Despite major advances in prevention and treatment, cardiovascular disease remains the leading cause of death in the United States. The vast number of patients with cardiovascular disease coupled with ongoing clinical advances makes the Oxford American Handbook of Cardiology a mustbuy for residents, fellows, and students, as well as an excellent reference guide for general practitioners. The reader will find here all the essential practice guidelines and management strategies as well as a unique chapter on preventive cardiology and a useful summary of recent major clinical trials in cardiology. Common cardiac conditions, including coronary artery disease, arrhythmias, valvular and congenital heart disease, cardiomyopathies, and heart failure, are covered comprehensively yet concisely.
Oxford American Handbook of Cardiology About the Oxford American Handbooks in Medicine The Oxford American Handbooks are pocket clinical books, providing practical guidance in quick reference, note form Titles cover major medical specialties or cross-specialty topics and are aimed at students, residents, internists, family physicians, and practicing physicians within specific disciplines Their reputation is built on including the best clinical information, complemented by hints, tips, and advice from the authors Each one is carefully reviewed by senior subject experts, residents, and students to ensure that content reflects the reality of day-to-day medical practice Key series features • Written in short chunks, each topic is covered in a two-page spread to enable readers to find information quickly They are also perfect for test preparation and gaining a quick overview of a subject without scanning through unnecessary pages • Content is evidence based and complemented by the expertise and judgment of experienced authors • The Handbooks provide a humanistic approach to medicine – it’s more than just treatment by numbers • A “friend in your pocket,” the Handbooks offer honest, reliable guidance about the difficulties of practicing medicine and provide coverage of both the practice and art of medicine • For quick reference, useful “everyday” information is included on the inside covers Published and Forthcoming Oxford American Handbooks Oxford American Handbook of Clinical Medicine Oxford American Handbook of Anesthesiology Oxford American Handbook of Cardiology Oxford American Handbook of Clinical Dentistry Oxford American Handbook of Clinical Diagnosis Oxford American Handbook of Clinical Pharmacy Oxford American Handbook of Critical Care Oxford American Handbook of Emergency Medicine Oxford American Handbook of Geriatric Medicine Oxford American Handbook of Nephrology and Hypertension Oxford American Handbook of Neurology Oxford American Handbook of Obstetrics and Gynecology Oxford American Handbook of Oncology Oxford American Handbook of Otolaryngology Oxford American Handbook of Pediatrics Oxford American Handbook of Physical Medicine and Rehabilitation Oxford American Handbook of Psychiatry Oxford American Handbook of Pulmonary Medicine Oxford American Handbook of Rheumatology Oxford American Handbook of Sports Medicine Oxford American Handbook of Surgery Oxford American Handbook of Urology Oxford American Handbook of Cardiology Edited by Jeffrey R Bender, MD Robert I Levy Professor of Preventive Cardiology Associate Chief, Cardiovascular Medicine Yale University School of Medicine New Haven, Connecticut Kerry S Russell, MD, PhD Associate Professor of Cardiovascular Medicine Yale University School of Medicine New Haven, Connecticut Lynda E Rosenfeld, MD Associate Professor of Medicine and Pediatrics Section of Cardiovascular Medicine Yale University School of Medicine New Haven, Connecticut Sabeen Chaudry, MD Fellow, Section of Cardiovascular Medicine Yale University School of Medicine New Haven, Connecticut with Punit Ramrakha Jonathan Hill Oxford University Press, Inc publishes works that further Oxford University’s objective of excellence in research, scholarship and education Oxford New York Auckland Cape Town Dar es Salaam Hong Kong Karachi Kuala Lumpur Madrid Melbourne Mexico City Nairobi New Delhi Shanghai Taipei Toronto With offices in Argentina Austria Brazil Chile Czech Republic France Greece Guatemala Hungary Italy Japan Poland Portugal Singapore South Korea Switzerland Thailand Turkey Ukraine Vietnam Copyright © 2011 by Oxford University Press, Inc Published by Oxford University Press Inc 198 Madison Avenue, New York, New York 10016 www.oup.com Oxford is a registered trademark of Oxford University Press First published 2011 All rights reserved No part of this publication may be reproduced, stored in a retrieval system, or transmitted, in any form or by any means, electronic, mechanical, photocopying, recording, or otherwise, without the prior permission of Oxford University Press Library of Congress Cataloging-in-Publication Data Oxford American handbook of cardiology / edited by Jeffrey R Bender [et al.] p ; cm.