 4t
Lepirudin, 492, 492b, 504, 835
Leptin, influence in CAD, 575
Lesions (cardiac lesions)
mitral valve regurgitation, 405
natural selection, 761
obstructive lesions, 754, 754b, 755b
pulmonary vasculature, 165
rheumatic lesions, 408
traumatic lesions, 821b
Libman-Sacks endocarditis, associated with
systemic lupus, 592t
Lidocaine, 365–366
Likelihood ratios (in predictive values),
47–48, 47f
Lipid-lowering clinical trials and medications,
558–570
alcohol consumption, 563
bile acid-binding sequestrants, 562
cholesterol ester transfer protein, 568
clinical trial comparison, 563f
combination therapy
SHARP trial, 568
statin with bile acid-binding resin, 568
statin with ezetimibe, 568
statin with fibric acid derivative, 568
coronary artery regression studies
ARBITER-6 study, 567–568
ASTEROID trial, 567
GAIN trial, 567
CV disease, primary prevention
AFCAPS/TexCAPS trial, 564
ASCOT-LLA trial, 564
CARDS, 564
JUPITER trial, 564–565
WOSCOP study, 564
CV disease, secondary prevention
AVERT trial, 565–566
CARE study, 565
Heart Protection Study, 566
IDEAL study, 566
LIPID trial, 566
Scandinavian Simvastatin Survival
Study, 565
TNT trial, 566
DART trial, 558
drug interactions, side effects, 568, 569t
ezetimibe, 562
fibric acid derivatives, 561–562fi
sh oils, 563
hormone replacement therapy, 563
isolated low HDL-C value, 568
Lyon Diet Heart Study, 558
Moradabad Heart Study, 558
nicotinic acid (niacin), 560–561
pitfalls in treatment, 568–569
polymeal strategy, 559
serum CRP risk factors, 563
sitostanol plant esters, 562–563
special populations
diabetic patients, 570
elderly patients, 569–570
organ transplant patients, 570
women with heart disease, 569
statins/statin studies, 559–560
CARE trial, 566
MIRACL trial, 566–567
PROVE IT TIMI 22, 567
A to Z trial, 567
Lipoprotein metabolism basics
diabetes mellitus, 554
high density lipoprotein, 553
LDL subtractions, 552–553
Lp(a) lipoprotein, 553–554
metabolic syndrome, 554
Livedo reticularis, 453
Loeys-Dietz syndrome, 517
Lone atrial flutter, 272
Long QT syndrome (LQTS), 64
in children, 269
clinical presentation, 262, 296–297
congenital long QT syndrome, 248t
genetic basis/genotype-phenotype
correlations, 262–263
in HIV disease, 776
SCD in athletes, 357, 358
sudden death from, 290b
torsades de pointes patient, 212f
treatment options, 262
Losartan, 518
Low density lipoprotein cholesterol (LDL-C)
CAD risk factors, 572t
goals for, 556
levels in vegetarians, 551
levels/risk factors, 551–552
lipoprotein metabolism, 552–553
Low-molecular-weight heparin (LMWH), 423,
493–494, 494b, 495f, 500–501, 643
acute coronary syndromes, 494b
body weight and, 494
in pregnancy, 758, 759–760
pulmonary embolism, 494
Low-risk operations (described), 50, 50b
Lp(a) lipoprotein
CAD risk factors, 572t
lipoprotein metabolism, 553–554
role in atherosclerosis, 5511078 Index
Lp-PLA2, CAD risk factors, 572t
L-type calcium channel, 243, 263t, 264, 600
Lupus erythematosus, 4t
LVAD (left ventricular assist device), 870,
874–876
Lyme disease, 269, 504, 879t
Lymphedema, 503f, 504, 504t
Lymphocytic myocarditis, 798, 861, 877,
878f, 882, 883–884, 883b, 883f
Lyon Diet Heart Study, 558
Macrolide antibiotics, 248t
MADIT, ICD for SCD prevention trial
(1996), 352t
MADIT-CRT clinical trial (for CRT),
336t, 338
MADIT II, ICD for SCD prevention trial
(2002), 355
Magnetic resonance angiography (MRA)
specific indications
abdominal aorta, 155f, 156
aortic arch, thoracic aorta, 152, 154f
aortic arch branches, 151f, 152
central venous structures, 151f, 152
extracranial carotid artery disease, 456
mesenteric ischemia, 156–157
pulmonary arteries, 152
renal artery stenosis, 156, 156f–157f
technique of, 152
vs. CTA, 147f, 148, 150, 152
Magnetic resonance imaging (MRI). See also
cardiac magnetic resonance imaging;
magnetic resonance angiography;
velocity-encoded cardiac MRI
ARVC/ACM criteria, 261t
clinical uses
abdominal aortic aneurysm, 460–461
aortic dissection, 466, 467f
constrictive pericarditis, 721
delayed myocardial enhancement,
144–145, 146f
heart failure, 860–861
hypertension, 581
hypertrophic cardiomyopathy, 143
lumbar spinal stenosis, 447
Marfan syndrome, 519, 520
pericardial cyst, 710
popliteal artery entrapment, 452
primary aldosteronism, 587
pulmonary embolism, 727, 729
pulmonary hypertension, 739
renal artery stenosis, 586
secondary hypertension, 587
stress imaging, 143–144
thoracic aortic aneurysm, 460
heart, frontal plane, 160f
image formation mechanics, 139, 331
inappropriate uses, 79b
risk/prognosis techniques, 198
risks and contraindications, 139–140
vascular imaging developments, 148–157
Malignant hypertension, 591
Marantic endocarditis, associated with
malignancy, 592t
Macrolides (erythromycin), 316b
Marfan syndrome, 67t, 514–521
aortic dissection from, 463, 516f, 517f, 519
aortic regurgitation from, 91, 437, 520
aortic root diameter, 518f, 520
aortic root dilatation, 4t, 516f
aortic root replacement, 519f
arachnodactyly, 519f
cardiovascular manifestations, 65–66, 393,
399, 514–515
clinical clues, 4t
diagnosis, 515–517, 515b
differential diagnosis, 517
driving restriction, 75t
genetics of, 514
Ghent criteria for diagnosis, 515, 515b
medical management, 517–520
pregnancy in, 521
prognosis, 521
risk factors, 519
sudden death from, 290b
surgical management, 520
systemic features, scoring, 515t
TEE evaluation, 107t
thoracic aortic aneurysm from, 460
thoracic aortic aneurysms from, 460
Massive pulmonary embolism,
688, 731–732, 732f
MASS phenotype, 517
MATCH clinical trial, 487t
Measures of effect, 45, 45b
Mechanical ventricular assist devices,
874–876
Mediterranean diet, 558, 957
Medium vessel arteritis
Behçet syndrome, 510
Kawasaki disease, 510
polyarteritis nodosa, 511
Men
abdominal aortic aneurysm, 461
aneurysms, 450
aortic stenosis, 388
atrial fibrillation, 270
biases, 595
Brugada syndrome, 264
CAD epidemiology vs. women, 529
congestive heart failure, 595
coronary artery disease, 525, 527f, 528f
coronary calcium evaluation, 141
diabetes mellitus, 554, 574
dyslipidemia, 555t
exercise ECG testing, 198, 201f
familial channelopathy syndromes, 296
lymphedema, 504
metabolic syndrome, 531–533, 534f, 535f
mitral valve prolapse, 393
novel plasma biomarkers, 572
Raynaud phenomenon, 453t
stress ECG evaluation, 103
stroke risks, 591
Takayasu arteritis, 509
temporal arteritis, 508
Mesenteric ischemia, 156–157, 157f
Metabolic cardiomyopathy, 891
Metabolic stress testing. See cardiopulmonary
exercise testing (CPX)
Metabolic syndrome, 531–536
AHA diagnostic criteria, 554t
CAD risk factor, 526, 554
calcific aortic valve disease, 436
CAV risk factor, 914
characteristics, 532t, 534f
chronic stable angina, 631
controversies about
definition clarification, 532
relationship with CV risk, 532–533
treatment issues, 533
coronary artery disease risk factors, 526
criteria for clinical diagnosis, 533t
CV risk factors, 533
defined, 531–532
endothelial cell dysfunction, 957
lipoprotein metabolism, 554
nicotinic acid therapy, 560
obstructive sleep apnea comparison, 555
prevalence of, 534–536
risk stratification pyramid, 571f
treatment, 560–561
type 2 diabetes, 574, 577
Metastatic cardiac tumors
AIDS, 811
melanoma, 810f
neoplastic pericarditis, 811, 811t
Methyldopa, 504, 585, 589, 756b, 885b, 886t
Metoprolol succinate, 871
Mexican Americans
CAD rate, 526, 574
diabetes mellitus rate, 574, 575t
high blood pressure rates, 580
stroke rate, 455
Mexiletine, 297, 366
Microscopic polyangiitis, 511
Mid-diastolic flow murmurs, 18
Minnesota Living With Heart Failure
Questionnaire, 337–338
Minoxidil, 583, 585–586, 588
MIRACLE-ICD II trial, 335t, 338
MIRACLE-ICD trial, 335t, 338
MIRACL trial, 566–567, 647
Mitral annular calcification, 29, 91, 437
Mitral regurgitation, 11b, 12
acute mitral valve regurgitation, 437
from anorexigen use, 414f
causes, 393–394
defective tensor apparatus, 393–394
left ventricular, left atrial size,
function, 394
mitral leaflets, commissures,
annulus, 393
chronic mitral valve regurgitation, 437–438
clinical syndrome of, 396
CMV approval/disapproval and, 75t
evaluation of, 91, 397
cardiac catheterization, 397
chest radiography, 397
Doppler indicators, 397f
ECG, 397
echocardiography, 397
Sellers criteria, 397b
experimental procedures, 974–975
mitral valve prolapse, 393, 397–398
natural history of, 398
pathophysiology of, 394–395
acute severe, 394f
acute stage, 394–395
chronic compensated stage, 395
chronic decompensated stage, 395
surgery, indications for, 427, 429f
treatment, 398
Mitral stenosis, 17
causes, 389, 431
clinical presentation, 389–390
CMV approval/disapproval and, 75tIndex 1079
CPX evaluation, 186
driving restrictions, 75t
ECG evaluation, 390–391
echocardiographic evaluation, 89e, 90, 92b
left ventricular enlargement in, 163f–164f
natural history, treatment, 391–392
noninvasive imaging evaluation, 90, 92f
pathophysiology of, 389
percutaneous mitral balloon valvotomy, 976
rheumatic mitral stenosis, 23, 30, 31f,
92f, 386
sounds produced by, 7, 10–11, 16–17
stroke risk stratification, 280
surgery, indications for, 428, 432f
valvular disease risks, 54
Mitral valve
applied anatomy
mitral annulus, 29
mitral leaflets, 29–30
papillary muscles, 30–31
valvular heart disease, pathogenesis,
437–438
Mitral valve prolapse
clinical clues, 4t
driving restrictions, 75t
echocardiography evaluation, 78t, 91,
115f, 1027
electrophysiologic findings, 234
isolated severe mitral regurgitation, 393
left ventriculogram evaluation, 936f
Marfan syndrome, 515, 517, 805
midsystolic clicks, 628
murmurs, 18
nonejection clicks, 8
review information, 1030
spondyloarthropathies, 800–801
sudden death from, 290b, 357
valvular regurgitation, 397–398, 437, 443
Williams syndrome, 806
M-mode and 2-dimensional
echocardiography, 77, 79f, 83e
Mobitz type I AV block, 72t, 373
Mobitz type II AV block, 72t, 251, 373
Molecular-based therapies for cardiovascular
disease, 66–68
Molecular basis of cardiovascular diseases,
64–66
Molecular biology of cardiovascular diseases,
58–68. See also deoxyribonucleic
acid; ribonucleic acid
gene expression, 58–59, 60f
gene function, 58, 60f
gene mapping, 63–64
gene structure, 58
genetic structure, 58–68
histones 2A, 2B, 3 and 4, relationships, 60f
tools of CV molecular biologist
DNA-protein interactions analysis, 62
DNA techniques, 60–62
RNA techniques, 62
transcription factors, 58, 59f, 60, 61f
Monomorphic ventricular tachycardia, 290b
Moradabad Heart Study, 558
Morphine, adjunctive therapy, for MI,
642–643
MTOR inhibitors, 911, 915, 1036. See also
everolimus; rapamycin
MUGA. See equilibrium radionuclide
angiography
Multiple pathway tachycardia, 290b
Murmurs (cardiac murmurs), 13f, 15t
amyl nitrate/vasopressors, effects of,
16t, 18
aortic origin, 6
diastolic murmurs, 16–18
maneuvers for differentiation of, 15t, 18–19
systolic murmurs, 12, 14–16, 14f, 16b
Muscular dystrophy
Becker muscular dystrophy, 64, 797
Duchenne type, 4t, 64
myotonic muscular dystrophy, 325, 798
Mustard procedure, 306
MUSTIC-AF clinical trial (for CRT),
335t, 338
MUSTIC-SR clinical trial (for CRT),
335t, 338
MUSTT, ICD for SCD prevention trial
(1999), 353t
Mycophenolate, 508, 911, 912, 915
Myocardial contusion, 611t, 658, 820,
821–822, 821b
Myocardial diseases, 29, 64–65, 290b,
721, 861
Myocardial hibernation in viable
myocardium, 129
Myocardial infarction (MI). See also
acute myocardial infarction; acute
ST-segment elevation myocardial
infarction; non-ST-segment elevation
myocardial infarction
acute mitral valve regurgitation, 437
alteplase treatment, 66
anterior MRI, 146f, 325
aortic dissection, 463
arterial thrombosis paradigm, 482f
atrial flutter association, 271
biomarkers, 609–614, 610b, 610t, 611b,
611t, 612f, 613b
CAST trial, 364f
claudication, 447
differential diagnosis of hypotension, 657
driving restrictions, 76
ECG complication detection, 93b
in elderly people, 604
inferior MI, 325
left ventricular aneurysms, 163
with a low ejection fraction, 592t
myocardial ischemia hallmark, 123f
nonfatal MI, 50, 54, 128, 447
perioperative, 51b, 52, 55
post-MI LV remodeling, 82
postoperative surveillance for, 56
recurrent myocardial infarction, 72t, 650f
risk stratification, post-MI, 690–694
scars, 294f
stress ECG evaluation, 103, 104f
stroke risks, 278
sudden cardiac death risks, 138, 618t
surgical risk factors, 51b
SWORD trial, 369f
syncope, 317b
TEE evaluation, 106
thallium planar projection image, 126f
transmural MI, 206
in women, 599
Myocardial lesions, 821b
Myocardial perfusion imaging (MPI).
