Cardiovascular Medicine and Surgery

Description:

Written by clinicians, for clinicians, Cardiovascular Medicine and Surgery offers a comprehensive, authoritative, and multidisciplinary approach to this rapidly evolving field. Covering every area relevant to the daily practice of cardiovascular medicine, this new and innovative reference text, led by Drs. Debabrata Mukherjee and Richard A. Lange, brings together a stellar team of cardiovascular specialists from leading medical centers worldwide who focus on cutting-edge strategies for the clinical and surgical management of patients. Both medicine and surgery are highlighted in chapters along with follow-up care and changing technology to equip the clinician for optimal patient care. Highly structured and templated chapters cover pathogenesis, diagnosis, management, special considerations/limitations, follow-up care, and on-going and future research.

 

Table of Contents:

 

SECTION 1: CLINICAL CARDIOLOGY

1 The Patient History

HISTORY: KEY STEP IN DIAGNOSIS

CARDIAC DISEASE SYMPTOMS

Chest Discomfort

Stable Angina

Unstable Angina

Dyspnea

Syncope

Palpitations

Claudication

REFERENCES

2 General Cardiovascular Exam

INTRODUCTION

INDICATIONS

FUNDAMENTALS AND CLINICAL APPLICATION OF THE PHYSICAL EXAMINATION

The Extracardiac Examination

General Appearance

Skin

Head and Neck

Extremities

Chest and Abdomen

Cardiac Examination

Jugular Venous Pressure

Measuring Blood Pressure

Assessing the Pulse

Palpation of the Heart

Cardiac Auscultation

LIMITATIONS OF TECHNIQUE

RESEARCH AND FUTURE DIRECTIONS—COVID-19

REFERENCES

3 Clinical Pharmacology: Pharmacogenomics, Pharmacovigilance, Pharmacoepidemiology, and Pharmacoeconomics

INTRODUCTION

PHARMACOGENOMICS

PHARMACOECONOMICS

PHARMACOVIGILANCE AND PHARMACOEPIDEMIOLOGY

REFERENCES

4 Stable Ischemic Heart Disease

INTRODUCTION

Epidemiology

Risk Factors

PATHOGENESIS

CLINICAL PRESENTATION

Common Signs and Symptoms

Physical Examination Findings

Differential Diagnosis

DIAGNOSIS

Patient Risk and Recommendations for Further Testing

Noninvasive Stress (Functional) Testing

Noninvasive Anatomic Imaging

Cardiac Computed Tomography Angiography

Combined Imaging

Coronary Angiography

MANAGEMENT OF PATIENTS WITH STABLE ISCHEMIC HEART DISEASE

Medical Approach

Antianginal Therapies

Nonpharmacologic Therapies for Refractory Angina in Stable Ischemic Heart Disease

Medical Therapy to Reduce Cardiovascular Risk

Patient Risk Factor Management

Percutaneous and Surgical Revascularization

Revascularization for Survival

Revascularization for Symptoms

Coronary Artery Bypass Graft Revascularization

Percutaneous Coronary Intervention Revascularization

SPECIAL CONSIDERATIONS

Unprotected Left Main Coronary Artery Revascularization

Revascularization in Multivessel Disease

Revascularization and Diabetes Mellitus

Hybrid Revascularization

FOLLOW-UP PATIENT CARE IN STABLE ISCHEMIC HEART DISEASE

RESEARCH AND FUTURE DIRECTIONS

REFERENCES

5 Unstable Angina, Non–ST-Elevation Myocardial Infarction-Acute Coronary Syndrome

INTRODUCTION

Epidemiology

PATHOGENESIS

CLINICAL PRESENTATION

DIAGNOSIS

History and Symptoms

Physical Examination

Electrocardiogram

Cardiac Biomarkers

Diagnostic Imaging

Risk Stratification

MANAGEMENT

Antianginal Therapy

Oxygen

Nitrates

Analgesics

Beta-blockers

Calcium Channel Blockers

Ranolazine

Anticoagulant Therapy

Unfractionated Heparin

Low-molecular-weight Heparin

Bivalirudin

Fondaparinux

Argatroban

Antiplatelet Therapy

Aspirin

P2Y Inhibitors

Clopidogrel

Prasugrel

Ticagrelor

Cangrelor

Glycoprotein IIb/IIIa Receptor Inhibitors

Lipid-Lowering Therapy

Statins

Renin-Angiotensin-Aldosterone System Inhibition

Angiotensin-converting Enzyme Inhibitors

Aldosterone Receptor Antagonists

Invasive Therapy

Ischemia-Guided Strategy Versus Early Invasive Strategies

SPECIAL PATIENT POPULATIONS

Older Patients

Patients in Cardiogenic Shock

FOLLOW-UP PATIENT CARE

RESEARCH AND FUTURE DIRECTIONS

REFERENCES

6 ST-Elevation Myocardial Infarction

INTRODUCTION

Epidemiology

Risk Factors

PATHOGENESIS

CLINICAL PRESENTATION

DIAGNOSIS

Emergent Electrocardiogram

Emergent Bedside Echocardiogram and Other Possible Diagnostic Testing

MANAGEMENT

Immediate Therapies

Reperfusion Strategies

Primary Percutaneous Coronary Intervention

Fibrinolytic Therapy

Surgical Approach

SPECIAL CONSIDERATIONS

Cardiogenic Shock

Cardiac Arrest

Nonreperfused Patients

Patients Taking Oral Anticoagulation

Multivessel Coronary Artery Disease

Microvascular Dysfunction

Myocardial Infarction with Nonobstructive Coronaries

Heart Blocks

Other Medications and Devices

Lipid-Lowering Therapy

-Blockers

Angiotensin Converting Enzyme Inhibitors or Angiotensin Receptor Blockers

Aldosterone Antagonists

Implantable Cardioverter Defibrillator (ICD)

PATIENT RECOVERY AND FOLLOW-UP

RESEARCH AND FUTURE DIRECTIONS

VIDEO CAPTIONS

REFERENCES

7 Acute Myocardial Infarction: Complications

INTRODUCTION

MECHANICAL COMPLICATIONS OF ACUTE MYOCARDIAL INFARCTION

Acute Mechanical Complications

Cardiogenic Shock

Right Ventricular Infarction

Cardiac Free Wall Rupture

Ventricular Septal Rupture

Papillary Muscle Rupture

MANAGEMENT OF ACUTE MECHANICAL COMPLICATIONS AFTER MYOCARDIAL INFARCTION

CHRONIC MECHANICAL COMPLICATIONS

Left Ventricular Aneurysms

Left Ventricular Thrombus

Ventricular Failure

ARRHYTHMIC COMPLICATIONS OF ACUTE MYOCARDIAL INFARCTION

Tachyarrhythmias

Atrial Arrhythmias

Ventricular Arrhythmias

Bradyarrhythmia

PERICARDIAL COMPLICATIONS OF MYOCARDIAL INFARCTION

Postmyocardial Infarction Pericarditis

Postmyocardial Infarction Pericardial Effusion

REFERENCES

8 Refractory Angina

INTRODUCTION

Prevalence

PATHOGENESIS

MANAGEMENT OF THE PATIENT WITH REFRACTORY ANGINA

Medical Approach

Percutaneous Coronary Interventions

Surgical Approach

SPECIAL CONSIDERATIONS AND EMERGING THERAPIES

RESEARCH AND FUTURE DIRECTIONS

REFERENCES

9 Rheumatic Heart Disease

INTRODUCTION

Epidemiology

PATHOGENESIS

Natural History

CLINICAL PRESENTATION

DIAGNOSIS

MANAGEMENT OF THE PATIENT WITH RHEUMATIC HEART DISEASE

Antibiotic Treatment of Group a Streptococcal Throat Infection

Treatment of Valvular Heart Disease and Congestive Heart Failure

Mitral Stenosis

Mitral Regurgitation

Aortic Stenosis

Aortic Regurgitation

Congestive Heart Failure

PREVENTION

FUTURE DIRECTIONS

REFERENCES

10 Mitral Valve Disease

INTRODUCTION

Epidemiology

Mitral Stenosis

PATHOGENESIS

Mitral Regurgitation

Degenerative Mitral Regurgitation

Functional Mitral Regurgitation

Mitral Stenosis

CLINICAL PRESENTATION

Common Signs and Symptoms

Mitral Regurgitation

Mitral Stenosis

Differential Diagnosis

Mitral Regurgitation

Mitral Stenosis

DIAGNOSIS: MITRAL VALVE DISEASE

Echocardiography

Magnetic Resonance Imaging

Computed Tomography

Positron Emission Tomography

Cardiac Catheterization

Mitral Stenosis

Mitral Regurgitation

MANAGEMENT OF THE PATIENT WITH MITRAL VALVE DISEASE

Medical Approach: Mitral Regurgitation

Degenerative Mitral Regurgitation

Functional Mitral Regurgitation

Medical Approach: Mitral Stenosis

Heart Rate Control/Prevention of Tachycardia

Control of Pulmonary Congestion

Management of Thromboembolism

Management of Pregnancy

Percutaneous Transcatheter Interventions

Mitral Regurgitation

Mitral Stenosis

Surgical Approach

Surgery for Mitral Regurgitation

Mitral Valve Repair and Replacement

Surgery for Functional Mitral Regurgitation

Rheumatic Mitral Stenosis

Degenerative (Nonrheumatic) Mitral Stenosis

FOLLOW-UP PATIENT CARE

RESEARCH AND FUTURE DIRECTIONS

REFERENCES

11 Aortic Valve Disease

INTRODUCTION

AORTIC STENOSIS

EPIDEMIOLOGY AND FACTORS CONTRIBUTING TO THE DEVELOPMENT OF AORTIC STENOSIS

CLINICAL PRESENTATION: AORTIC STENOSIS

Clinical Signs of Aortic Stenosis

DIAGNOSIS: AORTIC STENOSIS

MANAGEMENT: AORTIC STENOSIS

Medical Management

Interventional Therapy

Aortic Valve Replacement

Minimally Invasive Aortic Valve Replacement

Totally Endoscopic Aortic Valve Replacement

Aortic Valve Disease Associated With Aortic Root Dilation

Transcatheter Approaches

PATIENT FOLLOW-UP: AORTIC STENOSIS

AORTIC REGURGITATION

CHRONIC AORTIC REGURGITATION

Etiology

Hemodynamics in Chronic Aortic Regurgitation

Clinical Presentation: Chronic Aortic Regurgitation

Clinical Signs of Chronic Severe Aortic Regurgitation

Diagnosis: Chronic Aortic Regurgitation

MANAGEMENT: AORTIC REGURGITATION

Medical Management

Surgical Approaches for Severe Aortic Regurgitation

Transcatheter Approaches

ACUTE AORTIC REGURGITATION

Etiology

Clinical Presentation: Acute Aortic Regurgitation

Clinical Signs

Diagnosis: Acute Aortic Regurgitation

Management: Acute Aortic Regurgitation

Medical Approach

Surgical Approach

PATIENT FOLLOW-UP: AORTIC REGURGITATION

RESEAORTIC REGURGITATIONCH AND FUTURE DIRECTIONS

REFERENCES

12 Adult-Acquired Tricuspid and Pulmonary Valve Disease

INTRODUCTION

PATHOGENESIS

CLINICAL PRESENTATION

DIAGNOSIS

Echocardiography

Magnetic Resonance Imaging

MANAGEMENT OF PATIENT

Medical Approach

Surgical Approach

Percutaneous Intervention Approach

FOLLOW-UP PATIENT CARE

RESEARCH AND FUTURE DIRECTIONS

REFERENCES

13 Prosthetic Valve Dysfunction

INTRODUCTION

Epidemiology

Risk Factors

PATHOGENESIS

Acute Prosthetic Heart Valve Dysfunction

Chronic Prosthetic Heart Valve Dysfunction

CLINICAL PRESENTATION

Common Signs and Symptoms

Differential Diagnosis

DIAGNOSIS

Initial Evaluation of Suspected Prosthetic Heart Valve Dysfunction

Echocardiography (Transthoracic Echocardiogram and Transesophageal Echocardiogram)

