Essentials of Clinical Cardiology

Περιεχόμενα

1. Coronary Artery Disease ……………………………………………………………..1
Atherosclerosis 1
Angina Pectoris 1
Symptoms 1; Physical Findings in Angina 4; Laboratory Studies 5; Predisposing
Factors (Risk Factors) for Coronary Artery Disease 5; Treatment of Angina 6; Medical
Treatment of Angina 7; Things to Remember 8; Interventional Management of
Angina 8; Surgical Management of Angina: Coronary Artery Bypass 8; Acute
Myocardial Infarction and Preinfarction State 9; Diagnosis of Acute Myocardial
Infarction 10; Differential Diagnosis 10
How to Reopen a Thrombosed Coronary Artery? 10
Diagnosis of Acute Myocardial Infarction 11
Discharge Planning 11
Long-Term Management 11
2. Thrombolytic Therapy in Acute Myocardial Infarction ………………..13
Protocol for Therapy 14
Complications 14
Reperfusion Tachycardia 14; Hypotension 15; Bleeding 15; Allergic
Reaction 16
What Happens after Successful Thrombolysis? 16
Residual Lesion 16
Reversal of Atherosclerosis 16
Importance of Collateral Circulation in Coronary Artery Disease 16
Rentrop Classification of Collaterals 17; Therapeutic Measures to Improve
Collaterals 17
Remodeling of Heart 17
Complications of Acute Myocardial Infarction 17
Electrical Complications 17; Mechanical Complications 18; Embolic
Complications 18; Autoimmune Complications 18; Psychological
Complications 18
Killip Classification 18
3. Right Ventricular Infarction ……………………………………………………….20
Diagnosis 20
Treatment 21
Prognosis 22
4. Coronary Artery Disease in Women: A Special Consideration ………23
5. Epidemic of Coronary Artery Disease in Indians: A Special
Consideration ……………………………………………………………………………25
6. The Paradox of Coronary Artery Disease:
Some Answers/Questions …………………………………………………………..28
What are Peroxisome Proliferator-Activated Receptors? 29
What is the Role of Carbohydrates? 29
What is High-Fructose Corn Syrup? 30
Common-Sense Solutions 31

7. Pulmonary Embolism………………………………………………………………..32
Predisposing Factors 32
Symptoms 32
Signs 33
Diagnosis 33
Treatment 34
Prognosis 34
8. Lipid Metabolism ………………………………………………………………………35
Endogenous Source of Cholesterol 35
Exogenous Source 36
Reverse Cholesterol Pathway or High-Density Lipoprotein Pathway 36
Familial Hypercholesterolemia 36
Familial Hypertriglyceridemia 37
Mixed Hyperlipidemia or Familial Combined Hyperlipidemia 37
Low High-Density Lipoprotein or Hypoalphalipoproteinemia 37
Metabolic Syndrome 38
Treatment of Hyperlipidemia 38
Goals 38
Role of Lipoprotein(A) in Atherosclerosis 38
9. Hypertension …………………………………………………………………………….39
Definition 39
Etiology 39
Management 40
Preliminary Investigations 40
Physical Examination 41
Management of Severe Refractory Hypertension 41
Treatment Consideration of Refractory Severe Hypertension 42
Renal Artery Stenosis 42
Treatment of Renal Artery Stenosis 42; Pheochromocytoma 44; Treatment of
Pheochromocytoma is surgical 44
Primary Hyperaldosteronism (Conns Syndrome) 45
Clinical Feature 45; Diagnosis 45; Treatment 45
Cushings Syndrome 45
Signs and Symptoms 46; Diagnosis 46; Some of the conditions of which physician
must be aware of 46
10. Primary Pulmonary Hypertension ……………………………………………..47
Definition 47
Symptoms 47
Signs 47
Diagnosis 47
Causes 48
Treatment 48
11. Congestive Heart Failure ……………………………………………………………49
Definition 49
Causes 49
Symptoms and Signs 50
Compensatory Changes 50
Physical Findings 50
Determinants of Cardiac Output 51
Investigations and Management 52
Acute Management 52; Cardiac Remodeling 54; Mid-Range
Management 54; Long-Term Management 54