See also stress SPECT imaging studies
acute coronary syndromes assessment,
129, 135f
agents used in, 122–123, 198
described, 52, 122
imaging protocols, 124, 126–127
Myocardial revascularization
CAD risk factors, 564
clinical trials, 970
coronary revascularization, survival
benefit, 968
CV disease, secondary prevention, 565
indications, PCI in chronic CAD, 966–968
non-left main CAD revascularization,
966–967
symptom improvement,
recommendations, 967–968
myocardial infarction, 55, 624, 630,
634, 666
single-vessel coronary revascularization
intermediate left main CAD, 969
left circumflex coronary artery, 969
left main CAD, 968, 969
PCI prior to noncardiac surgery, 969–970
proximal LAD, 969
right coronary artery, 969
Myocardial stunning in viable
myocardium, 129
Myocarditis, 145, 269, 774
accelerated idioventricular rhythm, 653
acquired LQTS, 262t
acromegaly, 798
antimyosin imaging assessment, 129
Aspergillus myocarditis, 774f
brain natriuretic peptide, 841
and cardiomyopathy, 774
causes of histopathologic forms, biopsy
tissues, 887b
clinical presentation, diagnosis
biomarkers of cardiac injury, 879
cardiac magnetic resonance, 881–882
clinical clues, 4t
echocardiography, 881
electrocardiogram, 879, 881
endomyocardial biopsy, 882–883, 882f
physical examination, 879
clinical trials, 883
common causes, 879t
Cytomegalovirus myocarditis, 774f
delayed myocardial enhancement, 145
elevated troponin levels, 611, 615
eosinophilic myocarditis, 511f
etiology, acute myocarditis, 877–879, 882f
focal myocarditis, HIV, 773
gram-negative bacilli, 784
idiopathic VT, 297
inflammatory myocarditis, 774, 800,
860, 863
medium vessel arteritis, 510
noninfarct-related cardiogenic shock,
658, 665
polyarteritis nodosa, 801
QT prolongation factor, 316b
rheumatic myocarditis, 405, 407
sinus node dysfunction, 268
specific forms
acute rheumatic fever, 403–404, 437,
879t, 884–885
cardiac sarcoidosis, 801f, 881, 884, 884f,
890, 894, 894f1080 Index
Myocarditis (cont.)
Chagas cardiomyopathy, 886, 887t
giant cell myocarditis, 861, 862t,
883–884, 883f, 884f
HIV myocarditis, 774, 886–887
hypersensitivity, eosinophilic
myocarditis, 511f, 885, 885b, 887b
Lyme myocarditis, 886
lymphocytic myocarditis, 798, 861, 877,
878f, 882, 883–884, 883b, 883f
sudden death risks, 290b
third-degree AV block, 269
treatment, 883
valvular heart disease, 394
viral myocarditis, 800t
VT/wide complex tachycardia, 289
Myotonic muscular dystrophy, 325, 798
Myxedema, 4t, 207
Na-K-ATPase pump, 120, 121t
Narrow complex tachycardia
atrial termination of, 287f
diagnosis, 282–283
EP study recommendation, 251b
R-P interval classification, 283
Narrow-QRS tachycardia, 253–254, 267
National Cholesterol Association, 551, 552t
National Cholesterol Education Program
(NCEP), 528, 531–534, 532t,
539–540, 551–552, 558, 562
National Cholesterol Education Program
Adult Treatment Panel III (NCEP-ATP
III), 436, 531, 532t, 533t, 556f
National High Blood Pressure Education
Program, 588
National Institutes of Health
AIM-HIGH study, 536
CORAL trial, 474
diabetes statistics, 574
National Lipid Association, 551
Native valve endocarditis, 106, 784, 786b
causes of, 777, 784
pathogenesis, 787
TEE evaluation, 108
therapeutic approach, 785–786, 793–796
TTE evaluation, 787
valve replacement survival, 788
Native valve regurgitation, 78t
Native valve stenosis, 78t, 758
Neurally mediated syncope, 268, 314, 315b,
316, 317b
Nifedipine, 584, 589, 633, 641, 747, 871
Nitrates
in cocaine toxicity, 804
contraindications, 644, 687, 688
in HFpEF, 857
in myocardial infarction, 620, 624,
632–633
in pregnancy, 757, 758
in RVF/LV systolic dysfunction, 867
RV infarction sensitivity to, 639, 687
in stress cardiography, 101
in systolic dysfunction, 870t
Nitrogen-13 ammonia, 131–132, 132f, 133f,
134f, 136f, 137f
Nitroglycerin
adjunctive therapy, for MI, 644
CAD stress testing, 197
cardiac emergencies, 687
cardiogenic shock, 667
chest pain/normal coronary arteries, 963
chronic stable angina, 627
coronary artery spasm, 922
intravenous, hypertension, 589
myocardial infarction, 644, 686, 696
pregnancy, 757
syncope, sublingual, 317
types of administration, 632, 644
Noncardiac anesthesia, in patients with
cardiovascular disease
ASA physical classification status, 831t
devices, 832–833
evaluation, care algorithm, 832f
hemodynamic effects of common
drugs, 834t
intraoperative management
anesthetic choice, 833–835
monitoring, 835
postoperative care
disposition, 835
postoperative analgesia, 835–836
preoperative medications, 831–832
preoperative preparation, 830–831, 833b
risk stratification, 831t
Noncardiac surgery, in heart disease, 49–57
additional evaluations, 51–52
disease-specific considerations
arrhythmias, conduction disturbances,
54–55
coronary artery disease, 53–54
hypertrophic obstructive
cardiomyopathy, 54
perioperative myocardial infarction, 55
valvular heart disease, 54
vascular disease, 54
examination strategy, 56–57
general/stepwise preoperative evaluation,
49–51
intraoperative hemodynamic
monitoring, 55
medications/management, preoperative,
55–56
oral anticoagulation approach, long-term
care, 56
postoperative surveillance for MI, 56
preoperative hemodynamic assessment, 55
Non-GAS (group A streptococcal)
pharyngitis, 442
Noninvasive imaging. See cardiac
radiography; computed tomography;
drivers and aircraft pilots with
cardiac disease, restrictions on;
echocardiography principles; magnetic
resonance angiography; magnetic
resonance imaging; nuclear imaging;
positron emission tomography;
transesophageal echocardiography
Non-ST-segment elevation myocardial
infarction (NSTEMI)
ACS classification, 616f
cardiogenic shock, 665–666, 668
Class I, II management
recommendations, 622f
emergency treatment, 685
eptifibatide therapy, 491b
lepirudin therapy, 492b
mortality rates, 620f
preoperative coronary revascularization, 53
stress SPECT imaging, 129
thienopyridine therapy, 486b
tirofiban therapy, 491b
Nonvasculitic arteritis, 512
Norepinephrine (alpha-adrenergic receptor
function), 360
cardiogenic shock, 669
dilated cardiomyopathy, 890t
myocardial infarction, 628, 668
plasma norepinephrine levels, 363
sympathetic innervation of the heart,
822, 824, 841–842
ventricular dysfunction diagnosis, 861t
Normal sinus rhythm (NSR), 275
AF/AFL management, 272, 275
amiodarone efficacy, 277
atrial arrhythmia cardioversion and, 275
dronedarone efficacy, 276
pharmacologic therapy for maintenance,
275–276
spontaneous restoration data, 276–277
North American Society of Pacing and
Electrophysiology/British Pacing and
Electrophysiology Group Generic
Code, 325, 326t
NSTEMI. See non-ST-segment elevation
myocardial infarction
NT-proBNP
CAD risk factors, 571–572, 572t
chronic stable angina, 629, 630
HFpEF, 855
Nuclear imaging, 120–129
clinical applications
acute coronary syndromes, 129
coronary artery disease, 127–129, 128t
myocardial viability, 129
gated SPECT technique, 122
limitations, 129
LV size and function assessment, 127
myocardial perfusion imaging, 122–124,
126–127
radionucleotide imaging, 120–121, 122f
Null hypothesis, of a study, 45
Number needed to harm (in measures of
effect), 45
Number needed to treat (in measures of
effect), 45
Obesity
in acquired LQTS, 262t
in atrial fibrillation, 271f
bariatric surgery treatment, 577
in CAD, 526–528
drug-related heart disease and, 413
in dyslipidemia, 551, 555, 555t, 556
gait abnormalities from, 187
general examination evaluation, 4t
high diaphragm position in, 160
increased fibrinogen levels, 481
in metabolic syndrome, 531–534, 536
in mitral stenosis, 17
PET scanning recommendation, 199
in pulsus paradoxus, 7b
trends, 19602008–, U.S., 576f
in type 2 diabetes, 540
Obstructive coronary artery disease, 597, 956
Obstructive sleep apnea (OSA)
acute responses, 813
associated conditionsIndex 1081
arrhythmias, sudden cardiac death, 816
atherosclerosis, CAD, 815–816
congestive heart failure, 816–817
