Executive Editor: Rebecca Gaertner Senior Product Development Editor: Kristina Oberle Production Project Manager: Marian Bellus Marketing Manager: Stephanie Manzo Senior Manufacturing Manager: Beth Welsh Design Coordinator: Teresa Mallon Editorial Coordinator: Katie Sharp Production Service: Integra Software Services Pvt Ltd Third Edition © 2014 by Department of Medicine, Washington University School of Medicine Second Edition, © 2009 by Department of Medicine, Washington University School of Medicine First Edition, © 2004 by Department of Medicine, Washington University School of Medicine Printed in China All rights reserved This book is protected by copyright No part of this book may be reproduced or transmitted in any form or by any means, including as photocopies or scanned-in or other electronic copies, or utilized by any information storage and retrieval system without written permission from the copyright owner, except for brief quotations embodied in critical articles and reviews Materials appearing in this book prepared by individuals as part of their official duties as U.S government employees are not covered by the above-mentioned copyright To request permission, please contact Lippincott Williams & Wilkins at Two Commerce Square, 2001 Market Street, Philadelphia, PA 19103, via email at permissions@lww.com, or via our website at lww.com (products and services) 987654321 Library of Congress Cataloging-in-Publication Data The Washington manual cardiology subspecialty consult / editors, Phillip S Cuculich, Andrew M Kates, Thomas M De Fer — Third edition p ; cm — (Washington manual subspecialty consult series) Cardiology subspecialty consult Includes bibliographical references and index ISBN 978-1-4511-1422-5 I Cuculich, Phillip S., editor of compilation II Kates, Andrew M., editor of compilation III De Fer, Thomas M., editor of compilation IV Title: Cardiology subspecialty consult V Series: Washington manual subspecialty consult series [DNLM: Cardiovascular Diseases—Handbooks Cardiology—methods—Handbooks WG 39] RC667 616.1'2—dc23 2014003539 The Washington Manual™ is an intent-to-use mark belonging to Washington University in St Louis to which international legal protection applies The mark is used in this publication by LWW under license from Washington University Care has been taken to confirm the accuracy of the information present and to describe generally accepted practices However, the authors, editors, and publisher are not responsible for errors or omissions or for any consequences from application of the information in this book and make no warranty, expressed or implied, with respect to the currency, completeness, or accuracy of the contents of the publication Application of this information in a particular situation remains the professional responsibility of the practitioner; the clinical treatments described and recommended may not be considered absolute and universal recommendations The authors, editors, and publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accordance with current recommendations and practice at the time of publication However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any change in indications and dosage and for added warnings and precautions This is particularly important when the recommended agent is a new or infrequently employed drug Some drugs and medical devices presented in this publication have Food and Drug Administration (FDA) clearance for limited use in restricted research settings It is the responsibility of health care providers to ascertain the FDA status of each drug or device planned for use in their clinical practice We dedicate this book to the many people who influence us: our wives, children, teachers, students, and patients We thank you for inspiring us, teaching us and keeping us humble —PSC & AMK Ratin g Scheme