Prognosis 54
Cardiomyopathies 54
Differential Diagnosis 55
12. Hypertrophic Obstructive Cardiomyopathy ………………………………..56
Clinical Features 56
Diagnosis 57
Treatment 57
Medical 57; Surgical 58
13. Acute Circulatory Collapse (Shock)…………………………………………….59
Definition 59
Hinshaw and Cox Classification 59
Cardiogenic Shock (Vasoconstricted Shock) 59; Septic Shock (Endotoxic Shock,
Vasodilated Shock or Distributive Shock) 59; Hypovolemic Shock 59; Obstructive
Shock 60
Pathophysiology of Shock 60
Goals of Management 60
Drug Therapy 60
14. Atrial Arrhythmia ……………………………………………………………………..62
Atrial Fibrillation 64
Origin of Atrial Fibrillation 64; Classification of Atrial
Fibrillation 64; Rate Control 65; Rhythm Control 65; Ablation
Therapy for Atrial Fibrillation 66; Surgical Correction (Maze
Procedure) 66; Thromboembolism in Atrial Fibrillation 66; Special
Consideration 67; Symptoms 67; Diagnosis 68; Investigations 68; Standard
Protocol for Managing Atrial Fibrillation 68
Paroxysmal Atrial Tachycardia: Atrioventricular Node Reentrant
Tachycardia 68
Symptoms 69; Treatment 69
Atrial Flutter 69
Diagnosis 70; Treatment 70
15. Ventricular Arrhythmia ……………………………………………………………..72
Premature Ventricular Contractions 72
Causes 72; Symptoms 72; Investigations 72; Treatment 72
Ventricular Tachycardia 73
Accelerated Idioventricular Rhythm 73; Monomorphic Ventricular
Tachycardia 73; Polymorphic Ventricular Tachycardia 73; Torsades De
Pointes 74
Arrhythmogenic Right Ventricular Dysplasia/Cardiomyopathy 77
16. Artificial Pacemakers ………………………………………………………………..80
Restrictions 83
Pacemaker Mediated Tachycardia 84
Biventricular Pacing (Cardiac Resynchronization Therapy) 84
17. Rheumatic Fever ……………………………………………………………………….85
Diagnosis 85
Major Criteria 85; Minor Criteria 85
Treatment 86
18. Valvular Heart Disease ………………………………………………………………87
Mitral Stenosis 87
Symptoms 87; Signs 87; Diagnosis 88; Treatment 90

19. Mitral Regurgitation………………………………………………………………….92
Causes 92
Symptoms 92
Signs 93
Diagnosis 93
Indications for Valve Replacement 94
Treatment of Nonsurgical Mitral Regurgitation 94
20. Mitral Valve Prolapse Syndrome (Barlows Syndrome) ……………….95
Anatomical Defect in Mitral Valve Prolapse 95
Autonomic Instability in Mitral Valve Prolapse 95
Psychosomatic Component of Mitral Valve Prolapse 95
Typical Body Habitus 96
Signs 96
Diagnosis 96
Treatment 97
21. Valvular Aortic Stenosis …………………………………………………………….98
Symptoms 99
Signs 99
Diagnosis 99
Treatment 100
22. Aortic Regurgitation ………………………………………………………………..101
Etiology 101
Symptoms 101
Signs 101
Diagnosis 102
Treatment 102
23. Tricuspid Valve Disorders ………………………………………………………..103
Tricuspid Regurgitation 103
Causes 103; Diagnosis 103; Treatment 103
Ebsteins Anomaly 103
Carcinoid Syndrome 104
Pulmonary Valve Disorders 104
24. Congenital Heart Defects ………………………………………………………….105
Atrial Septal Defect 105
Types of Atrial Septal Defects 106
Hemodynamic Consequences of Atrial Septal Defects 106
Symptoms 107
Physical Findings 108
Fixed splitting of S2 108; Echocardiography 108; Right Heart Catheterization 108
Treatment 109
Patent Foramen Ovale 110
Ventricular Septal Defect 110
Diagnosis 111; Treatment 112
25. Bacterial Endocarditis ……………………………………………………………..113
General Consideration 113
Signs and Symptoms 114
Diagnosis 114
Major criteria 114; Minor criteria 114
Treatment 116
Prognosis 116
Prophylaxis 117