hypertension, 815
hypertrophic cardiomyopathy, 817
ischemic heart disease, 555
right ventricular failure, 864
stroke, 816
coronary artery disease risks, 556
diagnosis, treatment, 817
ischemic heart disease and, 555
metabolic syndrome comparison, 555
sustained effects, daytime wakefulness, 813
Octreotide acetate (Sandostatin), 409
Odds ratio (in measures of effect), 45
Orthodromic atrioventricular reentrant
tachycardia, 284f
Orthodromic reciprocating tachycardia, 290b
Orthostatic hypotension-based syncope, 315b
Osler-Weber-Rendu disease (hereditary
hemorrhagic telangiectasia), 4t
Oxygen therapy
acute pulmonary edema, 667
MI patients, with hypoxemia, 639, 642
Pacemaker bradycardia, 231f
Pacemaker-mediated tachycardia, 290b, 331,
332f, 685, 1027
Pacemakers, 324–333. See also implantable
cardioverter defibrillators
antibradycardiac pacing, generic code, 326t
crosstalk issues, 330–331
driving restrictions and, 72t, 73, 76
dual-chamber pacing system, 328f
electromagnetic interference
hospital environment, 331–332
nonhospital environment, 332
implantation risks, 333
intraoperative evaluation, 330t
lead abnormalities, 329–330
left ventricle and, 26
malfunctions, 329b
nonbradycardiac pacing indications
cardiac resynchronization therapy, 325
hypertrophic cardiomyopathy, 325
pacemaker-mediated tachycardia, 331
pacemaker syndrome, 327–329
pacing modes
indications, 327t
nomenclature, 325–326
switching modes, 326f
permanent pacing indications
anterior myocardial infarction, 325
AV conduction abnormality, 324–325
sinus node dysfunction,
dysregulation, 324
permanent pacing leads, 326–327
right ventricle and, 25
sinus node of heart as, 40
stress echocardiography issues, 101
superior vena cava and, 21
temporary pacing, 333
Pacemaker syndrome, 325, 327–329, 998f,
1003f, 2017
Palpable A wave (presystolic impulse), 3
Papillary fibroelastoma, 592t, 809, 810f
Papillary muscle dysfunction
acute myocardial infarction, 661
cardiac murmurs, 1028
mitral regurgitation, 12, 91, 605
myocardial infarction, 93b
nonejection clicks, 8
valvular regurgitation, 393–394
Paravalvular prosthetic regurgitation
repair, 974
Parietal pericardium, 20–21, 25, 709, 710f,
711, 714
Paroxysmal atrial fibrillation, 272, 592t, 593
Paroxysmal supraventricular tachycardia, 601
PARR-2 study, FDG-PET trial, 138
Partial anomalous pulmonary venous
connection, 22
PARTNER trial, 973
Patent ductus arteriosus (PDA), 183f–184f
amyl nitrates/vasopressors, effects, 16t
aortopulmonary window, 36
causative for S
3, 11b
clinical clues, 4t
evaluation and management, 764
heart sounds, 9f, 11b
large PDA, 183f
left-to-right shunts, 738b
physical examination, 764
pulmonary CTA, 152
PATH-CHF clinical trial, 335t, 338
PATH-CHF II clinical trial, 335t, 338
Patient-physician factors, in evidence-based
medicine, 44
PCI-CLARITY clinical trial, 487t
PCI-CURE clinical trial, 487t
Pediatric arrhythmias, 266–269
accessory-pathway mediated tachycardia,
266–267
atrial ectopic tachycardia, 267
atrial flutter, 268, 272t
atrioventricular node reentrant
tachycardia, 267
junctional ectopic tachycardia, 267–268
second-degree AV block, 268–269
sinus node dysfunction, 268
third-degree AV block, 269
ventricular arrhythmias, 268
Penetrating aortic ulcer, 467–468, 469f
Pentamidine, 296, 316b, 682, 774t
Percutaneous atrial septal occlusion devices,
978f, 978t
Percutaneous coronary intervention (PCI)
abciximab use, 490, 490b, 623
acute coronary syndromes, 621
AMI association, 615
aneurysms, 926
apixaban use, 493
atherosclerosis pathogenesis, 541
bivalirudin use, 492
CAD, 53, 596, 598, 604
cardiogenic shock, 657, 665, 668t
chronic stable angina, 634–645
clopidogrel use, trials, 64, 486, 487–488,
487t, 621
coronary bypass comparison, 703
coronary lesions, survival benefit, 968
coronary stent use, 1035–1040
CTA, diabetes mellitus patient, 472f
CV disease, secondary prevention, 565
driving restrictions, 72t, 74t
heparin therapy, 643–644
Kaplan-Meier Survival Curves, 634f
Mayo Clinic Risk Adjustment Model, 967f
myocardial infarction, 616, 618, 634–635,
660, 674
non-left main CAD revascularization,
966–967
post-PCI/cardiac surgery, troponin
elevation, 611
prasugrel use, 621, 622
pre-noncardiac surgery revascularization,
969–970, 1038f
RV infarction, 639
selection strategy, 674t, 676t, 680f
STEMI, 665, 672–680
symptom improvement recommendations,
967–968
ticlopidine use, 486
type 2 diabetes, 576
unstable angina, 598
women and CAD, 598–599
Percutaneous renal denervation (RDN)
method, 586, 586f
Percutaneous transluminal coronary
angioplasty (PTCA), 67–68, 598,
938f–940f, 960–961, 963, 968, 970,
1027, 1037f
Percutaneous treatment of structural heart
disease
paravalvular prosthetic regurgitation
repair, 974
pulmonary valve incompetence, 975–976
pulmonary valve stenosis, 975
severe mitral regurgitation, experimental
procedures, 974–975
surgical aortic valve replacement,
605, 971, 973
transcutaneous aortic valve implantation,
971–973, 973t, 974t
Pergolide, and valvular heart disease,
414–415
Pericardial diseases, 709–724. See also acute
pericarditis; pericardial effusion and
cardiac tamponade; pericardium
congenital absence of the pericardium,
709–710
constrictive pericarditis, 3, 95–96
echocardiographic evaluation
constrictive pericarditis, 95–96, 95f
effusion, 94, 94f
tamponade, 94, 94f
infiltrative cardiomyopathy, 613, 722
noninfiltrative restrictive cardiomyopathy,
722, 724
pericardial calcification, 169, 170f,
718, 719f
pericardial cyst, 710
pericardial defects, 169–170
pericardial effusion, 169
pericarditis and HIV infection, 773–774
pericarditis in acute MI, 716–717
restriction vs., constriction, 722, 724
Pericardial effusion and cardiac tamponade
ECG diagnosis of, 714–715
hemodynamics of cardiac tamponade,
713–714
pericardial effusion due to malignancy,
715–716
treatment of cardiac tamponade, 715
Pericardium, 20–21
anatomy and function, 20–21, 709
cross section, 710f1082 Index
Pericardium (cont.)
heterograft valves constructed from, 417
postinfarction syndrome, 663
TEE functional assessment, 77
trauma/fractured ribs, 25
true/false ventricular aneurysms, 660
Perioperative myocardial infarction, 52, 55,
56, 2016
Peripheral arterial occlusive disease, 447, 449,
451, 486b
Peripheral artery disease
CAD risk factor, 552
cardiogenic shock, 670
clopidogrel clinical trials, 487t
dyslipidemia risk factors, 551–552
Heart Protection Study, 566
Peripheral cardiomyopathy, 891
Peripheral vascular disease, 447–454
acute arterial occlusion, 450
aneurysms, 450–451
angiographic diagnosis, 448
aortoiliac disease, 448, 450
claudication, 447
differential diagnosis, 448t
driving restrictions, 74t
lower extremity grading system, 448t
MRA/CTA evaluation, 155f, 156
natural history of, 447–448
pseudoclaudication, 447
differential diagnosis, 448t
severe CAD with, 54
treatment of, 448–450
uncommon types
chronic pernio, 453f, 454
erythromelalgia, 454
heparin-induced thrombocytopenia, 452
livedo reticularis, 453
popliteal artery entrapment, 452
Raynaud phenomenon, 453
thoracic outlet compression
syndrome, 452
thromboangiitis obliterans, 451–452,
451f, 451t
vasospastic disorders, 452–453
Pernio, 453f, 454, 507b, 512
Persistent atrial fibrillation, 272
PET metabolic tracers, 132–133
PET MPI. See positron emission tomography
PET perfusion tracers, 131
Pharmacologic stress echocardiography
advantages/limitations, 103, 133, 199
agents use for, 100, 122, 199, 201
approaches, 144
interpretation, 101
myocardial perfusion imaging with, 202
stress echocardiography with, 198
Pharyngeal GAS (group A streptococcal), 442
Phenothiazines, 316b, 885b, 890t
Phentermine, 413
Phenytoin, 291f, 365, 366, 688, 886t
Pheochromocytoma, 4t, 7, 262, 362, 581,
587–588, 587–589, 617, 811
Phosphodiesterase III inhibitors, 449. See also
cilostazol
Phosphodiesterase inhibitors, 489. See also
dipyridamole
Phosphodiesterase type 5 inhibition, 749, 867.