Two-Dimensional Imaging/Three-Dimensional Visual Appearance

Chamber Quantification and Volumes

Color Doppler

Spectral Doppler

Comparison to Baseline Findings

Limitations of Echocardiography

Cine-fluoroscopy

Cardiac Computed Tomography

Cardiac Magnetic Resonance Imaging

Positron Emission Tomography/Computed Tomography

MANAGEMENT OF PROSTHETIC HEART VALVE DISEASE

Pannus

Prosthetic Heart Valve Thrombosis

Structural Valve Degeneration

Paravalvular Leak

Infective Endocarditis

Patient-Prosthesis Mismatch

SPECIAL CONSIDERATIONS AND EMERGING THERAPIES

Subclinical Prosthetic Heart Valve Thrombosis

Transcatheter Mitral Valve-in-Valve Replacement

Transcatheter Tricuspid Valve-in-Valve Replacement

FOLLOW-UP PATIENT CARE

After Repeat Valve Surgery

Prosthetic Heart Valve Infective Endocarditis

RESEARCH AND FUTURE DIRECTIONS

VIDEO CAPTION

REFERENCES

14 Infective Endocarditis

INTRODUCTION

Shifting Epidemiology

Incidence

PATHOGENESIS

Microbiology

Risk Factors

Clinical Outcomes

DIAGNOSIS

Echocardiography

Multimodality Imaging

MANAGEMENT OF THE PATIENT WITH INFECTIOUS ENDOCARDITIS

Antimicrobial Therapy

Surgery

Adjunctive Therapy

Dental Evaluation

Anticoagulation

Endocarditis Team

SPECIAL CONSIDERATIONS AND FUTURE DIRECTIONS

Transcatheter Aortic Valve Replacement Infective Endocarditis

Cardiac Implantable Electronic Device Infection

Intravenous Drug Use–Associated Infective Endocarditis

FOLLOW-UP PATIENT CARE

REFERENCES

15 Pericardial Disease

INTRODUCTION

Anatomy and Physiology of the Pericardium

PERICARDIAL EFFUSIONS

Cardiac Tamponade

ACUTE PERICARDITIS

Pathogenesis and Epidemiology

History and Physical

Diagnosis

Management of Pericarditis

Medical Therapy

Follow-Up Patient Care

CONSTRICTIVE PERICARDITIS

Pathophysiology and Etiology

History and Physical: Constrictive Pericarditis

Diagnostic Laboratory Tests and Imaging: Constrictive Pericarditis

Management: Constrictive Pericarditis

EFFUSIVE-CONSTRICTIVE PERICARDITIS

Pathophysiology and Epidemiology

Clinical Presentation

Diagnosis and Management of Effusive-Constrictive Pericarditis

HEMODYNAMIC ASSESSMENT OF CONSTRICTIVE PERICARDITIS, RESTRICTIVE CARDIOMYOPATHY, AND TAMPONADE

REFERENCES

16 Pulmonary Hypertension

INTRODUCTION

Normal Growth and Development of Pulmonary Vasculature

PATHOGENESIS

DIAGNOSIS

Hemodynamic Definitions and Clinical Definitions

Group I: Pulmonary Arterial Hypertension

Group II: Pulmonary Hypertension as a Result of Left Heart Disease

Group III: Pulmonary Hypertension because of Lung Disease or Hypoxia

Group IV: Pulmonary Hypertension because of Pulmonary Artery Obstructions

Group V: Pulmonary Hypertension with Unclear and/or Multifactorial Mechanisms

CLINICAL PRESENTATION

Diagnostic Testing Findings

MANAGEMENT

Risk Stratification

Treatment

Advanced Therapies/Transplant

Investigational Therapies

PULMONARY HYPERTENSION IN SPECIAL POPULATIONS

Pediatric Pulmonary Hypertension and Congenital Heart Disease

Eisenmenger Syndrome

Sickle Cell Disease

Elderly

Pregnancy

PROGNOSIS

RESEARCH AND FUTURE DIRECTIONS

REFERENCES

17 Adult Congenital Heart Disease

INTRODUCTION

PATHOGENESIS

CLINICAL PRESENTATION

DIAGNOSIS

MANAGEMENT AND SPECIAL CONSIDERATIONS

Medical Approach

Percutaneous Interventions

Surgical Approach

FOLLOW-UP PATIENT CARE

REFERENCES

18 Pregnancy and Heart Disease

INTRODUCTION

Epidemiology

Risk Factors

RISK ASSESSMENT

PATHOGENESIS

Physiologic Changes During Pregnancy and Puerperium

Intrapartum Hemodynamic Changes

Postpartum Hemodynamic Changes

CLINICAL PRESENTATION

MANAGEMENT OF CARDIOVASCULAR CONDITIONS DURING PREGNANCY

Hypertension

Congenital Heart Disease

Arrhythmias

Coronary Artery Disease

Cardiomyopathy

Anticoagulation in Pregnancy

POSTPARTUM MANAGEMENT

Percutaneous Interventions in Pregnancy

Cardiac Surgical Interventions in Pregnancy

SPECIAL CONSIDERATIONS

FOLLOW-UP PATIENT CARE

FUTURE DIRECTIONS

REFERENCES

19 Women and Heart Disease

INTRODUCTION

TRADITIONAL RISK FACTORS FOR CARDIOVASCULAR DISEASE

Age

Hypertension

Diabetes Mellitus

Hyperlipidemia

Smoking

Obesity and Physical Inactivity

NONTRADITIONAL RISK FACTORS FOR CARDIOVASCULAR DISEASE

Rheumatologic Disorders

Breast Cancer Treatment

Pregnancy-Related Complications

Depression

CLINICAL PRESENTATION

DIAGNOSIS

Noninvasive Testing for Ischemic Heart Disease

Ischemic Heart Disease in Women

Spontaneous Coronary Artery Dissection

Takotsubo or Stress-Induced Cardiomyopathy

Coronary Artery Disease

Arrhythmias

Valvular Heart Disease in Women

Heart Failure in Women

Peripartum Cardiomyopathy

RESEARCH AND FUTURE DIRECTIONS

REFERENCES

20 Elderly and Heart Disease

INTRODUCTION

EPIDEMIOLOGY

AGING AND THE HEART

TREATMENT GOALS IN ELDERLY WITH HEART DISEASE

Hypertension

Dyslipidemia

Coronary Artery Disease

DIAGNOSIS

MANAGEMENT OF THE OLDER PATIENT WITH CORONARY ARTERY DISEASE

Medical Management

Acute Coronary Syndromes

Percutaneous Coronary Intervention for Acute Coronary Syndrome

Optimal Revascularization Strategy for Elderly Patients With Multivessel Coronary Artery Disease

Congestive Heart Failure

Aortic Valve Disorders

Aortic Stenosis

Aortic Regurgitation

Mitral Valve Disorders

Mitral Regurgitation

Mitral Stenosis

Arrhythmias

Bradyarrhythmias

Tachyarrhythmias

Critically Ill Elderly With Cardiovascular Disease

RESEARCH AND FUTURE DIRECTIONS

REFERENCES

21 Cardiac Manifestations of Systemic Diseases

INTRODUCTION

AUTOIMMUNE/INFLAMMATORY SYSTEMIC DISEASES

Systemic Lupus Erythematosus

Rheumatoid Arthritis

Psoriatic Arthritis

Systemic Sclerosis

Ankylosing Spondylitis

Inflammatory Bowel Disease

Human Immunodeficiency Virus

ROLE OF IMAGING IN EVALUATION OF CARDIAC MANIFESTATIONS OF INFLAMMATORY SYSTEMIC DISEASES

ENDOCRINE/NEUROENDOCRINE DISORDERS

Thyroid Disorders

Acromegaly

Pheochromocytoma

Carcinoid

Neurofibromatosis

Antiphospholipid Syndrome

LIPID DISEASES

Familial Hypercholesterolemia

Familial Combined Hypercholesterolemia

Familial Dysbetalipoproteinemia or Type III Hyperlipoproteinemia

Sitosterolemia

Elevated Lipoprotein (a)