fo r the Stren gth o f the Reco mmen datio n s Class I: Conditions for which there is evidence and/or general agreement that a given procedure or treatment is beneficial, useful, and effective Class II: Conditions for which there is conflicting evidence and/or a divergence of opinion about the usefulness/efficacy of a procedure or treatment Class IIa: Weight of evidence/opinion is in favor of usefulness/efficacy Class IIb: Usefulness/efficacy is less well established by evidence/opinion Class III: Conditions for which there is evidence and/or general agreement that a procedure/treatment is not useful/effective and in some cases may be harmful Ratin g Scheme fo r the Stren gth o f the Eviden ce Level of Evidence A: Data derived from multiple randomized clinical trials or meta-analyses Level of Evidence B: Data derived from a single randomized trial or nonrandomized studies Level of Evidence C: Only consensus opinion of experts, case studies, or standardof-care Gibbons RJ, Smith S, Antman E American College of Cardiology/American Heart Association clinical practice guidelines: Part I: where they come from? Circulation 2003;107:2979-2986 Su zan n e V Arn o l d AdjunctAssistantPro fesso r o f Medicine Departmento f I nternal Medicine Cardio vascular Divisio n Washingto n University Scho o l o f Medicine St Louis, Misso uri Rich ard G B ach Asso ciate Pro fesso r o f Medicine Departmento f I nternal Medicine Cardio vascular Divisio n Washingto n University Scho o l o f Medicine St Louis, Misso uri Al o k B ach u w ar Clinical Fello w Departmento f I nternal Medicine Cardio vascular Divisio n Washingto n University Scho o l o f Medicine St Louis, Misso uri Su desh n a B an erjee Clinical Fello w Departmento f I nternal Medicine Cardio vascular Divisio n Washingto n University Scho o l o f Medicine St Louis, Misso uri Preben B jerregaard Clinical Fello w Departmento f I nternal Medicine Cardio vascular Divisio n Washingto n University Scho o l o f Medicine 10 parchment heart, 205 pulmonary arterial hypertension, 206f pulmonary embolism, 205 right heart failure (RHF), 205 right ventricular dysplasia, 205 classification of, 203t–204t pathophysiology, 202 definition of, 202 pulmonary artery capillary wedge pressure (PCWP), 202 diagnosis of, 206–209 antinuclear antibody (ANA), 207 atrial septal defects (ASD), 208 B-type natriuretic peptide (BNP), 207 diagnostic testing, 206 exertional dyspnea, 206 extractable nuclear antigens (ENA), 207 heart dysfunction, 206 hemoglobin electrophoresis, 207 hepatojugular reflux, 206 hypoventilation syndrome, 207 lower extremity edema, 206 LV end-diastolic pressure (LVEDP), 209 nocturnal oximetry, 208 parenchymal lung disease, 206 pulmonary angiography, 208 pulmonary artery systolic pressure (PASP), 207 pulmonary function testing (PFT), 208 pulmonary vascular resistance (PVR), 209 radiography, 206 right heart catheterization (RHC), 208 scleroderma, 206 systolic tricuspid, 206 transesophageal echocardiography (TEE), 208 transthoracic echocardiography (TTE), 207 tricuspid annular plane systolic excursion (TAPSE), 208 ventilation-perfusion (V/Q), 208 epidemiology of, 202 antiphospholipid syndrome, 204 chronic osteomyelitis, 204 chronic thromboembolic pulmonary hypertension (CTEPH), 204 heart failure with preserved ejection fraction (HFpEF), 202 hypoventilation syndromes, 204 hypoxemia, 204 idiopathic PAH (IPAH), 202 idiopathic pulmonary fibrosis, 204 inflammatory bowel disease, 204 interstitial lung disease, 204 left ventricular (LV), 202 liver transplantation, 202 obstructive sleep apnea (OSA), 204 715 portal hypertension, 202 pulmonary arteries/veins, 204 pulmonary emboli (PE), 204 systemic sclerosis population, 202 medications of, 211–212 nonpharmacologic therapies, 212 vasomodulator/vasodilator therapy, 211 nonpharmacologic therapies, 212 pathophysiology of