See also sildenafil citrate; tadalafil
Pickwickian syndrome, 4t
PIVOTAL trial, 874
Plasma norepinephrine levels, 362
POISE Trial, 55
Polyarteritis nodosa, 507t, 511, 786b, 801
Polymorphic ventricular arrhythmias, 296
Polymorphic ventricular tachycardia, 230f,
263t, 275, 290b, 292f, 299f, 357
Popliteal artery aneurysm, 451
Popliteal artery entrapment (PAE), 452
Positron emission tomography (PET)
annual event rates chart, 135t
cardiac PET radiopharmaceuticals
nitrogen-13 ammonia, 131–132, 132f,
133f, 134f, 136f, 137f
PET metabolic tracers, 132–133
PET perfusion tracers, 131
rubidium 82, 131f, 132, 133f, 134f
clinical applications
CAD, diagnosis and prognosis,
133, 135–136
viable myocardium identification,
136–138
interpretive certainty of, 133, 135f
metabolic imaging assessment, 129
in myocardial perfusion imaging, 198
myocardial viability assessment, 129
principles of, 130–131
Posteromedial mitral papillary muscle
rupture, 664f
Postinfarction syndrome (Dressler syndrome),
663, 717, 718b
Postoperative atrial flutter, 275, 276–277
Postoperative atrial tachyarrhythmias, 54
Postthrombotic syndrome, 501, 502
Potassium channel, 242, 243, 263, 263t, 296
PRAISE-II trial, 871
PRAISE trial, 871
Prasugrel, 486, 489, 620–622, 645, 679, 1039
Precordium
abnormalities on palpation, 3
left upper sternal area, 5
lower sternal area, 3, 5
right upper sternal area, 5
atrial septal defect, 1032
cardiac tamponade, 713
chronic mitral regurgitation, 396
mitral stenosis, 1030
patent ductus arteriosus, 1032
restrictive cardiomyopathy, 895
right ventricular failure, 1028
splitting of the S2, 9
systolic ejection clicks, 8
systolic ejection murmur, 903
PREDICT trial, 691, 692t
Preeclampsia, 504, 521, 588, 591, 756
Preexcitation syndromes, atrial flutter
association, 271
Preexcited atrial flutter, 276, 277f
Pregnancy. See also pregnancy-associated
arrhythmias
anticoagulation therapy
antiplatelet agents, 760
low-molecular-weight heparin, 758,
759–760
unfractionated heparin, 758, 759
warfarin, 758, 759
aortic dissection in, 399
arrhythmia management
adenosine, 758
amiodarone, verapamil, 757
beta-blockers, 757
digoxin, quinidine, 757
direct current cardioversion, 757
CAD management, 758
cardiac contraindications
congenital heart disease, 755
Marfan syndrome, 755–756
other aortopathies, 756
pericardium cardiomyopathy, 756
cardiac diseases during
high-risk pregnancy, 754b
management, 753–754
maternal prognosis, 754
CHF management
ACE inhibitors, angiotensin II
blockers, 757
digoxin, diuretics, 756–757
nitrates, 757
contraception and heart disease, 760
endocarditis prophylaxis, 760
hemodynamic changes
labor and delivery, 753
post partum, 753
increased pulmonary blood flow, 166
labor and delivery, hemodynamic
changes, 753
in Marfan syndrome, 521
physiology
cardiac examination, 752
cardiac studies, 753
hemodynamic changes, 752
rheumatic heart disease and, 408
valvular heart disease management
cardiac surgery, 758
percutaneous valve intervention, 758
prosthetic heart valves, 758
venous thromboembolism, 500
Pregnancy-associated arrhythmias,
307–312
ambulatory monitoring, 308
ECG evaluation, 307–308
echocardiographic evaluation, 308
electrophysiologic studies, 308
exercise treadmill testing, 308
fetal arrhythmias, 309, 312
pharmacologic therapy, 757–758
anticoagulation, 310
AV nodal blocking agents, 308–309
full drug list, 309t
pharmacokinetic changes, 308
Vaughan Williams classification,
309–310
physiological changes of pregnancy, 307
rhythm management principles, 307
specific arrhythmias
bradycardia, 311
cardiac arrest, 311
hypertrophic cardiomyopathy, 312
ICD therapy, 312
labor and delivery, 312
lactation, breastfeeding, 312
long QT syndrome, 312
normal heart, 310
resuscitation issues, 311–312
structural heart disease, 310
syncope, 311
ventricular tachycardia, 310–311
tilt table testing evaluation, 308Index 1083
Pregnancy-related venous
thromboembolism, 500
Premature atrial contractions, 652
Premature ventricular complexes, 653
Premature ventricular contractions (PVCs)
in adenosine-sensitive VT, 298
cardiomyopathy-associated PVCs, 301t
inappropriate indications for ECG, 79t
incidence, post-MI, 291
pharmacologic treatment, 301
polymorphic PVCs, 296
Pretest probability, of a disease, 47
Prevalence of a disease (defined), 44–45
Primary aldosteronism, 581, 587, 587t
Primary graft failure (cardiac
transplantation), 912
Primum atrial septal defect
CHD association, 762b
chest radiography, 762
congenital cleft of anterior mitral leaflet
and, 393
described, 24
ECG evaluation, 24, 763
evaluation and management, 763
presentation, 232
in a 1-year old boy, 234f
PRISM clinical trial, 491
PRISM-PLUS clinical trial, 491
Procainamide, 276t, 309, 365
PROFESS clinical trial, 487t, 489
Programmed electrical stimulation (PES)
for suspected bradyarrhythmia, 250–253
AV node function, 251, 254
sinus node function, 251
for suspected tachyarrhythmia, 253–254
broad-QRS tachycardia, 254
narrow-QRS tachycardia, 253–254
Propafenone, 276t, 309–310, 366–367
Propionyl-L-carnitine, 449
Propranolol, 246, 263, 275, 309, 309t, 352t,
468b, 518, 569t, 682, 756b
PROSPECT clinical trial, 338, 960
Prostanoids, 747, 748, 867. See also
epoprostenol sodium; inhaled iloprost
Prosthetic heart valves. See also cardiac valve
disease surgery
anticoagulation therapy
dysfunction evaluation, 421
hemorrhage complications, 419b
laboratory tests, 422–423
mechanical valve recommendation, 418,
423b, 424b
periprocedural recommendations, 424b
short-term discontinuation, 423
thromboembolism risks, 423b
assessment of, 107t
atrial fibrillation, stroke risk
stratification, 280t
bioprosthetic valves, 56, 106, 412
chronic mitral valve treatment, 398
complications, 419b
endocarditis, 420–421
management of, 424
perivalvular leak, 419
prosthesis-patient mismatch, 421
structural failure, 420
thromboembolism, 420
dysfunction diagnosis
ECG evaluation, 421–422
echocardiography, 421
laboratory tests, hemolysis, 422–423
mitral/tricuspid valve assessment, 422
patient history, 421
physical examination, 421
radiography, 421
TEE, 422
valve incompetence, 422
dysfunction prevention
antithrombotic therapy, 423–424
endocarditis prophylaxis, 424
echocardiographic evaluation, 78t, 85,
92–93
Hancock bioprosthetic valves, 175f
periprocedural anticoagulation
recommendations, 424b
Ross procedure, 419
selection principles, 418
severe chronic aortic regurgitation
treatment, 401
TEE evaluation, 116, 116f–117f
transcatheter valve replacement, 419
transcutaneous implantation, 175f
valve types
Bj?rk-Shiley valve, 416, 424b
Hancock bioprosthetic valves, 175f
heterograft valves, 417
homograft valves, 417–418
Medtronic-Hall valves, 416, 424b
St. Jude Medical valve,
174f, 416–417, 424b
Starr-Edwards valves, 162f, 416
Prosthetic valve dysfunction, 4t, 315b
Prosthetic valve endocarditis, 106, 107t, 783,
787, 788b
Protein C deficiency, 502
Protein S deficiency, 502
Prothrombin G20210A mutation,
503, 726, 726b
PROVE IT TIMI 22 trial, 548t, 567
PTA (percutaneous transluminal angioplasty),
449–450, 450f, 470, 473
Pulmonary atresia with VSD, 770
Pulmonary capillary hemangiomatosis, 736,
737b, 738, 866, 866b
Pulmonary click, 8, 8b
Pulmonary computed tomography
angiography (CTA), 152
Pulmonary embolism, 725–734
atrial fibrillation, 604
baseline patient characteristics, 730t
bleeding complications, 731
chronic thromboembolic pulmonary
hypertension, 733–734, 737b
clinical features, 727
diagnosis
arterial blood gases, 730
CT pulmonary angiology, 727
echocardiography, 727
electrocardiography, 729–730
MRI, 729
pulmonary angiography, 729
troponin/D-dimer (serum markers),
728–729
V/Q lung scan, 729
differential diagnosis, 628, 638–639, 667t
direct thrombin inhibitors, 731
ECG evaluation, 78t
elevated troponin levels, 611t, 615
epidemiology of, 725
etiology
cancer and VTE, 725–726
diagnosis of DVT, 727
lower extremity DVT, 726
pregnancy and VTE, 726
thrombophilic disorders and VTE, 726
upper extremity DVT, 726–727
heparin-induced thrombocytopenia,
452, 503
IVC interruption, 731
jugular vein clues, 5
low-molecular-weight-heparin, 494
massive pulmonary embolism,
688, 731–732, 732f
MRA/CTA evaluation, 152
pregnancy-related VTE, 500
prognostication in, 730
pulsus paradoxus, 6, 7b, 714
risk class distribution, 730t
submassive pulmonary embolism,
731, 732–733
sudden death risk, 290b
syncope and, 315b
TEE evaluation, 108
treatment, 730–731
Pulmonary hypertension, 735–751. See also
pulmonary hypertension, contingent
tests; pulmonary hypertension,
diagnostic classification; pulmonary
hypertension, essential diagnostic
testing; pulmonary hypertension,
treatment approaches
abnormal jugular venous pulse waves, 6b
assessment of severity and prognosis, 746
bronchial artery enlargement from, 35
causes, 166–167, 736t
angina, 735
heritable causes, 735–736
idiopathic, 736
left-to-right shunts, 738b
syncope, 315b, 735
chronic mitral regurgitation, 396
chronic thromboembolic pulmonary
hypertension, 733–734, 737b
classification of, 866, 866b, 867b
CPX interpretation, 188, 195t
defined, 735
from diet drugs, 413
differential diagnosis, 628
driving restrictions, 75t–76t
ECG evaluation, 78t
ejection clicks, 8b
elevated troponin levels, 611t
general examination clues, 4t
hemodynamic patterns, 659t
idiopathic pulmonary hypertension, 733
left upper sternal area palpation, 5
mechanisms, 739–740
nitroglycerin use, 644
P
2, S2 splitting caused by, 9
pathology, 739
percutaneous mitral balloon
valvotomy, 391t
pregnancy/rheumatic heart disease
and, 408
pulmonary/tricuspid valve regurgitation, 441
right ventricle overload from, 25
in right ventricular failure, 736t, 8661084 Index
Pulmonary hypertension (cont.)