26. Pericardial Diseases…………………………………………………………………118
Acute Pericarditis 118
Causes 118; Symptoms 118; Signs 119; Diagnosis 119; Treatment 119
Pericaridial Effusion 119
Clinical Signs 119; Treatment 121
Constrictive Pericarditis 122
Diagnosis 122; Treatment 122
27. Diseases of the Aorta ………………………………………………………………..123
Aortic Dissection 123
Classification 123; Signs and Symptoms 123; Diagnosis 124; Treatment 124;
Causes 124; Group B Dissection 125
Coarctation of the Aorta 125
Basic Embryology 125; Clinical Signs 125; Diagnosis 125; Treatment 125
28. Pregnancy and Heart Disease …………………………………………………..126
Gestational Hypertension 126
Treatment Considerations 127
Postpartum Cardiomyopathy 127
Anticoagulation Therapy in Pregnancy 127
29. Heart Transplant ……………………………………………………………………..128
Complications 128
Follow-Up 129
30. Cardiac Tumors……………………………………………………………………….130
Primary Tumors of the Heart: Atrial Myxoma 130
Symptoms 130
Diagnosis 130
Treatment 131
Secondary Tumors of the Heart 131
31. Depression in Post-Myocardial Infarction and Post-Coronary
Artery Bypass Graft Patients …………………………………………………….132
32. Miscellaneous Topics ……………………………………………………………….133
Oxygen Dissociation Curve 133
Doppler Equation 133
Potassium and the Electrocardiography 135
Cardiac Electrophysiology: Action Potential 135
33. Exercise Electrocardiographic Testing ………………………………………139
Background 139
Indications 139
Contraindications 139
Procedure 140
Interpretation 141
Factors Influencing Interpretation 142
Complications 142
34. Nuclear Imaging in Cardiology: An Overview …………………………….144
Indications 144
Equipment 144
Techniques 144
Radioisotopes (Radiopharmaceuticals) 145
Image Interpretation 146

35. Evaluation of Syncope ……………………………………………………………..148
Definition 148
Evaluation of Vasovagal Syncope (Neuromediated Syncope) 148
Tilt Table Test Protocol 148; Baseline Study 148
Pathophysiology 149
Interpretation 150
Treatment 150
36. Heart Catheterization: Basic Principles …………………………………….151
Right Heart Catheterization 151
Technique 151; Complications 154
Left Heart Catheterization 155
Introduction 155; Procedure 156; Access Site 156; Complications 159
37. Hemodynamic Data, Calculation of Shunts and
Valvular Stenosis ……………………………………………………………………..161
Normal Values and Formulae 161
Calculation for Left-to-Right Shunt 161
Calculation of Aortic Valve Area 162
Calculation of Mitral Valve Area 163
38. Risk Assessment in Noncardiac Surgical Procedures ………………….164
Factors that Predispose Patient to High Risk 164
Risky Procedure 165
How Do You Proceed? 165
How to Deal with Pacemakers and Implantable Cardiac Defibrillators? 165
How to Deal with Uncontrolled Hypertension? 166
How to Deal with Patients with Hypertrophic Cardiomyopathy? 166
39. Stem Cell Therapy ……………………………………………………………………167
Background 167
Introduction 167
Components of Adipose Tissue 168
Stem Cell Therapy in Heart Disease 168
40. Sudden Cardiac Death and Genomics ……………………………………….170
Background 170
How do Genes Affect Sudden Cardiac Death? 171
Remember these Seven Causes of SCD in Young Athletes (SCDY) 171
41. Application of Genetics and Genomics to Cardiovascular
Disease ……………………………………………………………………………………173
Coronary Artery Disease 174
Arrhythmias 174
Epilogue ………………………………………………………………………………………………177
Index …………………………………………………………………………………………………..179