Lysosomal Storage Disorders

INFILTRATIVE DISORDERS

Amyloidosis

Hemochromatosis

Sarcoidosis

VASCULAR DISORDERS

Fibromuscular Dysplasia

Vasculitis

Marfan Syndrome

Ehlers-Danlos Syndrome

REFERENCES

22 Substance Abuse and the Heart

INTRODUCTION

PATHOGENESIS AND CLINICAL PRESENTATION

Effects of Alcohol Abuse

Cardiomyopathy

Arrhythmias

Atherosclerotic Cardiovascular Disease

Hypertension

Effects of Tobacco and Electronic Cigarettes

Atherosclerotic Cardiovascular Disease

Effects of Opioid Abuse

Effects of Abuse of Marijuana and Synthetic Cannabinoids

Atherosclerotic Cardiovascular Disease

Effects of Methamphetamine

Cardiomyopathy

Pulmonary Arterial Hypertension

Effects of Cocaine Abuse

Atherosclerotic Cardiovascular Disease

Cardiomyopathy

DIAGNOSIS AND MANAGEMENT

RESEARCH AND FUTURE DIRECTIONS

REFERENCES

23 Cardiac Trauma

INTRODUCTION

PATHOGENESIS

Blunt Cardiac Injuries

Penetrating Cardiac Injuries

Aortic Injuries

CLINICAL FEATURES

DIAGNOSIS

Cardiac Biomarkers

Electrocardiography

Echocardiography

Chest X-ray

Computed Tomography

Invasive Aortography

Magnetic Resonance Imaging

MANAGEMENT OF THE PATIENT WITH CARDIAC TRAUMA

SPECIAL CONSIDERATIONS AND GUIDELINES

PATIENT FOLLOW-UP

FUTURE DIRECTIONS

REFERENCES

24 Cardiac Tumors

INTRODUCTION

BENIGN PRIMARY CARDIAC TUMORS

Clinical Presentation of Benign Primary Cardiac Tumors

Cardiac Myxoma

Papillary Fibroelastoma

Rhabdomyoma and Fibroma

Rare Primary Cardiac Tumors—Hemangiomas, Lipomas, Leiomyomas

Diagnosis and Imaging of Benign Primary Cardiac Tumors

Management and Outcome of Benign Primary Cardiac Tumors

Masses Mimicking Benign PCTs

Mitral Annular Calcification with Caseous Necrosis

Intracardiac Thrombus

Lambl Excrescences

MALIGNANT PRIMARY CARDIAC TUMORS

Clinical Presentation of Malignant Primary Cardiac Tumors

Diagnosis and Imaging of Malignant Primary Cardiac Tumors

Primary Cardiac Sarcomas

Primary Cardiac Lymphoma

SECONDARY CARDIAC TUMORS

Routes of Metastasis

Clinical Presentation of Secondary Cardiac Tumors

Diagnosis and Imaging of Secondary Cardiac Tumors

Management and Outcome of Secondary Cardiac Tumors

PERICARDIAL MASSES

Benign Primary Pericardial Tumors

Clinical Presentation of Benign Primary Pericardial Tumors

Diagnosis and Imaging of Benign Primary Pericardial Tumors

Management of Benign Primary Pericardial Tumors

Malignant Primary Pericardial Tumors

Clinical Presentation of Malignant Primary Pericardial Tumors

Diagnosis and Imaging of Malignant Primary Pericardial Tumors

Management and Outcome of Malignant Primary Pericardial Tumors

Secondary Pericardial Tumors

Clinical Presentation of Secondary Pericardial Tumors

Imaging and Diagnosis of Secondary Pericardial Tumors

Management of Secondary Pericardial Tumors

Pericardial Cysts

Clinical Presentation of Pericardial Cysts

Imaging and Diagnosis of Pericardial Cysts

Management and Outcome of Pericardial Cysts

REFERENCES

25 Cardiac Evaluation for Noncardiac Surgery

INTRODUCTION

Epidemiology

Risk Factors

Outcome Definitions

APPROACH TO CARDIAC EVALUATION FOR NONCARDIAC SURGERY

PATHOGENESIS

CLINICAL RISK ASSESSMENT

Prediction Tools

PREOPERATIVE DIAGNOSTIC TESTING

Noninvasive Stress Testing

Echocardiography

Cardiac Biomarkers

Coronary Angiography

MANAGEMENT OF THE PATIENT

Medical Approach

Beta-blockers

Alpha-2 Agonists

Statins

Antiplatelet Therapy

Anticoagulants

Other Medications

Percutaneous and Surgical Approach

SPECIAL CONSIDERATIONS

Coronary Stents

Valvular Heart Disease

Arrhythmias and Conduction Disease

The Older Patient

Emergency Surgery

FOLLOW-UP PATIENT CARE

RESEARCH AND FUTURE DIRECTIONS

REFERENCES

26 Cardio-Oncology

INTRODUCTION

PREVENTATIVE CARDIO-ONCOLOGY

CARDIOTOXICITIES OF CANCER THERAPIES

Anthracyclines

Tyrosine Kinase Inhibitors

Human Epidermal Growth Factor Receptor 2 Tyrosine Kinase Inhibitors

Vascular Endothelial Growth Factor Tyrosine Kinase Inhibitors

Bcr-Abl Tyrosine Kinase Inhibitors

Bruton Tyrosine Kinase Inhibitors

Immune Checkpoint Inhibitors

Chimeric Antigen Receptor T Cells

Proteasome Inhibitors

Androgen Deprivation Therapy

Radiation Therapy

SPECIAL CONSIDERATIONS AND MANAGEMENT DURING ONCOLOGY THERAPY

Cardiac Surveillance

Interventions and Procedures

Venous Thromboembolism

CARDIAC SURVEILLANCE AND PREVENTATIVE CARE DURING CANCER SURVIVORSHIP

Cardiomyopathy

Coronary Artery Disease

Hypertension

Exercise Training

RESEARCH AND FUTURE DIRECTIONS

REFERENCES

27 Cardiac Disease in Human Immunodeficiency Virus Infection

INTRODUCTION

Epidemiology

Potential Mechanistic Factors

PATHOGENESIS: HUMAN IMMUNODEFICIENCY VIRUS–RELATED IMMUNE ACTIVATION AND CARDIOVASCULAR DISEASE

Systemic Inflammation

Human Immunodeficiency Virus and Subclinical Atherosclerosis

CLINICAL PRESENTATION

Angiographic Findings

MANAGEMENT OF HUMAN IMMUNODEFICIENCY VIRUS PATIENTS

Antiretroviral Therapy

Management of Cardiovascular Risk Factors

Prevention

RESEARCH AND FUTURE DIRECTIONS

REFERENCES

28 Dysautonomia

INTRODUCTION

AUTONOMIC NERVOUS SYSTEM ANATOMY

CLINICAL EVALUATION

DIAGNOSTIC TESTS

Heart Rate Variability

Valsalva Maneuver

Tilt-Table Test

Carotid Sinus Massage

Radiotracer Iodine-123 Meta-iodobenzylguanidine

Quantitative Sudomotor Axon Reflex Test

Thermoregulatory Sweat Test

CLINICAL PRESENTATION AND MANAGEMENT IN VARIOUS DISORDERS

Vasovagal Syncope

Postural Orthostatic Tachycardia Syndrome

Synucleinopathies

Diabetes

Atrial and Ventricular Arrhythmias

Cardiomyopathy

Cancer Survivors

RESEARCH AND FUTURE DIRECTIONS

REFERENCES

29 Environmental Exposures and Cardiovascular Disease

INTRODUCTION

AIRBORNE POLLUTANTS

Nonchemical Pollutants: Noise

Chemical Pollutants

Air Pollutants

Carbon Monoxide

Inhalants

Solid Fuel

PLANT-BASED POLLUTANTS

Aconite

Cardenolides

Mad Honey

ARECA (BETEL) NUT

Herbal Supplements

HOUSEHOLD CHEMICALS

Camphor

Detergents

Skin Cleansers

Dettol

Perfluorooctanoic Acid

INDUSTRIAL EXPOSURE

Fluoride

Hydrogen Sulfide

Volatile Organic Compounds

FUMIGANTS AND PESTICIDES

Aluminum Phosphide

Endosulfan

Organophosphates

Pyrethroid Insecticides

Sulfur Fluoride

HEAVY METALS

Antimony

Arsenic

Bismuth

Cadmium

Chromium

Cobalt

Copper

Gold

Iron

Lead

Manganese

MERCURY

Molybdenum

Nickel

Thallium

Zinc

DIAGNOSIS AND MANAGEMENT OF A PATIENT WITH SUSPECTED OR KNOWN ENVIRONMENTAWL TOXICITY

RESEARCH AND FUTURE DIRECTIONS

REFERENCES

30 Amyloid Cardiomyopathy

INTRODUCTION

Epidemiology

Risk Factors

PATHOGENESIS

CLINICAL PRESENTATION

Common Signs and Symptoms

Differential Diagnosis

DIAGNOSIS

Diagnosis of Light Chain Amyloidosis

Diagnosis of Transthyretin Amyloidosis

MANAGEMENT OF THE PATIENT WITH AMYLOIDOSIS

Medical Approach

Light Chain Amyloidosis Therapy

Transthyretin Amyloidosis Therapy

Amyloid Fibril Inhibition

Transplant Approach

Autologous Stem Cell Transplant

Liver Transplant

Heart Transplant

SPECIAL CONSIDERATIONS

Hypotension

Heart Failure

Medications

Intracardiac Defibrillators

Atrial Fibrillation

Heart Block

FOLLOW-UP PATIENT CARE

Prognosis

RESEARCH AND FUTURE DIRECTIONS

REFERENCES

SECTION 2: CARDIOVASCULAR IMAGING

31 Principles of Imaging Techniques

INTRODUCTION

INDICATIONS

Evaluation of Symptoms

Prognosis and Risk Assessment

Therapy Guidance

ANATOMIC CONSIDERATIONS

Cardiac Chambers

Valves

Pericardium

Coronary Vessels

Great Vessels

FUNDAMENTALS OF CARDIAC IMAGING

Image Quality Considerations

Determination of Accuracy

Benefit and Risk Considerations

Outcome Analysis

Cost/Benefit Analysis

CLINICAL APPLICATIONS

Methodology

Image Acquisition and Storage

Digital Imaging and Communications in Medicine

Report Distribution

Cardiology Electronic Health Record Integration

LIMITATIONS OF NONINVASIVE IMAGING

Health Hazards of Cardiac Imaging

Ionizing Radiation

Contrast Agents

Limitations Associated With Noncontrast Cardiac Magnetic Resonance Imaging

Imaging Artifacts and Misdiagnosis

Hemodynamic Assessment

Economic Considerations

SPECIAL CONSIDERATIONS AND CONTRAINDICATIONS

Age Considerations

Pregnancy

FOLLOW-UP PATIENT CARE

RESEARCH AND FUTURE DIRECTIONS

VIDEO CAPTION

REFERENCES

32 Chest Radiography

INTRODUCTION

INDICATIONS

ANATOMIC CONSIDERATIONS

General Anatomy

Cardiac Position/Visceroatrial Situs

Aortic Arch

Valves

FUNDAMENTALS OF RADIOGRAPHY

Approach to Interpreting Radiographs

Radiographic Technique

CLINICAL APPLICATIONS

Pulmonary Vasculature

Congestive Heart Failure

Pulmonary Hypertension

Shunt Vascularity

Cardiomegaly

Pericardial Effusion

Calcifications

Aortic Dissection

Pulmonary Embolism

Noncardiac Pathology

Intensive Care Unit Recommendations and Device Complications

LIMITATIONS OF CHEST RADIOGRAPHY

Comparison Between Posteroanterior and Anteroposterior Techniques

Inspiration Versus Expiration

Rotation

Exposure

Research and Future Directions

REFERENCES

33 Electrocardiographic Exercise Testing

INTRODUCTION

INDICATIONS

PHYSIOLOGIC CONSIDERATIONS

Functional Capacity

Myocardial Oxygen Demand

Myocardial Oxygen Supply

FUNDAMENTALS OF EXERCISE TESTING

Aerobic Exercise Effects on Cardiovascular Physiology

Heart Rate Response

Blood Pressure Response

Resistance (Isometric) Exercise Effects on Cardiovascular Physiology

CLINICAL APPLICATIONS

Electrocardiographic Exercise Stress Test Procedure

Patient Assessment Preprocedure

Electrocardiogram

Exercise Protocols

Patient Monitoring

Test Supervision

Complications

Interpretation of Electrocardiographic Exercise Test

Diagnosis of Myocardial Ischemia

Prognostic Information

LIMITATIONS OF ELECTROCARDIOGRAPHIC EXERCISE TEST

CONTRAINDICATIONS

REFERENCES

34 Echocardiography

INTRODUCTION

INDICATIONS

Transthoracic Imaging

Transesophageal Imaging

Stress Echocardiography

Point-of-Care Ultrasound

ANATOMIC CONSIDERATIONS

Acoustic Windows

Transthoracic

Transesophageal

FUNDAMENTALS OF ECHOCARDIOGRAPHY

Physical Principles, Instrumentation, and Basic Ultrasound Physics

M-Mode, Two-Dimensional, and Three-Dimensional Imaging

Doppler Ultrasound

Pulsed-Wave Doppler Echocardiography

Continuous-Wave Doppler echocardiography

Color Doppler Echocardiography

Tissue Doppler Echocardiography

Strain Echocardiography

Ultrasound-Enhancing Agents

CLINICAL APPLICATIONS

Methodology

Ischemic Heart Disease

Valvular Heart Disease

Heart Failure and Cardiomyopathies

Pericardial Disease

Cardiac Masses

Congenital Heart Disease

Evaluation of Mechanical Assist Devices and Transplant

Acute and Chronic Aortic Syndromes

Evaluation of the Stroke Patient

LIMITATIONS OF ECHOCARDIOGRAPHY

SPECIAL CONSIDERATIONS AND CONTRAINDICATIONS

FOLLOW-UP PATIENT CARE

RESEARCH AND FUTURE DIRECTIONS

REFERENCES

35 Nuclear Cardiology and Molecular Imaging

INTRODUCTION

FUNDAMENTALS OF CARDIAC NUCLEAR SCINTIGRAPHY

Physical Principles and Instrumentation

Myocardial Perfusion Imaging

Indications

Stress Modality Selection

IMAGING PROTOCOLS

Single-Photon Emission Computed Tomography Imaging Protocol

Interpretation: Myocardial Perfusion Images

SPECIAL CONSIDERATIONS AND CONTRAINDICATIONS: SINGLE-PHOTON EMISSION COMPUTED TOMOGRAPHY AND POSITRON EMISSION TOMOGRAPHY MYOCARDIAL PERFUSION IMAGING

LIMITATIONS: SINGLE-PHOTON EMISSION COMPUTED TOMOGRAPHY AND POSITRON EMISSION TOMOGRAPHY MYOCARDIAL PERFUSION IMAGING

Metabolic Imaging With F-Fluorodeoxyglucose Positron Emission Tomography

Indications of Fluorodeoxyglucose Positron Emission Tomography

Imaging Protocols for Fluorodeoxyglucose Positron Emission Tomography

Interpretation: Fluorodeoxyglucose Positron Emission Tomography

Special Considerations and Contraindications: FDG Positron Emission Tomography

Limitations: FDG Positron Emission Tomography

Technetium-99m-Pyrophosphate Amyloid

Indications: Technetium-99m-Pyrophosphate Amyloid

Imaging Protocols: Technetium-99m-Pyrophosphate Amyloid

Interpretation: Technetium-99m-Pyrophosphate Amyloid

Special Considerations and Contraindications: Technetium-99m-Pyrophosphate Amyloid

Limitations: Technetium-99m-Pyrophosphate Amyloid

Equilibrium Radionuclide Angiography

Indications: Equilibrium Radionuclide Angiography

Imaging Protocols: Equilibrium Radionuclide Angiography

Interpretation: Equilibrium Radionuclide Angiography

Special Considerations and Contraindications: Equilibrium Radionuclide Angiography

Limitations: Equilibrium Radionuclide Angiography

Cardiac Innervation/Metaiodobenzylguanidine

Indications: Cardiac Innervation/Metaiodobenzylguanidine

Imaging Protocols: Cardiac Innervation/Metaiodobenzylguanidine

Interpretation: Cardiac Innervation/Metaiodobenzylguanidine

Special Considerations and Contraindications: Cardiac Innervation/Metaiodobenzylguanidine

Limitations: Cardiac Innervation/Metaiodobenzylguanidine

FUTURE DIRECTIONS

REFERENCES

36 Cardiac Computed Tomography

INTRODUCTION

PHYSICAL PRINCIPLES AND INSTRUMENTATION

ANATOMIC CONSIDERATIONS

FUNDAMENTALS OF CARDIAC COMPUTED TOMOGRAPHY IMAGING

CLINICAL APPLICATION AND INDICATIONS

Coronary Artery Calcium Scan

Indications for Coronary Artery Calcium Testing

Coronary Computed Tomography Angiography

Indications for Coronary Computed Tomography Angiography

Patient Management Following Coronary Computed Tomography Angiography

Cine-Coronary Computed Tomography

Valvular Function

Cardiac Masses

Left Atrial Appendage

Myocardial Morphology and Cardiac Function

LIMITATIONS OF TECHNIQUE/PROCEDURE

SPECIAL CONSIDERATIONS AND CONTRAINDICATIONS

RESEARCH AND FUTURE DIRECTIONS

REFERENCES

37 Cardiac Magnetic Resonance Imaging

INTRODUCTION

FUNDAMENTALS OF CARDIAC MAGNETIC RESONANCE

Physics for Clinicians and Instrumentation

System and Signal Encoding

Cardiac Synchronization and Respiratory Gating

Magnetic Resonance Sequences

Gadolinium-Based Contrast Agents

Late Gadolinium Enhancement

INDICATIONS

SPECIAL CONSIDERATIONS AND CONTRAINDICATIONS

CLINICAL APPLICATIONS

Chamber Morphology and Function

Ischemic Heart Disease, Myocardial Infarction, and Viability

Myocardial Infarction

Stress Cardiac Magnetic Resonance Imaging for Detecting and Quantifying Myocardial Ischemia

Cardiomyopathies

Nonischemic Dilated Cardiomyopathy

Hypertrophic Cardiomyopathy

Cardiac Amyloidosis

Cardiac Sarcoidosis

Fabry Disease

Arrhythmogenic Right Ventricular Cardiomyopathy

Left Ventricular Non-compaction Cardiomyopathy

Iron Overload Cardiomyopathy

Myocarditis

Valvular Heart Disease

Cardiac Thrombi and Masses

Pericardial Disease

Congenital Heart Disease

RESEARCH AND FUTURE DIRECTIONS

REFERENCES

38 Hybrid and Multimodality Imaging

INTRODUCTION

FUNDAMENTALS OF HYBRID IMAGING

Technologic Advantage

IMAGING MODALITIES AND PROCEDURES

Single-Photon Emission Computed Tomography/Computed Tomography

Positron Emission Tomography/Computed Tomography

Hybrid Positron Emission Tomography/Magnetic Resonance and Single-Photon Emission Computed Tomography/Magnetic Resonance Imaging

X-ray Fluoroscopy and Computed Tomography

X-ray Fluoroscopy and Echocardiography

HYBRID IMAGING PROBES

Multi-Isotope Single-Photon Emission Computed Tomography and Positron Emission Tomography Imaging

LIMITATIONS OF HYBRID TECHNOLOGY

RESEARCH AND FUTURE DIRECTIONS

REFERENCES

39 Periprocedural Imaging

INTRODUCTION

INDICATIONS AND FUNDAMENTALS OF PERIPROCEDURAL IMAGING

Preprocedural Imaging

Procedural Guidance

Postprocedural Evaluation

RESEARCH AND FUTURE DIRECTIONS

REFERENCES

FURTHER READINGS

SECTION 3: CARDIAC CATHETERIZATION AND INTERVENTION

40 Cardiac Catheterization and Hemodynamic Assessment

INTRODUCTION

INDICATIONS

ANATOMIC CONSIDERATIONS

FUNDAMENTALS OF CARDIAC CATHETERIZATION AND HEMODYNAMIC ASSESSMENT

CLINICAL APPLICATION

Hemodynamic Assessment

Intracardiac Pressures

Shunts

Cardiac Output

Vascular Resistance

Mechanical Circulatory Support

SPECIAL CONSIDERATIONS AND CONTRAINDICATIONS

FOLLOW-UP PATIENT CARE

RESEARCH AND FUTURE DIRECTIONS

REFERENCES

41 Diagnostic Coronary and Pulmonary Angiography and Left Ventriculography

INTRODUCTION

INDICATIONS

Suspected or Known Coronary Artery Disease

Arrhythmias

Valvular Heart Disease

Other Indications

CONTRAINDICATIONS TO CORONARY ANGIOGRAPHY

ANATOMIC CONSIDERATIONS

Femoral Artery Access

Radial Artery Access

Complications of Radial Artery Access

Radial versus Femoral Artery Access

FUNDAMENTALS OF DIAGNOSTIC CORONARY ANGIOGRAPHY (FLUOROSCOPY AND RADIATION SAFETY)

Dosage Rates

Radiation Complications and Strategies for Risk Reduction

CLINICAL APPLICATIONS

Performing Diagnostic Coronary Angiography

Diagnostic Catheter Selection

Left Coronary System

Right Coronary Artery

Performing Diagnostic Angiography with Bypass Grafts

Reading and Interpreting a Diagnostic Coronary Angiogram

Performing Left Ventricular Angiography

Performing Pulmonary Angiography

SPECIAL CONSIDERATIONS AND CONTRAINDICATIONS

Cardiac Catheterization in Patients with Renal Dysfunction

Biplane Imaging

Hydration Protocols

Anomalous Coronary Anatomy

FOLLOW-UP PATIENT CARE

Discharge Instructions

REFERENCES

42 Intracoronary Imaging

INTRODUCTION

INTRAVASCULAR ULTRASOUND

FUNDAMENTALS OF INTRAVASCULAR ULTRASOUND

CLINICAL APPLICATIONS

Diagnostic Utility: Intravascular Ultrasound

Procedural Guidance: Intravascular Ultrasound

LIMITATIONS AND FUTURE DIRECTIONS: INTRAVASCULAR ULTRASOUND

OPTICAL COHERENCE TOMOGRAPHY

FUNDAMENTALS OF OPTICAL COHERENCE TOMOGRAPHY

CLINICAL APPLICATIONS

Diagnostic Utility: Optical Coherence Tomography

Procedural Guidance: Optical Coherence Tomography

SPECIAL CONSIDERATIONS AND FUTURE DIRECTIONS

LIMITATIONS OF INTRAVASCULAR IMAGING

INTRACARDIAC ECHOCARDIOGRAPHY

FUNDAMENTALS OF INTRACARDIAC ECHOCARDIOGRAPHY

CLINICAL APPLICATIONS

Diagnostic Utility: Intracardiac Echocardiography

Procedural Guidance: Intracardiac Echocardiography

LIMITATIONS OF INTRACARDIAC ECHOCARDIOGRAPHY

REFERENCES

43 Percutaneous Coronary Intervention

HISTORY OF PERCUTANEOUS CORONARY INTERVENTION

Emergence of Coronary Stents

Drug-Eluting Stents

ADJUNCTIVE DEVICES

Rotational and Orbital Atherectomy

Excimer Laser Atherectomy

Focused Ultrasound Energy—Intravascular Lithotripsy

INDICATIONS FOR PERCUTANEOUS CORONARY INTERVENTION

Physiologic Measurements in the Catheterization Laboratory

Fractional Flow Reserve

Instantaneous Wave-Free Ratio

INTRAVASCULAR ULTRASOUND AND OPTICAL COHERENCE TOMOGRAPHY

MULTIVESSEL DISEASE

ISOLATED LEFT MAIN CORONARY DISEASE

ROLE OF PERCUTANEOUS CORONARY INTERVENTION IN STABLE ISCHEMIC HEART DISEASE

ROLE OF PERCUTANEOUS CORONARY INTERVENTION IN ACUTE CORONARY SYNDROMES

Unstable Angina and Non–ST-Segment Elevation Myocardial Infarction

ST-Segment Elevation Myocardial Infarction

Saphenous Vein Graft Interventions

FOLLOW-UP PATIENT CARE: DUAL ANTIPLATELET THERAPY

REFERENCES

44 Percutaneous Valvular Intervention

INTRODUCTION

TRANSCATHETER AORTIC-VALVE REPLACEMENT

Landmark Clinical Trials

TYPES OF TRANSCATHETER AORTIC VALVES

LIMITATIONS OF TAVR

Structural Deterioration

Paravalvular Leak

Stroke

Leaflet Dysfunction

Conduction Abnormalities

Bicuspid Valve

Prosthetic Valve Endocarditis

TAVR Cost

Transcatheter Aortic Valve Replacement Use in Young Patients

Transcatheter Aortic Valve Replacement Use in Other Conditions

TRICUSPID REGURGITATION

RESEARCH AND FUTURE DIRECTIONS

MANAGEMENT OF MITRAL REGURGITATION

Transcatheter Edge-to-Edge Mitral-Valve Repair

MitraClip System

MitraClip XTR System

PASCAL Transcatheter Mitral-Valve Repair System

Transcatheter Direct Annuloplasty Mitral-Valve Repair

Cardioband System

Research and Future Directions: Management of Secondary (Functional) Mitral Regurgitation