secondary pulmonary hypertension,
5, 11, 389
stress ECG evaluation, 103
stress echocardiography evaluation, 103
sudden cardiac death risk, 290b, 305b
sudden death risks, 290b
symptoms and signs, 735
syncope in, 315b, 735
TEE evaluation, 97, 99f
Pulmonary hypertension, contingent tests
contingent blood tests, 746
CT of the chest, 745
invasive pulmonary angiography, 745–746
lung biopsy, 746
polysomnography, 746
presymptomatic screening, 745
Pulmonary hypertension, diagnostic
classification
flowchart for evaluation, 741f
group 1 PH
connective tissues diseases, 737
heritable, 736–737
HIV infection, 737
idiopathic, 733, 736
persistent PH of newborn, 738
portal hypertension, 738
pulmonary capillary
hemangiomatosis, 738
pulmonary venoocclusive disease, 738
schistosomiasis, 738
systemic-pulmonary shunts, 738
toxic exposure, 737–738
group 2 PH: left heart disease, 738
group 3 PH: lung disease and/or hypoxia,
738–739
group 4 PH: CTEPH, 739
group 5 PH: PH with unclear multifactorial
mechanisms, 739
Pulmonary hypertension, essential diagnostic
testing
cardiac MRI, 743
chest radiography, 740, 742f
electrocardiography, 740
essential blood tests, 744
exercise capacity assessment, 745
pulmonary function testing, 744
radionuclide studies, 743–744
right heart catheterization, 745
screening overnight oximetry, 744
transthoracic Doppler echocardiography,
740, 742f, 743, 743f
ventilation-perfusion lung scans, 744f
Pulmonary hypertension, treatment
approaches
choice of therapy, 749
group 1 approach
calcium channel blockers, 747
choice of therapy, 749
endothelin receptor antagonists, 748–749
phosphodiesterase type 5 inhibition, 749
prostanoids, 747–748
pulmonary vascular-targeted therapy, 747
group 2 approach: PH due to left heart
disease, 750–751
group 3 approach: PH due to lung disease
and/or hypoxia, 751
pharmacologic management algorithm, 750f
procedures and surgical treatment, 749–750
Pulmonary stenosis
amyl nitrate/vasopressors, effects, 16t
blood flow, 166
carcinoid heart disease, 410
clinical clues, 4t
ECG evaluation, 765
heart sounds, 8, 10–12
isolated pulmonary stenosis, 33
lower sternal area palpation, 3
physical examination, 764–765
pulmonary valve regurgitation, 441
transmitted murmurs, 6, 6b
transthoracic Doppler ECG, 740, 743
valvular pulmonary stenosis, 27
Pulmonary thromboembolism, 688, 745f, 747
Pulmonary valve, applied anatomy, 32
Pulmonary valve incompetence, 975–976
Pulmonary valve regurgitation, 182f, 183f,
410–411, 441, 1030
Pulmonary valve stenosis, 5, 6b, 8b, 12, 441,
806, 811f, 933f, 934f, 975
Pulmonary vascular-targeted therapy, 747
Pulmonary veno-occlusive disease, 866b
Pulsed wave Doppler echocardiography, 81,
81b, 81f, 91, 91f, 93
Pulsus alternans, 6–7, 7b, 995, 1027, 1028
Pulsus paradoxus, 6, 7b, 637, 714–715, 714f,
718b, 724, 1002f, 1027, 1029
Pulsus parvus, 6–7, 12, 605, 1027, 1029t
Pulsus tardus, 6–7, 605
PURSUIT clinical trial, 492
PURSUIT-STEMI trial, 692t
PVCs. See premature ventricular contractions
P-wave abnormalities
ECG diagnoses, 206
ECG score sheet diagnosis, 214
P2Y
12 antiplatelet therapy, for myocardial
infarction, 644–645, 679. See also
clopidogrel; prasugrel; ticagrelor
QRS voltage/axis abnormalities
ECG diagnoses, 206
ECG score sheet diagnosis, 214, 217–218
Quantitative sudomotor axon reflex test
(QSART), 361
Quinidine, 309, 364–365
RAAVE clinical trial, 436, 440f
RADIANCE trial, 869–870
Radiation-induced cardiac disease, 803
Radiation-induced injury, 255b
Radiofrequency ablation
atrial flutter, 913
AVNRT, younger patients, 286
complete heart block from, 267
driving restrictions, 72t
Ebstein anomaly, 768
ECG indications for use, 78t
incessant VT, 294
pacemaker inhibition from, 331
paroxysmal supraventricular
tachycardia, 601
pulmonary vein stenosis from, 21
PVCs and cardiomyopathy, 301
for tachycardia, 286
TEE guiding, 110
Radionucleotide imaging, 120, 129, 588, 625
Radionuclide perfusion imaging
instrumentation, 121, 121t
isotope characteristics, 121t
radioisotopes, 120–121
radiopharmaceuticals, 120
stress echocardiography comparison, 103
Radiopharmaceuticals, 120, 131–133. See also
cardiac PET radiopharmaceuticals
Rapamycin (sirolimus), 911, 915, 1036
Raynaud phenomenon, 4t, 365, 451t,
452–453, 506, 512–513, 800, 807
Recombinant DNA technology, 66–67
Recurrent myocardial infarction, 72t, 650f
Reentrant atrial tachycardia, 290b
Reflex and humoral control, of circulation,
839–842
Reflex sympathetic dystrophy, 507b
Regurgitant valvular lesions, 161, 163f,
992–993
RE-LY clinical trial, 493, 593
REMATCH trial, 874
Renal artery stenosis, 67t
clinical clues, 470
clinical trials, 473–474
CTA/MRA evaluation, 156
diagnostic testing, 470–473
CTA, 472, 472f
duplex ultrasonography, 471
invasive arteriography, 472–473
MRA, 471–472, 472f
revascularization for, 473–474
types of, 470
Renal fibromuscular dysplasia (FMD),
470, 471f
Renal percutaneous transluminal
angioplasty, 474
Renin-angiotensin-aldosterone antagonist
therapy, for acute MI, 645, 646f, 647
Renin-angiotensin-aldosterone system,
840–842, 841b
Renovascular hypertension, 587
Reperfusion arrhythmias, 653
Resistant hypertension, 585–587, 585t, 586f
RESPECT trial, 977
RESTORE clinical trial, 491
Restrictive cardiomyopathy (RCM)
amyloidosis, 799
Churg-Strauss syndrome, 801
clinical presentation, 894–895
CMV approval/disapproval and, 75t–76t
constrictive pericarditis, 95–96, 718,
720–722
definition, etiology, 892
diagnostic evaluation
cardiac catheterization, 895
cardiac MRI, 895
echocardiography, 895
differential diagnosis, 724, 877, 895–896
driving restrictions, 75t
HFpEF, 853, 856t
hypereosinophilic syndrome, 803
minimally dilated restrictive
cardiomyopathy, 888–889
noninfiltrative restrictive cardiomyopathy,
722, 724
pathogenesis, natural history
amyloidosis, 892–893, 893f
endomyocardial fibrosis, 894
eosinophilic endomyocardial disease, 894
idiopathic RCM, 892
infiltrative/storage diseases, 893–894Index 1085
radiation-induced cardiac disease, 803
treatment
cardiac amyloidosis, 897
endomyocardial fibrosis, 897
eosinophilic cardiomyopathy, 897
symptomatic therapy, 896–897
RethinQ clinical trial, 338
REVERSE clinical trial, 336t, 338
Revised Cardiac Risk Index, 50–51, 50b
Reynolds Risk Score, 529
Rheumatic fever (RF), 269, 393, 442
consequences in children, young adults, 406
intrinsic valvular disease, 398–399
mitral regurgitation, 393
mitral stenosis, 391, 391f, 428, 437, 605
myocarditis, 879t
third-degree AV block, 269
tricuspid valve involvement, 429
Rheumatic heart disease (RHD), 403–408
acute rheumatic fever
clinical features, 404, 804–805
epidemiology, 403
Jones criteria, 404b
pathogenesis, 403–404
WHO criteria, 404b
carditis and, 404–406
echocardiographic evaluation, 442–443
epidemiology of, 442–443
left ventricular dysfunction, 407
mitral valve stenosis from, 162
multichamber cardiac enlargement
from, 163f
myocarditis and, 879t
pregnancy and, 408
relation to valvular heart disease, 442
subclinical rheumatic heart disease,
406–407
treatment
antibiotic prophylaxis, 408
antibiotic therapy, 407–408
relief of symptoms, 407
tricuspid stenosis in, 17
valvular aortic stenosis from, 385, 386b
valvular disease management, 408
Rheumatic mitral stenosis, 23, 30, 31f,
92f, 386
Rheumatic mitral valve disease,
271b, 393, 592t
Rheumatoid arthritis, 4t, 393, 399, 404, 437,
506, 507t, 718b
Ribonucleic acid (RNA)
analytic techniques, 62
messenger RNA, 58, 59f
structure of, 58
Right-sided infective endocarditis, 441, 786b
Right-to-left intracardiac shunt, 4t
Right ventricular failure (RVF). See also
arrhythmogenic right ventricular
myopathy; cor pulmonale
coronary artery bypass surgery, 705
diagnostic evaluation, 864–865, 865f, 866f
diuretic use, 747
hemodynamic patterns, 659t
management
RVF with LV systolic dysfunction,
867–868
RVF with PAH, 867
manifestations, 865b
mitral stenosis, 389
pulmonary hypertension with, 736t, 866
right ventricular S3 in, 11b
secundum ASD, 761
tetralogy of Fallot, 769
transposition of great arteries, 770
ventricular arrhythmia prediction, 295
Right ventricular (RV) infarction, 5, 93b, 106,
652, 657–662
clinical presentation, 637–638
complications, 639
culprit coronary lesion, 637
diagnosis
echocardiography, 638
electrocardiography, 638
hemodynamic assessment, 638
pulmonary embolism, 638–639
dynamic LV outflow tract obstruction, 660
failed reperfusion, 659
healed right, with right ventricular wall
fibrosis, 638f
infarct extension, expansion, 659–660
myocardial (cardiac) rupture, 660
prognosis, 640
with right ventricular dilatation, 638f
treatment, 639–640
true/false ventricular aneurysms, 660
ventricular free wall rupture, 660–661
ventricular septum rupture, 661–662
Rivaroxaban, 278, 493, 731
Romano-Ward syndrome. See long QT
syndrome
Rosuvastatin, 436–437, 440, 441f, 559t, 564,
567, 776
R-R cycle length, 17
Rubidium 82, 131f, 132, 133f, 134f
RV (right ventricular) hypertrophy, 3, 5
SALTIRE clinical trial, 436, 440f
SAPPHIRE trial, 458
Sarcoidosis
characteristics, 799, 801f, 884, 884f
clinical clues, 4t
dilated cardiomyopathy, 890t
endomyocardial biopsy, 861, 894,
1041, 1042b
myocardial damage, 145, 879, 881
pulmonary hypertension, 737
restrictive cardiomyopathy, 893b
sarcoid myositis, 1042
with solitary granuloma, 1044f
systolic heart failure, 862t
Scandinavian Simvastatin Survival Study, 565
SCD-HeFT, ICD for SCD prevention trial
(2005), 349–350, 353t, 354f
Scimitar syndrome, 22, 166, 177f
SEAS clinical trial, 437
Secondary hypertension, 470, 578, 586, 587
Second-degree AV block, 268–269, 654–655
Second-degree heart block, 101, 123
Second heart sound (S2), 8–10
intensity, 10
paradoxical splitting of, 9–10
S
2-mitral OS interval, 10–11
splitting of, 8–9, 9f
Secundum atrial septal defect
chest radiography, 762
described, 24, 761–762
driving restrictions, 75t
ECG study, 98f, 207, 762
evaluation and management, 762–763
physical examination, 762
TEE evaluation, 97
in 6 year old girl, 233f
Semilunar valves, applied anatomy,
31–32
Senning procedure, 306
Serous pericardium, 20
Sestamibi (in radiopharmaceuticals), 120
Severe angina, Canadian class III or IV, 51b
Severe aortic stenosis
asymptomatic patients with, 388–389
athletic restriction with, 358
definition, 389
diagnostic markers, 386–387
ECG evaluation, 90, 387–388
Edwards Sapien valve replacement, 419