—Other title: American handbook of cardiology Adapted from: Oxford handbook of neurology / Hadi Manji [et al.] 2007 Includes index ISBN 978-0-19-538969-2 Cardiovascular system—Diseases—Handbooks, manuals, etc I Bender, Jeffrey R II Title: American handbook of cardiology [DNLM: Cardiovascular Diseases—Handbooks WG 39 O98 2011] RC669.15.O94 2011 616.1 dc22 2010003761 987654321 Printed in China on acid-free paper This material is not intended to be, and should not be considered, a substitute for medical or other professional advice Treatment for the conditions described in this material is highly dependent on the individual circumstances And, while this material is designed to offer accurate information with respect to the subject matter covered and to be current as of the time it was written, research and knowledge about medical and health issues is constantly evolving and dose schedules for medications are being revised continually, with new side effects recognized and accounted for regularly Readers must therefore always check the product information and clinical procedures with the most up-to-date published product information and data sheets provided by the manufacturers and the most recent codes of conduct and safety regulation Oxford University Press and the authors make no representations or warranties to readers, express or implied, as to the accuracy or completeness of this material, including without limitation that they make no representation or warranties as to the accuracy or efficacy of the drug dosages mentioned in the material The authors and the publishers not accept, and expressly disclaim, any responsibility for any liability, loss, or risk that may be claimed or incurred as a consequence of the use and/or application of any of the contents of this material This page intentionally left blank vii Preface Despite major advances in prevention and treatment, cardiovascular disease remains the leading cause of death in the United States There are greater than 1.4 million myocardial infarcts per year Furthermore, the incidence of atrial fibrillation and of heart failure is rising, in part due to increased survival following acute coronary events, to our aging population, and to other undetermined factors Management of cardiovascular disease spans a wide range, from acute care of the hemodynamically unstable patient, interventions directed at acute coronary obstructions and electrically unstable rhythms, to disease prevention and care of the chronically ill In an era of genome-wide scans and growing lists of cardiovascular disease genes, we still require a careful and detailed understanding of disease pathophysiology and management In this Handbook, we attempt to represent this wide range of cardiovascular disease We are fortunate to practice in this era of evidencebased medicine, in which care algorithms are developed and therapeutic approaches are carefully defined The chapters of this Handbook provide the pathophysiological basis for many of these approaches, followed by delineation of management Although these chapters will not replace the time-dependent accumulation of experience in clinical care, we hope that this Handbook provides easy and rapid access to many major day-to-day management approaches to patients with cardiovascular problems We hope it will appeal to a broad range of clinicians in many settings, including the coronary care unit, interventional laboratories, emergency departments, and medicine units, both inpatient and outpatient It is designed to be a rapid reference guide for practicing cardiologists, internists, and relevant trainees There should still be sufficient space in white coat pockets for a handbook such as this one It is our hope that pearls of cardiovascular care will be easily removed from these white pockets and extracted from our Handbook of Cardiology viii Acknowledgments We, the four editors of the Oxford American Handbook of Cardiology, would like to express our gratitude to all contributors This includes the chapter authors, who are all members of the Yale University Cardiovascular Medicine Division, either junior faculty or senior fellows They carefully have reviewed the most recent data and recommendations for cardiovascular care, incorporating the latest large clinical trials and published recommendations of our largest cardiovascular organizations, the American Heart Association and the American College of Cardiology Thus, this represents the most up-to-date guidelines and recommendations We also acknowledge all involved at Oxford