activin-like kinase receptor (ALK 1), 204 platelet inhibitors, 205 proliferative vasculopathy, 205 pulmonary vascular resistance (PVR), 205 right ventricle (RV), 205 treatment of, 209–213 heart-lung transplantation, 213 nonsteroid anti-inflammatory drugs (NSAIDs), 209 pulmonary thromboendarterectomy, 209 ventricular failure, 210f Pulmonary vascular resistance (PVR), 67, 205, 209 Pulmonary vein isolation (PVI), 324 Pulmonary veins (PVs), 314 Pulmonic stenosis (PS), 10 Pulse pressure (PP), Q QT syndromes, 326–337 interval, acquired prolongation, 334–335 common medications for, 334t effects, 334 quinidine, 334 torsades de pointes, 334 long QT syndromes (LQTSs), 327–332 short QT syndrome (SQTS), 335–337 R Renal artery stenosis causes of, 346t diagnosis of, 347 angiotensin receptor blocker (ARB), 347 catheter angiography, 347 clinical presentation, 347 duplex ultrasonography, 347 epidemiology of, 345 etiology of, 345 fibromuscular dysplasia (FMD), 345, 346f pathophysiology of, 346 renin–angiotensin system, 346 treatment of 716 renovascular hypertension, 347 risk modification, 348 surgical management, 347–348 Renin-angiotensin-aldosterone system (RAAS), 150, 168 Restrictive cardiomyopathy, 174–175, 198, 199t, 455 Right atrial enlargement (RAE), 18, 248 Right atrium (RA), 66 Right axis deviation (RAD), 18 Right bundle branch block (RBBB), 299 Right coronary artery (RCA), 123, 273, 288 Right heart failure (RHF), 205 Right ventricular (RV), 5, 64, 123, 205 S Salmonella, 356 Secondary prevention cardiac rehabilitation, 146–147 coronary artery bypass grafting, 146 coronary intervention, 146 hormone replacement therapy, 146 patients with CHD, 147t lipid management, 144 acute coronary syndromes, 146 AHA/ACC of, 145t–146t atherosclerotic disease, 146 Serum protein electrophoresis (SPEP), 153 Short QT syndrome (SQTS), 335–337 definitions of, 335–336 diagnosis of, 336–337 clinical presentation of, 336 ventricular tachyarrhythmia, 336 epidemiology of, 336 etiology of, 336 chronic fatigue syndrome, 336 hypercalcemia, 336 lead II in, 335f pathophysiology of, 335–336 treatment of, 337 flecainide and propafenone, 337 quinidine, 337 Sick sinus syndrome (SSS), 315, 458 Single-photon emission computed tomography (SPECT), 369 Stable angina, 86–98 cardiac stress adenosine, 91 bradycardia, 91 bronchospasm, 91, 92 echocardiography, 92 left bundle branch block (LBBB), 91 717 myocardial perfusion, 91 pharmacologic, 91 regadenoson, 91 ventricular pacing, 91 causes of, 87–93 aortic stenosis as, 88 cocaine as, 88 congenital anomalies as, 88 coronary artery ectasia as, 88 hypertrophic cardiomyopathy as, 88 myocardial bridge as, 88 Prinzmetal angina as, 88 radiation therapy as, 88 syndrome X as, 88 classification of myocardial infarction (MI), 86 definition of, 86 anginal equivalent, 86 atypical, 86 Stable angina (continued) coronary artery disease (CAD), 86 noncardiac chest pain, 86 typical, 86 diabetes as, 87 diagnosis of, 87–93 abdomen, 88 aortic stenosis, 88 cardiac, 88 chest discomfort, 87 cocaine, 88 congenital cardiac anomalies, 88 coronary arteritis, 88 coronary artery disease in, 87t coronary artery ectasia, 88 coronary disease, 88 hypertrophic cardiomyopathy, 88 ischemic cardiac disease, 87 myocardial bridge, 88 myocardial disease, 88 pericardial disease, 88 physical examination, 88 Prinzmetal angina, 88 radiation arteriopathy, 88 syndrome X, 88 testing for, 88–93 epidemiology of coronary heart disease (CHD), 86 evaluation of, 88–93 with biochemical markers, 88 with Bruce protocol, 89 with stress testing, 89–92 follow-up, 96–97 718 hypertension as, 87 nonpharmacologic therapies CABG for, 96 chelation therapy, 96 coronary artery dissection, 96 enhanced external counterpulsation (EECP), 96 LV dysfunction, 96 PCI for, 95 percutaneous transluminal coronary angioplasty (PTCA), 95 transmural endomyocardial channels, 96 