paradoxical S2 splitting in, 10
pulsus tardus in, 6
valvular heart disease risks, 54
SHARP trial, 568
SHEP trial, 872
SHOCK Trial, 46
Sickle cell anemia, 4t
Sildenafil citrate, 749
Simvastatin-ezetimibe study, 437
Single-photon emission computed
tomography (SPECT) scan. See gated
SPECT; stress SPECT imaging studies
Sinoatrial conduction time evaluation, 251
Sinoatrial reentry tachycardia, 248t
Sinus bradycardia, 207, 231, 238, 268, 652
Sinus node dysfunction, 251b, 268, 271,
276, 302
Sinus node recovery time evaluation, 251
Sinus tachycardia, 248t, 290b, 652
Sinus venosus atrial septal defect, 22, 24, 98f,
119f, 763
Sirolimus (rapamycin), 911, 915, 1036
Sleep apnea. See also obstructive
sleep apnea
central sleep apnea
acute/chronic effects, 817
CVD association, 817–818
heart failure, 818f
treatment, 818–819
defined, 812
hypertension and, 587
normal sleep, 812
Small vessel arteritis
Churg-Strauss syndrome, 511
Henoch-Sch?nlein purpura, 511–512
hypersensitivity vasculitis, 511
microscopic polyangiitis, 511
Wegener granulomatosis, 511
Sneddon syndrome, 507b
Society for Cardiovascular Angiography and
Interventions, 77
Society for Cardiovascular Magnetic
Resonance., 77
Society of Cardiovascular Computed
Tomography, 77
Sodium channel, 241, 263, 263t, 264, 297
Sotalol, 243, 260, 267, 274t, 276t, 293f,
304, 310
SPECT MPI. See gated SPECT; stress SPECT
imaging studies
Spironolactone, 583, 585–587, 647, 648t, 867,
871–872, 885b, 886t1086 Index
ST-, T-, U-wave abnormalities
ECG diagnoses, 206
ECG score sheet diagnosis, 223, 227–229
Staphylococcal endocarditis, 784
STAR trial, 474
Statins
for acute myocardial infarction, 647
in aortic valve disease, 435–436
calcific aortic valve disease studies, 439t
combination therapy
with bile acid-binding resin, 568
with ezetimibe, 568
with fibric acid derivative, 568
for peripheral arterial disease, 449
statin trials, 553f
for sudden death prophylaxis, 294
Statistics in cardiology
alpha level, 45, 46
beta level, 45, 46
confidence intervals, 45–46
defined, 44
measures of effect, 45, 45b
null hypothesis, 45
prevalence and incidence, 44–45
Stepwise approach for patient evaluation,
49–51
ACCF/AHA perioperative guidelines
algorithm, 49, 50
additional preoperative tests, 51, 52b
estimated requirements for activities, 50t
Revised Cardiac Risk Index, 50–51, 50b
risk stratification, noncardiac surgical
procedures, 50b
surgical risk factors, 50, 51b, 51t
Streptococcal endocarditis, 783–784
Stress echocardiography, 100–105
contraindications, 100
contrast agent facilitation, 82, 100,
103, 104f
exercise vs. pharmacologic stress, 198
interpretation, 101, 101f, 102f
methods, 100–101
new developments, 105
nonischemic heart disease and, 103, 105
pacemaker issues, 101
prognostic value, 103
SPECT compared with, 128
usefulness for detecting CAD, 52–53, 103
Stress-induced cardiomyopathy, 891
Stress SPECT imaging studies, 122, 127,
128–129. See also pharmacologic
stress echocardiography
acute coronary syndromes, 128
chronic coronary artery disease
diagnostic assessment, 127–128
post-revascularization assessment, 129
prognostic assessment, 128
myocardial viability, 128
Stress testing. See also cardiopulmonary
exercise testing; exercise myocardial
perfusion imaging; exercise stress
echocardiography; pharmacologic
stress echocardiography; stress
SPECT imaging studies
for CAD diagnosis, 198–199
ACCF/AHA recommendations, 51b
advantages/limitations of modalities,
198–199, 199t
choice of appropriate modality, 199–201
noncardiac surgery evaluation, 53
pretest probability, 52b, 197–198
standard test techniques, 133, 198
for risk stratification, prognosis, 201–202
Strokes. See also ischemic stroke; transient
ischemic attack (TIA)
ACAS study, 457
aspirin risk reduction, 278
aspirin/warfarin prevention efficacy, 593t
ATHENA trial, 368
atrial fibrillation risks, 270, 277, 279f, 280t,
592–593, 592t, 594t
beta-blocker risks, 55
blood pressure risks, 580f
cardiac arrest/hypoxic-ischemic brain
injury, 592s
cardioembolic strokes, 592t
cardiovascular disease and, 591–594
carotid artery stenting, 457–458
carotid endarterectomy, 456
as carotid sinus massage
contraindication, 316
causes of, 455–456
cerebral blood flow autoregulation
physiology, 591
clinical trials, 458–459
cryptogenic stroke, 593
CV examination, 17
DEFINITE trial, 350
dronedarone risk reduction, 276
hypertension and, 455, 592
hypertensive encephalopathy, 591–592
intracerebral hemorrhage, 593
invasive EP testing risks, 254
ischemic stroke, 110, 452
mitral valve prolapse complication, 397
noninvasive evaluation, 456
novel anticoagulant risk reduction, 278–279
obstructive sleep apnea and, 816
perfusion in ischemic stroke, 593
peripheral vascular disease risks, 447
risks of pacing, 269
statin therapy treatment, 457
subarachnoid hemorrhage, 236f, 262t,
290b, 316b, 456, 592, 594
thrombolytic therapy risks, 424, 434
U.S. death data, 455, 457
ST-segment elevation myocardial infarction
(STEMI), 487t, 495b, 693f
ACS classification, 616f
acute imaging restrictions, 129
cardiac catheterization assessment, 675
clinical detection of reperfusion, rescue
PCI, 675
clopidogrel trial, 487t
evidence for, 672–673
facilitated reperfusion, 675–676
fibrinolysis
adjunctive therapy, 679
advantages, principles, 677
clinical trials, acute MI mortality,
677–679
contraindications, 673t
PCI selection guidelines, 674t, 676t
prehospital strategy, 676–677
primary PCI vs., 673
fibrinolytic drugs, 676
intracranial hemorrhage with
reperfusion, 674
late reperfusion (1248– hour symptom
onset), 674
myocardial reperfusion principles, 675
PCI in, 672
PCI-related delay and, 673
reperfusion strategies, 672–681, 680f
thrombosis, 546
Subarachnoid hemorrhage (SAH), 236f, 262t,
290b, 316b, 456, 592, 594
Subclavian artery, arterial occlusive
disease, 448
Subclinical cerebrovascular
disease, 593
Submassive pulmonary embolism,
731, 732–733
Subvalvular aortic stenosis, 385–386,
902, 932f
Sudden cardiac death (SCD)
ACE inhibitors, prophylaxis, 294
aortic aneurysms, 290b
aortic valve stenosis, 290b, 358
arrhythmias, risk assessment, 305
arrhythmogenic right ventricular
dysplasia, 290b
aspirin, prophylaxis, 294
atherosclerosis, 290b
athletes and heart disease, 257, 260, 262
atrial arrhythmias, 290b
beta-blockers, prophylaxis, 294
bradycardias, 290b
Brugada syndrome, 264, 290b
catecholinergic polymorphic ventricular
tachycardia, 290b
coronary artery conditions, 290b
CPVT-triggered, 265
dilated cardiomyopathy, 290b
HCM risk stratification, 258, 259–260,
906–907
heart failure, 872
hypertension, 290b, 305b
ICD risk, 268, 295t
ICD therapy, clinical trials, 351t–353t
implantable cardioverter defibrillators,
268, 295t
long QT syndrome, 262, 290b
Marfan syndrome, 290b
mitral valve prolapse, 290b
myocardial diseases, 290b
myocardial infarction, 138, 618t
obstructive sleep apnea, 816
primary arrhythmias, 290b
primary/secondary prevention, 305
pulmonary embolism, 290b
pulmonary hypertension, 290b, 305b
pulmonary valve embolism, 290b
statin prophylaxis, 294
syncope, 314f
valvular diseases, 290b
ventricular tachycardia, 291–292, 294
VT, CAD, heart failure, 291–292, 294
Wolff-Parkinson-White syndrome, 290b
in women, 601–602
Superior vena cava (SVC) syndrome, 21, 22,
501–502
Supravalvular aortic stenosis, 5b, 6, 12, 15,
65–66, 67t, 385–386
blood pressure discrepancy, 5b
in congenital heart disease, 65–66
described, 385Index 1087
in hypertrophic obstructive
cardiomyopathy, 6, 386
in pulsus alternans, 7
systolic murmur in, 12, 15
Supraventricular arrhythmias with
uncontrolled ventricular rate, 51b
Supraventricular tachyarrhythmias, 248t
Supraventricular tachycardias, 266, 273,
281–288. See also junctional ectopic
tachycardia
atrial ectopic tachycardia, 267
atrial tachycardia, 282–283
atrioventricular node reentrant tachycardia,
281–282
atrioventricular reentrant tachycardia, 282
clinical features, 281
CMV approval/disapproval and, 74t–75t
driving restrictions, 72t, 74t
electrocardiographic recognition, 283,
284f, 285–286
G protein-gated Kir channel and, 244
in infants, 266–267
syncope, 315b
treatment options
for accessory pathway-related
tachycardias, 286–287
for atrial tachycardia, 287–288
for AVNRT, 286
Surgical aortic valve replacement (AVR),
605, 971, 973
Sustained atrial fibrillation, 592t
SWORD clinical trial (1996), 352t, 369
Syncope, 313–323
algorithm for evaluation, 314f
cardiogenic syncope factors, 317b
classifications of, 315b
clinical spectrum, diagnostic strategy,
313–314
congenital sinus node dysfunction, 302
defined, 313
driving risks, 71, 72t–73t
ECG indications, 78t
EGM evaluation, 373–375
EP testing evaluation, 250–251,
255, 255f
exercise-induced, 265
in HCM, 257
history/physical examination, 314–316
invasive AV node study, 254b
laboratory investigation
electrophysiologic testing, 317, 319, 320t
implantable loop recorders, 319, 321t
risk stratification, 316
“routine“ testing, 317b
tilt-table testing, 316–317, 318t–319t,
319b, 320t, 359
long QT syndrome, 262, 298
narrow-QRS tachycardia, 254b
noncardiogenic syncope factors, 317b
in pregnancy, 308, 311
ryanodine receptors, 243
in SVT, in elderly patients, 281
therapeutic management
ICD implantation, 322
reflex syncope, 322t
vasovagal syncope, 320–322
in VT, 291
SYNTAX trial, 576, 970
Systemic atherosclerosis, 447
Systemic disease
drug-induced cardiac disease
anorectic drugs, 804
chemotherapy, 803–804
cocaine, 804
ergot alkaloids, 804
pergolide, 804
endocrine, metabolic disease
acromegaly, 4t, 798
Addison disease, 166, 799
Cushing syndrome, 555, 587t, 798,
798f, 841b
thyroid disease, 798
hematologic, oncologic diseases
anemia, thalassemia, sickle cell disease,
801–802
carcinoid, 802
hemochromatosis, 802
hypereosinophilic syndrome, 803
infiltrative cardiomyopathies, storage
diseases
amyloidosis, 799, 799f, 800f
Fabry disease, 799
glycogen storage diseases, 799
sarcoidosis, 799, 801f
neurologic disease
Becker muscular dystrophy, 64, 797
cerebral hemorrhage, 455, 687, 798
Duchenne muscular dystrophy, 797
Friedreich ataxia, 4t, 797
Guillain-Barré syndrome, 798
Kearns-Sayre syndrome, 65, 269,
425, 798
myotonic muscular dystrophy, 325, 798
radiation-induced cardiac disease, 803
renal failure, 803, 805f
rheumatologic diseases
polymyositis, dermatomyositis, 800, 803f
relapsing polychondritis, 801
rheumatoid arthritis, 800
scleroderma, 800
spondyloarthropathies, 800–801
systemic lupus erythematosus, 800, 802f
specific syndromes
Ehlers-Danlos syndrome, 805, 805f
Kartagener syndrome, 804
Marfan syndrome, 805
Noonan syndrome, 806
osteogenesis imperfecta, 806
pseudoxanthoma elasticum, 806
Williams syndrome, 806
vasculitis
Behçet syndrome, 507t, 510, 786, 801
Churg-Strauss syndrome, 507t, 511,
511b, 511f, 801, 803f
polyarteritis nodosa, 507t, 511,
786b, 801
Systolic heart function
in accessory pathway-related
tachycardias, 286
cardiac PET radiopharmaceuticals, 132
CPX, case studies, 193b, 194f
in end-state disease, 258
exertional dyspnea, 386
in hypertrophic cardiomyopathy, 257
in hypertrophic obstructive
cardiomyopathy, 903
LV contraction, cellular aspects
contraction mechanics, 845
excitation, contraction coupling,
843, 844f, 845
microanatomy, 843
LV contraction (intact LV), determinants
afterload, 845–846
contractility, 846
heart rate, 846–847
LV hypertrophy, 848
myocardial infarction, 847
preload, 845
LV function
aortic stenosis differentiation, 90
in CAD, 53, 133
coronary artery bypass, 136f
ECG assessment, 83, 84f, 93, 724
ECT study, 827
mitral valve replacement for, 408
PET MPI assessment, 136
post-revascularization improvements, 137
in valvular heart disease, 54, 386, 389, 408
LV function, physiologic measures
ejection fraction, 848
maximal elastance, 848
myocardial infarction evaluation, 626
myocardial relaxation, 848–849
ventricular compliance, 849
in noninfiltrative restrictive
cardiomyopathy, 722
in pulmonary embolism, 731
in pulmonary hypertension, 743
reduced function, survival rates, 194f
restriction vs. constriction, 722
right ventricular infarction, 637
S
3, in hypertrophic obstructive
cardiomyopathy, 11
stress ECG assessment, 104f, 105
systolic vs. diastolic failure, 601, 603
in valvular regurgitation, 393, 395, 397–398
Systolic murmurs, 14f
aortic/pulmonary stenosis, 12
categories, 12
hypertrophic obstructive
cardiomyopathy, 12
innocent systolic murmurs, 15–16
mitral regurgitation, 12
supravalvular aortic stenosis, 12
tricuspid regurgitation, 12
ventricular septal defect, 12, 14–15
Systolic ventricular dysfunction (SVD)
causes of, 859–860, 862t
general approaches to, 870t
pharmacologic therapy
ACE inhibitors, 869–870
aldosterone antagonists, 871
anticoagulation in heart failure, 872–873
ARBs, 870
beta-blockers, in heart failure, 871
calcium channel blockers, in heart
failure, 871
digitalis glycosides, 870–871
diuretics, in heart failure, 872
hydralazine/isosorbide dinitrate, in heart
failure, 871
intermittent, continuous IV inotropic
therapy, 871–872
oral inotropic agents, in heart failure, 871
treatment principles, 869
reversible SVD in sleep apnea,
859–860, 862t1088 Index
Tachyarrhythmias
automatic tachyarrhythmias, 246
EP testing indications, 251b
fitness to drive evaluation, 71
PES evaluation, 253–254
broad-QRS tachycardia, 254
narrow-QRS tachycardia, 253–254
postoperative atrial tachyarrhythmias, 54
ventricular tachyarrhythmias, 248t
Tachycardia-induced cardiomyopathy, 272
Tachycardias. See also supraventricular
tachycardias; ventricular tachycardia;
wide complex tachycardia
accelerated junctional tachycardias, 246
acquired tachycardia, 303
atrial ectopic tachycardia, 267
atrial tachycardia, 206, 248t
atrial/ventricular EGM analysis, 375
AV node reentrant tachycardia,
375, 377–379
bradycardia-tachycardia syndrome, 268
broad-QRS tachycardia, 254
catecholaminergic polymorphic ventricular
tachycardia, 263
congenital tachycardia, 246
driving restrictions, 72t
ECG diagnosis, 205–206
ectopic atrial tachycardias, 246
evaluation in children, 266
inappropriate sinus tachycardia, 248t
intra-atrial reentry tachycardia, 303–304
junctional tachycardia, 74t, 246
narrow-QRS tachycardia, 253–254
orthodromic atrioventricular reentrant
tachycardia, 284f
pacemaker-mediated tachycardia, 331
pharmacologic management, 127
sinoatrial reentry tachycardia, 248t
sinus tachycardia, 246, 248t
stress testing, 202
valvular heart disease, 7
Tacrolimus, 911, 912
Tadalafil, 749, 867
Takayasu arteritis, 460, 462f, 507t, 508,
509–510, 1033
TARGET clinical trial, 490
Technetium 99m, 120–121, 124, 127, 129
Temporal (giant cell) arteritis, 507, 507t,
508–509
Tetracyclics, 316b
Tetralogy of Fallot, 27
adult, repaired, 182f
in arrhythmias, 306
chest radiography, 769
ECG evaluation, 769
evaluation and management, 769–770
infant, unrepaired, 181f, 182f
physical examination, 769
sudden death from, 290b
Tetrofosmin (in radiopharmaceuticals),
120, 121, 198
Thallium 201 radioisotope, 120–122, 124,
126, 129, 198
Thermoregulatory Sweat Test, 360f–361f, 361
Thienopyridines, 486–489, 486b, 487t.
See also clopidogrel; prasugrel;
ticagrelor; ticlopidine
Third-degree AV block, 72t, 209, 212, 231,
251, 255–256, 269
Third-degree heart block, 123, 251, 655, 1043t
Thoracic aortic aneurysm, 172, 460, 463f, 517
Thoracic bony abnormality, 4t
Thoracic outlet compression syndrome,
452, 507b
Thrombin inhibitors
apixaban, 493
argatroban, 493, 504, 835
bivalirudin, 492, 492b, 835
dabigatran etexilate, 278, 493
desirudin, 835
direct thrombin inhibitors, 731
lepirudin, 492, 492b, 504, 835
rivaroxaban, 493
ximelagatran, 493
Thromboangiitis obliterans (Buerger disease),
451–452, 451f, 451t, 512
Thromboembolism. See also venous
thromboembolism
AF/AFL and, 270, 272, 275, 278
anticoagulation risk factor, 56, 423b
CABG surgery risks, 635
cardiac arrest and, 311
catheters/pacemakers and, 21
differential diagnosis, 517
driving restrictions, 75t
HIV infection risks, 775
invasive EP testing risks, 255b
pharmacologic recommendations, 493–496
prosthetic valves, 92, 419b, 420
pulmonary thromboembolism,
688, 745f, 747
stroke risks, 592
Thyrotoxicosis, 7, 166, 271, 275, 280t, 587,
628, 856t, 891
Ticagrelor, 489, 620–622, 624, 645, 679
Ticlopidine, 486, 489, 624t, 760, 835
TIMI 2A trial, 678–679
TIMIC trial, 883
TIMI-STEMI trial, 692t
TIMI trials, 678
201Tl radioisotope, 120–122, 124, 126, 129
TNT statin trial, 548t
Tobacco use
abdominal aortic aneurysm management, 461
abdominal aortic aneurysm risks, 461
atherosclerotic risk factor, 538, 541, 552
CAD risk factor, 525–527, 529t
cardiac risk factor, 50
cardiac transplant contraindication, 909b
cerebrovascular disease, coronary artery
stenting, 457
chronic stable angina, 631
claudication, 447
endothelial dysfunction, 956
fibrinogen levels from, 481
heart failure, 600
hypertension, 738, 815
metabolic syndrome, 554
peripheral vascular disease risks, 447–451
post-MI secondary prevention, 691
stroke risks, 456
suspected RVF, 664
thromboangiitis obliterans, 451t, 512
Torsades de pointes
bradycardia risk factor, 276
patient with long QT syndrome, 212f
risk factors, 276b
VT as, 289
Total anomalous pulmonary venous
connection, 21–22
Toxicity-related tachycardia, 290b
Transcutaneous aortic valve implantation
(TAVI)
complications of TAVI, 973
medical therapy vs. TAVI, inoperable
patients, 973, 973t
procedural mechanics, 971–972
surgery vs. TAVI, high-risk patients,
973, 973t
Transesophageal echocardiography (TEE),
23, 77, 80f, 106–119
abnormalities diagnosed with
acute MI complications, 106.109f
aortic dissection, 106, 110f
aortic stenosis, 90
atrial fibrillation, 273
atrial flutter, 273
cardiovascular interventions, 110, 116f
cardioversion, 108, 108t
congenital heart diseases, 107f, 117, 119f
critically ill patients, 108, 108t
infective endocarditis, 93–94, 106,
107t, 108
intraoperative TEE, 107t, 108, 110,
115f, 116f
mitral regurgitation, 91
mitral stenosis, 90
prosthetic valve assessment,
107t, 116, 118f
sources of emboli, 96–97, 110, 116, 116f
thoracic aorta, 96
thoracic aortic aneurysm, 460, 461f
appropriateness criteria for use of, 77
thoracic aorta visualization, 95f, 96
Transient ischemic attack (TIA), 67t, 279f,
280, 455–456, 456b, 592
Transmitted murmurs, aortic origin, 6
Transmural myocardial infarction
ECG diagnoses, 206
ECG score sheet diagnosis, 221, 223
Transplantation. See cardiac transplantation
Transthoracic echocardiography (TEE)
Treadmill exercise test. See cardiopulmonary
exercise testing (CPX); stress SPECT
imaging studies
Tricuspid atresia, 770
Tricuspid valve, 28–29
applied anatomy, 21, 22f, 25f, 28–29
atrial fibrillation, 272
atrial flutter, 303
atrial septal defect, 1032
bedside right heart catheterization, 997
carcinoid heart disease, 409, 410, 411f,
412f, 804f, 811f
constrictive pericarditis, 721f
Doppler examination, 740, 742f
Doppler flow velocity method, 985
Ebstein anomaly, 7, 165, 303, 767,
768, 1027
Ehlers-Danlos syndrome, 805
great artery transposition, 768–769
HIV infection, 775
infective endocarditis, 777, 785
Marfan syndrome, 515
medical cardiac injury, 821, 822, 822f
M-mode, 2D echocardiography, 77
opening snap sound, 10Index 1089
papillary fibroelastoma, 810f
post-transplant, rejection, 912
primum ASD, 763
regurgitation, 92, 441–442
RV failure, 864
RV infarction, 639
surgical choices, 429, 432
tamponade, 94
TEE evaluation, 107t
tricuspid atresia, 770
tricuspid regurgitation, 3, 6b, 12, 92,
409, 441
valvular heart disease, 422, 441
ventricular septal defect, 763
Tricuspid valve stenosis, 6b, 17, 409, 410, 441
Triggered activity, 246–247
Trimethoprim-sulfamethoxazole, 316b
TRITON-TIMI clinical trial, 489
Truncus arteriosus, 8b, 27, 770
Tuberous sclerosis, 4t, 808
Turner syndrome, 4t, 762b
T-wave alternans, 294, 653
2-dimensional echocardiography. See
M-mode and 2-dimensional
echocardiography
Type 2 diabetes mellitus
atherosclerosis pattern, 448
CAD risk factors, 526, 574–575
CARDS diabetes study, 564
clinical trials, 536, 561, 575–577
C-reactive protein measure, 541
demographic date, U.S., 575t
dyslipidemia in, 551–552, 554, 555t
Health and Human Services study, 574
metabolic syndrome and, 531
MI risks, 540
obesity/bariatric surgery recommendation,
577
statin therapy effects, 560
treatment strategies, 576–577
UKPDS study, 576
Unfractionated heparin
adult tachycardia, 686
arterial thrombosis prevention, 490–491
atrial flutter/atrial fibrillation, 272
for “bridging therapy,“ 56
description, 493
DVT therapy, 501
in pregnancy, 500, 758, 759–760
unstable angina, 622f
valve dysfunction prevention, 423
Unstable angina (UA)
abciximab treatment, 490
acute MI risk factors, 539
AFCAPS/TexCAPS trial, 564
aspirin therapy, 485, 485b