University Press, most notably Andrea Seils, Senior Editor of Clinical Medicine We are particularly grateful for Andrea’s patience, as the coordination of this handbook production took longer than expected Most importantly, we want to formally and emphatically display our gratitude to Professors Ramrakha, Hill and all the authors of the original, U.K version of the Oxford Handbook of Cardiology They all did extraordinary work, assembling the original Handbook Much of that work has been retained in the U.S version As noted, we have attempted to incorporate U.S guidelines and recently published data into the new Handbook However, many of the original chapters remain state-of-the-art, and required very little editing or conversion The work done by the U.K authors was more than the foundation for the U.S version If approval and commendations are forthcoming, as we hope they are, these must be directed to both the U.K and U.S authors Jeffrey Bender Kerry Russell Lynda Rosenfeld Sabeen Chaudry ix Contents Detailed contents xi Contributors xxv Symbols and Abbreviations xxvii Cardiovascular emergencies and practical procedures Coronary artery disease Peripheral vascular disease Valvular heart disease Heart failure Preventive cardiology Diseases of the myocardium and pericardium Congenital heart disease Arrhythmias 10 Heart disease in pregnancy 11 Multisystem disorders 12 Stress testing and cardiac imaging 13 Invasive electrophysiology 14 Cardiac catheterization and coronary intervention 15 Major trials in cardiology 16 Special populations: women and elderly Index 659 85 133 173 211 245 285 329 353 405 427 445 511 549 597 647 THE ELDERLY AND HEART DISEASE Table 16.2 Lipid-lowering therapy in those over 65 years old Study No of elderly subjects Results 4S 1021 subjects >65 years old 34% lower all-cause mortality, 43% lower CHD mortality, 34% lower MACE, 41% lower revascularization procedures CARE 1283 subjects between 65 For every 1000 elderly patients treated, and 75 years old 225 CV hospitalizations and 207 CV events were prevented LIPID 3514 subjects between 65 Absolute benefit was greater in the and 75 years old elderly compared to the younger patients (fewer patients needed to be treated to prevent a death, MI, or stroke) HPS 20K patients age 40–80 years old Similar reduction in CV events in patients above and below age 65 CARDS N/A 38% reduction in first CV event in subjects older than 65 years Box 16.3 Antihypertensive therapy in the elderly • First line: thiazide diuretics • Second line: ACE inhibitor/ARB or long-acting dihydropyridine calcium channel blocker (i.e., amlodipine) • B-Blockers should not be used as primary therapy for hypertension in the elderly in the absence of another specific indication (i.e., prior MI or CHF) responsiveness, as well as impaired cerebral autoregulation, which necessitates cautious initiation of therapy to prevent or minimize ischemic and orthostatic side effects (see Box 16.3) Therefore, when starting antihypertensive therapy, lower initial doses should be used (about one-half the dose used in younger patients) Valvular heart disease in the elderly Aortic stenosis Calcific or degenerative aortic valve disease is the most common valvular abnormality seen in the elderly The prevalence of at least moderate aortic stenosis (AVA 130/>85 mmHg HDL cholesterol < 40 mg/dL in men < 50 mg/dL in women Triglycerides >150 mg/dL TIMI Risk Score for UA/NSTEMI Risk Score = Total Points (0–7) Factor Points 14-Day risk of cardiac events Age ē 65 SCORE ē CAD Risk factors 0/1 Known coronary stenosis ē 50% ASA use in prior days 13 Recent severe angina (Ĕ24 h) 20 Elevated cardiac biomarkers 26 ST deviation ē 0.5 mm 6/7 41 RISK (%) Antman et al JAMA, 264: 835–842 CHADS Score = sum of individual risk factors (0–6) Score Adjusted stroke rate (%/year) Risk Factor Points 1.9 Congestive Heart Failure 1 2.8 Hypertension Age > 75 y 5.9 Diabetes mellitus 8.5 Prior stroke or TIA 12.5 18.2 Gage et al JAMA 2001; 285:2854–2870 Duke Criteria for Infective Endocarditis Definite endocarditis requires major, major and minor, or minor criteria Major criteria Positive blood culture Positive echocardiogram or new valve regurgitation Minor criteria Predisposing condition or IV drug use Fever >38o C Vascular phenomena: arterial emboli, septic pulmonary infarcts, mycotic aneurysm, intracranial and conjunctival hemorrhage, Janeway lesions Immunologic phenomena: glomerulonephritis, Osler’s nodes, Roth spots, rheumatoid factor Positive blood cultures not meeting major criteria Durack DT, Lukes AS, Bright DK Am J Med 96:200–209, 1994 Framingham risk scoring system for men Age Diabetes Years Points Points 30–34 –1 No 35–39 Yes 40–44 45–49 50–54 55–59 60–64 65–69 70–74 Coronary heart disease risk Total points 10 yr risk (%) < –3 –2 Points –1 No 0 Yes 5 6 7 Smoker LDL-C (mg/dL) HDL-C (mg/dL) Points Points 11 60 –1 11 33 DBP (mmHg) 12 40 < 80 80–84 85–89 90–99 t100 13 47 14 56 SBP (mmHg) [...]