transmyocardial laser revascularization, 96 pathophysiology of, 86–87 heart rate (HR), 86 myocardial oxygen, 86 patient history of, 87–88 physical exams for, 88 risk factors for, 87 testing for acute coronary syndrome (ACS), 88 acute MI, 90 anginal symptoms, 89 asymptomatic disease, 93 Bruce protocol, 89 calcium channel blockers (CCBs), 90 cardiac arrhythmias, 90 cardiac stress, 90–92 causes of chest pain, 89t coronary angiography, 93 coronary artery bypass grafting (CABG), 92 coronary revascularization, 90 Duke treadmill score (DTS), 89, 90t elderly stress, 92 electrocardiography, 89 exercise stress, 89–90 imaging of, 89 LV hypertrophy (LVH), 89 pharmacologic testing, 92 specific populations, 92 ST-segment depression, 89 T-wave inversion, 89 vasodilator-mediated stress, 92 women stress, 92 tobacco use as, 87 treatment of, 93–96 angiotensin converting enzyme (ACE), 95 aspirin, 93 beta blockers, 93–94 cardiomyocyte sodium ion, 95 cardiovascular events, 93 CCB, 94 719 cholesterol-lowering agents, 95 chronic obstructive pulmonary disease (COPD), 94 chronic stable angina, 95 clopidogrel, 93 dihydropyridines, 94 epicardial coronary arteries, 94 inflammatory-mediated process, 95 medical, 93–95 nitrates, 94 nonpharmacologic therapies, 95–96 ranolazine, 95 revascularization as, 95–97 Standard imaging and diagnostic testing modalities, 369–380 definitions of, 369 acute coronary syndromes, 375 acute myocardial infarction, 375 anterolateral wall, 373 breast tissue, 373 chest pain syndromes, 374 coronary artery disease (CAD), 373 electrocardiogram (ECG), 374 18-fluorodeoxyglucose (FDG), 376 left ventricle, 369, 372f, 375 multi-vessel disease, 373 myocardial infarction (MI), 375 myocardial perfusion imaging (MPI), 369 myocardial viability, 376 peri-infarct ischemia, 373 positron emission tomography (PET), 376 radiotracers, 369 single-photon emission computed tomography (SPECT), 369 transient ischemic dilatation (TID), 373 indications of, 377–378 acute coronary syndrome (ACS), 377 adenosine, 377 left bundle branch block (LBBB), 377 methylxanthines, 377 peripheral vascular disease, 377 pulmonary disease, 377 Staphylococcus, 356 STEMI See ST-segment elevation myocardial infarction (STEMI) Streptococcus, 356 ST-segment elevation myocardial infarction (STEMI), 30, 49, 117–132 acute coronary syndromes (ACS), 117 cardiac biomarkers, 117 classification of, 117 clinical presentation cardiogenic pulmonary edema, 120 chest discomfort, 118 percutaneous coronary intervention (PCI), 119 720 physical examination, 120 thrombolytic therapy, 119t ventricular septal defect (VSD), 120 complications of, 127–131 angiotensin converting enzyme (ACE), 131 arrhythmias, 130 atrioventricular (AV), 130 bradycardias, 130 cardiogenic shock, 129 Dressler syndrome, 130 free wall rupture, 129 intraaortic balloon pump (IABP), 130 LV thrombus, 131 nonsteroidal antiinflammatory drugs (NSAIDs), 130 papillary muscle rupture, 130 post-MI pericarditis, 130 prophylactic antiarrhythmic, 130 pseudoaneurysm, 129 pulmonary artery (PA), 130 RV Infarct, 130 ventricular aneurysm, 131 ventricular fibrillation (VF), 130 ventricular tachycardia (VT), 130 VSD, 129 diagnosis of, 118–124 chest pain, 120 clinical presentation, 118–120 Forrester classification, 120, 121t Killip classification, 120, 121t life-threatening, 120 pulmonary capillary wedge pressure (PCWP), 120 risk stratification, 120 testing for, 120–124 thrombolysis in myocardial infarction (TIMI), 120 thrombolytic therapy, 120 early adjunctive therapy beta blockers, 124 clopidogrel, 124 glycoprotein IIb/IIIa inhibitors, 125 low-molecular-weight heparin, 124 magnesium, 124 morphine, 124 thrombin inhibitors, 124 electrocardiogram (ECG), 117 epidemiology of, 117 etiology of preexisting coronary plaque, 118 ischemic symptoms, 117 myocardial infarction (MI), 117 myocardial necrosis, 117 myocyte cell