Ebook Manual of cardiac diagnosis Part 1

(BQ) Part 1 book Manual of cardiac diagnosis presentation of content: History, physical examination, plain film imaging of adult cardiovascular disease, electrocardiogram, electrocardiogram, transthoracic echocardiography, stress echocardiography, transesophageal echocardiography,...

Prelims.indd Manual of Cardiac Diagnosis 11-02-2014 13:37:07 Prelims.indd 11-02-2014 13:37:07 Prelims.indd Manual of Cardiac Diagnosis Editors Kanu Chatterjee  MBBS Clinical Professor of Medicine The Carver College of Medicine University of Iowa United States of America Emeritus Professor of Medicine University of California, San Francisco United States of America ® JAYPEE BROTHERS MEDICAL PUBLISHERS (P) LTD New Delhi • London • Philadelphia • Panama 11-02-2014 13:37:07 Prelims.indd ® Jaypee Brothers Medical Publishers (P) Ltd Headquarters Jaypee Brothers Medical Publishers (P) Ltd 4838/24, Ansari Road, Daryaganj New Delhi 110 002, India Phone: +91-11-43574357 Fax: +91-11-43574314 Email: jaypee@jaypeebrothers.com Overseas Offices J.P Medical Ltd 83 Victoria Street, London SW1H 0HW (UK) Phone: +44-2031708910 Fax: +02-03-0086180 Email: info@jpmedpub.com Jaypee-Highlights Medical Publishers Inc City of Knowledge, Bld 237, Clayton Panama City, Panama Phone: +1 507-301-0496 Fax: +1 507-301-0499 Email: cservice@jphmedical.com Jaypee Medical Inc The Bourse 111 South Independence Mall East Suite 835, Philadelphia, PA 19106, USA Phone: +1 267-519-9789 Email: jpmed.us@gmail.com Jaypee Brothers Medical Publishers (P) Ltd 17/1-B Babar Road, Block-B, Shaymali Mohammadpur, Dhaka-1207 Bangladesh Mobile: +08801912003485 Email: jaypeedhaka@gmail.com Jaypee Brothers Medical Publishers (P) Ltd Bhotahity, Kathmandu, Nepal Phone: +977-9741283608 Email: kathmandu@jaypeebrothers.com Website: www.jaypeebrothers.com Website: www.jaypeedigital.com © 2014, Jaypee Brothers Medical Publishers The views and opinions expressed in this book are solely those of the original contributor(s)/author(s) and not necessarily represent those of editor(s) of the book All rights reserved No part of this publication may be reproduced, stored or transmitted in any form or by any means, electronic, mechanical, photocopying, recording or otherwise, without the prior permission in writing of the publishers All brand names and product names used in this book are trade names, service marks, trademarks or registered trademarks of their respective owners The publisher is not associated with any product or vendor mentioned in this book Medical knowledge and practice change constantly This book is designed to provide accurate, authoritative information about the subject matter in question However, readers are advised to check the most current information available on procedures included and check information from the manufacturer of each product to be administered, to verify the recommended dose, formula, method and duration of administration, adverse effects and contraindications It is the responsibility of the practitioner to take all appropriate safety precautions Neither the publisher nor the author(s)/editor(s) assume any liability for any injury and/or damage to persons or property arising from or related to use of material in this book This book is sold on the understanding that the publisher is not engaged in providing professional medical services If such advice or services are required, the services of a competent medical professional should be sought Every effort has been made where necessary to contact holders of copyright to obtain permission to reproduce copyright material If any have been inadvertently overlooked, the publisher will be pleased to make the necessary arrangements at the first opportunity Inquiries for bulk sales may be solicited at: jaypee@jaypeebrothers.com Manual of Cardiac Diagnosis First Edition:  2014 ISBN 978-93-5152-194-5 Printed at 11-02-2014 13:37:07 Prelims.indd Contributors Abhimanyu (Manu) Uberoi  MD Department of Cardiology The Stanford School of Medicine Palo Alto, California, USA Amardeep K Singh  MD Department of Cardiology University of California San Francisco, USA Andrew Boyle  MD Assistant Professor of Medicine University of California San Francisco, USA Brad H Thompson  MD Professor of Medicine The Carver College of Medicine University of Iowa, USA Ellen El Gordon  MD Associate Professor of Medicine The Carver College of Medicine University of Iowa, USA Eric A Osborn  MD PhD Cardiology Division Beth Israel Deaconess Medical Center Harvard Medical School, Boston, MA Cardiovascular Research Center Cardiology Division, and Center for Molecular Imaging Research, Massachusetts General Hospital Harvard Medical School, Boston, MA, USA Farouc A Jaffer  MD PhD Associate Professor of Medicine The Carver College of Medicine University of Iowa, USA Cardiovascular Research Center Cardiology Division and Center for Molecular Imaging Research Massachusetts General Hospital Harvard Medical School Boston, MA, USA Dipti Gupta  MD MPH Gardar Sigurdsson  MD Byron F Vandenberg  MD Cardiology Division The Carver College of Medicine University of Iowa, USA Donald Brown  MD Associate Professor of Medicine The Carver College of Medicine University of California San Francisco, USA Professor of Medicine The Carver College of Medicine University of Iowa, USA Isidore C Okere  MBBS Edwin JR van Beek  MD Jagat Narula  MD PhD Professor of Medicine Chair of Clinical Radiology Clinical Research Imaging Centre Queen’s Medical Research Institute University of Edinburgh, United Kingdom The Carver College of Medicine University of Iowa, USA Cardiology Division University of California Irvine School of Medicine Irvin, CA Kanu Chatterjee  MBBS Professor of Medicine and Radiology University of California San Francisco, USA Professor of Medicine The Carver College of Medicine University of Iowa Emeritus Professor of Medicine University of California San Francisco, USA Elaine M Demetroulis  MD Manjula V Burri  MD Elias H Botvinick  MD Associate Professor of Medicine The Carver College of Medicine University of Iowa, USA Department of Cardiology The Carver College of Medicine University of Iowa, USA 11-02-2014 13:37:07 Prelims.indd vi Manual of Cardiac Diagnosis Mohan Brar  MD Assistant Clinical Professor of Medicine The Carver College of Medicine University of Iowa, USA Nelson B Schiller  MD Professor of Medicine University of California San Francisco, USA Paul Lindower  MD Professor of Medicine The Carver College of Medicine University of Iowa, USA Peter J Fitzgerald  MD Professor of Medicine The Stanford University School of Medicine Pala Alto, California, USA Rakesh K Mishra  MD University of California San Francisco, USA Richard E Kerber  MD Professor of Medicine The Carver College of Medicine University of Iowa, USA Robert M Weiss  MD Professor of Medicine The Carver College of Medicine University of Iowa, USA Seyed M Hashemi  MD Division of Cardiology The Carver College of Medicine University of Iowa, USA Teresa De Marco  MD Professor of Medicine University of California San Francisco, USA Teruyoshi Kume  MD Stanford School of Medicine Palo Alto, California, USA Victor F Froelicher  MD Professor of Medicine The Stanford University School of Medicine Pala Alto, California, USA Vijay U Rao  MD PhD Department of Cardiology University of California San Francisco, USA Wassef Karrowni  MD Division of Cardiology The Carver College of Medicine University of Iowa, USA William Parmley  MD Emeritus Professor of Medicine University of California, San Francisco, USA Yasuhiro Honda  MD Stanford School of Medicine Palo Alto, California, USA Yerem Yeghiazarians  MD Associate Professor of Medicine University of California, San Francisco, USA 11-02-2014 13:37:07 Prelims.indd Preface Diagnosis is the first stone, which needs to be turned in order to discover the cure Progress in the diagnosis and management of patients with congenital and acquired heart diseases has been intimately tied to technological developments in cardiac imaging We have witnessed the development of newer diagnostic techniques and the refinement of older methods for detection of cardiovascular pathology Molecular imaging, threedimensional echocardiography, and intravascular ultrasound imaging have been introduced Advances have occurred in cardiovascular nuclear, computerized tomographic, and magnetic resonance imaging In this book, the advancements in these diagnostic techniques and their clinical applications in the practice of cardiology have been extensively discussed The role of resting and stress electrocardiography and echocardiography has also been elaborated upon The success of cardiac angiography stimulated the continued development of selective catheter coronary arteriography, which is the driving force in the progress and increased effectiveness of coronary artery bypass surgery, prosthetic valve replacement, and valve repair With contributions from nationally and internationally recognized experts, an effort has been made to bring forth a book that will serve as a useful diagnostic manual for students and practitioners, whole-heartedly involved in the field of cardiology Kanu Chatterjee 11-02-2014 13:37:07 Prelims.indd 11-02-2014 13:37:07 Prelims.indd Contents History Kanu Chatterjee ‰‰ ‰‰ The History  References   17 Physical Examination Kanu Chatterjee ‰‰ ‰‰ ‰‰ ‰‰ ‰‰ ‰‰ ‰‰ ‰‰ ‰‰ ‰‰ ‰‰ ‰‰ ‰‰ ‰‰ ‰‰ ‰‰ ‰‰ ‰‰ ‰‰ ‰‰ ‰‰ ‰‰ ‰‰ ‰‰ ‰‰ ‰‰ ‰‰ ‰‰ 137 Introduction 137 Before the Test  138 Methodology of Exercise Testing  142 During the Test  147 After the Test  160 Screening 166 Left Ventricle Rakesh K Mishra, Nelson B Schiller ‰‰ 96 Introduction 96 Basis of Electrocardiography  96 Component Parts of the Electrocardiogram  100 Lead Systems Used to Record the Electrocardiogram  100 Common Electrode Misplacements  103 Other Lead Systems  107 Identification of Atrial Activity  107 Characterization of QRS Complex  121 ST–T Wave Abnormalities  131 “U” Wave  134 QT Interval  134 ECG Exercise Testing Abhimanyu (Manu) Uberoi, Victor F Froelicher ‰‰ 71 Introduction 71 Chest Film Technique  71 Overview of Cardiomediastinal Anatomy  73 Cardiac Anatomy on Chest Radiographs  75 Cardiac Chamber Enlargement  76 Radiographic Manifestations of Congestive Heart Failure  80 Cardiac Calcifications  86 Acquired Valvular Heart Disease  88 Pericardial Disorders  92 Electrocardiogram Donald Brown ‰‰ 18 General Appearance  18 Measurement of Arterial Pressure  23 Auscultation 40 References 68 Plain Film Imaging of Adult Cardiovascular Disease Brad H Thompson, Edwin JR van Beek ‰‰ 177 Introduction 177 Systolic Function  178 11-02-2014 13:37:07 Prelims.indd 10 x Manual of Cardiac Diagnosis ‰‰ ‰‰ ‰‰ ‰‰ ‰‰ ‰‰ ‰‰ ‰‰ ‰‰ ‰‰ Contrast-Enhanced Echocardiography  197 Other Echo-Derived Indices of LV Systolic Function  197 Strain-Derived Indices  199 Recognizing the Etiology of Cardiac Dysfunction  199 Dilated Cardiomyopathy  200 Hypertrophic Cardiomyopathy  201 Restrictive Cardiomyopathy  203 Left Ventricular Noncompaction  205 Visual Qualitative Indicators of Systolic Dysfunction  205 Diastolic Function  210 Ventricular Function—Assessment and Clinical Application Kanu Chatterjee, Wassef Karrowni, William Parmley ‰‰ ‰‰ ‰‰ ‰‰ ‰‰ ‰‰ Introduction 233 Determinants of Left Ventricular Performance  233 Left Ventricular Pump Function  240 Heart Rate  247 Diastolic Function  249 Right Ventricular Function  251 Transthoracic Echocardiography Byron F Vandenberg, Richard E Kerber ‰‰ ‰‰ ‰‰ ‰‰ ‰‰ ‰‰ ‰‰ ‰‰ ‰‰ ‰‰ ‰‰ ‰‰ ‰‰ ‰‰ ‰‰ ‰‰ ‰‰ ‰‰ ‰‰ ‰‰ ‰‰ ‰‰ 316 Introduction 316 Using Stress Echocardiography in Clinical Decisions  317 Future of Stress Echo  348 10 Transesophageal Echocardiography Seyed M Hashemi, Paul Lindower, Richard E Kerber ‰‰ 261 Introduction 261 Chamber Quantitation  261 Doppler Echo  271 Diastolic Function  272 Pulmonary Hypertension  277 Pericardial Disease  279 Valvular Heart Disease  285 Infective Endocarditis  303 Intracardiac Masses  304 Contrast Echocardiography  305 Cardiac Resynchronization Therapy  307 9 Stress Echocardiography Ellen El Gordon, Richard E Kerber ‰‰ 233 357 Introduction 357 History 357 Guidelines 358 Performance 358 Safety 359 Views 359 Major Clinical Applications  360 Structural Valve Assessment  366 Acute Aortic Dissection  371 Procedural Adjunct or Intraoperative Transesophageal Echocardiography (TEE)  372 11-02-2014 13:37:07 FIGURES 33A TO C: (A) Bounded echo-free space behind the aorta imaged in parasternal long-axis view (B) Live three-dimensional transthoracic echocardiography (C) Tilting of the full volume 3D dataset shows the bounded echo-free space (arrowhead) to be continuous with the RA This is consistent with SVC (Abbreviations: Ao: Aorta; IVC: Inferior vena cava; LA: Left atrium; LV: Left ventricle; RA: Right atrium; RV: Right ventricle; SVC: Superior vena cava; TV: Tricuspid valve) (Source: Modified from Burri et al120) 418 Manual of Cardiac Diagnosis FIGURES 34A TO F: Real-time 3D TEE-guided closure of three atrial septal defects: (A) 2D imaging suggested more than defect of a mobile interatrial septum with; (B) left-to-right shunt obtained by color Doppler; (C) a 3D left atrial view more detailed demonstrated three separated defects; (D) the septum was crossed under 3D guidance and a 34 mm Amplatzer occluder (occluder) was advanced from the left atrium (LA); (E and F) online 3D imaging allowed positioning the left-sided disk so that it covered all defects and assuring secure placement of the right sided disk (Abbreviation: RA: Right atrium) (Source: Modifie from Dodos et al123) Real-time Three-dimensional Echocardiography 419 420 Manual of Cardiac Diagnosis FIGURES 35A AND B: LAA oblite­ration with suboptimal positioning: (A) en face view from the left atrium into the LAA showing off-angle LAA occlusion device The device is not perpendicular to the opening of the LAA, and a residual potential com­muni­cation between the LAA and the main left atrium is still noticeable (3D zoom mode acquisition); (B) two-dimensional imaging of the off-angle closure device with color Doppler (asterisk) demonstrating residual flow between the LAA and the main left atrium (Source: Modified from Perk et al69) delineating the area intended for controlled infarction by alcohol injection.91 Procedural guidance is an actively evolving advanced application of RT3DE and is yet to be validated well on a larger scale RT3DE is currently underutilized due to several factors including the potential need for general anesthesia, lack of standardization of 3D echocardio­graphic views, prolongation of the procedure time (but less radiation/contrast exposure), the interventional or electrophysiologist’s need to integrate continuously the multimodality visual feedback to catheter manipulation, lack of adequate trained operators in advanced echo­c ardiography and the lack of standard nomenclature conventions to describe the position of the device in space, that could lead to potential harm FUTURE DIRECTIONS Since its advent in 2002, RT3DE has plunged forward holding interest of the advanced imagers, and now with the integration of the miniaturized matrix probe with the TEE probe, the indications for its use in valvular and procedural applications Real-time Three-dimensional Echocardiography FIGURES 36A TO C: Mitral valve clipping with two clips: (A) mitral valve with the first clip in place seen from the left atrium A double orifice mitral valve has been created (O1 and O2) However, color Doppler interro­gation demonstrated signifi­cant residual mitral regurgitation (MR), so a second clip was deemed necessary The guiding catheter is seen directed toward the larger part of the mitral valve orifice (O2) to place another clip in the mitral valve (3D zoom mode acqui­sition); (B) two clips have been deployed in the mitral valve, resulting in a three-orifice mitral valve The image shows an en face view of the mitral view, as seen from the left atrium The three orifices (O1, O2 and O3) are noted (3D zoom mode acqui­si­­tion); (C) color Doppler demonstra­tion of the result of the procedure (Left) Before the procedure, severe MR is clearly demonstrated (Right) After the procedure, only mild MR can be seen (Source: Modified from Perk et al69) are exploding Further advances in this technology will allow for a probe with smaller footprints, better spatiotemporal resolution, wider acoustic angle, single beat wide angle and color flow acquisition capabilities, eliminating artifacts and patient discomfort to a large extent Undersampling issues will be resolved with higher frame rates A comprehensive echo­cardiogram can potentially be completed in a fraction of a time needed now, as one can eliminate the different 2D views currently acquired, thereby improving the workflow in the echocardio­graphic laboratory Stress echocardiograms may possibly be performed solely in a 3D format or in combination with single photon emission computerized tomography, as the temporal resolution improves Myocardial perfusion echo­ cardiography applications should emerge with this 3D technique as further evidence gathers RT3DE will discover its applications 421 422 Manual of Cardiac Diagnosis FIGURES 37A TO C: Percutaneous aortic valve replacement: (A) guiding catheter seen passing through the aortic valve (3D zoom mode acqui­sition); (B1) systolic and (B2) diastolic frames of a percutaneously implan­ted aortic valve as seen from the left ventricular perspective (3D zoom mode acquisition); (C) the proximal left main coronary artery, as seen from the left ventricular perspective Patency of the ostium of the left main coronary artery is confirmed after valve implantation (3D zoom mode acquisition) (Source: Modified from Perk et al69) and limitations in determining regional RV volumes in various conditions affecting the RV 3D speckle or strain imaging, making possible the extension of robust strain derived information to three dimensions will find its applications in a variety of conditions Similar integration to contraction front mapping in electro­physiological procedures would allow for RT3DE-guided ablation procedures, along with RT3DE guided placement of the LV lead to obtain an optimal response to CRT The user interface will be further refined and made user friendly with ability to crop in a more intuitive fashion The advent of real-time triplane imaging will eliminate the cropping time while retaining the advantage of imaging in three dimensions that may be adequate for evaluation of certain conditions, such as aortic stenosis and stress imaging As more operators are trained in RT3DE, this modality has the potential to become the standard of care especially in the interventional laboratory and the operating room Further advances in technology may make possible stereoscopic vision display (3D display as opposed to the current 2D display of 3D images) of RT3DE to better guide intracardiac beating-heart procedures or surgery Real-time Three-dimensional Echocardiography LIMITATIONS The main limitation of RT3DE is the need for advanced expertise of the operator which calls for independent judgment and problem solving skills similar to that demanded by 2DE As with any newly developed technique, there is a substantial learning curve At this time, not all institutions offer training in RT3DE Guidelines for training requirements are yet to be established Quality of the 2DE image dictates the quality of the 3D dataset Most of the currently used 3D probes have compromised spatial and temporal resolution (espe­cially with color Doppler) compared to their 2D counterparts The 3D dataset is displayed in 2D and hence the depth perception is limited during procedural guidance Novel displays provide differential color hues with respect to depth of the image; however, unless one performs carefully calibrated depth measurements by manipulating the image to display the Z-axis (depth) parallel to the screen, certainty of depth perception is questionable The analysis of the volumetric data can be time consuming Artifacts that are seen with 2DE are all common to 3DE as well In addition, stitch artifacts in space or time, as alluded to previously, can be seen due to respiratory motion or due to irregular heart rates respectively, 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Echocardiogr 2011;24:706.e5-7 122 Silvestry FE, Kerber RE, Brook MM, et al Echocardiography-guided interventions J Am Soc Echocardiogr 2009;22: 213-31 123 Dodos F, Hoppe UC Percutaneous closure of complex atrial septum defect guided by real-time 3D transesophageal echocardiography Clin Res Cardiol 2009;98:455-6 124 Amitai ME, Schnittger I, Popp RL, et al Comparison of threedimensional echocardiography to two-dimensional echocardiography and fluoroscopy for monitoring of endomyocardial biopsy Am J Cardiol 2007;99:864-6 ...Prelims.indd 11 -02-2 014 13 :37:07 Prelims.indd Manual of Cardiac Diagnosis Editors Kanu Chatterjee  MBBS Clinical Professor of Medicine The Carver College of Medicine University of Iowa United States of. .. Delhi 11 0 002, India Phone: + 91- 11- 43574357 Fax: + 91- 11- 43574 314 Email: jaypee@jaypeebrothers.com Overseas Offices J.P Medical Ltd 83 Victoria Street, London SW1H 0HW (UK) Phone: +44-20 317 08 910 ... jaypee@jaypeebrothers.com Manual of Cardiac Diagnosis First Edition:  2 014 ISBN 978-93- 515 2 -19 4-5 Printed at 11 -02-2 014 13 :37:07 Prelims.indd Contributors Abhimanyu (Manu) Uberoi  MD Department of Cardiology