... Section of Cardiovascular Medicine Yale University School of Medicine New Haven, Connecticut Brian J Malm, MD Assistant Professor Section of Cardiovascular Medicine Yale University School of Medicine New Haven, Connecticut Carlos Mena, MD Clinical Instructor Section of Cardiovascular Medicine Yale University School of Medicine New Haven, Connecticut Rebecca Scandrett, MD Clinical Instructor Section of Cardiovascular... electrophysiology 511 Mechanism of tachycardias 512 Mechanism of arrhythmias 514 The electrophysiology study (EPS) 516 Uses of the EPS 518 Programmed ventricular stimulation 522 New technologies 524 Catheter ablation 525 Catheter ablation: complications 527 Atrial tachyarrhythmias: mechanism 528 Ablation of atrial tachycardias 530 Catheter ablation of atrial fibrillation 532 Mechanism of AV reentry tachycardias... Preventive cardiology 245 Background 246 Atherosclerosis: pathophysiology 247 Development of atherosclerotic plaques 249 Epidemiology 251 Assessment of atherosclerotic risk 252 Risk factors for coronary artery disease 256 Hypertension 262 Treatment of high blood pressure 264 Combining antihypertensive drugs 267 Lipid management in atherosclerosis 269 Lipid-lowering medications 272 Goals of lipid-lowering... ventricular outflow tract (LVOT) obstruction 347 Coarctation of the aorta 347 Anomalous pulmonary venous drainage 348 Transposition of the great arteries 348 Tetralogy of Fallot 349 Fontan patients 349 Congenitally corrected transposition of the great arteries 350 Ebstein’s anomaly of the tricuspid valve 350 Extracardiac complications 351 9 Arrhythmias The cardiac conduction system 354 Bradyarrhythmias: general... Transthoracic echocardiography (TTE) 449 Transthoracic Doppler imaging 453 The standard TTE 456 Assessment of wall motion 460 Assessment of LV systolic function 462 Assessment of LV diastolic function 464 Echocardiography in aortic stenosis 468 Transesophageal echocardiography (TEE) 470 TEE for a cardiac source of embolism 474 TEE in aortic dissection 475 TEE in endocarditis 476 TTE/TEE in mitral regurgitation... Medicine Yale University School of Medicine New Haven, Connecticut This page intentionally left blank xxvii Symbols and Abbreviations AAA ABC ABG ACC ACE ACLS ACS AD AED AF AFB AFP AHA AICD AIH AMI ANA ANP AP APC AR ARB ARDS ARVC ARVD AS ASA ASD ASH AST ATP AV AVN AVNRT AVR AVRT BB Abdominal aortic aneurysm airway, breathing, circulation arterial blood gas American College of Cardiology angiotensin-converting... 558 Angiographic study of grafts 560 549 xix xx DETAILED CONTENTS Complications of angiography 561 Right heart catheterization 564 Cardiac output and LV function 566 Cardiac catheterization in valve disease 567 Intravascular ultrasound 569 Angioplasty and coronary stenting 571 Restenosis following PTCA 573 Drug-eluting stents 574 Stent thrombosis 576 Physiological assessment of coronary flow 578 Primary... Primary angioplasty: procedure 581 Invasive assessment of vulnerable plaque 583 Complex coronary angioplasty 584 Left main stem angioplasty 586 Adjunctive therapy for angioplasty and stenting 587 Embolic protection devices 589 Thrombectomy 591 Mitral valvuloplasty 592 Glossary of terms and abbreviations 594 Further reading 596 15 Major trials in cardiology ACUITY 598 ADMIRAL 598 AFCAPS/TexCAPS 598 AFFIRM... chronic ischemic MR 482 TTE/TEE for mitral stenosis 482 TEE for prosthetic valve dysfunction 483 TEE assessment of mitral valve prosthesis 484 Echocardiography in aortic regurgitation 486 TEE for aortic valve prosthesis 487 Intraoperative TEE 489 445 DETAILED CONTENTS Echocardiographic assessment of cardiac masses 491 SPECT perfusion imaging 492 PET scanning 497 Equilibrium radionuclide angiography (ERNA)... Atrioventricular block 360 Bundle branch block 362 Tachyarrhythmias: general approach 363 Tachyarrhythmias: classification 365 353 DETAILED CONTENTS ECG diagnosis of tachyarrhythmias 367 Tachycardia: emergency management 369 Drug treatment of tachyarrhythmias 371 Supraventricular tachycardia 372 Sinus tachycardia 373 Sinus nodal reentrant tachycardia 373 Atrial tachycardia 374 Atrioventricular nodal ... Forthcoming Oxford American Handbooks Oxford American Handbook of Clinical Medicine Oxford American Handbook of Anesthesiology Oxford American Handbook of Cardiology Oxford American Handbook of Clinical... Handbook of Psychiatry Oxford American Handbook of Pulmonary Medicine Oxford American Handbook of Rheumatology Oxford American Handbook of Sports Medicine Oxford American Handbook of Surgery Oxford American. .. 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