death, 117 721 non-ST-segment elevation myocardial infarction (NSTEMI), 117 pathophysiology of, 118 atheromatous plaque, 118 fibrin-rich red thrombus, 118 plaque erosion, 118 plaque rupture, 118 reperfusion of bleeding risk, 127 cardiogenic shock, 126 complicated STEMI management, 126 congestive heart failure (CHF), 126 coronary artery bypass grafting (CABG), 126 decision making for, 125 infarct-related vessel, 127 intracerebral hemorrhage (ICH), 127 ST-segment elevation myocardial infarction (STEMI) (continued) myocardial salvage, 125 primary PCI, 126–127 rescue PCI, 126 thrombolytic agents, 128t thrombolytic/fibrinolytic therapy, 126, 127 tissue plasminogen activator (tPA), 127 testing for cardiac biomarkers, 120 chest radiograph (CXR), 123 ECG leads, 122t electrocardiogram, 121–123 imaging, 123–124 left anterior descending (LAD), 123 left circumflex artery, 122, 123 myocardial necrosis, 121 posterior MI, 123 pulmonary edema, 123 right coronary artery (RCA), 123 right ventricular (RV), 123 Sgarbossa criteria, 123 ST-segment elevation (STE), 122 TIMI risk score, 122t T waves, 121 treatment of, 124–129 early adjunctive therapy, 124–125 reperfusion of, 125–129 ST-segment elevation (STE), 122 Sublingual (SL), 107 Sudden cardiac death, 301–313 abnormalities associated with, 303t–304t antiarrhythmic drug (AAD), 305 arrhythmogenic right ventricular cardiomyopathy (ARVC), 308 atherosclerotic medications, 307 biologic model of, 304f 722 bradyarrhythmias, 301 Brugada syndrome, 309 cardiac amyloidosis, 309 cardiac-related deaths, 301 cardiac sarcoidosis, 308 cardiopulmonary resuscitation (CPR), 309 commotio cordis, 309 diagnosis of, 310 biologic death, 310 cardiac arrest, 310 cardiac biomarker, 310 prodrome, 310 testing for, 310 transthoracic echocardiography, 310 electrophysiologic study (EPS), 305 etiology of, 302f event rates of, 302f hypertrophic cardiomyopathy (HCM), 308 implantable cardioverter-defibrillators (ICDs), 305 ischemic cardiomyopathy (ICM), 305 myocardial infarction (MI), 305 nonischemic cardiomyopathies (NICMs), 301, 307 primary electrical abnormalities, 309 risk factors, 305 left ventricular ejection fraction (LVEF), 305 left ventricular hypertrophy (LVH), 305 premature ventricular contractions (PVCs), 305 treatment of, 310–312 acute management, 310 Advanced Cardiac Life Support (ACLS), 311 amiodarone, 311 beta blocker, 311 catheter ablation, 312 ICDs, 311 lidocaine, 311 long-term management, 311 IV magnesium, 311 type of, 306t–307t ventricular arrhythmias, 301 ventricular fibrillation (VF), 301 ventricular tachycardia (VT), 301 Superior vena cava (SVC), 418 Supraventricular tachycardia (SVT), 52 Syncope approach, 40–48 clinical presentation blood pressure (BP), 43 cardiac etiology, 43 cerebrovascular accident, 44 electrocardiogram (ECG), 40 heart rate (HR), 43 723 history of, 43 nonsyncopal TLOC, 41t orthostatic syncope, 43 physical examination, 43–44 presentations of, 41t–42t transient ischemic attack (TIA), 44 definition of, 40 nonsyncopal etiologies, 40 transient loss of consciousness (TLOC), 40 diagnosis of, 40–46 clinical presentation, 40–44 testing of, 44–46 epidemiology of, 40 etiology of, 40 cardiopulmonary disease, 40 neurally mediated, 40 orthostatic, 40 primary cardiac arrhythmias, 40 structural cardiac, 40 evaluation of, 43t, 45f medications acute renal failure, 46 beta blockers, 46 carotid artery disease (CAD), 46 fludrocortisone, 46 midodrine, 46 orthostatic hypotension, 46 peripheral arterial disease, 46 treatment of, 47t prognosis of, 47–48 left ventricular (LV), 48 orthostatic hypotension, 48 reflex syncope, 48 testing of ambulatory cardiac, 44 American College of Cardiology (ACC), 44 American Heart Association (AHA), 44 arrhythmogenic right ventricular dysplasia (ARVD), 44 cardiac catheterization, 44 echocardiogram, 44 electrocardiography of, 44 electrophysiology