Canadian class III or IV, 51b
CAPTURE study assessment, 490
Class I, II management
recommendations, 622f
classification, 618–619
coronary angiography recommendation, 53b
ECG evaluation, 200f
GpIIb-IIIa inhibitors comparison, 491
invasive ECG contraindications, 251b
JUPITER trial, 564–565
percutaneous coronary intervention, 598
plaque rupture, 525, 546
PROVE-IT trial, 546
renal artery stenosis, 471f
stress SPECT imaging, 129
Unstable coronary syndromes, 51b
VA Cooperative Study, 968
VALIANT trial, 647
Valsalva maneuver
AV node reentrant tachycardia, 267
cardiac murmurs, 15, 15t, 1028
description, 18
diastolic function assessment, 84–85, 86f
HFpEF, 853
hypertrophic cardiomyopathy, 93, 903,
903f, 904, 1032
hypertrophic obstructive cardiomyopathy,
1013
mitral valve prolapse, 8, 397, 1030
pacemaker-mediated tachycardia, 685
paroxysmal supraventricular
tachycardia, 684
right atrium, 22
Valsartan, 583, 647, 648t
Valve disease surgery. See cardiac valve
disease surgery
Valve-ring abscess, 420–421, 784, 787–788
Valvular aortic stenosis. See also
supravalvular aortic stenosis; valvular
stenosis
clinical presentation, 386–387
congenital valvular aortic stenosis, 8b
ECG/radiography tests, 387–388
murmur/heart sounds, 14f
pathophysiology, 386
Valvular cardiomyopathy, 891
Valvular heart diseases, 54
driving restrictions and, 73t
drug-related
anorexigens, 413
ergot alkaloids, 413–414
pergolide, 414–415
epidemiology of, 442–443
pathogenesis
aortic valve, 435–437
mitral valve, 437–438
pulmonary valve, 441
tricuspid valve, 441
stress echocardiography evaluation, 103
stroke risks, 455
surgical risk factors, 54
Valvular regurgitation, 393–402
aortic regurgitation
causes, 398–399
clinical syndrome of, 399–400
evaluation of, 400
natural history, treatment, 400–402
pathophysiology, 399
causes of, 35, 92
ECG evaluation, 81
intraoperative TEE evaluation, 107
mitral regurgitation
causes, 393–394
clinical syndrome of, 396
evaluation of, 397
mitral valve prolapse, 397–398
natural history of, 398
pathophysiology of, 394–395
treatment, 398
risk factors, 54
Valvular stenosis, 385–392. See also mitral
stenosis; rheumatic mitral stenosis;
supravalvular aortic stenosis; valvular
aortic stenosis
aortic click absence in, 8
cardiac MRI finding, 143
ECG hemodynamic variable assessment, 85
subvalvular aortic stenosis, 385–386
valvular aortic stenosis
clinical presentation, 386–387
ECG/radiography tests, 387–388
pathophysiology, 386
Vascular computed tomography (CT)
CTA vs. MRA, 148, 148f, 149f, 150, 152
technical issues, 148
Vascular magnetic resonance imaging (MRI)
CTA vs. MRA, 148, 148f, 149f, 150, 152
technical issues, 147f, 148
Vasculitis, 506–513
classification, 506
connective tissue disease, 512–513
definitions, 506
evaluative work-up, 508b
large vessel arteritis, 508–510
in livedo reticularis, 453
medium vessel arteritis, 510–511
mimics of, 507b
in myocarditis, 405
nonvasculitic arteritis, 512
pathogenesis, 506
pernio, 512
polyarteritis nodosa, 511
secondary, causes of, 507t
signs and symptoms, 506–507
small vessel arteritis, 511–512
thromboangiitis obliterans, 512–513
Vasodilator therapy, 56
Vasospastic disorders, 452–453
Vasovagal syncope (common faint), 311, 313,
315b, 317, 320–322
Vaughan Williams classification of drugs
Class IA
disopyramide, 309
procainamide, 309
quinidine, 309
Class IC, 309–310
flecainide, 309–310
propafenone, 309–310
Class III, 310
amiodarone, 310
sotalol, 310
Velocity-encoded cardiac MRI, 143
Venous duplex ultrasonography, 501
Venous thromboembolism (VTE)
acquired risk factors, 501b
clinical evaluation, 500–501
DVT treatment, 501
familial thrombophilia, 502–503
management
dabigatran etexilate study, 493
fondaparinux evaluation, 495–496
heparin for, 493b
LMWH, 494
rivaroxaban, 493
warfarin for, 496
postthrombotic syndrome, 502
pregnancy-related VTE, 500
superior vena cava syndrome, 21, 22,
501–5021090 Index
Venous thromboembolism (VTE) (cont.)
thrombolytic therapy contraindications, 733b
Ventricles, applied anatomy, 25–28, 26f
comparison of, 26
congenital heart disease
double-outlet right ventricle, 27
Tetralogy of Fallot, 27
transposition of great arteries, 27
truncus arteriosus, 27
ventricular septal defect, 12, 14–15,
26–27
left ventricle, 25–26, 26f
myocyte response to injury, 27–28
right ventricle, 25, 25f
Ventricular arrhythmias
in ARVC, 260
in atrial tachycardia, 283f
AV septal defects risk, 305
in children, 268
commercial motor vehicle restriction,
74t–75t
congenital heart disease risks, 295
in decompensated CHF, 51b
in Ebstein anomaly, 303
ECG evaluation, 231, 283f
ICD implantation in syncope, 322
ICD troubleshooting, 339–340, 344,
346f, 347
isoproterenol hydrochloride risks, 254
in long QT syndrome, 262
pharmacologic stress test risks, 199
polymorphic ventricular arrhythmias, 296
Ventricular fibrillation, 653
Ventricular function assessment
diastolic, 84–85, 84f, 85f
systolic, 83, 83e
Ventricular hypertrophy
ECG diagnoses, 206
ECG score sheet diagnosis, 218–219, 221
Ventricular rhythms
ECG diagnoses, 206
ECG score sheet diagnosis, 210–211
Ventricular septal defect, 12, 14–15, 22,
26–27, 98f, 119f, 763
acquired bradycardia, 302
amyl nitrate/vasopressors effects, 16t
aortic regurgitation, 399
in arrhythmias, 305–306
cardiogenic shock, 657
causative for S
3, 11b
CHD and, 762b
described, 26–27, 305–306
driving restrictions, 75t–76t
ECG evaluation, 93b, 764
evaluation and management, 764
heart sounds, 10f, 11b, 14f
MI/heart failure and, 109f
physical examination, 763–764
pulmonary hypertension, left-to-right
shunts, 738b
unrepaired Tetralogy of Fallot
angiogram, 182f
Ventricular tachyarrhythmias, 248t
Ventricular tachycardia
distinct clinical syndromes
adenosine-sensitive VT, 298–300
ARVD, HCM, infiltrative heart diseases,
295–296
bundle branch reentry VT, 294–295
congenital heart-disease, 295
familial channelopathy syndromes,
296–297
idiopathic VT, normal heart, no
repolarization abnormalities, 297–298
ischemia/post-MI VT, 290–291
sudden death, 291–292, 294
verapamil-sensitive intrafascicular VT,
300–301
scar-mediated, in IART, 304
wide complex tachycardia and, 289, 290b
Ventriculography
abnormalities, uncommon, 928
aortic regurgitation, 993
Chagas cardiomyopathy, 886
ejection fraction, 848
left ventriculography
cardiac catheterization, 397
cardiogenic shock, 668
contraindications to, 927–928
ejection fraction, 928
indications for, 927
mitral regurgitation, 397, 928–929,
992, 993
right ventriculography, 928, 929
technique, 927
uncommon abnormalities, 929
wall motion, 928
limitations, 993
radionuclide ventriculography, 848
Verapamil, 265, 274t, 275, 277, 298, 308, 871
Verapamil-sensitive intrafascicular VT,
300–301
Vertebrobasilar ischemia, 255
V-HeFT III trial, 871
Viable myocardium
nuclear imaging identification of, 129
PET identification of, 136–138
Viral myocarditis, 800t
Visceral pericardium, 20
VO
2 to cardiac output relationship, in
cardiopulmonary exercise testing, 186f
body weight influence, 186–187
COX vs. conventional exercise ECG,
187–188
cycle ergometer exercise tests, 188
description of VO2, 185–186
gender-based equations, 187
genetic factors, 186
interpretation of measurement, 188–189
ranges for VO2 max, 195–196
sample CPX tests: case studies, 189–192,
189b, 189f, 189t, 190f, 191b, 191f,
191t, 192f, 192t
Warfarin
aortic atheroembolism from, 460
atrial fibrillation, 593, 593t, 603–604
benefits, limitations, 278
bleeding complications, 731
cesarean delivery, in CVD, 754b
clinical trials, 487t
combinations, 487t, 488
drug interactions, 365, 366
for heparin-induced thrombocytopenia,
452, 495
INR level adjustments, 56, 275, 593
intracranial hemorrhage with
reperfusion, 674
Kawasaki disease, 510
mechanical heart valve patients,
520, 759b, 788
mechanisms of action, 495b, 496–497,
496b, 497f
during pregnancy, 310, 310t, 500
pregnancy, anticoagulation, 758–759
prosthetic valve issues, 418, 423–424,
429–430
pulmonary embolism, 730–731
pulmonary hypertension, 747
restrictive cardiomyopathy, 897
right ventricular failure, 867
stroke risk assessment, 280f, 280t, 593
ticlopidine comparison, 486
warfarin embryopathy, 759
Wegener granulomatosis, 511
Wenckebach second-degree heart block,
101, 251
Wide complex tachycardia, 285f–286f
accessory pathway-mediated tachycardia
and, 266
assessment, 285
AV reciprocating tachycardia and, 282
intracardiac electrophysiology tracings,
375, 377f, 379, 379f, 381f
types of, 290b
ventricular tachycardia and, 283, 289, 290b
Wide QRS complex
due to antegrade preexcitation, 285–286
due to bundle branch block, 285
Williams syndrome, 67t
Wolff-Parkinson-White syndrome, 303, 379
AV nodal reentrant tachycardia in, 310
AV reciprocating tachycardia in, 248
ECG evaluation, 205, 206, 209,
212–213, 216f
stress SPECT evaluation, 127
sudden death from, 290b
venous circulation, 40
wide complex tachycardia, 289
Women. See also pregnancy; pregnancyassociated arrhythmias; pregnancyrelated venous thromboembolism
aortic stenosis, 388
carotid artery disease, 455
congestive heart failure, 595
coronary artery disease, 525, 527f, 528f
diabetes mellitus, 554, 574
drug-related heart disease, 413
drugs for pregnancy use, 309t
dyslipidemia, 555t
endothelial dysfunction, 600
exercise ECG testing, 198
familial channelopathy syndromes, 296
heart disease in, 569, 595–602
heart failure, 600–601
ICD study, 350
long QT syndrome, 262, 296
lymphedema, 504
Marfan syndrome, 521
metabolic syndrome, 531–533,
534f, 535f
microvascular dysfunction, 600
mitral regurgitation in, 393
mitral valve prolapse, 393
MPI superiority in, 133–134
myocardial infarction, 599
novel plasma biomarkers, 572Index 1091
postmenopausal hormonal therapy, 599–600
prosthetic valves, 418
Raynaud disease, 453
SPECT studies, 128
stroke risks, 591
syncope in, 311, 314
Takayasu arteritis, 509
temporal arteritis, 508
VO
2 output, 187
X-linked disorders, 63
Women and coronary artery disease,
525, 527f, 528f
coronary angiography, 598
coronary artery bypass grafting, 599–600
epidemiology vs. men, 529
medical therapy
ACE inhibitors, 598
aspirin, 597
beta-blockers, 597
statins, 597–598
percutaneous coronary intervention, 598–599
risk factors, 564
stress testing, 596–597
symptoms, 595–596
WOSCOP study, 564
Ximelagatran, 278, 493
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