Transapical Off-Pump Mitral-Valve Repair With NeoChord Implantation

Transcatheter Mitral-Valve Replacement

REFERENCES

45 Catheter Interventions in Adults With Congenital Heart Disease

TRANSCATHETER THERAPY FOR AORTIC AND PULMONARY STENOSIS

INTRODUCTION

INDICATIONS: BALLOON VALVULOPLASTY

ANATOMIC CONSIDERATIONS: BALLOON VALVULOPLASTY

CLINICAL APPLICATION/METHODOLOGY: BALLOON VALVULOPLASTY

LIMITATIONS: BALLOON VALVULOPLASTY

FOLLOW-UP PATIENT CARE: BALLOON VALVULOPLASTY

TRANSCATHETER THERAPY FOR PULMONARY ARTERY STENOSIS

INTRODUCTION

INDICATIONS: PULMONARY ANGIOPLASTY AND STENT PLACEMENT

FUNDAMENTALS AND ANATOMIC CONSIDERATIONS: PULMONARY ANGIOPLASTY AND STENT PLACEMENT

CLINICAL APPLICATIONS: PULMONARY ANGIOPLASTY AND STENT PLACEMENT

LIMITATIONS: PULMONARY ANGIOPLASTY AND STENT PLACEMENT

FOLLOW-UP PATIENT CARE: PULMONARY ANGIOPLASTY AND STENT PLACEMENT

RESEARCH AND FUTURE DIRECTIONS: PULMONARY ANGIOPLASTY AND STENT PLACEMENT

CONDUIT ANGIOPLASTY, STENTS, AND TRANSCATHETER VALVES

INTRODUCTION

INDICATIONS: CONDUIT ANGIOPLASTY, STENTS, AND TRANSCATHETER VALVES

ANATOMIC CONSIDERATIONS: CONDUIT ANGIOPLASTY, STENTS, AND TRANSCATHETER VALVES

FUNDAMENTALS: CONDUIT ANGIOPLASTY, STENTS, AND TRANSCATHETER VALVES

CLINICAL APPLICATIONS: CONDUIT ANGIOPLASTY, STENTS, AND TRANSCATHETER VALVES

LIMITATIONS: CONDUIT ANGIOPLASTY, STENTS, AND TRANSCATHETER VALVES

SPECIAL CONSIDERATIONS AND CONTRAINDICATIONS

FOLLOW-UP PATIENT CARE: CONDUIT ANGIOPLASTY, STENTS, AND TRANSCATHETER VALVES

RESEARCH AND FUTURE DIRECTIONS: CONDUIT ANGIOPLASTY, STENTS, AND TRANSCATHETER VALVES

TRANSCATHETER THERAPY FOR COARCTATION IN ADULTS

INTRODUCTION

INDICATIONS: TRANSCATHETER THERAPY FOR COARCTATION IN ADULTS

ANATOMIC CONSIDERATIONS

FUNDAMENTALS: TRANSCATHETER THERAPY FOR COARCTATION IN ADULTS

CLINICAL APPLICATIONS: TRANSCATHETER THERAPY FOR COARCTATION IN ADULTS

LIMITATIONS? SPECIAL CONSIDERATIONS: TRANSCATHETER THERAPY FOR COARCTATION IN ADULTS

FOLLOW-UP PATIENT CARE: TRANSCATHETER THERAPY FOR COARCTATION IN ADULTS

RESEARCH AND FUTURE CONSIDERATIONS

TRANSCATHETER THERAPY FOR PATENT DUCTUS ARTERIOSUS

INTRODUCTION

INDICATIONS/ANATOMIC CONSIDERATIONS: TRANSCATHETER THERAPY FOR PATENT DUCTUS ARTERIOSUS

CLINICAL APPLICATIONS: TRANSCATHETER THERAPY FOR PATENT DUCTUS ARTERIOSUS

SPECIAL CONSIDERATIONS/LIMITATIONS: TRANSCATHETER THERAPY FOR PATENT DUCTUS ARTERIOSUS

FOLLOW-UP PATIENT CARE: TRANSCATHETER THERAPY FOR PATENT DUCTUS ARTERIOSUS

RESEARCH AND FUTURE DIRECTIONS

DEVICE CLOSURE OF VENTRICULAR SEPTAL DEFECTS

INTRODUCTION

INDICATIONS AND ANATOMIC CONSIDERATIONS: DEVICE CLOSURE OF VENTRICULAR SEPTAL DEFECT

FUNDAMENTALS: DEVICE CLOSURE OF VENTRICULAR SEPTAL DEFECTS

CLINICAL APPLICATIONS: DEVICE CLOSURE OF VSDs

LIMITATIONS/SPECIAL CONSIDERATIONS: DEVICE CLOSURE OF VSDs

FOLLOW-UP PATIENT CARE: DEVICE CLOSURE OF VENTRICULAR SEPTAL DEFECT

RESEARCH AND FUTURE CONSIDERATIONS

FONTAN—SINGLE VENTRICLE INTERVENTIONS

INTRODUCTION

INDICATIONS: FONTAN—SINGLE VENTRICLE INTERVENTIONS

ANATOMIC CONSIDERATIONS: FONTAN—SINGLE VENTRICLE INTERVENTIONS

CLINICAL APPLICATIONS: FONTAN—SINGLE VENTRICLE INTERVENTIONS

LIMITATIONS/SPECIAL CONSIDERATIONS: FONTAN—SINGLE VENTRICLE INTERVENTIONS

FOLLOW-UP PATIENT CARE: FONTAN—SINGLE VENTRICLE INTERVENTIONS

RESEARCH AND FUTURE CONSIDERATIONS

REFERENCES

46 Percutaneous Closure of Patent Foramen Ovale and Atrial Septal Defect

PATENT FORAMEN OVALE CLOSURE

INTRODUCTION

DIAGNOSIS

Echocardiography

Anatomic Characteristics as Prognostic Indicator and Device Selection

INDICATIONS FOR PATENT FORAMEN OVALE CLOSURE

Cryptogenic Stroke

Decompression Sickness

Hypoxia

FUNDAMENTALS OF PERCUTANEOUS PFO CLOSURE

Vascular Access

Sizing the PFO

Crossing the PFO

Device Insertion

GORE®Cardioform Septal Occluder

Amplatzer™ PFO Occluder

LIMITATIONS AND ANATOMICAL CHALLENGES

ATRIAL SEPTAL DEFECT CLOSURE

INTRODUCTION

Diagnostic Modalities to Evaluate ASD

ANATOMIC CONSIDERATIONS: ASD

INDICATIONS FOR PERCUTANEOUS ASD CLOSURE

CLINICAL APPLICATIONS: PERCUTANEOUS ASD CLOSURE

FOLLOW-UP PATIENT CARE FOR PFO/ASD CLOSURE

LIMITATIONS AND CONTRAINDICATIONS: PFO/ASD CLOSURE

RESEARCH AND FUTURE DIRECTIONS

REFERENCES

47 Ethanol Septal Ablation

INTRODUCTION

INDICATIONS AND ANATOMIC CONSIDERATIONS

FUNDAMENTALS OF ALCOHOL SEPTAL ABLATION

Transvenous Pacing

Vascular Access

Procedural Hemodynamic Assessment

ASA Procedure

FOLLOW-UP PATIENT CARE

In-Hospital Postprocedure Care

Discharge PostProcedure Care

CLINICAL CASE

SPECIAL CONSIDERATIONS

RESEARCH/FUTURE DIRECTIONS

REFERENCES

48 Left Atrial Appendage Closure

INTRODUCTION

INDICATIONS

ANATOMIC CONSIDERATIONS

FUNDAMENTALS OF LEFT ATRIAL APPENDAGE CLOSURE

Preprocedure

Intraprocedure

CLINICAL APPLICATIONS

Watchman Methodology

LARIAT Methodology

LIMITATIONS

SPECIAL CONSIDERATIONS AND CONTRAINDICATIONS

FOLLOW-UP PATIENT CARE

RESEARCH AND FUTURE DIRECTIONS

REFERENCES

SECTION 4: ELECTROPHYSIOLOGY

49 The Electrocardiogram

INTRODUCTION

INDICATIONS

ANATOMIC CONSIDERATIONS

FUNDAMENTALS OF ELECTROCARDIOGRAPHY

CLINICAL APPLICATIONS

P-QRS-T Waves

Rate

Rhythm

Axis

Intervals

Hypertrophy

Ischemia and Infarction

Specific Diagnoses

LIMITATIONS

SPECIAL ISSUES OR CONTRAINDICATIONS

RESEARCH AND FUTURE DIRECTIONS

REFERENCES

50 Mechanisms of Cardiac Arrhythmias

INTRODUCTION

IMPULSE FORMATION

Spontaneous Automaticity

Changes in Spontaneous Automaticity

Enhanced Automaticity

Triggered Activity

Early Afterdepolarizations

Delayed Afterdepolarizations

ABNORMAL IMPULSE CONDUCTION

Reentry

Reentry Around a Fixed Anatomic Obstacle

Functional Reentry

Spatially Discordant Action Potential Duration Alternans

Other Variations of Functional Reentry

REFERENCES

51 Genetics of Arrhythmias

INTRODUCTION

CARDIAC ACTION POTENTIAL AND ION CHANNELS

COMMON HEREDITARY ARRHYTHMIA SYNDROMES

Long QT Syndrome

Genotype-Phenotype Correlations

Diagnosis and Treatment

Andersen-Tawil Syndrome

Timothy Syndrome

Short QT Syndrome

Genotype-Phenotype Correlations

Diagnosis and Treatment

Brugada Syndrome

Genotype-Phenotype Correlations

Diagnosis and Treatment

Catecholaminergic Polymorphic Ventricular Tachycardia

Genotype-Phenotype Correlations

Diagnosis and Treatment

Progressive Cardiac Conduction Disease

Atrial Fibrillation

REFERENCES

52 Ambulatory Rhythm Monitoring

INTRODUCTION

INDICATIONS

Syncope

Palpitations

Risk Stratification

Preablation Assessment

Cardiomyopathy

FUNDAMENTALS OF AMBULATORY RHYTHM MONITORING

Holter Monitoring

Extended Holter Monitor

Event Monitoring

Implantable Loop Recorder

SPECIAL CONSIDERATIONS AND CONTRAINDICATIONS

Direct-to-Consumer Products and Research

FUTURE DIRECTIONS

REFERENCES

53 Electrophysiology Testing

INTRODUCTION

INDICATIONS

ANATOMIC CONSIDERATIONS

FUNDAMENTALS OF ELECTROPHYSIOLOGIC TESTING

Baseline Intervals

Pacing Maneuvers

Electroanatomic Mapping

Complications

CLINICAL APPLICATIONS OF ELECTROPHYSIOLOGY TESTING

LIMITATIONS OF ELECTROPHYSIOLOGY TESTING

SPECIAL CONSIDERATIONS—PREGNANCY

REFERENCES

54 Bradycardias: Sinus Node Dysfunction and Atrioventricular Conduction Disturbances

INTRODUCTION

SINUS NODE DYSFUNCTION

Epidemiology and Etiology

Intrinsic Bradycardia

Extrinsic (Functional) Bradycardia

Clinical Presentation of Sinus Node Dysfunction

Common Signs and Symptoms

Diagnosis of Sinus Node Dysfunction

History and Physical Examination

Noninvasive Testing

Electrocardiographic Features

Electrophysiologic Features

Management of Sinus Node Dysfunction

ATRIOVENTRICULAR CONDUCTION DISTURBANCES

Epidemiology

Pathogenesis

Congenital Atrioventricular Block

Acquired Atrioventricular Block

Clinical Presentation of Atrioventricular Conduction Disturbances

Diagnosis of Atrioventricular Conduction Disturbances

Electrocardiographic and Electrophysiologic Features

Differential Diagnosis

Management of Atrioventricular Conduction Disturbances

Immediate Management

Long-Term Management

SPECIAL CONSIDERATIONS AND FUTURE DIRECTIONS

FOLLOW-UP PATIENT CARE

REFERENCES

55 Supraventricular Tachycardias

INTRODUCTION

Epidemiology and Risk Factors

PATHOGENESIS

Atrioventricular Nodal Reentrant Tachycardia

Accessory Pathway-Mediated Reentrant Tachycardia

Atrial Flutter

Atrial Ectopic Tachycardia

Focal Atrial Tachycardia

Junctional Tachycardia

Inappropriate Sinus Tachycardia

CLINICAL PRESENTATION

Common Signs and Symptoms

Physical Examination Findings

DIAGNOSIS

Risk Stratification in Wolff-Parkinson-White Syndrome

MANAGEMENT

Acute Management

Ongoing Management

Catheter Ablation

Electroanatomic Mapping

Ablation Outcomes

FOLLOW-UP PATIENT CARE

RESEARCH AND FUTURE DIRECTIONS

REFERENCES

56 Atrial Fibrillation and Atrial Flutter

INTRODUCTION

Epidemiology

Risk Factors

PATHOGENESIS

CLINICAL PRESENTATION

Common Signs and Symptoms

Physical Examination Findings

DIAGNOSIS

MANAGEMENT OF ATRIAL FIBRILLATION

Medical Approach

Prevention of Thromboembolic Events

Periprocedural Considerations

Anticoagulation Agents

Left Atrial Appendage Closure

Risk Factor Modification

Rate Control

Pharmacologic Rate Control Agents

Atrioventricular Junction Ablation

Rhythm Control

Cardioversion

Antiarrhythmic Medications

Percutaneous Catheter Ablation for Atrial Fibrillation

Percutaneous Catheter Ablation for Atrial Flutter

Surgical Procedures for Atrial Fibrillation

Management of Postoperative Atrial Fibrillation

FOLLOW-UP PATIENT CARE

RESEARCH AND FUTURE DIRECTIONS

REFERENCES

57 Ventricular Tachycardia

INTRODUCTION

PATHOGENESIS

CLINICAL PRESENTATION

DIAGNOSIS

MANAGEMENT OF VENTRICULAR TACHYCARDIA

Medical Approach

Percutaneous Interventions

Surgical Approach

EMERGING THERAPIES AND FUTURE DIRECTIONS

REFERENCES

58 Antiarrhythmic Drugs

INTRODUCTION

ANATOMY OF THE CARDIAC ELECTRICAL CONDUCTION SYSTEM

CARDIAC ACTION POTENTIAL

Conduction Velocity

Refractory Period

Effect of the Autonomic Nervous System

CLASSIFICATION OF ANTIARRHYTHMIC DRUGS

CLASS IA DRUGS

Quinidine

Pharmacokinetics

Clinical Use

Adverse Effects of Quinidine

Procainamide

Pharmacokinetics

Clinical Use

Adverse Effects

Disopyramide

Pharmacokinetics

Clinical Use

Adverse Effects

CLASS IB DRUGS

Lidocaine

Pharmacokinetics

Clinical Use

Adverse Effects

Mexiletine

Pharmacokinetics

Clinical Use

Adverse Effects

CLASS IC DRUGS

Flecainide

Pharmacokinetics

Clinical Use

Adverse Effects

Propafenone

Pharmacokinetics

Clinical Use

Adverse Effects

CLASS II DRUGS

Beta-adrenoceptor Blockers

Pharmacokinetics

Clinical Use

Adverse Effects

CLASS III DRUGS

Amiodarone

Pharmacokinetics

Clinical Use

Adverse Effects

Dronedarone

Pharmacokinetics

Clinical Use

Adverse Effects

Sotalol

Pharmacokinetics

Clinical Use

Adverse Effects

Ibutilide

Pharmacokinetics

Clinical Use

Adverse Effects

Dofetilide