studies (EPS), 46 hypertrophic cardiomyopathy (HCM), 44 imaging of, 44–46 reflex-mediated, 46 tachyarrhythmias, 44 treatment of, 46–47 medications, 46–47 nonpharmacologic therapies, 47 preventing recurrences, 46 724 risk modification, 47 Systemic coronary risk evaluation (SCORE), 135 Systemic vascular resistance (SVR), 67 Systolic anterior motion (SAM), 177 Systolic blood pressure (SBP), Systolic heart failure abnormal cardiac function, 149 arrhythmias, 152 beta blocker therapy, 163 cardiac dysfunction, 149 cardiac transplantation, 164 classification of, 149, 150f diastolic dysfunction, 149 systolic dysfunction, 149 diagnosis of, 152–154 acute coronary syndrome, 153 antineutrophil cytoplasmic antibody (ANCA), 153 antinuclear antibody (ANA), 153 brain natriuretic peptide (BNP), 153 cardiac biomarkers, 153 cardiac MRI, 154 chest radiography (CXR), 153, 154 diuretic therapy, 154 electrolyte abnormalities, 153 empiric inotrope, 154 Framingham criteria, 153 left bundle branch block (LBBB), 154 left ventricular hypertrophy (LVH), 154 myocardial ischemia, 153 pulmonary artery catheter, 154 pulmonary artery (PA), 154 serum protein electrophoresis (SPEP), 153 transthoracic echocardiogram (TTE), 154 urine protein electrophoresis (UPEP), 153 hospital care, 164 ischemic cardiomyopathy (ICM), 150 left ventricular (LV), 149 myocardial infarction (MI), 150 myocardial injury, 150 nonischemic cardiomyopathy (NICM), 150 cause of, 151t peripheral edema, 149 post–heart transplant, 164 prevention of, 152 atrial fibrillation (AF), 152 diabetic CM, 152 prognosis of, 165 pulmonary edema, 149 renin–angiotensin–aldosterone system (RAAS), 150 risk factors of, 152 725 cardiomyopathies, 152 risk modification, 163 hyponatremia, 163 treatment of, 154–163 acute decompensated HF (ADHF), 154 acute pulmonary edema, 154–157, 156 aldosterone antagonists, 159 angiotensin converting enzyme (ACE), 157 angiotensin receptor blockers (ARBs), 158 beta blockers, 159 cardiac dysfunction, 162 cardiac filling pressures, 156 Systolic heart failure (continued) cardiac resynchronization therapy (CRT), 162 cardiogenic shock, 160 carvedilol, 158 chronic end-organ hypoperfusion, 162 distal tubular hypertrophy, 160 end-organ hypoperfusion, 157 furosemide infusion, 157 heart transplantation, 162 hypertension, 154–157 implantable cardiac defibrillators (ICDs), 161 intra-aortic balloon pump (IABP), 160 kidney dysfunction, 157 LV assist device (LVAD), 160 management of ADHF, 156f IV morphine, 156 nesiritide infusion, 157 PA catheter, 155t percutaneous circulatory support, 161t spironolactone, 159 thiazide diuretic, 157 torsemide/bumetanide, 160 ultrafiltration (UF), 162 volume overload, 157 T Tetralogy of Fallot (ToF) arrhythmia prevention, 437 clinical presentation, 434–436 definition of, 434 diagnostic testing, 436 epidemiology for, 434 infundibular septum, 434 lifestyle/risk modification, 436–437 oxygenated and deoxygenated blood, 435f pathophysiology for, 434 surgical management, 436 726 Thermodilution (TD), 66 Thoracic aortic aneurysm causes of, 355t definition of, 354 diagnosis of, 356–357 chest radiography (CXR), 357 clinical presentation, 356–357 CT with angiography (CTA), 357 transesophageal echocardiogram (TEE), 357 transthoracic echocardiogram (TTE), 357 epidemiology of, 354 etiology of, 354–356 aortic dissection (AD), 355 atherosclerosis, 355 bicuspid aortic valve (BAV), 355 cystic medial degeneration (CMD), 354 familial thoracic aortic aneurysm (FTAA), 356 infectious aneurysms, 356 inflammatory aortitis, 356 Loeys-Dietz syndrome (LDS), 355 Marfan syndrome (MFS), 355 Turner syndrome, 356 vascular Ehlers-Danlos syndrome (vEDS), 356 treatment of, 357–358 aortic regurgitation (AR), 358 medications, 357 nonpharmacologic therapies, 357 surgical treatment, 358 thoracic aortic aneurysm, 358 Thoracic endovascular aortic aneurysm repair (TEVAR), 358 Thrombolysis in myocardial infarction (TIMI), 103, 120 Thrombotic thrombocytopenic purpura (TTP), 110 Tissue plasminogen activator (tPA), 127 Toe-brachial index (TBI), 341 Totally anomalous pulmonary venous return (TAPVR), 427–428 Transcatheter aortic valve replacement (TAVR), 220 Transesophageal echocardiography (TEE), 194, 208, 317, 357, 387 Transient ischemic attack (TIA), 339 Transient loss of consciousness (TLOC), 40 Transposition of the great arteries (TGA), 437–442 arterial switch operation (ASO), 440 arterial switch procedure, 439f classification of, 437 clinical presentation, 437–440 common surgical procedures, 438 diagnostic testing, 440 intra-atrial reentry tachycardia (IART), 440 lifestyle/risk modification, 441–442 nonpharmacologic therapies, 441 727 pathophysiology, 437 surgical management, 441 systemic and venous systems, 439f Transthoracic echocardiography (TTE), 70, 154, 187, 207, 232, 258, 357, 386 longitudinal transducer position, 387 Tricuspid annular plane systolic excursion (TAPSE), 208 Tricuspid regurgitation (TR), 5, 232, 248 Tricuspid stenosis (TS), 247 Tricuspid valve disease, 247–250 definition of, 247, 248–249 tricuspid regurgitation (TR), 248 tricuspid stenosis (TS), 247 diagnosis of, 247–248, 249–250 abdominal girth, 247 atrial fibrillation (AF), 248 diagnostic criteria, 249 diagnostic testing, 249 jugular venous pulsations (JVP), 249 lower extremity edema, 249 mid-diastolic murmur, 247 peripheral edema, 247 pulmonary artery systolic pressure (PASP), 249 right atrial enlargement (RAE), 248 right bundle branch block (RBBB), 249 right ventricular hypertrophy (RVH), 249 transthoracic echocardiography (TTE), 248 etiology of, 247, 248–249 carcinoid syndrome, 247 endocardial fibroelastosis, 247 implanted cardiac defibrillator (ICD), 249 left-sided cardiac disease, 248 left ventricular (LV), 248 methysergide toxicity, 247 myocardial infarction (MI), 249 rheumatic heart disease, 247, 249 treatment of, 248, 249 diuretic therapy, 248 medical therapy, 250 tricuspid valvuloplasty, 248 tricuspid regurgitation, 248–250 tricuspid stenosis, 247–248 U Ultrafiltration (UF), 162 Unfractionated heparin (UFH), 108 Upper rate limit (URL), 298 Upper reference limit (URL), 99 Urine protein electrophoresis (UPEP), 153 728 V Valvular heart disease, 454–455 aortic regurgitation (AR), 454 aortic stenosis (AS), 454 diagnosis for, 454 mitral regurgitation (MR), 454 mitral stenosis (MS), 454 treatment for, 455 Vascular Ehlers-Danlos syndrome (vEDS), 356 Vascular resistance, 67 Ventricular fibrillation (VF), 53, 301 Ventricular premature depolarization (VPD), 329 Ventricular septal defect (VSD), 12, 59, 120, 208, 251 Bethesda exercise classification, 421t classification for, 420–422 clinical presentation, 422 diagnostic testing, 422–423 lifestyle/risk modification, 423 pathophysiology, 422 surgical management, 423 Ventricular tachycardia (VT), 301 W Wolff-Parkinson-White (WPW) syndrome, 19, 276, 281, 325 729 [...]... Division of Medical Education in the Department of Medicine at Washington University School of Medicine, for his advice and guidance I believe this Manual will meet its desired goal of providing practical knowledge that can be directly applied at the bedside and in outpatient settings to improve patient care Victoria J Fraser, MD Adolphus Busch Professor of Medicine Chairman, Department of Medicine Washington. .. restore the lost art of the cardiovascular physical exam, we asked one of our most gifted master clinicians to author a dedicated chapter on this topic Additionally, the clinical impact of heart failure with preserved ejection fraction, or diastolic heart failure, has inspired a new chapter for this edition The continued importance of individualization of medicine inspired dedicated chapters 24 on cardiovascular... benefit the millions of patients with