Pharmacokinetics

Clinical Use

Adverse Effects

CLASS IV DRUGS

Calcium Channel Blockers

Pharmacokinetics

Clinical Use

Adverse Effects

UNCLASSIFIED ANTIARRHYTHMIC DRUGS

Adenosine

Pharmacokinetics

Clinical Use

Adverse Effects

Digoxin

Pharmacokinetics

Clinical Use

Adverse Effects

Ranolazine

Pharmacokinetics

Clinical Use

Adverse Effects

OTHER CLASSIFICATION SCHEMES

CONCLUSIONS

REFERENCES

59 Catheter Ablation Therapy

INTRODUCTION

FUNDAMENTALS OF CATHETER-BASED MAPPING OF CARDIAC ARRHYTHMIAS

Three-Dimensional Electroanatomic Mapping Systems

Voltage Mapping

Activation Mapping

Pace Mapping

ENERGY SOURCES FOR CATHETER ABLATION OF ARRHYTHMIAS

Radiofrequency Ablation

Cryoablation

Laser Ablation

Other Sources of Energy

INDICATIONS FOR CATHETER ABLATION

Supraventricular Arrhythmias Focal Atrial Tachycardia

Atrioventricular Nodal Reentrant Tachycardia

Accessory Pathways

Atrial Fibrillation

Macroreentrant Atrial Tachycardia (MRAT)/Atrial Flutter

Ventricular Arrhythmias

Premature Ventricular Contractions and Idiopathic Ventricular Arrhythmias

Scar-Mediated Ventricular Tachycardia

COMPLICATIONS OF CATHETER ABLATION

PATIENT FOLLOW-UP CARE

REFERENCES

60 Implantable Cardioverter-Defibrillators

INTRODUCTION

INDICATIONS

Secondary Prevention

Primary Prevention

Ischemic Cardiomyopathy

Nonischemic Cardiomyopathy

Genetic and Acquired Disorders

“High-Risk” Syncope

CONTRAINDICATIONS: IMPLANTABLE CARDIOVERTER-DEFIBRILLATORS

DEVICE SELECTION

Transvenous ICDs

Subcutaneous ICDs

ANATOMIC CONSIDERATIONS

Site Selection

Venography

Implant Techniques

CLINICAL ASPECTS OF ICD MANAGEMENT

Device Programming

PATIENT AND DEVICE FOLLOW-UP

SPECIAL CONSIDERATIONS—WEARABLE DEFIBRILLATORS

RESEARCH AND FUTURE DIRECTIONS

REFERENCES

61 Syncope

INTRODUCTION

PATHOGENESIS, CAUSES, AND CLASSIFICATION

Reflex Syncope

Orthostatic Syncope

Cardiac Syncope

DIAGNOSIS

MANAGEMENT

SPECIAL CONSIDERATIONS AND FUTURE RESEARCH

REFERENCES

62 Sudden Cardiac Arrest

INTRODUCTION

Epidemiology of SCD

Risk Factors Associated With SCA

Genetics

Risk Prediction

PATHOGENESIS

CLINICAL PRESENTATION

Differential Diagnosis

DIAGNOSIS

Evaluation Upon Initial Presentation

Evaluation After Return of Spontaneous Circulation

MANAGEMENT

Management of Sudden Cardiac Arrest Upon Initial Presentation

Management After Return of Spontaneous Circulation

Preventing Sudden Cardiac Arrest and Reducing Burden of Ventricular Tachycardia/Ventricular Fibrillation Episodes

Management of Electrical Storm

Autonomic Modulation

PREVENTION OF SUDDEN CARDIAC ARREST

RESEARCH AND FUTURE DIRECTIONS

REFERENCES

63 Permanent Cardiac Pacemakers

INTRODUCTION

CLINICAL INDICATIONS

Cardiac Native Conduction

PACEMAKER SYSTEM AND BASICS OF PACING

FOLLOW-UP PATIENT CARE

Programmed Modes and Application

Rate-Response Programming

Atrial Mode Switch

Pacemaker-Mediated Tachycardia

Physiologic Pacing

Leadless Permanent Pacemaker

PERMANENT PACEMAKER COMPLICATIONS

Acute (Procedure-Related) Complications

Chronic (Device-Related) Complications

Device Malfunction: Undersensing/Oversensing

SPECIAL CONSIDERATIONS (PERIOPERATIVE MANAGEMENT AND MAGNETIC RESONANCE IMAGING)

REFERENCES

64 Lead Extraction

INTRODUCTION AND HISTORY

INDICATIONS FOR LEAD EXTRACTION

FACILITY CONSIDERATIONS

Risk Stratification

IMAGING CONSIDERATIONS

ANATOMIC CONSIDERATIONS

FUNDAMENTALS OF LEAD EXTRACTION

Telescoping Sheaths

Laser Sheaths

Rotational Mechanical Cutting Sheaths

LIMITATIONS OF TRANSVENOUS LEAD EXTRACTION

SPECIAL CONSIDERATIONS

Femoral Snaring

Coronary Sinus Leads

Ghosts

COMPLICATIONS

Rescue Device

PATIENT FOLLOW-UP

RESEARCH AND FUTURE DIRECTIONS

REFERENCES

SECTION 5: HEART FAILURE

65 Heart Failure: Epidemiology, Characteristics, and Prognosis

INTRODUCTION

CLASSIFICATIONS OF HEART FAILURE

Midrange Ejection Fraction, Preserved Ejection Fraction, and Reduced Ejection Fraction

Stages of Heart Failure

Risk Factors

Ischemic Heart Disease

Hypertensive Heart Disease

Valvular Heart Disease

Cardiomyopathies

OTHER IMPORTANT COMORBIDITIES

Diabetes Mellitus

Chronic Kidney Disease

Chronic Obstructive Pulmonary Disease

Arrhythmias

Anemia

Frailty

Depression

Cognitive Disorder

EPIDEMIOLOGY

Incidence

Secular Trends

Prevalence

Gender and Racial Differences

Geographical Variability and Global Burden

PROGNOSIS

Mortality

Hospitalization and Health Care Burden

Cost and Financial Burden

Challenges in Underresourced Regions: Health Care Access and Quality of Care

REFERENCES

66 Heart Failure Pathophysiology

INTRODUCTION AND CLASSIFICATIONS

VICIOUS CYCLE OF NEUROHORMONAL ADAPTIVE AND MALADAPTIVE MECHANISMS IN HEART FAILURE WITH REDUCED EJECTION FRACTION

MOLECULAR AND CELLULAR CHANGES

Myocardial Structural Changes and Extracellular Matrix

Molecular Changes in the Failing Heart

β-Receptor Signaling

Calcium Signaling

CARDIAC AND SYSTEMIC METABOLISM WITH DEVELOPMENT OF INSULIN RESISTANCE

HEMODYNAMICS IN HEART FAILURE

REFERENCES

67 Genetics of Cardiomyopathies

INTRODUCTION

DILATED CARDIOMYOPATHY

HYPERTROPHIC CARDIOMYOPATHY

ARRHYTHMOGENIC CARDIOMYOPATHY

ARRHYTHMOGENIC RIGHT VENTRICULAR CARDIOMYOPATHY

ARRHYTHMOGENIC LEFT VENTRICULAR CARDIOMYOPATHY

LEFT VENTRICULAR NONCOMPACTION

RESTRICTIVE CARDIOMYOPATHY

MITOCHONDRIAL GENOME AND NUCLEAR GENES WITH MITOCHONDRIAL FUNCTION AND CARDIOMYOPATHIES

MUSCLE IS MUSCLE: CARDIOMYOPATHY AND SKELETAL MYOPATHY GENES OVERLAP

REFERENCES

68 Heart Failure With Preserved Ejection Fraction

INTRODUCTION

Definition and Guidelines

Epidemiology

Risk Factors

PATHOGENESIS

Underlying Mechanisms and Multisystem Involvement

Cardiac Abnormalities

Pulmonary Hypertension

Role of Peripheral Abnormalities

CLINICAL PRESENTATION

Clinical Symptoms and Associated Comorbidities

Physical Examination

DIAGNOSIS

Diagnostic Testing

Serum Natriuretic Peptides

Metabolic Panel

Electrocardiogram and Chest X-Ray

Echocardiography

Identify Etiology and Rule Out HFpEF Mimickers

MANAGEMENT OF PATIENT WITH HFPEF

Nonpharmacologic Measures

Sodium and Fluid Restriction

Exercise and Weight Loss

Medical and Pharmacologic Approaches

Treatment of Volume Overload and Congestion—Diuretics

Treatment of Hypertension

Treatment of Atrial Fibrillation and Other Underlying Comorbidities

Research and Future Directions

Treatment of Preserved Cardiac Function Heart Failure With an Aldosterone Antagonist or TOPCAT Trial

Prospective Comparison of ARNI With ARB Global Outcomes in HFpEF PARAGON-HF Clinical Trial

Ongoing Trial: PARAGLIDE-HF (Changes in NT-proBNP and Outcomes, Safety, and Tolerability in HFpEF Patients With Acute Decompensated Heart Failure [ADHF] Who Have Been Stabilized During Hospitalization and Initiated In-hospital or Within 30 Days Post-discharge)

Emerging Pharmacotherapy

Selective Inhibitors of the Sodium-Glucose Cotransporter 2 (SGLT-2) Inhibitors—Promising Results

Potential Device-Based Therapies

Left Atrial Pressure Reduction

Pressure Monitoring Devices

REFERENCES

69 Heart Failure With Reduced Ejection Fraction

INTRODUCTION

Epidemiology

Racial Disparities

Hospitalizations

Prognosis and Mortality

Health Care Cost Burden

Etiologies of Heart Failure with Reduced Ejection Fraction

PATHOGENESIS

Neurohormonal Axes

Ventricular Remodeling

Protective Counterregulatory Mechanisms

History and Common Signs and Symptoms

Physical Examination

DIAGNOSIS

Metabolic Laboratory Data

Serum Biomarkers

Electrocardiogram

Imaging

Invasive Testing

MANAGEMENT OF THE PATIENT WITH HEART FAILURE WITH REDUCED EJECTION FRACTION

Therapeutic Targets in Modern Heart Failure Therapy

RECOVERY

RESEARCH AND FUTURE DIRECTIONS

REFERENCES

70 Dilated Cardiomyopathy

INTRODUCTION

Definition and Classifications

Epidemiology

PATHOGENESIS

CLINICAL PRESENTATION AND EVALUATION

History and Physical

DIAGNOSIS

Diagnostic Testing

Echocardiography

Cardiac Magnetic Resonance Imaging

Cardiac Computed Tomography

Nuclear Medicine Imaging

Endomyocardial Biopsy

Genetic Testing

MANAGEMENT OF DILATED CARDIOMYOPATHY

Medical Management

Asymptomatic Left Ventricular Systolic Dysfunction

Symptomatic Left Ventricular Systolic Dysfunction

Device Therapy

Advanced Heart Failure Therapies

SPECIAL CONSIDERATIONS

Genetic/Familial Cardiomyopathy

Cardiac Amyloidosis

AL Amyloidosis

ATTR Amyloidosis

Myocarditis

HIV/Chagas Disease

Toxic Cardiomyopathy

Chemotherapy-Induced Cardiomyopathy

Peripartum Cardiomyopathy

Autoimmune Cardiomyopathy

Arrhythmia-Associated Cardiomyopathy

Tachycardia-Induced Cardiomyopathy

Left Bundle Branch Block-Associated Cardiomyopathy

Premature Ventricular Contractions

Metabolic/Endocrine Causes

FOLLOW-UP PATIENT CARE

REFERENCES

71 Hypertrophic Cardiomyopathy

INTRODUCTION

Epidemiology

Genetic Basis of Hypertrophic Cardiomyopathy

Cardiac Histopathology

Cardiac Physiology

PATHOGENESIS

Primary Effect

Functional Defects

Secondary Molecular Changes

Histologic and Morphologic Phenotypes

Clinical Phenotype

CLINICAL PRESENTATION

Symptoms and Signs

DIAGNOSIS

Electrocardiogram

Echocardiography

Cardiac Magnetic Resonance

Biomarkers

Genetic Testing

Genotype-Phenotype Correlation in Hypertrophic Cardiomyopathy

Differential Diagnosis

PROGNOSIS

MANAGEMENT

Pharmacologic Therapy

Management of Patients at Risk of Sudden Cardiac Death

Management of Left Ventricular Outflow Tract Obstruction

RESEARCH AND FUTURE DIRECTIONS

REFERENCES

72 Restrictive Cardiomyopathies

INTRODUCTION

CARDIAC SARCOIDOSIS

Clinical Presentation: Cardiac Sarcoidosis

DIAGNOSIS: CARDIAC SARCOIDOSIS

Cardiac Magnetic Resonance Imaging: Cardiac Sarcoidosis

F-Fluorodeoxyglucose Positron Emission Tomography Imaging: Cardiac Sarcoidosis

MANAGEMENT: CARDIAC SARCOIDOSIS

CARDIAC AMYLOIDOSIS

Clinical Presentation: Cardiac Amyloidosis

DIAGNOSIS: CARDIAC AMYLOIDOSIS

Diagnostic Testing

Endomyocardial Biopsy

Genetic Testing

MANAGEMENT: AMYLOIDOSIS

Orthotopic Heart Transplant

FABRY CARDIOMYOPATHY

CLINICAL PRESENTATION

DIAGNOSIS: FABRY CARDIOMYOPATHY

MANAGEMENT: FABRY CARDIOMYOPATHY

ENDOMYOCARDIAL FIBROSIS

CLINICAL PRESENTATION AND DIAGNOSTIC TESTING: ENDOMYOCARDIAL FIBROSIS

MANAGEMENT: ENDOMYOCARDIAL FIBROSIS

IRON OVERLOAD CARDIOMYOPATHY

CLINICAL PRESENTATION: IRON OVERLOAD CARDIOMYOPATHY

DIAGNOSIS: IRON OVERLOAD CARDIOMYOPATHY

MANAGEMENT: IRON OVERLOAD CARDIOMYOPATHY

FOLLOW-UP PATIENT CARE

RESEARCH AND FUTURE DIRECTIONS

REFERENCES

73 Myocarditis

INTRODUCTION

Epidemiology

PATHOGENESIS

Infectious Etiologies

Enterovirus

Adenovirus

B19V of the Genus Erythrovirus

Human Immunodeficiency Virus (HIV)

Influenza A and B

COVID-19

Nonviral Pathogens (Bacteria and Parasites)

Noninfectious Etiologies

Drug Toxicity

Chemotherapeutic Agents

Giant Cell Myocarditis and Arrhythmogenic Right Ventricular Cardiomyopathy/Dysplasia

CLINICAL PRESENTATION

DIAGNOSIS

Electrocardiography

Chest Radiography and Biomarkers

Echocardiography and Magnetic Resonance Imaging

Endomyocardial Biopsy

MANAGEMENT OF THE PATIENT WITH MYOCARDITIS

Acute Myocarditis Presenting With Dilated Cardiomyopathy

Tachyarrhythmias and Conduction Abnormalities

Fulminant Myocarditis and Altered Hemodynamics

Immunosuppressive Therapy

Antiviral Therapy

B19V-Related Myocarditis: Intravenous Immunoglobulins, Telbivudine, and Prednisone Plus Azathioprine

FOLLOW-UP PATIENT CARE

RESEARCH AND FUTURE DIRECTIONS

REFERENCES

74 Toxin-Induced Cardiomyopathies

INTRODUCTION

ALCOHOLIC CARDIOMYOPATHY

COCAINE-INDUCED CARDIOMYOPATHY

METHAMPHETAMINE-INDUCED CARDIOMYOPATHY

OTHER DRUG-INDUCED CARDIOMYOPATHIES

MANAGEMENT OF THE PATIENT WITH DRUG-INDUCED CARDIOMYOPATHY

CHEMOTHERAPY-INDUCED CARDIOMYOPATHY

ANTHRACYCLINES

Pathogenesis

Clinical Presentation: Anthracycline Toxicity

Management of Patient with Anthracycline Toxicity

Research and Future Directions

HER2-TARGETED AGENTS: TRASTUZAMAB AND PERTUZUMAB

Epidemiology and Risk Factors: Trastuzumab and Pertuzumab Therapy

Pathogenesis: Trastuzumab and Pertuzumab Toxicity

Diagnosis and Cardiac Monitoring: Trastuzumab and Other HER2-Targeted Agents

Management: Trastuzumab Cardiotoxicity

Research and Long-term Implications of Trastuzumab Cardiotoxicity

OTHER CHEMOTHERAPY

REFERENCES

75 Acute Heart Failure

INTRODUCTION

Epidemiology

Disease Burden, Incidence, and Trends

Hospitalization and Outcomes

Demographics and Risk Factors

PATHOPHYSIOLOGY

Myocardial Injury

Cardiorenal Mechanisms

Vascular Mechanisms

CLINICAL PRESENTATION AND DIAGNOSTIC EVALUATION

Symptoms

Physical Examination

Biomarkers

Radiography, Electrocardiogram, and Echocardiography

MANAGEMENT OF PATIENT WITH ACUTE HEART FAILURE

Triage of Patients With Acute Heart Failure

Clinical Classifications and Profiles

Medical Approach

Respiratory Management for Acute Decompensated Heart Failure

Blood Pressure

Invasive Hemodynamic Monitoring

Volume Status and Decongestion

Electrolyte Management

Pharmacologic Therapy for Acute Decompensated Heart Failure

General Principles

Beta-Blockers

Renin-Angiotensin-Aldosterone System Inhibitor Therapy

Angiotensin Receptor-Neprilysin Inhibitors

Nitrates

Sodium Nitroprusside

Inotropes and Inodilators

Dobutamine

Phosphodiesterase Inhibitors

Vasopressors

Arginine Vasopressin (AVP) Antagonists

Vasodilators

Nonpharmacologic Therapies

Hypertonic Saline

Clinical Trajectories During Hospitalization for ADHF

Decongestion

DISCHARGE AND FOLLOW-UP PATIENT CARE

Predischarge Planning

Rehospitalization Problem

RESEARCH AND FUTURE DIRECTIONS

REFERENCES

76 Chronic Heart Failure Management

INTRODUCTION

GOALS OF CHRONIC HEART FAILURE TREATMENT

PHARMACOLOGIC THERAPY

Diuretics

Angiotensin Converting Enzyme Inhibitors

Angiotensin Receptor Blockers

Angiotensin Receptor Neprilysin Inhibitors

β-Blockers

Mineralocorticoid Receptor Antagonists

Isosorbide Dinitrate and Hydralazine

Ivabradine

Sodium Glucose Cotransporter 2 Inhibitors

Intravenous Iron

Digoxin

Pharmacotherapeutic Approach to Heart Failure

NONPHARMACOLOGIC THERAPIES

RESEARCH AND FUTURE DIRECTIONS

Heart Failure with Preserved Ejection Fraction

FOLLOW-UP PATIENT CARE

REFERENCES

77 Cardiac Electronic Implantable Device Therapy

INTRODUCTION

INDICATIONS

Secondary Prevention

Primary Prevention

Cardiac Resynchronization Therapy

ANATOMIC CONSIDERATIONS

FUNDAMENTALS OF IMPLANTABLE CARDIOVERTER-DEFIBRILLATOR AND CRT IMPLANTATION

Preoperative Preparation

Vascular Access

Pocket Creation

Placement of the Leads

Left Ventricular Lead

Generator Placement

Postprocedural Care

SPECIAL CONSIDERATIONS AND CONTRAINDICATIONS

Contraindications

Noninfectious Complications of Implantation

Infectious Complications

FOLLOW-UP PATIENT CARE

RESEARCH AND FUTURE DEVELOPMENTS IN CRT

REFERENCES

78 Mechanical Circulatory Support

INTRODUCTION

INDICATIONS

Candidate Selection

PREIMPLANTATION CONSIDERATIONS: VALVE DISEASE AND PULMONARY HYPERTENSION

Aortic Valve Disease

Mitral Valve Disease

Tricuspid Valve Regurgitation

Pulmonary Hypertension

OTHER PREIMPLANTATION CONSIDERATIONS: PATIENT COMORBIDITIES

Renal Dysfunction

Hepatic Dysfunction

Obesity

Age, Malnutrition, and Debilitation

Psychosocial Considerations

SURGICAL IMPLANTATION TECHNIQUE

Right Ventricular Assessment

FUNDAMENTALS OF MANAGEMENT

Clinical Assessment

Device Interrogation

Diagnostic Laboratory Tests

Imaging

CHRONIC MANAGEMENT

Neurohormonal Antagonists

Antithrombotic Therapy

Device Therapy

COMPLICATIONS OF LEFT VENTRICULAR ASSIST DEVICES

Neurologic Emergencies

Left Ventricular Assist Device Infection

Gastrointestinal Bleeding

Ventricular Arrhythmias

Heart Failure

Left Ventricular Assist Device Malfunction

Pump Thrombosis

SPECIAL CONSIDERATIONS

Recovery

Transplantation

Palliative Care and Shared Decision Making

FUTURE DIRECTIONS

REFERENCES

SECTION 6: VASCULAR MEDICINE

79 Aortic Diseases

GENERAL INTRODUCTION AORTIC DISSECTION

Epidemiology

Pathogenesis

CLINICAL PRESENTATION

DIAGNOSIS

MANAGEMENT OF PATIENT

MEDICAL VERSUS SURGICAL APPROACH

Percutaneous Intervention

Surgical Approaches

PATIENT FOLLOW-UP CARE

RESEARCH AND FUTURE DIRECTIONS

Plaque Rupture/Penetrating Atherosclerotic Ulcer

Intramural Hematoma

AORTIC ANEURYSM

EPIDEMIOLOGY

PATHOGENESIS OF AORTIC ANEURYSMS

CLINICAL FEATURES OF THORACIC AND ABDOMINAL AORTIC ANEURYSMS

DIAGNOSIS OF THORACIC AND ABDOMINAL AORTIC ANEURYSMS

MANAGEMENT OF AORTIC ANEURYSMS

Approaches to Aortic Aneurysm Repair

FOLLOW-UP OF PATIENTS WITH AORTIC ANEURYSMS

REFERENCES

80 Peripheral Arterial Disease

INTRODUCTION

Epidemiology

Risk Factors

PATHOGENESIS

CLINICAL PRESENTATION

Acute Limb Ischemia

Chronic Limb Ischemia: Intermittent Claudication to Chronic Limb-Threatening Ischemia

Aneurysmal Disease

Iliac Artery Aneurysms

Popliteal Artery Aneurysms

DIAGNOSTIC TESTING IN PERIPHERAL ARTERIAL DISEASE

Ankle-Brachial Index

Pulse Volume Recording

Exercise Ankle-Brachial Index

Arterial Duplex Ultrasound

Computed Tomography Angiogram

Magnetic Resonance Angiogram

Transcutaneous Oxygen Pressure

Skin Perfusion Pressure

Invasive Angiography/Digital Subtraction Angiography

MANAGEMENT OF PERIPHERAL ARTERIAL DISEASE

Medical Approach

Lifestyle, Diet, and Exercise Program

Chronic Limb-Threatening Ischemia

Percutaneous Interventions in Peripheral Arterial Disease

Revascularization Strategy

Surgical Approach—Special Considerations

Operative Risk

Define Bypass Vessels

Conduit Status

RESEARCH AND FUTURE DIRECTIONS

FOLLOW-UP PATIENT CARE

Aneurysms

Chronic Limb Ischemia

REFERENCES

81 Cerebrovascular Disease

INTRODUCTION

PATHOGENESIS

CLINICAL PRESENTATION

Middle Cerebral Artery Stroke

The Anterior Cerebral Artery Stroke

Posterior Cerebral Artery Stroke

Differential Diagnosis of Acute Stroke

Hemorrhagic Stroke

Cardioembolic Stroke

Types of Stroke

DIAGNOSTIC APPROACH

Referral to Stroke Center

Diagnostic Modalities

MANAGEMENT

Medical Approach

Percutaneous Approaches

Surgical Management of Stroke

Acute Medical Management Post a Stroke

Evaluation of Unknown Etiology of Acute Stroke

Secondary Prevention

INTRACRANIAL ANEURYSM

Demographics

Clinical Presentation

Diagnosis

Medical Therapy

Percutaneous and Surgical Approaches

SPECIAL CONSIDERATIONS

RESEARCH AND FUTURE DIRECTIONS

REFERENCES

82 Renal Artery Atherosclerosis

INTRODUCTION

Epidemiology

Risk Factors

PATHOGENESIS

CLINICAL PRESENTATION

Common Signs and Symptoms

Renovascular Hypertension

Ischemic Nephropathy

Cardiac Destabilization Syndromes

Differential Diagnosis

DIAGNOSIS

Doppler Ultrasound Evaluation

Computed Tomographic Angiography

Magnetic Resonance Angiography

Invasive Renal Angiography

MANAGEMENT OF THE PATIENT WITH RENAL ARTERY STENOSIS

Medical Approach

Percutaneous Interventions

Surgical Approach

SPECIAL CONSIDERATIONS

FOLLOW-UP PATIENT CARE

REFERENCES

83 Mesenteric Arterial Disease

INTRODUCTION

Epidemiology

Risk Factors

PATHOGENESIS

CLINICAL PRESENTATION

Common Signs and Symptoms

Physical Examination Findings

Differential Diagnosis

DIAGNOSIS

Acute Mesenteric Ischemia

Chronic Mesenteric Ischemia

MANAGEMENT OF ACUTE MESENTERIC ARTERIAL DISEASE

Medical Approach

Percutaneous Interventional Approaches

Surgical Approaches

MANAGEMENT OF CHRONIC MESENTERIC ISCHEMIA

Medical Approach

Percutaneous Interventional Approaches

Surgical Approaches

SPECIAL CONSIDERATIONS REGARDING MORTALITY

Acute Mesenteric Ischemia

Chronic Mesenteric Ischemia

FOLLOW-UP PATIENT CARE

Follow-up for Acute Mesenteric Ischemia

Follow-up for Chronic Mesenteric Ischemia

RESEARCH AND FUTURE DIRECTIONS

REFERENCES

84 Venous Thromboembolism

INTRODUCTION

PATHOPHYSIOLOGY

NOMENCLATURE

ANATOMIC CONSIDERATIONS

DIAGNOSIS

Clinical Presentation and Laboratory Testing

Noninvasive Imaging

Venography

MANAGEMENT

Medical Approach

Malignancy

Pregnancy

Duration of Medical Therapy

Endovascular Interventions

Percutaneous Approach

Surgical Approach

Venous Thromboembolism Recurrence

Inferior Vena Cava Filters

Long-Term Sequelae

Post-thrombotic Syndrome

SPECIAL CONSIDERATIONS

Superficial Vein Thrombosis

May-Thurner Syndrome

Paget-Schroetter Disease

FOLLOW-UP PATIENT CARE

RESEARCH AND FUTURE DIRECTIONS

REFERENCES

85 Pulmonary Embolism

INTRODUCTION

PATHOGENESIS

CLINICAL PRESENTATION

DIAGNOSIS

MANAGEMENT OF THE PATIENT

SPECIAL CONSIDERATIONS

Pulmonary Embolism Response Teams

Coronavirus Disease 2019 and Pulmonary Embolisms

FOLLOW-UP PATIENT CARE

RESEARCH AND FUTURE DIRECTIONS

REFERENCES

SECTION 7: CARDIOVASCULAR SURGERY

86 Coronary Artery Bypass Grafting

HISTORY/BACKGROUND

INDICATIONS FOR CORONARY ARTERIAL BYPASS GRAFTING

Clinical Indications and Coronary Anatomy Considerations

Special Subgroups

SURGICAL TECHNIQUES

Conduits for Coronary Bypass Grafts

Use of Cardiopulmonary Bypass

Minimally Invasive Approaches

PATIENT RISK ASSESSMENT

LIMITATIONS AND COMPLICATIONS

Limitations of CABG

Complications of Coronary Arterial Bypass Grafting

LONG-TERM OUTCOMES

REOPERATIONS

COMPARISONS WITH MEDICAL THERAPY AND PERCUTANEOUS CORONARY INTERVENTION

Coronary Arterial Bypass Grafting Versus Medical Therapy in Ischemic Cardiomyopathy (the STITCH Trial)

CABG Versus PCI in Patients With Complex Coronary Artery Disease (SYNTAX Trial)

CABG Versus PCI in Patients With Left Main Disease (The EXCEL and NOBLE Trials)

FOLLOW-UP PATIENT CARE

Antiplatelet Therapy

Secondary Prevention Measures—Guideline-Directed Strategies

RESEARCH AND FUTURE DIRECTIONS

REFERENCES

87 Aortic Valve Surgery

INTRODUCTION

INDICATIONS

Aortic Stenosis

Surgical Aortic Valve Replacement Versus Transcatheter Aortic Valve Replacement for Aortic Stenosis

Aortic Regurgitation

Choice of Valve Type

ANATOMIC CONSIDERATIONS

FUNDAMENTALS OF AORTIC VALVE REPLACEMENT

FUNDAMENTALS OF TRANSCATHETER AORTIC VALVE REPLACEMENT

SPECIAL CONSIDERATIONS AND CONTRAINDICATIONS

Small Annulus and Patient-Prosthesis Mismatch

Aortic Root Enlargement

Porcelain Aorta

FOLLOW-UP PATIENT CARE

RESEARCH AND FUTURE DIRECTIONS

REFERENCES

88 Mitral Valve Surgery: A Pathoanatomic Approach

INTRODUCTION

INDICATIONS

ANATOMIC CONSIDERATIONS

FUNDAMENTALS OF MITRAL VALVE SURGERY

CLINICAL ASPECTS OF APPLICATION

LIMITATIONS OF TECHNIQUE OR PROCEDURE

SPECIAL CONSIDERATIONS

RESEARCH AND FUTURE DEVELOPMENTS

REFERENCES

89 Thoracic Aortic Surgery

INTRODUCTION

ANATOMY OF THE AORTA

DEFINITION AND CLASSIFICATIONS OF THORACIC AORTIC DISEASE

PATHOGENESIS

Thoracic Aortic Aneurysms

Incidence and Survival

Aortic Growth Rate and Aortic Events

Aortic Dissection

Epidemiology and Risk Factors

Clinical Presentation: Acute Aortic Dissection

HISTORY OF AORTIC SURGERY

SURGICAL INDICATIONS AND RISK EVALUATION

Perioperative Risk Evaluation

AORTIC ANEURYSM REPAIR

Aortic Root Replacement

Ascending and Proximal Arch Replacement

Transverse Arch Replacement

Descending/Thoracoabdominal Aortic Replacement

Endovascular Thoracic Aortic Repair

PATIENT FOLLOW-UP CARE

RESEARCH AND FUTURE DIRECTIONS

REFERENCES

90 Peripheral Arterial Surgery

INTRODUCTION

Epidemiology

Risk Factors

PATHOGENESIS

CLINICAL PRESENTATION

Common Signs and Symptoms

Physical Examination Findings

Differential Diagnosis

DIAGNOSIS

MANAGEMENT OF PERIPHERAL ARTERIAL DISEASE

Medical Approach

Endovascular Management of Peripheral Arterial Disease

Aortoiliac Occlusive Disease

Infrainguinal Occlusive Disease

Surgical Management of Peripheral Arterial Disease

Endarterectomy

Surgical Arterial Bypass

Aortoiliac Occlusive Disease

Infrainguinal Occlusive Disease—Open Arterial Bypass

SPECIAL CONSIDERATIONS

FOLLOW-UP PATENT CARE

RESEARCH AND FUTURE DIRECTIONS

BASIL Trial

BEST-CLI

Technology

REFERENCES

91 Carotid Artery Revascularization

INTRODUCTION

PATHOGENESIS

CLINICAL PRESENTATION

Asymptomatic Carotid Disease

Symptomatic Carotid Stenosis

Transient Ischemic Attack

Cerebrovascular Accident

Crescendo Transient Ischemic Attack

Stroke-In-Evolution

Transient Monocular Blindness (Amaurosis Fugax)

Jaw Claudication

Aphasia

DIAGNOSIS

Ultrasound

Computed Tomography

Magnetic Resonance Imaging

Arteriography

MANAGEMENT OF THE PATIENT WITH CAROTID ARTERY STENOSIS

Medical Management

Stroke Risk Stratification

Symptomatic Patients

Asymptomatic Patients

Degree of Stenosis

Plaque Character and Progression

Contralateral Disease

Evidence of Clinically Silent Emboli

Patient Selection for Carotid Intervention

Life Expectancy

Age

Sex

Functional Status

Timing of Intervention

Asymptomatic Patients

Combined Coronary and Carotid Disease

Choice of Intervention

CAROTID ENDARTERECTOMY

Preoperative

Intraoperative

Surgical Technique: Carotid Endarterectomy

Complications: Carotid Endarterectomy

CAROTID ARTERY STENTING

Intraprocedural

Periprocedural

Surgical Technique: Carotid Artery Stenting

Transfemoral Access

Transcervical Access

Transbrachial/Transradial Access

Target Lesion Access

Arteriography

Delivery System

Embolic Protection Device Selection

Stent Selection

Complications: Carotid Artery Stenting

TRANSCAROTID ARTERY REVASCULARIZATION

Procedure Details

Short-Term Outcomes and Ongoing Trials

FOLLOW-UP PATIENT CARE

REFERENCES

92 Transplantation and Long-Term Implantable Mechanical Circulatory Support

INTRODUCTION

INDICATIONS

ANATOMIC CONSIDERATIONS

Cardiac Transplantation

Ventricular Assist Device Implantation

FUNDAMENTALS OF ADVANCED HEART FAILURE THERAPIES

CLINICAL APPLICATIONS

Orthotopic Heart Transplantation

Heterotopic Cardiac Transplantation

Combined Heart-Lung Transplantation

Left Ventricular Assist Device Implantation

Right and Biventricular Assist Device Implantation

Total Artificial Heart

LIMITATIONS OF ADVANCED HEART FAILURE THERAPIES

Cardiac Transplantation

Ventricular Assist Device Therapy

SPECIAL CONSIDERATIONS AND CONTRAINDICATIONS

Transplantation

Ventricular Assist Device Therapy

FOLLOW-UP PATIENT CARE

RESEARCH AND FUTURE DIRECTIONS

REFERENCES

93 Surgical Approaches for Common Congenital Heart Diseases

INTRODUCTION AND BACKGROUND

VENTRICULAR SEPTAL DEFECTS

INTRODUCTION

Pathogenesis

Clinical Features: Ventricular Septal Defect

Diagnosis: Ventricular Septal Defect

Electrocardiogram

Chest X-Ray

Echocardiography

Other Studies

MANAGEMENT OF VSD

Medical Management

Timing of Surgery

Surgical Approach

Surgical Approach to Perimembranous VSD or Inlet VSD

Surgical Approach to Supracristal Ventricular Septal Defect

Surgical Approach to Muscular Ventricular Septal Defects (Including Interventional)

SURGICAL RESULTS

FOLLOW-UP PATIENT CARE

FUTURE DIRECTIONS

TETRALOGY OF FALLOT

INTRODUCTION

PATHOGENESIS/EMBRYOLOGY

CLINICAL PRESENTATION, SIGNS AND SYMPTOMS, DIFFERENTIAL DIAGNOSIS

DIAGNOSIS: TETRALOGY OF FALLOT

MANAGEMENT: TETRALOGY OF FALLOT

Medical Approach

Interventional Approaches

Percutaneous Interventional Approaches

SPECIAL ISSUES, CONTROVERSIES, EMERGING THERAPIES: TETRALOGY OF FALLOT

FOLLOW-UP PATIENT CARE: TETRALOGY OF FALLOT

RESEARCH AND FUTURE DIRECTIONS

SINGLE VENTRICLE—HYPOPLASTIC LEFT HEART SYNDROME

INTRODUCTION

PATHOGENESIS AND EMBRYOLOGY: HLHS

CLINICAL PRESENTATION AND CLINICAL SIGNS

Anatomy: Left Heart Obstructive Lesions

DIAGNOSIS: HLHS

MANAGEMENT: HYPOPLASTIC LEFT HEART SYNDROME

Medical Approach

Percutaneous Intervention Approaches

Surgical Approaches: Staged Surgical Palliation

Stage 1 Palliation: Norwood Procedure

Surgical Technique: Norwood Procedure

Follow-Up Patient Care and Subsequent Palliation

FUTURE DIRECTIONS: NORWOOD PROCEDURE

REFERENCES

94 Chest Wall Infections Following Open Heart Surgery

INTRODUCTION

Epidemiology

Risk Factors

PATHOGENESIS

CLINICAL PRESENTATION

Common Signs and Symptoms

Differential Diagnosis

MANAGEMENT OF STERNOTOMY WOUND INFECTION

SURGICAL APPROACH

SPECIAL CONSIDERATIONS (INCLUDING EMERGING THERAPIES)

FOLLOW-UP PATIENT CARE

RESEARCH AND FUTURE DIRECTIONS

REFERENCES

SECTION 8: PREVENTIVE CARDIOLOGY

95 Pathophysiology of Atherosclerosis

INTRODUCTION

STAGES OF PLAQUE FORMATION

Initiation of Atherosclerosis

Progression of Atherosclerotic Plaque

Plaque Stability

Vulnerable Plaque, Plaque Rupture, and Erosion

EPIDEMIOLOGY

RISK FACTORS FOR ATHEROSCLEROSIS

PATHOGENESIS

CLINICAL PRESENTATION

Common Signs and Symptoms

Differential Diagnosis

DIAGNOSIS

MANAGEMENT OF ATHEROSCLEROSIS

Medical Approach

Pharmacologic Approach

Percutaneous Interventions and Surgical Approach

FOLLOW-UP PATIENT CARE

RESEARCH AND FUTURE DIRECTIONS

REFERENCES

96 Cardiovascular Disease Risk Assessment in Clinical Practice

INTRODUCTION

BASIC CONCEPTS AND TARGET POPULATIONS IN ASCVD RISK ASSESSMENT AND MANAGEMENT

Atherosclerotic Cardiovascular Disease Risk Assessment in Primary Prevention

Atherosclerotic Cardiovascular Disease Risk Assessment in Secondary Prevention Patients

CLINICAL RISK SCORES FOR PRIMARY ASCVD PREVENTION

Risk Scores for 10-Year Atherosclerotic Cardiovascular Disease Risk Assessment

Other Approaches for Clinical Risk Assessment Using Risk Scores

IMAGING TOOLS IN PRIMARY PREVENTION SETTINGS

The Coronary Artery Calcium Score

Association With Events During Follow-Up and Prognostic Value Beyond Traditional Risk Factors

Interpretation of Coronary Artery Calcium Scores in Clinical Practice: Combining Absolute and Relative Scores

Coronary Artery Calcium in Primary Prevention Guidelines

Carotid Ultrasound Imaging

Cardiac Computed Tomographic Angiography

OTHER PROPOSED TESTS FOR FURTHER RISK ASSESSMENT IN PRIMARY ASCVD PREVENTION

RISK-ENHANCING FACTORS AND RISK MODIFIERS

RISK ASSESSMENT IN SPECIAL POPULATIONS

Women

Under 40 years age group and over 75 years (elderly)

Low Socioeconomic Status

TOOLS FOR ASCVD RISK ASSESSMENT IN SECONDARY PREVENTION PATIENTS

CLINICIAN–PATIENT RISK DISCUSSIONS AND SHARED DECISION-MAKING

CHALLENGES, EVIDENCE GAPS, AND FUTURE DIRECTIONS

REFERENCES

97 Lifestyle Implementation for Cardiovascular Disease Prevention: A Focus on Smoking Cessation, Diet, and Physical Activity

INTRODUCTION

SMOKING

Cessation Advice/Treatment

Electronic Nicotine Delivery Systems

NUTRITION AND DIET

Dietary Guidelines

Macronutrient Approaches to Optimize Health

Dietary Carbohydrates and Sugars

Dietary Fats

Dietary Protein

Dietary Patterns and Cardiovascular Health

The DASH Diet

The Mediterranean Diet

The Vegetarian Diet

Emerging Dietary Trends

Comparison of Diets

Importance of Nutrition Counseling

PHYSICAL ACTIVITY AND EXERCISE

Sedentary Behavior

Benefits of Physical Activity Relating to CVD and Its Risk Factors

SPECIAL CONSIDERATIONS

Children and Adolescents

Pregnancy

Chronic Medical Conditions and Functional Disability

LIFESTYLE COUNSELING IN CLINICAL PRACTICE

CHALLENGES, EVIDENCE GAPS, AND FUTURE DIRECTIONS

REFERENCES

98 Diabetes and Cardiometabolic Medicine

INTRODUCTION

Epidemiology

Risk Factors

PATHOGENESIS

Type 1 Diabetes Mellitus

Type 2 Diabetes Mellitus

Common Signs and Symptoms

Typical Symptoms of Diabetes

DIAGNOSIS

MANAGEMENT OF PATIENTS WITH DIABETES

Lifestyle Intervention

Glycemic Control

General Therapeutic Plan According to Guidelines

Type 1 Diabetes Mellitus

Type 2 Diabetes Mellitus

Pharmacologic Therapy for Type 1 Diabetes Mellitus

Insulin

Noninsulin Therapy Type 1 Diabetes Mellitus

Pharmacologic Therapy for Type 2 Diabetes Mellitus

Cardiovascular Outcome Trials

Drugs That Lower Cardiovascular Disease Risk

Drugs That Do Not Lower Cardiovascular Disease Risk

FOLLOW-UP CARE AND RESEARCH AND FUTURE DIRECTIONS

Microvascular Complications

Macrovascular Complications

Risk Assessment

Risk-Enhancing Factors

Hypoglycemia

Cardiac Surgery and Glycemic Control

REFERENCES

99 Lipid Disorders

INTRODUCTION

Epidemiology

Risk Factors

PATHOGENESIS

High-Density Lipoprotein-C

Triglyceride-Rich Lipoproteins

Lipoprotein(a)

CLINICAL PRESENTATION

Differential Diagnosis

DIAGNOSIS

MANAGEMENT OF THE PATIENT WITH LIPID DISORDER

Diet and Lifestyle Changes

Medications

Statins

Ezetimibe

Proprotein Convertase Subtilisin/Kexin Type 9 Inhibitors

N-3 Fatty Acids

Percutaneous Intervention Approaches to Lowering Cholesterol

Surgical Approach

SPECIAL CONSIDERATIONS AND EMERGING THERAPIES

Special Considerations

Emerging Therapies

FOLLOW-UP PATIENT CARE

RESEARCH AND FUTURE DIRECTIONS

REFERENCES

100 Hypertension

INTRODUCTION

Epidemiology

Risk Factors

PATHOGENESIS

Genetic Link

Immunologic Role

Psychosocial Stressors

CLINICAL PRESENTATION

Definitions and Guidelines

Accurate Blood Pressure Measurement

Ambulatory Blood Pressure Monitoring

Home Blood Pressure Monitoring

Office-Based Blood Pressure Measurement

CLINICAL PRESENTATION

Signs and Symptoms

DIAGNOSIS

Primary Hypertension

Secondary Hypertension

MANAGEMENT OF THE PATIENT WITH HYPERTENSION

Cardiovascular Risk-Based Treatment Approach

Lifestyle Interventions

Blood Pressure Treatment Targets

Pharmacotherapy

SURGICAL APPROACH AND SPECIAL CONSIDERATIONS

Renal Artery Revascularization

Renal Sympathetic Denervation

FOLLOW-UP PATIENT CARE

RESEARCH AND FUTURE DIRECTIONS

Wearable “Smart” Blood Pressure Devices

Patient Risk Factor Subsets

Resistant Hypertension Procedure-Based Therapies

Health Care Disparities in Certain Populations

Cost Effectiveness of Antihypertensive Medications

Genetics

REFERENCES

101 Cardiac Rehabilitation

INTRODUCTION

INDICATIONS FOR CARDIAC REHABILITATION

Coronary Artery Disease

Peripheral Artery Disease

Postvalve Surgery

Heart Failure and Heart Transplant

FUNDAMENTALS OF CARDIAC REHABILITATION

Supervised Exercise Therapy for Peripheral Arterial Disease

Intensive Cardiac Rehabilitation

EXPECTED BENEFITS AND OUTCOMES OF CARDIAC REHABILITATION

Coronary Heart Disease

Heart Failure and Heart Transplant Outcomes

Intensive versus Traditional CR Outcomes

CONTRAINDICATIONS TO CARDIAC REHABILITATION

LIMITATIONS OF CARDIAC REHABILITATION

Healthcare Access and Socioeconomic Disparities in the United States

Strategies to Improve Cardiac Rehabilitation Utilization

Home-based Cardiac Rehabilitation

REFERENCES

SECTION 9: ADULT CONGENITAL HEART DISEASE

102 Anatomic and Physiologic Classification of Congenital Heart Disease

INTRODUCTION AND CLASSIFICATIONS

CARDIAC POSITION AND AXIS

MORPHOLOGY OF THE CARDIAC SEGMENTS

Atria

Atrioventricular Valves

Ventricles

Great Arteries

SEQUENTIAL SEGMENTAL ANALYSIS

Cardiac Sidedness

Atrioventricular Connections

Ventriculoarterial Connections

Assessment of Associated Lesions

PHYSIOLOGIC CLASSIFICATION OF CONGENITAL HEART DISEASE: CYANOTIC AND ACYANOTIC LESIONS

Acyanotic Congenital Heart Lesions

Cyanotic Congenital Heart Lesions with Decreased Pulmonary Blood Flow

Cyanotic Congenital Heart Lesions with Increased Pulmonary Blood Flow

Cyanotic Congenital Heart Lesions That May Present Decreased or Increased Pulmonary Blood Flow

Congenital Heart Lesions That May Be Cyanotic or Acyanotic

REFERENCES

103 Evaluation of Suspected and Known Adult Congenital Heart Disease

INTRODUCTION

Epidemiology

Risk Factors

Genetic Syndromes

SYNDROMES ASSOCIATED WITH CONGENITAL HEART DISEASE

CLINICAL PRESENTATION

Patient History

Physical Examination

Vital Signs

Four-Limb Blood Pressure

Inspection

Palpation

Auscultation

DIAGNOSTIC TESTING

Chest X-Ray

Electrocardiography

Echocardiography

Cardiac Magnetic Resonance Imaging

Cardiovascular Computed Tomography

Cardiac Catheterization

Cardiopulmonary Exercise Testing

REFERENCES

104 Pregnancy and Reproductive Health in Adult Congenital Heart Disease

INTRODUCTION

PATHOGENESIS

CLINICAL PRESENTATION

DIAGNOSIS

Echocardiography

Computed Tomography

Magnetic Resonance Imaging

Cardiac Catheterization

Exercise Testing

MANAGEMENT OF THE PATIENT WITH ADULT CONGENITAL HEART DISEASE

Overview of Risk Stratification of Pregnant Women With Congenital Heart Disease

Cardiac Disease in Pregnancy Study II (CARPREG II) Risk Score

ZAHARA (Zwangerschap bij vrouwen met een Aangeboren HARtAfwijking-II [translated as “Pregnancy in Women with CHD II Risk Index”]) Risk Score

World Health Organization Classification

Risk Stratification by Defect Complexity

Simple Defects

Moderate Complexity Congenital Heart Disease

Complex Congenital Heart Disease

Management of Cardiac Events in Pregnancy

Contraception, Assisted Reproduction, and Genetics

Male Reproductive Health

FOLLOW-UP PATIENT CARE

RESEARCH AND FUTURE DIRECTIONS

REFERENCES

105 Pharmacologic Therapy for Adult Congenital Heart Disease

INTRODUCTION

PHARMACOKINETICS OF DRUGS IN ADULTS WITH CONGENITAL HEART DISEASE

MEDICAL MANAGEMENT OF ARRHYTHMIA

Pharmacotherapy for Atrial Tachyarrhythmia

Arrhythmia-Specific Considerations

ANTICOAGULATION AND ANTIPLATELET THERAPY

MEDICAL MANAGEMENT OF HEART FAILURE

Biventricular Physiology With a Systemic Left Ventricular and Right Ventricular Dysfunction

Biventricular Physiology With a Systemic Right Ventricle

Single Ventricle Post-Fontan Palliation

Sacubitril-Valsartan

MANAGEMENT OF CYANOSIS

INFECTIVE ENDOCARDITIS

CONTRACEPTION

FUTURE DIRECTIONS

ACKNOWLEDGMENTS

REFERENCES

106 Shunt Lesions

INTRODUCTION

ATRIAL SEPTAL DEFECTS

EPIDEMIOLOGY AND PATHOGENESIS

CLINICAL PRESENTATION AND DIAGNOSIS: ATRIAL SEPTAL DEFECTS

MANAGEMENT: ATRIAL SEPTAL DEFECTS

FOLLOW-UP PATIENT CARE: ATRIAL SEPTAL DEFECTS

VENTRICULAR SEPTAL DEFECTS

EPIDEMIOLOGY AND PATHOGENESIS

CLINICAL PRESENTATION AND DIAGNOSIS: VENTRICULAR SEPTAL DEFECT

MANAGEMENT: VENTRICULAR SEPTAL DEFECT

FOLLOW-UP PATIENT CARE

ATRIOVENTRICULAR SEPTAL DEFECTS

EPIDEMIOLOGY AND PATHOGENESIS

CLINICAL PRESENTATION AND DIAGNOSIS: ATRIOVENTRICULAR SEPTAL DEFECT

MANAGEMENT: ATRIOVENTRICULAR SEPTAL DEFECT

FOLLOW-UP PATIENT CARE: ATRIOVENTRICULAR SEPTAL DEFECT

PATENT DUCTUS ARTERIOSUS

EPIDEMIOLOGY AND PATHOGENESIS

CLINICAL PRESENTATION AND DIAGNOSIS: PATENT DUCTUS ARTERIOSUS

MANAGEMENT: PATENT DUCTUS ARTERIOSUS

FOLLOW-UP PATIENT CARE: PATENT DUCTUS ARTERIOSUS

PARTIAL ANOMALOUS PULMONARY VENOUS CONNECTION

EPIDEMIOLOGY AND PATHOGENESIS

CLINICAL PRESENTATION AND DIAGNOSIS: PARTIAL ANOMALOUS PULMONARY VENOUS CONNECTION

MANAGEMENT: PAPVC

FOLLOW-UP PATIENT CARE: PARTIAL ANOMALOUS PULMONARY VENOUS CONNECTION

GERBODE DEFECT

CORONARY ARTERY FISTULA

SURGICAL SHUNTS

REFERENCES

107 Left-Sided Obstructive Lesions

INTRODUCTION

Epidemiology

Bicuspid Aortic Valve and Valvar Aortic Stenosis

Subvalvular Aortic Stenosis

Supravalvular Aortic Stenosis

Coarctation of the Aorta

Mitral Stenosis

PATHOGENESIS

Bicuspid Aortic Valve and Valvar Aortic Stenosis

Subvalvular Aortic Stenosis

Supravalvular Aortic Stenosis

Coarctation of the Aorta

Mitral Stenosis

CLINICAL PRESENTATION

Bicuspid Aortic Valve and Valvar Aortic Stenosis

Subvalvular Aortic Stenosis

Supravalvular Aortic Stenosis

Coarctation of the Aorta

Mitral Stenosis

DIAGNOSIS

Electrocardiogram

Chest X-Ray

Echocardiogram

Cardiac Catheterization

Cardiac Magnetic Resonance Imaging and Computed Tomography

MANAGEMENT

Medical Approach

Percutaneous Intervention

Bicuspid Aortic Valve and Valvar Aortic Stenosis

Subvalvular Aortic Stenosis, Supravalvular Aortic Stenosis, and Mitral Stenosis

Coarctation of the Aorta

Surgical Approach

Bicuspid Aortic Valve and Valvar Aortic Stenosis

Subvalvular Aortic Stenosis

Supravalvular Aortic Stenosis

Coarctation of the Aorta

Mitral Stenosis

SPECIAL CONSIDERATIONS

FOLLOW-UP PATIENT CARE

RESEARCH AND FUTURE DIRECTIONS

REFERENCES

108 Right-Sided Lesions

INTRODUCTION

DOUBLE-CHAMBERED RIGHT VENTRICLE

PATHOGENESIS AND ASSOCIATED DEFECTS

CLINICAL PRESENTATION

DIAGNOSIS

MANAGEMENT: DOUBLE-CHAMBERED RIGHT VENTRICLE

VALVULAR PULMONARY STENOSIS

CLINICAL PRESENTATION: VALVULAR PULMONARY STENOSIS

DIAGNOSIS: VALVULAR PULMONARY STENOSIS

Echocardiography

Cross-Sectional Imaging

Catheterization

MANAGEMENT: VALVULAR PULMONARY STENOSIS

Medical Therapy and Surveillance

Percutaneous or Surgical Intervention

SPECIAL CONSIDERATIONS: PREGNANCY

SUPRAVALVULAR PULMONARY STENOSIS

PATHOGENESIS AND ASSOCIATED DEFECTS

CLINICAL PRESENTATION: SUPRAVALVULAR PULMONARY STENOSIS

DIAGNOSIS: SUPRAVALVULAR PULMONARY STENOSIS

MANAGEMENT: SUPRAVALVULAR PULMONARY STENOSIS

PULMONARY ATRESIA WITH INTACT VENTRICULAR SEPTUM

PATHOGENESIS

Right Ventricle

Tricuspid Valve

Coronary Arteries

PATHOPHYSIOLOGY

CLINICAL PRESENTATION: PULMONARY ATRESIA WITH INTACT VENTRICULAR SEPTUM

Common Signs and Symptoms

DIAGNOSIS: PULMONARY ATRESIA WITH INTACT VENTRICULAR SEPTUM

MANAGEMENT: PULMONARY ATRESIA WITH INTACT VENTRICULAR SEPTUM

Initial Surgical Palliation

Medical Therapy and Surveillance

Surgical Reintervention

Percutaneous Interventions

SPECIAL CONSIDERATIONS—PREGNANCY IN PULMONARY ATRESIA WITH INTACT VENTRICULAR SEPTUM

EBSTEIN ANOMALY

PATHOGENESIS

Tricuspid Valve

Right Ventricle

Associated Defects

CLINICAL PRESENTATION: EBSTEIN ANOMALY

Differential Diagnosis

DIAGNOSIS: EBSTEIN ANOMALY

Echocardiography

Cardiac Magnetic Resonance Imaging and Computed Tomography

MANAGEMENT: EBSTEIN ANOMALY

Medical Therapy and Surveillance

Surgical Management: Ebstein Anomaly

Percutaneous Interventions: Ebstein Anomaly

SPECIAL CONSIDERATIONS—PREGNANCY IN EBSTEIN ANOMALY

FOLLOW-UP PATIENT CARE

RESEARCH AND FUTURE DIRECTIONS

REFERENCES

109 Complex Lesions

INTRODUCTION

D-TRANSPOSITION OF THE GREAT ARTERIES

D-TGA AFTER ATRIAL SWITCH REPAIR

CLINICAL PRESENTATION

DIAGNOSTIC EVALUATION

MANAGEMENT: D-TGA AFTER ATRIAL SWITCH REPAIR

D-TGA AFTER ARTERIAL SWITCH OPERATION

CLINICAL PRESENTATION

DIAGNOSTIC EVALUATION

MANAGEMENT: D-TGA AFTER ARTERIAL SWITCH OPERATION

D-TGA WITH VENTRICULAR SEPTAL DEFECT AND PULMONIC STENOSIS AFTER RASTELLI OPERATION

CLINICAL PRESENTATION

DIAGNOSTIC EVALUATION

MANAGEMENT

CONGENITALLY CORRECTED TRANSPOSITION OF THE GREAT ARTERIES

CLINICAL PRESENTATION

DIAGNOSTIC EVALUATION

MANAGEMENT: CONGENITALLY CORRECTED TRANSPOSITION OF THE GREAT ARTERIES

FONTAN CIRCULATION

PATHOGENESIS

CLINICAL PRESENTATION, COMPLICATIONS, AND TREATMENT

Congestive Hepatopathy and Protein-Losing Enteropathy

Atrial Arrhythmias and Thromboembolic Events

“Failing Fontan”

HYPOPLASTIC LEFT VENTRICLE SYNDROME

FOLLOW-UP PATIENT CARE

TRUNCUS ARTERIOSUS

PATHOGENESIS

CLINICAL PRESENTATION

DIAGNOSTIC EVALUATION

Management: Truncus Arteriosus

DOUBLE OUTLET RIGHT VENTRICLE

PATHOGENESIS

CLINICAL PRESENTATION

DIAGNOSTIC EVALUATION

MANAGEMENT: DOUBLE OUTLET RIGHT VENTRICLE

FOLLOW-UP PATIENT CARE

REFERENCES

110 Pulmonary Arterial Hypertension Associated With Congenital Heart Disease

CLASSIFICATION OF PULMONARY HYPERTENSION IN CONGENITAL HEART DISEASE

Epidemiology of PAH in CHD

Outcomes of Patients With PAH-CHD

PATHOGENESIS OF PULMONARY VASCULAR DISEASE IN CHD

CLINICAL PRESENTATION

Signs and Symptoms

Physical Examination

Differential Diagnosis

DIAGNOSIS

History and Physical Examination Findings

Electrocardiogram

Chest Radiograph

Computer Tomography

Pulmonary Function Testing

Echocardiography

MANAGEMENT OF PATIENTS WITH PAH-CHD

Prostacyclins

Endothelin Receptor Antagonists

Phosphodiesterase-5 Inhibitors

Guanylate Cyclase Stimulator

Combination Therapy

EISENMENGER SYNDROME

Presentation

Examination

Imaging Studies

SPECIAL CONSIDERATIONS

Hyperviscosity

Noncardiac Surgery

Pregnancy and Contraception

Paradoxical Emboli

Endocarditis

Systemic Vasodilation

Stroke

Prognosis

Treatment

FOLLOW-UP PATIENT CARE

RESEARCH AND FUTURE DEVELOPMENTS

REFERENCES

111 Noncardiac Surgery in Those With Adult Congenital Heart Disease

INTRODUCTION

Cardiac Risk Stratification

PREOPERATIVE EVALUATION AND CONSIDERATIONS

Location of Care

History

Physical Examination

Functional Assessment

Arrhythmia Assessment

Antiplatelet and Anticoagulation Therapy

Preoperative Testing

Laboratory Workup

Imaging

EVALUATION FOR ACQUIRED CARDIAC DISEASE/CORONARY ARTERY DISEASE

Heart Failure

Pulmonary Hypertension

Noncardiac Pathology

Lung

Kidney

Liver

Advanced Directive and Consent

PERIOPERATIVE SPECIAL CONCERNS AND MANAGEMENT

Anesthesia

Endocarditis Prophylaxis

Vascular Access and Intraoperative Monitoring

Electrophysiology Device Management

Fluid Management

Saturation

Laparoscopic Procedures

POSTOPERATIVE PATIENT CARE

HIGHEST RISK PATIENTS AND SPECIAL CONSIDERATIONS

Fontan Palliation

Eisenmenger Syndrome and Severe Pulmonary Hypertension

RESEARCH AND FUTURE DEVELOPMENTS

REFERENCES

Index

 

 

An aparitie	25/01/2022
Autor	Debabrata Mukherjee MD, FACC, Richard Lange, Steve Bailey MD, MSCAI, Ragavendra R. Baliga MD, MBA, Michael Blaha MD, MPH, Biykem Bozkurt MD, PhD, Joaquin E. Cigarroa MD, Mario J. Garcia MD, Michael Jessen MD, ACC, Kalyanam Shivkumar MD, PhD, Karen Stout MD
Dimensiuni	213 x 276 mm
Editura	LWW
Format	Hardcover
ISBN	9781975148218
Limba	Engleza
Nr pag	1100
Versiune digitala	DA