cardiovascular disease Douglas L Mann, MD Lewin Chair and Chief, Cardiovascular Division Professor of Medicine, Cell Biology and Physiology Cardiologist-in-Chief, Barnes-Jewish Hospital St Louis, Missouri 23 e, the editors of the third edition of The Washington Manual ™ Cardiology Subspecialty Consult, wish to thank you for choosing our book as worthy of your time to... passion that our authors have harnessed to create this up-todate and clinically impactful portable text We specifically wish to thank the editor of the first edition, Dr Peter Crawford, who planted the seeds of high-level intellect and compassionate tutelage from which this edition grows We are most indebted to the marvelous effort of those who contributed to the current edition: house staff, fellows, and... education are unsurpassed, and their efforts and skill in compiling this manual are evident in the quality of the final product In particular, I would like to acknowledge our editors, Drs Phillip S Cuculich and Andrew M Kates, and the series editor, Dr Tom De Fer, who have worked tirelessly to produce another outstanding edition of this manual I would also like to thank Dr Melvin Blanchard, Chief of. .. f I nternal Medicine Cardio vascular Divisio n Washingto n University Scho o l o f Medicine St Louis, Misso uri Al an Zajarias AssistantPro fesso r o f Medicine Departmento f I nternal Medicine 20 Cardio vascular Divisio n Washingto n University Scho o l o f Medicine St Louis, Misso uri 21 t is a pleasure to present the new edition of The Washington Manual ™ Subspecialty Consult Series: Cardiology Subspecialty... health care providers The third edition of The Washington Manual Cardiology Subspecialty Consult was written with the challenges of the busy practitioner in mind Each chapter in the third edition was written by a cardiovascular fellow who was paired with an attending physician with considerable clinical expertise This team approach to writing allowed each chapter to be suffused with real-world approaches... real-world problems that are not only evidence based, but also based on the expertise of seasoned clinicians who have devoted their careers to training the next generation of health care providers The new edition, which was masterfully edited and organized by Drs Andy Kates and Phillip Cuculich, has new chapters on the physical exam, heart failure with preserved ejection fraction, and cardiovascular diseases... While we expected excellence from our authors, we were overwhelmed by the high quality of information and clear passion for teaching found in each chapter Every chapter of the third edition has been written by a pair of authors: one cardiovascular fellow and one cardiovascular or pulmonary clinician-educator This pairing embodies the overriding theme of this edition: front-line, middle -of- the-night synthesis... with the previous editions, the chapters contain simple easy-to-read figures and flow diagrams coupled with bullet-point lists and countless bold-faced clinical pearls I believe the third edition of The Washington Manual ™ Cardiology Subspecialty Consult will be enormously useful as an extremely “readable” resource for health care providers who must provide care for the growing numbers of patients with ... Department of Medicine, Washington University School of Medicine First Edition, © 2004 by Department of Medicine, Washington University School of Medicine Printed in China All rights reserved This... Mallon Editorial Coordinator: Katie Sharp Production Service: Integra Software Services Pvt Ltd Third Edition © 2014 by Department of Medicine, Washington University School of Medicine Second Edition,... II Kates, Andrew M., editor of compilation III De Fer, Thomas M., editor of compilation IV Title: Cardiology subspecialty consult V Series: Washington manual subspecialty consult series [DNLM: