2nd Edition HARRISON’S TM Cardiovascular Medicine Derived from Harrison’s Principles of Internal Medicine, 18th Edition Editors Dan L Longo, md Professor of Medicine, Harvard Medical School; Senior Physician, Brigham and Women’s Hospital; Deputy Editor, New England Journal of Medicine, Boston, Massachusetts Dennis L Kasper, md William Ellery Channing Professor of Medicine, Professor of Microbiology and Molecular Genetics, Harvard Medical School; Director, Channing Laboratory, Department of Medicine, Brigham and Women’s Hospital, Boston, Massachusetts J Larry Jameson, md, PhD Robert G Dunlop Professor of Medicine; Dean, University of Pennsylvania School of Medicine; Executive Vice-President of the University of Pennsylvania for the Health System, Philadelphia, Pennsylvania Anthony S Fauci, md Chief, Laboratory of Immunoregulation; Director, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland Stephen L Hauser, md Robert A Fishman Distinguished Professor and Chairman, Department of Neurology, University of California, San Francisco, San Francisco, California Joseph Loscalzo, md, PhD Hersey Professor of the Theory and Practice of Medicine, Harvard Medical School; Chairman, Department of Medicine; Physician-in-Chief, Brigham and Women’s Hospital, Boston, Massachusetts 2nd Edition HARRISON’S TM Cardiovascular Medicine Editor Joseph Loscalzo, MD, PhD Hersey Professor of the Theory and Practice of Medicine, Harvard Medical School; Chairman, Department of Medicine; Physician-in-Chief, Brigham and Women’s Hospital, Boston, Massachusetts New York Chicago San Francisco Lisbon London Madrid Mexico City Milan New Delhi San Juan Seoul Singapore Sydney Toronto Copyright © 2013 by McGraw-Hill Education, LLC All rights reserved Except as permitted under the United States Copyright Act of 1976, no part of this publication may be reproduced or distributed in any form or by any means, or stored in a database or retrieval system, without the prior written permission of the publisher ISBN: 978-0-07-181499-7 MHID: 0-07-181499-X The material in this eBook also appears in the print version of this title: ISBN: 978-0-07-181498-0, MHID: 0-07-181498-1 All trademarks are trademarks of their respective owners Rather than put a trademark symbol after every occurrence of a trademarked name, we use names in an editorial fashion only, and to the benefit of the trademark owner, with no intention of infringement of the trademark Where such designations appear in this book, they have been printed with initial caps McGraw-Hill Education eBooks are available at special quantity discounts to use as premiums and sales promotions, or for use in corporate training programs To contact a representative please e-mail us at bulksales@mcgraw-hill.com Dr Fauci’s work as an editor and author was performed outside the scope of his employment as a U.S government employee This work represents his personal and professional views and not necessarily those of the U.S government This book was set in Bembo by Cenveo® Publisher Services The editors were James F Shanahan and Kim J Davis The production supervisor was Catherine H Saggese Project management was provided by Tania Andrabi, Cenveo Publisher Services The cover design was by Thomas DePierro Cover illustration, the coronary vessels of the heart, © MedicalRF.com/Corbis TERMS OF USE This is a copyrighted work and McGraw-Hill Education, LLC and its licensors reserve all rights in and to the work Use of this work is subject to these terms Except as permitted under the Copyright Act of 1976 and the right to store and retrieve one copy of the work, you may not decompile, disassemble, reverse engineer, reproduce, modify, create derivative works based upon, transmit, distribute, disseminate, sell, publish or sublicense the work or any part of it without McGraw-Hill Education’s prior consent You may use the work for your own noncommercial and personal use; any other use of the work is strictly prohibited Your right to use the work may be terminated if you fail to comply with these terms THE WORK IS PROVIDED “AS IS.” McGRAW-HILL EDUCATION AND ITS LICENSORS MAKE NO GUARANTEES OR WARRANTIES AS TO THE ACCURACY, ADEQUACY OR COMPLETENESS OF OR RESULTS TO BE OBTAINED FROM USING THE WORK, INCLUDING ANY INFORMATION THAT CAN BE ACCESSED THROUGH THE WORK VIA HYPERLINK OR OTHERWISE, AND EXPRESSLY DISCLAIM ANY WARRANTY, EXPRESS OR IMPLIED, INCLUDING BUT NOT LIMITED TO IMPLIED WARRANTIES OF MERCHANTABILITY OR FITNESS FOR A PARTICULAR PURPOSE McGraw-Hill Education and its licensors not warrant or guarantee that the functions contained in the work will meet your requirements or that its operation will be uninterrupted or error free Neither McGraw-Hill Education nor its licensors shall be liable to you or anyone else for any inaccuracy, error or omission, regardless of cause, in the work or for any damages resulting therefrom McGraw-Hill Education has no responsibility for the content of any information accessed through the work Under no circumstances shall McGraw-Hill Education and/or its licensors be liable for any indirect, incidental, special, punitive, consequential or similar damages that result from the use of or inability to use the work, even if any of them has been advised of the possibility of such damages This limitation of liability shall apply to any claim or cause whatsoever whether such claim or cause arises in contract, tort or otherwise Contents Contributors vii Preface ix 13 Diagnostic Cardiac Catheterization and Coronary Angiography 117 Jane A Leopold, David P Faxon SECTION I SECTION III Introduction to Cardiovascular Disorders Heart Rhythm Disturbances 14 Principles of Electrophysiology 128 David D Spragg, Gordon F Tomaselli Basic Biology of the Cardiovascular System Joseph Loscalzo, Peter Libby, Jonathan Epstein 15 The Bradyarrhythmias 137 David D Spragg, Gordon F Tomaselli Epidemiology of Cardiovascular Disease 20 Thomas A Gaziano, J Michael Gaziano 16 The Tachyarrhythmias 151 Francis Marchlinski Approach to the Patient with Possible Cardiovascular Disease 28 Joseph Loscalzo SECTION IV Disorders of the heart SECTION II Diagnosis of Cardiovascular Disorders 17 Heart Failure and Cor Pulmonale 182 Douglas L Mann, Murali Chakinala Chest Discomfort 34 Thomas H Lee 18 Cardiac Transplantation and Prolonged Assisted Circulation 201 Sharon A Hunt, Hari R Mallidi Dyspnea 42 Richard M Schwartzstein 19 Congenital Heart Disease in the Adult 207 John S Child, Jamil Aboulhosn Hypoxia and Cyanosis 49 Joseph Loscalzo 20 Valvular Heart Disease 219 Patrick O’Gara, Joseph Loscalzo Edema 54 Eugene Braunwald, Joseph Loscalzo 21 Cardiomyopathy and Myocarditis 248 Lynne Warner Stevenson, Joseph Loscalzo Palpitations 61 Joseph Loscalzo 22 Pericardial Disease 273 Eugene Braunwald Physical Examination of the Cardiovascular System 63 Patrick T O’Gara, Joseph Loscalzo 23 Tumors and Trauma of the Heart 284 Eric H Awtry, Wilson S Colucci 10 Approach to the Patient with a Heart Murmur 76 Patrick T O’Gara, Joseph Loscalzo 24 Cardiac Manifestations of Systemic Disease 289 Eric H Awtry, Wilson S Colucci 11 Electrocardiography 89 Ary L Goldberger 25 Infective Endocarditis 294 Adolf W Karchmer 12 Noninvasive Cardiac Imaging: Echocardiography, Nuclear Cardiology, and MRI/CT Imaging 101 Rick A Nishimura, Panithaya Chareonthaitawee, Matthew Martinez 26 Acute Rheumatic Fever 309 Jonathan R Carapetis 27 Chagas’ Disease 316 Louis V Kirchhoff, Anis Rassi, Jr v Contents vi 28 Cardiogenic Shock and Pulmonary Edema 320 Judith S Hochman, David H Ingbar 38 Diseases of the Aorta 467 Mark A Creager, Joseph Loscalzo 29 Cardiovascular Collapse, Cardiac Arrest, and Sudden Cardiac Death 328 Robert J Myerburg, Agustin Castellanos 39 Vascular Diseases of the Extremities 476 Mark A Creager, Joseph Loscalzo SECTION V Disorders of the vasculature 30 The Pathogenesis, Prevention, and Treatment of Atherosclerosis 340 Peter Libby 31 Disorders of Lipoprotein Metabolism 353 Daniel J Rader, Helen H Hobbs 32 The Metabolic Syndrome 377 Robert H Eckel 33 Ischemic Heart Disease 385 Elliott M Antman, Andrew P Selwyn, Joseph Loscalzo 34 Unstable Angina and Non-ST-Segment Elevation Myocardial Infarction 407 Christopher P Cannon, Eugene Braunwald 40 Pulmonary Hypertension 490 Stuart Rich SECTION VI Cardiovascular Atlases 41 Atlas of Electrocardiography 500 Ary L Goldberger 42 Atlas of Noninvasive Cardiac Imaging 517 Rick A Nishimura, Panithaya Chareonthaitawee, Matthew Martinez 43 Atlas of Cardiac Arrhythmias 526 Ary L Goldberger 44 Atlas of Percutaneous Revascularization 539 Jane A Leopold, Deepak L Bhatt, David P Faxon 35 ST-Segment Elevation Myocardial Infarction 415 Elliott M Antman, Joseph Loscalzo Appendix Laboratory Values of Clinical Importance 549 Alexander Kratz, Michael A Pesce, Robert C Basner, Andrew J Einstein 36 Percutaneous Coronary Interventions and Other Interventional Procedures 434 David P Faxon, Deepak L Bhatt Review and Self-Assessment 575 Charles Wiener, Cynthia D Brown, Anna R Hemnes 37 Hypertensive Vascular Disease 443 Theodore A Kotchen Index 615 CONTRIBUTORS Numbers in brackets refer to the chapter(s) written or cowritten by the contributor UCLA Adult Noninvasive Cardiodiagnostics Laboratory, Ronald Reagan-UCLA Medical Center, Los Angeles, California [19] Jamil Aboulhosn, MD Assistant Professor, Departments of Medicine and Pediatrics, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California [19] Wilson S Colucci, MD Thomas J Ryan Professor of Medicine, Boston University School of Medicine; Chief of Cardiovascular Medicine, Boston Medical Center, Boston, Massachusetts [23, 24] Elliott M Antman, MD Professor of Medicine, Harvard Medical School; Brigham and Women’s Hospital, Boston, Massachusetts [33, 35] Mark A Creager, MD Professor of Medicine, Harvard Medical School; Simon C Fireman Scholar in Cardiovascular Medicine; Director, Vascular Center, Brigham and Women’s Hospital, Boston, Massachusetts [38, 39] Eric H Awtry, MD Assistant Professor of Medicine, Boston University School of Medicine; Inpatient Clinical Director, Section of Cardiology, Boston Medical Center, Boston, Massachusetts [23, 24] Robert H Eckel, MD Professor of Medicine, Division of Endocrinology, Metabolism and Diabetes, Division of Cardiology; Professor of Physiology and Biophysics, Charles A Boettcher, II Chair in Atherosclerosis, University of Colorado School of Medicine, Anschutz Medical Campus, Director Lipid Clinic, University of Colorado Hospital, Aurora, Colorado [32] Robert C Basner, MD Professor of Clinical Medicine, Division of Pulmonary, Allergy, and Critical Care Medicine, Columbia University College of Physicians and Surgeons, New York, New York [Appendix] Deepak L Bhatt, MD, MPH Associate Professor of Medicine, Harvard Medical School; Chief of Cardiology, VA Boston Healthcare System; Director, Integrated Interventional Cardiovascular Program, Brigham and Women’s Hospital and VA Boston Healthcare System; Senior Investigator, TIMI Study Group, Boston, Massachusetts [36, 44] Andrew J Einstein, MD, PhD Assistant Professor of Clinical Medicine, Columbia University College of Physicians and Surgeons; Department of Medicine, Division of Cardiology, Department of Radiology, Columbia University Medical Center and New York-Presbyterian Hospital, New York, New York [Appendix] Eugene Braunwald, MD, MA (Hon), ScD (Hon) FRCP Distinguished Hersey Professor of Medicine, Harvard Medical School; Founding Chairman, TIMI Study Group, Brigham and Women’s Hospital, Boston, Massachusetts [7, 22, 34] Jonathan A Epstein, MD, DTMH William Wikoff Smith Professor of Medicine; Chairman, Department of Cell and Developmental Biology; Scientific Director, Cardiovascular Institute, University of Pennsylvania, Philadelphia, Pennsylvania [1] Cynthia D Brown, MD Assistant Professor of Medicine, Division of Pulmonary and Critical Care Medicine, University of Virginia, Charlottesville, Virginia [Review and Self-Assessment] David P Faxon, MD Senior Lecturer, Harvard Medical School; Vice Chair of Medicine for Strategic Planning, Department of Medicine, Brigham and Women’s Hospital, Boston, Massachusetts [13, 36, 44] Christopher P Cannon, MD Associate Professor of Medicine, Harvard Medical School; Senior Investigator, TIMI Study Group, Brigham and Women’s Hospital, Boston, Massachusetts [34] J Michael Gaziano, MD, MPH Professor of Medicine, Harvard Medical School; Chief, Division of Aging, Brigham and Women’s Hospital; Director, Massachusetts Veterans Epidemiology Center, Boston VA Healthcare System, Boston, Massachusetts [2] Jonathan Carapetis, PhD, MBBS, FRACP, FAFPHM Director, Menzies School of Health Research, Charles Darwin University, Darwin, Australia [26] Agustin Castellanos, MD Professor of Medicine, and Director, Clinical Electrophysiology, Division of Cardiology, University of Miami Miller School of Medicine, Miami, Florida [29] Thomas A Gaziano, MD, MSc Assistant Professor, Harvard Medical School; Assistant Professor, Health Policy and Management, Center for Health Decision Sciences, Harvard School of Public Health; Associate Physician in Cardiovascular Medicine, Department of Cardiology, Brigham and Women’s Hospital, Boston, Massachusetts [2] Murali Chakinala, MD Associate Professor of Medicine, Division of Pulmonary and Critical Care Medicine, Washington University School of Medicine, St Louis, Missouri [17] Panithaya Chareonthaitawee, MD Associate Professor of Medicine, Mayo Clinic College of Medicine, Rochester, Minnesota [12, 42] Ary L Goldberger, MD Professor of Medicine, Harvard Medical School; Wyss Institute for Biologically Inspired Engineering, Harvard University; Beth Israel Deaconess Medical Center, Boston, Massachusetts [11, 41, 43] John S Child, MD, FACC, FAHA, FASE Streisand Professor of Medicine and Cardiology, Geffen School of Medicine, University of California, Los Angeles (UCLA); Director, Ahmanson-UCLA Adult Congenital Heart Disease Center; Director, Anna R Hemnes, MD Assistant Professor, Division of Allergy, Pulmonary, and Critical Care Medicine, Vanderbilt University Medical Center, Nashville, Tennessee [Review and Self-Assessment] vii viii Contributors Helen H Hobbs, MD Professor of Internal Medicine and Molecular Genetics, University of Texas Southwestern Medical Center, Dallas, Texas; Investigator, Howard Hughes Medical Institute, Chevy Chase, Maryland [31] Judith S Hochman, MD Harold Snyder Family Professor of Cardiology; Clinical Chief, Leon Charney Division of Cardiology; Co-Director, NYU-HHC Clinical and Translational Science Institute; Director, Cardiovascular Clinical Research Center, New York University School of Medicine, New York, New York [28] Sharon A Hunt, MD, FACC Professor, Division of Cardiovascular Medicine, Stanford University, Palo Alto, California [18] David H Ingbar, MD Professor of Medicine, Pediatrics, and Physiology; Director, Pulmonary Allergy, Critical Care and Sleep Division, University of Minnesota School of Medicine, Minneapolis, Minnesota [28] Adolf W Karchmer, MD Professor of Medicine, Harvard Medical School; Division of Infectious Diseases, Beth Israel Deaconess Medical Center, Boston, Massachusetts [25] Louis V Kirchhoff, MD, MPH Professor of Internal Medicine (Infectious Diseases) and Epidemiology, Department of Internal Medicine, The University of Iowa, Iowa City, Iowa [27] Theodore A Kotchen, MD Professor Emeritus, Department of Medicine; Associate Dean for Clinical Research, Medical College of Wisconsin, Milwaukee, Wisconsin [37] Alexander Kratz, MD, PhD, MPH Associate Professor of Pathology and Cell Biology, Columbia University College of Physicians and Surgeons; Director, Core Laboratory, Columbia University Medical Center, New York, New York [Appendix] Thomas H Lee, MD, MSc Professor of Medicine, Harvard Medical School; Network President, Partners Healthcare System, Boston, Massachusetts [4] Jane A Leopold, MD Associate Professor of Medicine, Harvard Medical School; Brigham and Women’s Hospital, Boston, Massachusetts [13, 44] Peter Libby, MD Mallinckrodt Professor of Medicine, Harvard Medical School; Chief, Cardiovascular Medicine, Brigham and Women’s Hospital, Boston, Massachusetts [1, 30] Joseph Loscalzo, MD, PhD Hersey Professor of the Theory and Practice of Medicine, Harvard Medical School; Chairman, Department of Medicine; Physician-in-Chief, Brigham and Women’s Hospital, Boston, Massachusetts [1, 3, 6–10, 20, 21, 33, 35, 38, 39] Hari R Mallidi, MD Assistant Professor of Cardiothoracic Surgery; Director of Mechanical Circulatory Support, Stanford University Medical Center, Stanford, California [18] Douglas L Mann, MD Lewin Chair and Chief, Cardiovascular Division; Professor of Medicine, Cell Biology and Physiology, Washington University School of Medicine, St Louis, Missouri [17] Francis Marchlinski, MD Professor of Medicine; Director, Cardiac Electrophysiology, University of Pennsylvania Health System, Philadelphia, Pennsylvania [16] Matthew Martinez, MD Lehigh Valley Physician Group, Lehigh Valley Heart Specialists, Allentown, Pennsylvania [12, 42] Robert J Myerburg, MD Professor, Departments of Medicine and Physiology, Division of Cardiology; AHA Chair in Cardiovascular Research, University of Miami Miller School of Medicine, Miami, Florida [29] Rick A Nishimura, MD, FACC, FACP Judd and Mary Morris Leighton Professor of Cardiovascular Diseases; Professor of Medicine; Consultant, Division of Cardiovascular Diseases and Internal Medicine, Mayo Clinic College of Medicine, Rochester, Minnesota [12, 42] Patrick T O’Gara, MD Professor of Medicine, Harvard Medical School; Director, Clinical Cardiology, Brigham and Women’s Hospital, Boston, Massachusetts [9, 10, 20] Michael A Pesce, PhD Professor Emeritus of Pathology and Cell Biology, Columbia University College of Physicians and Surgeons; Columbia University Medical Center, New York, New York [Appendix] Daniel J Rader, MD Cooper-McClure Professor of Medicine and Pharmacology, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania [31] Anis Rassi, Jr., MD, PhD, FACC, FACP, FAHA Scientific Director, Anis Rassi Hospital, Goiânia, Brazil [27] Stuart Rich, MD Professor of Medicine, Department of Medicine, Section of Cardiology, University of Chicago, Chicago, Illinois [40] Richard M Schwartzstein, MD Ellen and Melvin Gordon Professor of Medicine and Medical Education; Associate Chief, Division of Pulmonary, Critical Care, and Sleep Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts [5] Andrew P Selwyn, MD, MBCHB Professor of Medicine, Harvard Medical School; Brigham and Women’s Hospital, Boston, Massachusetts [33] David D Spragg, MD Assistant Professor of Medicine, Johns Hopkins University, Baltimore, Maryland [14, 15] Lynne Warner Stevenson, MD Professor of Medicine, Harvard Medical School; Director, Heart Failure Program, Brigham and Women’s Hospital, Boston, Massachusetts [21] Gordon F Tomaselli, MD Michel Mirowski, MD Professor of Cardiology; Professor of Medicine and Cellular and Molecular Medicine; Chief, Division of Cardiology, Johns Hopkins University, Baltimore, Maryland [14, 15] Charles M Wiener, MD Dean/CEO Perdana University Graduate School of Medicine, Selangor, Malaysia; Professor of Medicine and Physiology, Johns Hopkins University School of Medicine, Baltimore, Maryland [Review and Self-Assessment] PREFACE it As knowledge about these complex systems expands, the opportunity for identifying unique therapeutic targets increases, holding great promise for definitive interventions in the future Regenerative medicine is another area of cardiovascular medicine that is rapidly achieving translation Recognition that the adult human heart can repair itself, albeit sparingly with typical injury, and that cardiac precursor (stem) cells reside within the myocardium to this can be expanded, and can be used to repair if not regenerate a normal heart is an exciting advance in the field These concepts represent a completely novel paradigm that will revolutionize the future of the subspecialty In view of the importance of cardiovascular medicine to the field of internal medicine, and the rapidity with which the scientific basis for the discipline is advancing, Harrison’s Cardiovascular Medicine was developed The purpose of this sectional is to provide the readers with a succinct overview of the field of cardiovascular medicine To achieve this goal, Harrison’s Cardiovascular Medicine comprises the key cardiovascular chapters contained in the eighteenth edition of Harrison’s Principles of Internal Medicine, contributed by leading experts in the field This sectional is designed not only for physicians-in-training on cardiology rotations, but also for practicing clinicians, other health care professionals, and medical students who seek to enrich and update their knowledge of this rapidly changing field The editors trust that this book will increase both the readers’ knowledge of the field, and their appreciation for its importance The first section of the book, “Introduction to Cardiovascular Disorders,” provides a systems overview, beginning with the basic biology of the cardiovascular system, followed by epidemiology of cardiovascular disease, and approach to the patient The integration of pathophysiology with clinical management is a hallmark of Harrison’s, and can be found throughout each of the subsequent disease-oriented chapters The book is divided into six main sections that reflect the scope of cardiovascular medicine: (I) Introduction to the Cardiovascular System; (II) Diagnosis of Cardiovascular Disorders; (III) Heart Rhythm Disturbances; (IV) Disorders of the Heart; (V) Disorders of the Vasculature; and (VI) Cardiovascular Atlases Our access to information through web-based journals and databases is remarkably efficient Although these sources of information are invaluable, the daunting body of data creates an even greater need for synthesis by experts in the field Thus, the preparation of these chapters is a special craft that requires the ability to distill Harrison’s Principles of Internal Medicine has been a respected information source for more than 60 years Over time, the traditional textbook has evolved to meet the needs of internists, family physicians, nurses, and other health care providers The growing list of Harrison’s products now includes Harrison’s for the iPad, Harrison’s Manual of Medicine, and Harrison’s Online This book, Harrison’s Cardiovascular Medicine, now in its second edition, is a compilation of chapters related to cardiovascular disorders Our readers consistently note the sophistication of the material in the specialty sections of Harrison’s Our goal was to bring this information to our audience in a more compact and usable form Because the topic is more focused, it is possible to enhance the presentation of the material by enlarging the text and the tables We have also included a Review and Self-Assessment section that includes questions and answers to provoke reflection and to provide additional teaching points Cardiovascular disease is the leading cause of death in the United States, and is rapidly becoming a major cause of death in the developing world Advances in the therapy and prevention of cardiovascular diseases have clearly improved the lives of patients with these common, potentially devastating disorders; yet, the disease prevalence and the risk factor burden for disease (especially obesity in the United States and smoking worldwide) continue to increase globally Cardiovascular medicine is, therefore, of crucial importance to the field of internal medicine Cardiovascular medicine is a large and growing subspecialty, and comprises a number of specific subfields, including coronary heart disease, congenital heart disease, valvular heart disease, cardiovascular imaging, electrophysiology, and interventional cardiology Many of these areas involve novel technologies that facilitate diagnosis and therapy The highly specialized nature of these disciplines within cardiology and the increasing specialization of cardiologists argue for the importance of a broad view of cardiovascular medicine by the internist in helping to guide the patient through illness and the decisions that arise in the course of its treatment The scientific underpinnings of cardiovascular medicine have also been evolving rapidly The molecular pathogenesis and genetic basis for many diseases are now known and, with this knowledge, diagnostics and therapeutics are becoming increasingly individualized Cardiovascular diseases are largely complex phenotypes, and this structural and physiological complexity recapitulates the complex molecular and genetic systems that underlie ix Index atherosclerosis and, 348 cardiovascular disease and, 26 chronic kidney disease and physical examination, 459 renal parenchymal disease, 452 renin-angiotensin-aldosterone system in, 446–448 renovascular hypertension, 452–453 clinical disorders of, 451 in coarctation of the aorta, 457 cognitive function and, 449 complications of, 593, 612 in Cushing’s syndrome, 455 definition of, 450, 450t diagnosis of, 458–459, 459t drug-induced, 451t dyspnea in, 45 encephalopathy in, 449 encephalopathy of, 465t, 466 epidemiology of, 443–444 essential, 451–452 genetic factors in, 444, 456t headache in, 458 heart failure and, 182, 449, 463–464 See also Heart failure (HF) heart sounds in, 459 history in, 458, 458t hypokalemia and, 454 intermittent claudication and, 450 ischemic heart disease and, 398 isolated systolic, 450, 450t laboratory evaluation of, 458–459, 459t left ventricular hypertrophy and, 449 malignant See Malignant hypertension mechanisms of, 444–448 autonomic nervous system, 445–446 intravascular volume, 444–445 renin-angiotensin-aldosterone system, 446–448, 447f vascular, 448 in metabolic syndrome, 349, 380, 383, 452 mineralocorticoid-mediated, 447 monogenic, 456t, 457–458, 457f obesity and, 443–444 in paraganglioma, 456 pathologic consequences of, 448–450 peripheral artery disease and, 450 in pheochromocytoma, 446, 455–456 physical examination in, 459 portal, 492t, 494–495 postoperative, 465t in pregnancy, 456t, 458 pulmonary arterial See Pulmonary arterial hypertension (PAH) racial differences in complications of, 443 renin-dependent, 446–448 resistant, 464–465, 593–594, 612–613 retinopathy in, 459 risk factors for, 443–444 secondary causes of, 451t sleep apnea and, 456–457 sodium intake and, 444 stroke and, 449, 466 systolic with wide pulse pressure, 450, 451t in thyroid disease, 457 treatment of ACE inhibitors, 461t, 462, 463–464 aldosterone antagonists, 461t, 462 alpha blockers, 461t, 462–463 ARBs, 461t, 462, 463–464 beta blockers, 461t, 462 blood pressure goals in, 464–465 calcium channel blockers, 461t, 463 comparisons of antihypertensives, 463–464 diuretics, 460–461, 461t, 463–464 lifestyle modifications, 459–460, 460t, 593, 612 sympatholytics, 461t, 463 vasodilators, 461t, 463 white coat, 451 Hypertensive crisis, 465 Hypertensive emergency, 465–466, 465t Hypertensive urgency, 465 Hyperthyroidism cardiac manifestations of, 290t, 291 atrial fibrillation, 156 heart failure, 262 edema in, 59 hypertension in, 451t, 457 pretibial myxedema in, 488–489 Hypertrophic cardiomyopathy apical, 270 chest pain in, 34 clinical features of, 249t, 269–270 diagnosis of, 270 differential diagnosis of, 270 dyspnea in, 45 ECG in, 270, 509f echocardiography in, 269f, 270, 517V genetic factors in, 270 MRI in, 111f murmur in, 73, 77f, 80, 86, 589, 607 natural history of, 31 palpitations in, 61 pathophysiology of, 268–270, 269f, 270f sudden death in, 272, 272t treatment of, 271–272, 271f ventricular tachycardia in, 174 Hypertrophic osteoarthropathy, 53 Hyperuricemia, metabolic syndrome and, 381 Hyperviscosity, Raynaud’s phenomenon in, 484 Hypoalbuminemia, 57 Hypoalphalipoproteinemia, 366 Hypobetalipoproteinemia, familial, 363 629 Hypocalcemia clinical features of, 262–263 ECG in, 99, 99f, 513f Hypokalemia in aldosteronism, 454 arrhythmia in, 132 ECG in, 99, 99f, 512f, 577, 598 Hypomagnesemia arrhythmia in, 132 clinical features of, 263 Hypophosphatemia, 263 Hypoproteinemia, 60 Hypothermia arrhythmia in, 139 ECG in, 99, 99f SA node dysfunction in, 138t Hypothyroidism cardiac manifestations of, 290t, 291–292 AV conduction block, 143t heart failure, 262 SA node dysfunction, 138t, 139 edema in, 59 hypertension in, 451t, 457 Hypoventilation, hypoxia in, 50 Hypovolemia, in myocardial infarction, 429 Hypovolemic shock, 323t Hypoxemia in pulmonary edema, 48 pulmonary hypertension in, 492t Hypoxia, 49 effects of, 49 etiology of, 49–51, 575, 595–596 histotoxic, 51 pulmonary hypertension in, 496 SA node dysfunction in, 138t, 139 I band, of sarcomere, Ibuprofen, for idiopathic acute pericarditis, 278 Ibutilide action of, 135t adverse effects of, 160t for atrial fibrillation, 157 dosage of, 158t indications for, 158t for pharmacologic cardioversion, 162 ICD See Implantable cardioverterdefibrillator (ICD) Idiopathic hypertrophic subaortic stenosis See Hypertrophic cardiomyopathy IDLs (intermediate-density lipoproteins), 353–355, 353f, 354t, 364t Ifosfamide, cardiotoxicity of, 262 Iloprost, for pulmonary hypertension, 494 Immune response/immune system endothelium in, reference values for laboratory tests, 552–559t in rheumatic fever, 310, 311f 630 Immunoglobulin(s), 556t Immunosuppressive therapy, after cardiac transplantation, 203 Impella device, 442 Implantable cardioverter-defibrillator (ICD) for Brugada syndrome, 179 for catecholaminergic polymorphic VT, 179 endocarditis associated with, 295 for heart failure, 195 for hypertrophic cardiomyopathy, 272 for long QT syndrome, 177–178 for myocardial infarction, 430, 431f for short QT syndrome, 178 for ventricular tachycardia, 135, 171, 173 Indomethacin, for idiopathic acute pericarditis, 278 Infective endocarditis, 294 Abiotrophia, 301 abscesses in, 297 acute, 294 aortic regurgitation and, 238 AV conduction block in, 143t Bartonella, 296, 304, 591, 609 blood culture in, 299 Candida, 295t, 304 clinical features of, 296–298, 297f, 576, 596–597 clubbing/hypertrophic osteoarthropathy in, 53 complications of, 306–307 Corynebacterium, 295 culture-negative, 295t, 591, 609 diagnosis of, 297t, 298–299, 298t, 590, 609 echocardiography in, 299, 300f embolic events in, 297–298, 297f, 306 enterococcal incidence of, 295t treatment of, 301, 302t etiology of, 294–296, 295t, 590, 609 Gemella morbillorum, 301, 302t global considerations, 294 Granulicatella, 301 HACEK group clinical features of, 296 incidence of, 295t treatment of, 303t, 304 health care–associated, 298 heart failure in, 297, 306 implanted defibrillator-associated, 295 in injection drug users, 295, 295t, 296 murmur in, 79 mycotic aneurysm in, 297–298, 307 outcome of, 307 pacemaker-associated, 295 pathogenesis of, 296 perivalvular infection in, 306 pneumococcal, 295t, 304 polymicrobial, 295t prevention of, 307–308, 590–591, 609 Index prophylaxis for dental care, 307, 307t, 308t prophylaxis in congenital heart disease, 218 septic emboli in, 297, 297f staphylococcal clinical features of, 296 echocardiography in, 300f emboli in, 297, 297f incidence of, 295t pathophysiology of, 296 treatment of, 301, 302t, 303, 306 streptococcal incidence of, 295t treatment of, 302t, 304 subacute, 294 treatment of antibiotics after cardiac surgery, 306 antimicrobial therapy, 301–304, 302–303t, 591, 610 empirical, 304 monitoring, 304 prevention of systemic emboli, 306 surgical, 305–307, 305t vegetations in, 517V Inflammation atherosclerosis and, 340, 350–351, 351f endothelium in, Inflammatory bowel disease (IBD), aortitis in, 474 Influenza, myocarditis and, 258 Injection drug users, endocarditis in, 295, 295t, 297 Inotropes, for acute heart failure, 197–198, 197t Insulin resistance atherosclerosis and, 349 free fatty acids in, 379 lipodystrophy and, 367 treatment of, 384 Intercostal muscle cramps, 37 Interferon-α (IFN-α), adverse effects of, 262 Interleukin-2 (IL-2) therapy, adverse effects of, 58t Intermediate-density lipoproteins (IDLs), 353–355, 353f, 354t, 364t Internal cardiac defibrillator (ICD), 337 Interstitial fluid, 54 Interstitial lung diseases (ILDs) dyspnea in, 44t, 45 pulmonary hypertension in, 492t, 496 Interventional cardiology, 434 Intestinal lymphangiectasia, 488 Intima, Intimal dissection, 435f, 436 Intraaortic balloon, percutaneous, 441–442 Intraaortic balloon pumping, for cardiogenic shock, 324, 610–611 Intraaortic counterpulsation, for pulmonary edema, 327 Intracranial pressure (ICP), SA node dysfunction in increased, 138t, 139 Intravascular volume, effect on blood pressure, 444–445 Intravenous immunoglobulin (IVIg), for rheumatic fever, 314 Ion channels, cardiac, 128–129, 129f, 130f Irbesartan, for heart failure, 191t Ischemic heart disease, 385 angina pectoris in See Angina pectoris arrhythmia in, 387 asymptomatic (silent), 387–388, 406 cardiac catheterization in, 395–396 cardiomegaly in, 387 cardiomyopathy and, 387–388 chest pain in, 34–36, 34t coronary atherosclerosis in, 386–387 See also Coronary artery disease (CAD) diabetes mellitus and, 398 diagnosis of approach to, 116f, 391f coronary arteriography in, 394–395 CT in, 394 ECG in, 95–98, 96f, 97f, 98t, 390, 391f echocardiography in, 392f history in, 388–389 laboratory tests in, 390 MRI in, 392f, 394 myocardial perfusion imaging in, 392f, 394 nuclear cardiology in, 107–110, 107f, 109f, 392f, 394 PET scan in, 109f, 392f, 394 physical examination in, 389–390 stress testing in, 390–394, 391f, 392f, 393t test selection for, 116f dyslipidemia and, 398 epidemiology of, 385 family history in, 397 global considerations, 385 heart failure in, 387, 402 hypertension and, 398 obesity and, 397 pathophysiology of, 385–386 See also Atherosclerosis prevalence of, in emergency department patient with chest pain, 39t prognosis of, 395–396 risk factors for, 397–398 smoking and, 398 symptomatic, 387–388 treatment of, 396–402 ACE inhibitors, 401–402 activity adaptation, 396–397, 397t aggravating conditions, 396 algorithm for, 403f antiplatelet drugs, 401 beta blockers, 399t, 400–401 CABG, 404–405 See also Coronary artery bypass grafting Index calcium channel blockers, 399t, 401 enhanced external counterpulsation, 406 explanation and reassurance, 396 nicorandil, 402 nitrates, 398–400, 399t PCI, 402–404 See also Percutaneous coronary interventions (PCI) ranolazine, 402 risk factor management, 397–398 in women, 398 Islet-1, 17 Isoproterenol for AV conduction block, 145, 147 for Brugada syndrome, 179 for long QT syndrome, 178 for SA node dysfunction, 141 Isosorbide dinitrate for heart failure, 429 for ischemic heart disease, 399t for pulmonary edema, 326 Isosorbide mononitrate, for ischemic heart disease, 399t Isradipine adverse effects of, 399t for ischemic heart disease, 399t, 401 for Raynaud’s phenomenon, 484 Janeway lesions, 65 Joint disorders, in rheumatic fever, 311–312 Jones criteria, for acute rheumatic fever, 312–313, 313t Jugular venous pressure in heart failure, 187 measurement of, 65–67, 66f Junctional bradycardia, ECG in, 528f Junctional premature complexes, 154 Kearns-Sayre syndrome AV conduction block in, 143, 143t clinical features of, 139 SA node dysfunction in, 138t, 139 ventricular arrhythmia in, 174t Kerley B lines, 222 Keshan disease, 262 Kidney disease/failure See Chronic kidney disease (CKD) renin-secreting tumors of, 447 Klinefelter syndrome, lymphedema in, 488 Korotkoff sounds, 458 Kussmaul’s sign, 66, 265, 281 Kwashiorkor (protein-calorie malnutrition), cardiac manifestations of, 289, 290t Kyphoscoliosis, 43t, 44 Labetalol for aortic dissection, 473 for hypertension, 461t, 462 for hypertensive emergencies, 465t, 466 for ischemic heart disease, 399t Laboratory tests See Clinical laboratory tests LAMB syndrome, 284–285 Lamin proteins, 250 Laplace’s law, 14 Laser therapy, for varicose veins, 487 Late potential, 134 LDL See Low-density lipoprotein (LDL) Lead poisoning, 562t Lecithin-cholesterol acyltransferase (LCAT), 356f Lecithin-cholesterol acyltransferase (LCAT) deficiency, 366 Left bundle branch, 142 Left bundle branch block conditions associated with, 95, 577, 598 ECG in, 94–95, 94f, 515f, 534f heart sounds in, 70f Left coronary artery, anomalous origin from pulmonary artery, 213 Left ventricular aneurysm apical, MRI of, 520V, 521f Left ventricular aneurysm, in myocardial infarction, 432 Left ventricular assist devices (LVADs) as bridge to cardiac transplantation, 204–205 components of, 205f for heart failure, 204, 585, 603–604 indications for, 204 for pulmonary edema, 327 results of, 205–206 types of, 204–205 Left ventricular dysfunction acute, treatment of, 465t cardiogenic shock in, 320–321 diagnosis of echocardiography in, 106f, 569t imaging tests for, 114t, 115 ventriculography in, 122–123, 122f in heart failure, 184, 184f pulmonary venous hypertension and, 495 Left ventricular ejection fraction, 16 Left ventricular hypertrophy ECG in, 94, 94f, 514f, 578, 599 hypertension and, 449, 514f with myocardial ischemia, 386 Left ventricular noncompaction, 264 Left ventricular remodeling, 185t, 186, 428 Lenègre disease, 143t Leriche syndrome, 473 Lev disease, 143t Levine’s sign, 388 Levocardia, isolated, 217 Levosimendan, for acute heart failure, 197t Libman-Sacks endocarditis, 293 631 Liddle’s syndrome clinical features of, 456t genetic factors in, 456t pathophysiology of, 458 Lidocaine adverse effects of, 160t for cardiac arrest, 335 dosage of, 158t indications for, 158t for ventricular tachycardia, 171 Lifestyle modifications for atherosclerosis prevention, 351 for hypertension, 459–460, 460t for metabolic syndrome, 382 Lipedema, 489 Lipid(s) dietary, transport of, 355–356, 355f hepatic, transport of, 356 Lipid profile, 346–347 Lipoatrophy, in metabolic syndrome, 381 Lipodystrophy in HIV infection, 378–379 insulin resistance and, 367 Lipoma, cardiac, 286 Lipoprotein(a), 354t, 356, 361, 376 Lipoprotein(s) classification of, 353–355, 353f, 354t composition of, 353–355, 354t See also High-density lipoprotein (HDL); Low-density lipoprotein (LDL) metabolism of disorders of See Lipoprotein disorders endogenous pathway (hepatic lipids), 355f, 356 exogenous pathway (dietary lipids), 355–356, 355f HDL and reverse cholesterol transport, 356–357, 356f oxidized, 341 proteins associated with, 353–355 Lipoprotein disorders, 357 atherosclerosis and, 340, 346t cardiovascular disease risk and, 26, 398 diagnosis of, 369 with elevated HDL-C CETP deficiency, 366 familial hyperalphalipoproteinemia, 366–367 with elevated LDL–C and normal triglycerides, 358–360, 358t autosomal dominant hypercholesterolemia due to mutations in PCSK9, 360 autosomal recessive hypercholesterolemia, 360 familial defective ApoB-100, 360 familial hypercholesterolemia, 358–360 polygenic hypercholesterolemia, 360–361 sitosterolemia, 360 632 Lipoprotein disorders (Cont.): with elevated lipoprotein(a), 361 with elevated triglycerides, 358t, 361–363 ApoA-V deficiency, 361 familial chylomicronemia syndrome, 361, 364t familial combined hyperlipidemia, 363 familial dysbetalipoproteinemia, 362 familial hypertriglyceridemia, 362–363 GPIHBP1 deficiency, 361 hepatic lipase deficiency, 361–362 in metabolic syndrome, 380, 383 Frederickson classification of, 357–358, 357t with low ApoB familial hypobetalipoproteinemia, 363 PCSK9 deficiency, 363–365 with low HDL-C genetic deficiency of apoA-I, 365 LCAT deficiency, 366 primary hypoalphalipoproteinemia, 366 Tangier disease See Tangier disease (ABCA1 deficiency) screening for classification of results, 563t cutpoints for therapy in, 347t recommendations, 368–369 secondary forms, 364t alcohol consumption and, 368 in Cushing’s syndrome, 368 diabetes mellitus and, 349, 367 See also Metabolic syndrome drug-related, 364t, 368 estrogen and, 368 liver disorders and, 368 lysosomal storage diseases and, 368 in obesity, 367 renal disorders and, 67–368 thyroid disease and, 367 treatment of bile acid sequestrants, 373t, 374 for CHD risk reduction, 369–371 cholesterol absorption inhibitors, 373–374, 373t clinical approach to, 371–372, 373t combination drug therapy, 375 dietary modification, 371 elevated lipoprotein(a) management, 376 ezetimibe for, 348 fibric acid derivatives, 373t, 374–375 foods and dietary additives, 371 LDL apheresis, 375 lifestyle modifications, 348, 371 low HDL–C management, 347, 348, 375–376 in metabolic syndrome, 383 nicotinic acid, 373t, 374 nonpharmacologic, 371 omega-3 fatty acids, 373t, 375 statins, 347–348, 372, 373t Index Lipoprotein lipase (LPL), 355, 356f, 379 Lipoprotein lipase (LPL) deficiency, 361 Lisinopril for heart failure, 191t for hypertension, 461t Lithium AV conduction block with, 143t SA node dysfunction with, 138t Livedo reticularis, 485 Liver disease/failure, lipoprotein metabolism effects on, 368 LMWH (low-molecular-weight heparin), for myocardial infarction, 427 Loeys-Dietz syndrome, 64, 468, 468t Löffler’s endocarditis, 268 Long QT syndrome, 176 acquired, 178 arrhythmia in, 132 in athletes, 180t congenital, 132, 176, 177t, 537f ECG in, 133, 151, 169f, 537f mechanism of, 153 treatment of, 132, 178 Long RP tachycardia, 166 Loop diuretics, for heart failure, 190–191 Lorazepam, for sedation after myocardial infarction, 426 Losartan for heart failure, 191t for hypertension, 461t Lovastatin adverse effects of, 373t for hyperlipidemia, 373t Low-density lipoprotein (LDL) atherosclerosis and, 347–348 composition of, 353–355, 353f coronary heart disease and, 347 elevated, disorders associated with, 358–360, 358t, 364t, 592, 611–612 See also Lipoprotein disorders estimation of, 368 goal for, 347, 347t, 382–383 lowering levels of, 347–348, 347t See also Lipoprotein disorders, treatment of in metabolic syndrome, 380 oxidized, 341 reduced, disorders associated with, 364t Low-density lipoprotein (LDL) apheresis, 375 Low-density lipoprotein (LDL) receptors, 342, 611 Low-molecular-weight heparin (LMWH), for myocardial infarction, 427 LPL (lipoprotein lipase), 355, 356f, 379 LPL (lipoprotein lipase) deficiency, 361 Lung cancer chest pain in, 34t clubbing in, 53 Lung disease cyanosis in, 52 pulmonary hypertension in, 492t pulmonary venous hypertension in, 495 Lung transplantation, for pulmonary hypertension, 494 Lung volume(s), 571t Lusitropic effect, 12f Luteinizing hormone (LH), 557t LVADs See Left ventricular assist devices (LVADs) Lyme borreliosis (Lyme disease) AV conduction block in, 143, 143t, 529f, 580–581, 600 myocarditis in, 259 SA node dysfunction in, 138t Lymphangiography, 489 Lymphangiomatosis, pulmonary hypertension in, 492t Lymphangitis, 58, 488, 488t Lymphatic filariasis, lymphedema in, 488, 488t Lymphatic obstruction, edema and, 57 Lymphedema, 58, 488–489, 488t Lymphedema praecox, 488, 488t Lymphedema tarda, 488, 488t Lymphoid malignancies, AV conduction block in, 143t Lymphoscintigraphy, 489 Lysosomal storage diseases, lipoprotein metabolism effects on, 368 Macroalbuminuria, 450 Magnetic resonance angiography (MRA) in congenital heart disease, 110–111, 111f, 214f in peripheral artery disease, 477f Magnetic resonance imaging (MRI) in atrial myxoma, 286f basic principles, 110 clinical applications, 110–112 in cor pulmonale, 200 with gadolinium enhancement, in anteroapical infarction, 111f in hypertrophic cardiomyopathy, 111f limitations, 112 stress testing with, 88, 394 Mahaim fibers, 166 Maladie de Roger, 82–8383 Malignant hypertension cerebral effects, 449 renal effects, 449–450 treatment of, 465–466, 465t Mallory-Weiss tears, chest pain in, 37 Mammary souffle, 74, 85 Marantic endocarditis, 296 Marasmus, cardiac manifestations of, 289 Marfan syndrome cardiac manifestations of, 290t aortic aneurysm, 468, 468t, 470 aortic dissection, 36, 471, 473 Index hand deformities in, 65 murmur in, 83 oral deformities in, 64 Mastocytosis, palpitations in, 61 MCTD See Mixed connective tissue disease (MCTD) Means-Lerman scratch, 291 Mechanical ventilation, for pulmonary edema, 326 Meige’s disease/syndrome, 488 Melanoma, AV conduction block in, 143t MEN (multiple endocrine neoplasia type 2), pheochromocytoma in, 456t Mercury exposure/poisoning, 562t Mesocardia, 217 Mesothelioma AV conduction block in, 143t, 286 clinical features of, 283 intracardial, 286 Metabolic syndrome, 377 adiponectin in, 381 age and, 378 cardiovascular disease and, 28, 378, 381 clinical features of, 349t, 381–382 cytokines in, 380–381 diabetes mellitus and, 378, 381, 384 diagnosis of, 377t, 382 dyslipidemia in, 349, 380 epidemiology of, 377–378, 378f fatty liver disease and, 381 glucose intolerance in, 380 hypertension in, 383, 452 hyperuricemia/uric acid stones in, 381 insulin resistance in, 379–380, 384 lipodystrophy and, 378–379 obesity and, 382 pathophysiology of, 379–381, 379f polycystic ovary syndrome and, 381 risk factors for, 378–379 sedentary lifestyle and, 378 sleep apnea and, 381 treatment of, 349, 382–384 waist circumference and, 380 Metastatic disease, to heart, 286–287 Metformin, for metabolic syndrome, 384 Methadone, adverse effects of, 138t Methemoglobin, 51 Methicillin-resistant Staphylococcus aureus (MRSA) infections, in endocarditis, 302t, 303 Methotrexate, therapeutic monitoring of, 561t α-Methyldopa adverse effects of, 58t for hypertension, 461t Methysergide, adverse effects of, 484 Metolazone, for heart failure, 191t Metoprolol for aortic dissection, 473 dosage of, 158t, 159t for heart failure, 191t for hypertension, 461t indications for, 158t, 159t for ischemic heart disease, 399t for myocardial infarction, 421 pharmacology of, 158t, 159t Mexiletine adverse effects of, 160t dosage of, 159t indications for, 159t pharmacology of, 159t MI See Myocardial infarction (MI) Microvascular angina, 386 Migraine, Raynaud’s phenomenon and, 484 Milrinone for acute heart failure, 197–198, 197t for pulmonary edema, 326 Milroy’s disease, 488, 488t Mineral(s), 562t Minoxidil adverse effects of, 58t, 463 for hypertension, 461t, 463 Mitochondria, genetic defects of, 252t Mitral regurgitation, 225 cardiogenic shock in, 321, 325 chest radiograph in, 28 clinical features of, 227 in dilated cardiomyopathy, 254 ECG in, 227, 508f echocardiography in, 227, 517V, 570t etiology of, 220t, 225–226 heart sounds/murmur in, 72, 77–85, 77f, 227, 597 hemodynamic patterns in, 323t left atrial compliance in, 226–227 pathophysiology of, 226 pulmonary venous hypertension in, 495 severity classification, 570t TEE in, 104f, 227, 517V treatment of medical, 224t, 228 percutaneous valve repair, 229–230, 229f strategy for, 228f surgical, 228–229, 588, 606 Mitral stenosis, 219 associated lesions, 222 cardiac catheterization in, 223 cardiac output in, 219–220 chest radiograph in, 222 clinical features of, 221 differential diagnosis of, 222, 577, 598 Doppler echocardiography in, 104f, 107f ECG in, 222, 507f, 508f echocardiography in, 222, 517V, 570t embolization in, 221 etiology of, 219, 220t heart sounds/murmur in, 74, 76, 77f, 83f, 84, 221 633 hemodynamic measurements in, 120f, 219–220 pathology of, 219 pathophysiology of, 219–221 percutaneous treatment of, 440 pulmonary changes in, 221 pulmonary hypertension in, 220–221, 495, 586, 604 rheumatic, 84, 219, 310–311, 311f, 587–588, 598, 605–606 severity classification, 570t TEE in, 225 treatment of medical therapy, 223, 224t, 588, 606 strategy for, 223f valve replacement, 225, 225t valvotomy, 224–225, 224f, 225t valvuloplasty, 224f, 225, 225t Mitral valve prolapse, 230 clinical features of, 230 ECG in, 231 echocardiography in, 517V etiology of, 230 heart sounds/murmur in, 73, 73f, 77–81, 80f, 86, 230, 576, 587, 597, 605 imaging in, 231 palpitations in, 61 pathophysiology of, 230 treatment of, 231 Mitral valve replacement, 225, 229 Mitral valvotomy, 224–225, 224f Mitral valvuloplasty, 224f, 225, 229–230 Mixed connective tissue disease (MCTD) AV conduction block in, 143, 143t SA node dysfunction in, 139 Monge’s syndrome (chronic mountain sickness), 51 Monoamine oxidase inhibitors (MAOIs), hypertension with, 451t Moricizine, 159t, 160t Morphine adverse effects of, 421 for pulmonary edema, 326 for STEMI, 421 for UA/NSTEMI, 410t Motor efferents, 42 Mountain sickness, chronic, 51 Mouth-to-mouth resuscitation, 335 MRA See Magnetic resonance angiography (MRA) MRI See Magnetic resonance imaging (MRI) MRSA (methicillin-resistant Staphylococcus aureus) infections, in endocarditis, 302t, 303 MSCRAMMs, 296 Mucopolysaccharidoses, 267 Multiple endocrine neoplasia type (MEN 2), pheochromocytoma in, 456t Multiple myeloma, 593, 612 634 Muscular dystrophy AV conduction block in, 143, 143t ventricular arrhythmia in, 174t, 589, 607 Musculoskeletal disease, chest pain in, 35t, 37 Myasthenia gravis, dyspnea in, 44 Mycotic aneurysm etiology of, 468, 468t incidence of, 474 in infective endocarditis, 307 symptoms of, 474 Myeloperoxidase, 40 Myocardial contusion, 287 Myocardial infarction (MI) vs acute pericarditis, 273–274, 279 arrhythmia in accelerated idioventricular rhythm, 168 AV conduction block, 143–144 AV conduction block in, 143t SA node dysfunction, 138t, 139 atherosclerosis and, 344 cardiogenic shock in See Cardiogenic shock chest pain in characteristics of, 39f duration, 35t history, 38 location, 35t onset of, 36 physical examination findings, 36 quality, 35t STEMI, 416–417, 432 UA/NSTEMI, 408 circadian variations in, 451 diagnosis of ECG in, 502–506f MRI in, 111f, 112f hemodynamic patterns in, 323t murmur after, 79, 417 natural history of, 31 non-ST segment elevation See Unstable angina/non-ST-segment elevation myocardial infarction (UA/ NSTEMI) pacemaker for, 149–150, 150t during PCI, 437 prevalence of, in emergency department patient with chest pain, 39t prevention of, 351 Q wave abnormalities in, 96–97, 97f, 503f, 507f right ventricular See Right ventricular failure/infarction ST-segment elevation See ST-segment elevation myocardial infarction (STEMI) Myocardial ischemia See also Ischemic heart disease anterior wall, 96, 96f, 500f anterolateral wall, 501f in aortic stenosis, 386 Index arrhythmia in, 132 chest pain in, 34–36, 38–40 clinical features of, 28–29 diagnosis of, 29–30 dyspnea in, 43t, 45 ECG in, 95–98, 96f, 97f, 387, 500–501f effects of, 387 lateral, 501f with left ventricular hypertrophy, 386 pathophysiology of, 385–386 silent, 387, 406, 413 transmural, 95–96, 96f Myocardial perfusion imaging in ischemic heart disease, 108f, 109f, 392f, 394 in myocardial infarction, 419 nuclear, 107–109, 107f, 109f Myocardial rupture cardiogenic shock in, 325 traumatic, 287 Myocarditis accelerated idioventricular rhythm in, 168 acute fulminant, 255, 257f, 325 bacterial, 259 cardiogenic shock in See Cardiogenic shock endomyocardial biopsy in, 257f fungal, 259 giant cell, 260 granulomatous, 259–260 in HIV infection, 258 hypersensitivity, 260 lymphocytic, 261 parasitic, 258–259, 588, 606 See also Chagas’ disease rickettsial, 259 SA node dysfunction in, 138t, 139 in sarcoidosis, 259–260, 260f spirochetal, 259 viral cardiomyopathy in, 256 clinical features of, 254–256 diagnosis of, 256 pathophysiology of, 254–255 treatment of, 256–257 viruses causing, 258, 588, 606 VT storm in, 171 Myocardium oxygen supply and demand, 385–386 regenerative potential of, 19 rupture of, cardiogenic shock in, 325 viability assessment of, 108–109 Myocytes, Myosin in cardiac contraction, 9f, 10 defects in, 249 Myosin light chain, in vascular smoothmuscle contraction, 6–7 Myotonic dystrophy AV conduction block in, 143, 143t SA node dysfunction in, 138t, 139 ventricular tachycardia in, 174 Myxedema edema in, 59 pericardial effusion in, 280 pretibial, 488–489 Myxoma clinical features of, 284–285 dyspnea in, 45 echocardiography in, 103f, 285, 285f, 517V epidemiology of, 284–285, 284t heart sounds/murmur in, 84, 285 vs mitral stenosis, 222 MRI in, 286f, 520f palpitations in, 61 pathology of, 285 treatment of, 285 Nadolol dosage of, 159t indications for, 159t for ischemic heart disease, 399t pharmacology of, 159t Nafcillin, for infective endocarditis, 302t NAFLD (nonalcoholic fatty liver disease), in metabolic syndrome, 381 NAME syndrome, 284–285 National Cholesterol Education Project Adult Treatment Panel III (ATP III), 346t, 347 Naxos disease, 175 NBTE (nonbacterial thrombotic endocarditis), 296 Nephropathy, contrast-induced, 118 Nephrosclerosis, 452 Nephrotic syndromes edema in, 57, 58 hyperlipidemia in, 593, 612 Nesiritide for acute heart failure, 197, 197t for pulmonary edema, 326 Neurofibromatosis type (NF1) clinical features of, 456t genetic factors in, 456t Neurologic disease, arrhythmia in, 174 Neurotransmitter(s), in vascular smoothmuscle cells, New York Heart Association (NYHA), classification of cardiovascular disease, 29, 29t, 183t, 389t, 585, 603 Nicardipine adverse effects of, 399t for hypertensive emergencies, 465t, 466 for ischemic heart disease, 399t, 401 Nicoladoni-Branham sign, 483 Index Nicorandil, 402 Nicotinic acid adverse effects of, 373t for lipoprotein disorders, 373t, 374 for metabolic syndrome, 383 for raising high-density lipoproteins, 348 Nifedipine adverse effects of, 59, 399t for hypertension, 461t, 463 for ischemic heart disease, 399t, 401 for pulmonary hypertension, 493 for Raynaud’s phenomenon, 484 Nifurtimox, for Chagas’ disease, 318 Nisoldipine, for ischemic heart disease, 399t Nitrates adverse effects of, 421 for heart failure, 429 interaction with phosphodiesterase type inhibitors, 410, 421 for ischemic heart disease, 398–400, 399t long-acting, 400 for myocardial infarction STEMI, 421 UA/NSTEMI, 410, 410t for Prinzmetal’s variant angina, 414 for pulmonary edema, 326 tolerance to, 400 Nitric oxide in blood vessels, 4, for pulmonary vasodilator reactivity testing, 491 Nitroglycerin adverse effects of, 197, 400 for angina pectoris, 40 for heart failure, 197, 197t, 429 for hypertensive emergencies, 465t intravenous, 428 for ischemic heart disease, 399t, 400 for myocardial infarction, 421 for Prinzmetal’s variant angina, 414 for pulmonary edema, 326 Nitroprusside for acute heart failure, 197, 197t for adrenergic crisis, 466 for aortic dissection, 473 for hypertensive emergencies, 465t, 466 for pulmonary edema, 326 therapeutic monitoring of, 561t Nonalcoholic fatty liver disease (NAFLD), in metabolic syndrome, 381 Nonbacterial thrombotic endocarditis (NBTE), 296 Nonsteroidal anti-inflammatory drugs (NSAIDs) adverse effects of edema, 58, 58t hypertension, 451t in ischemic heart disease, 402 in myocardial infarction, 422 for rheumatic fever, 314 Noonan syndrome, 488 Norepinephrine in cardiac contraction, 11 for cardiogenic shock, 324 in cardiovascular regulation, 445–446 in vascular smooth-muscle cells, NOTCH1 gene, 231–232 NSAIDs See Nonsteroidal antiinflammatory drugs (NSAIDs) NSTEMI See Unstable angina/non-STsegment elevation myocardial infarction (UA/NSTEMI) N-terminal pro-BNP, in heart failure, 189 Nuclear cardiology in ischemic heart disease, 392f, 394 in myocardial infarction, 419 principles of, 107 Nuclear membrane, inherited defects of, 251t Nutritional diseases, edema in, 59 Nutritional support/therapy for hypertension, 459–460, 460t for lipoprotein disorders, 371 for metabolic syndrome, 382 for myocardial infarction, 426 NYHA (New York Heart Association), classification of cardiovascular disease, 29, 29t, 183t, 389t, 585, 603 Obesity cardiovascular disease and, 26, 262, 290t, 291 central adiposity in, 378 coronary artery disease and, 351 dyspnea in, 45 hypertension and, 443–444 ischemic heart disease and, 397 lipoprotein metabolism effects on, 367 in metabolic syndrome, 377t, 378, 382 Obstructive sleep apnea hypertension and, 451t, 456–457 in metabolic syndrome, 381 pulmonary hypertension in, 492t, 496 treatment of, 457 OKT3 therapy, adverse effects of, 58t Omega-3 fatty acids adverse effects of, 373t for lipoprotein disorders, 373t, 375 for metabolic syndrome, 383 Orlistat, for metabolic syndrome, 382 Orthodromic AV reentry, 166 Orthopnea, 45, 186 Orthostatic hypotension definition of, 67 pathophysiology of, 67 in pheochromocytoma, 446 Osler maneuver, 465 635 Osler’s nodes, 65 Osler-Weber-Rendu syndrome (hereditary hemorrhagic telangiectasia), skin manifestations of, 64 Ostium primum, 80, 143 Ostium secundum, 80, 208 Oxacillin, for infective endocarditis, 302t Oxazepam, for sedation after myocardial infarction, 426 Oxidative stress hypothesis, 379–380 Oxygen requirement, cardiac, 16 Oxygen therapy for dyspnea, 47 for myocardial infarction, 420–421 for pulmonary edema, 326 Pacemaker, 147 for AV conduction block, 149, 149t, 150, 150t for bradyarrhythmia, 135, 137 for carotid sinus hypersensitivity, 148–149 complications of, 147–148, 295 five-letter codes for, 147 indications for, 135 for myocardial infarction, 149–150, 150t, 432 nomenclature of, 147 pacing mode, 147, 150 for pulmonary edema, 327 for SA node dysfunction, 137, 148, 149t, 150 for vasovagal syncope, 148–149 Pacemaker cells, 128–129, 137 Pacemaker syndrome, 148 Paclitaxel, in drug-eluting stents, 436 Paget-Schroetter syndrome, 482 PAH See Pulmonary arterial hypertension (PAH) PAI-1 See Plasminogen activator inhibitor I (PAI-1) Palmar crease, 64 Palpitations, 61 approach to the patient, 61–62, 581, 600 in arrhythmia, 133 in atrial fibrillation, 156 etiology of, 61 in tachyarrhythmia, 151 treatment of, 62 PANDAS (pediatric autoimmune neuropsychiatric disorders associated with streptococcal infection), 312 Panic attack, 61 Papillary fibroelastoma, 286 Paradoxical pulse, 276–277 Paraganglioma, hypertension in, 456 Paralysis, edema in, 60 Parkinson’s disease, ECG in, 530f Paroxysmal AV block, 145, 145f Paroxysmal nocturnal dyspnea, 187 636 Paroxysmal supraventricular tachyarrhythmia, 152 Parvovirus B19 infections, myocarditis in, 258 Parvus et tardus pulse, 80 Pasteur effect, 49 Patent ductus arteriosus clinical features of, 212 murmur in, 74, 77f pathophysiology of, 212 treatment of, 212 Patent foramen ovale, 440 PCI See Percutaneous coronary interventions (PCI) PCOS (polycystic ovarian syndrome), in metabolic syndrome, 381 PCSK9 deficiency, 363–365 PCSK9 mutation, 363 PE See Pulmonary embolism (PE) Pediatric autoimmune neuropsychiatric disorders associated with streptococcal infection (PANDAS), 312 Penicillin(s) for infective endocarditis, 302t, 303 for rheumatic fever, 313–314 Pentaerythritol tetranitrate, for ischemic heart disease, 399t Pentamidine, SA node dysfunction with, 138t Pentoxifylline, for intermittent claudication, 478 Peptic ulcer disease, chest pain in, 34t, 35t, 37 Percutaneous coronary interventions (PCI), 434 for adult congenital heart disease, 439–440 aortic valve replacement, 236–237, 237f, 440, 545–547, 545V, 546f aortic valvuloplasty, 236 atherectomy, 436 atrial septic defect repair, 547–548, 547f, 547V, 548f balloon angioplasty, 435–436, 435f balloon angioplasty and stenting, 434–436, 435f vs CABG, 405, 405f, 438–439, 439f for cardiogenic shock, 324 complications of, 437–438 distal protection device for, 436, 541–542, 542f, 542V embolic protection device for, 436 Impella device for, 442 indications and patient selection for, 438–439 intimal dissection in, 435f, 436 intraaortic balloon for circulatory support in, 441–442 vs medical therapy in acute coronary syndromes, 439 mitral balloon valvotomy, 224–225, 224f Index mitral valve repair, 229–230, 229f for myocardial infarction facilitated, 424, 425f patient selection, 438–439, 439f rescue, 424 STEMI, 422f, 423 left main, 542–544, 542f, 543f, 543V with manual thrombectomy, 540–541, 541f, 541V UA/NSTEMI, 412–413 multivessel, 544, 544V urgent, 424 for revascularization, 402 of bifurcation lesions, 540, 540f, 540V vs CABG, 405, 405f of chronic total occlusion, 539, 539V efficacy of, 403–404 indications and patient selection for, 402–403 restenosis after, 403–404 risks of, 403 saphenous vein graft with distal protection, 541–542, 542f, 542V stent thrombosis in proximal LAD lesion following, 544–545, 545f, 545V steerable guidewire in, 435 success of, 436–437, 437f techniques for, 434–436 transluminal coronary angioplasty, 434 for valvular heart disease, 439–440 Percutaneous interventions coronary See Percutaneous coronary interventions (PCI) peripheral artery, 440–442, 441f, 479 transluminal renal angioplasty, 453 Perfusion lung scan, in pulmonary hypertension, 490 Pergolide, adverse effects of, 485 Pericardial effusion cardiac imaging in, 114t, 115 chest radiograph in, 275f chronic, 276f, 280, 283 echocardiography in, 102, 103f, 275f, 518V in pericarditis, 274 physical examination in, 75 Pericardial friction rub in myocardial infarction, 417, 432 in pericarditis, 75, 274–275 Pericardial tamponade, 75, 575, 596 Pericardiocentesis, 278 Pericarditis acute chest radiograph in, 275f clinical features of, 273–274, 388, 416, 432, 607 diagnosis of, 275–276 ECG in, 274, 275f, 506f, 507f, 589–590, 607–608 echocardiography in, 275, 275f MRI in, 521f viral/idiopathic, 278–279 cardiac tamponade in See Cardiac tamponade chest pain in, 34t, 36, 273, 388, 416, 432 in chronic kidney disease, 279 classification of, 274t in collagen vascular disease, 279, 292–293 constrictive calcific, 523f clinical features of, 277t, 281 CT in, 523f differential diagnosis of, 277t, 281–283, 589, 607 dyspnea in, 45 ECG in, 281 echocardiography in, 281, 281f etiology of, 590, 608 heart sounds in, 281, 608 hemodynamic profile in, 280 mitral and tricuspid flow in, 276f MRI in, 282f pathophysiology of, 280, 608 pulse pressure in, 280 treatment of, 282 differential diagnosis of, 279–280 in myocardial infarction, 432 in neoplastic disease, 280 pericardial effusion in, 274 pericardial friction rub in, 75, 273–274 postcardiac injury, 279 pyogenic (purulent), 279 radiation-induced, 280 SA node dysfunction in, 138t, 139 SLE and, 279, 293 subacute effusive–constrictive, 282 Pericardium calcification of, 112, 113f, 523f cysts of, 283 structure and function of, 273 tumors of, 283 Pericytes, 2, 3f Peripheral artery disease, 476 acute occlusion, 480 atheroembolism, 481, 481f clinical features of, 476–477, 576, 597 coronary heart disease and, 476 cyanosis in, 52 diagnosis of, 477, 477f hypertension and, 450 pathophysiology of, 476 preoperative risk assessment in, 479 prognosis of, 477–478 treatment of, 478–479 exercise program, 478 percutaneous interventions, 440–442, 441, 441f, 479 Index pharmacologic, 478–479 revascularization, 479 Pernio (chilblain), 485 PET See Positron emission tomography (PET) Pharmacogenomics, vascular, 8, 8t Phenothiazines, cardiac effects of, 132, 138t Phenoxybenzamine, for hypertension, 461t Phentermine, for metabolic syndrome, 382 Phentolamine for adrenergic crisis, 466 for hypertensive emergencies, 465t Phenylephrine, for acute heart failure, 197t Phenytoin, therapeutic monitoring of, 561t Pheochromocytoma cardiac manifestations of, 61, 262, 290t, 292 clinical features of, 446, 455, 456t genetic factors in, 456, 456t hypertension in, 446, 451t, 455–456 Phlebotomy, for cyanotic CHD, 212 Phosphodiesterase type inhibitors interaction with nitrates, 410, 421 for pulmonary hypertension, 493 Phospholamban, 7, 12, 12f Phospholipid transfer protein (PLTP), 357 Physical activity See Exercise Pickwickian syndrome, 291 Pindolol, for ischemic heart disease, 399t Pitting edema, 54 Plasminogen activator inhibitor I (PAI-1) in atherosclerosis, 350 in endothelial cells, in vascular smooth-muscle cell, Platelet(s), reference values for, 551t Platypnea, 46 Pleuritis, chest pain in, 34t, 35t, 37 PLTP (phospholipid transfer protein), 357 Pneumococcal infections, in endocarditis, 295t, 304 Pneumonia chest pain in, 34t, 35t, 37 cyanosis in, 52 Pneumothorax chest pain in, 35t, 37 physical examination in, 38–39 Poisoning/drug overdose, 560–562t Polycystic kidney disease clinical features of, 456t genetic factors in, 456t physical examination in, 459 Polycystic ovarian syndrome (PCOS), in metabolic syndrome, 381 Polycythemia as adaptation to hypoxia, 51 erythromelalgia in, 485 secondary, 52 Polycythemia vera, vs cyanosis, 51 Polygenic hypercholesterolemia, 360–361 Polymorphonuclear leukocytes (PMNs), in STEMI, 419 Polymyositis, Raynaud’s phenomenon in, 484 Polypill, 27 Popliteal artery aneurysm, 482 Popliteal artery entrapment, 482 Popliteal artery pulse, 69 Portal hypertension, pulmonary hypertension and, 492t, 494–495 Portal vein-pulmonary vein anastomosis, 52 Positive-pressure ventilation, for pulmonary edema, 326 Positron emission tomography (PET) advantages and disadvantages, 109t for assessment of myocardial metabolism and viability, 108–109, 110f for assessment of myocardial perfusion and coronary artery disease, 107–110, 108f, 109f, 392f, 394 for assessment of ventricular function, 109–110 cardiac for assessment of ventricular function, 518f Postextrasystolic beat, 61 Postextrasystolic potentiation, 61 Postmenopausal hormone therapy, coronary heart disease and, 349–350 Post-premature ventricular contraction, 86–87 Poststreptococcal reactive arthritis (PSRA), 312 Potassium, in cardiac contraction, 11 Potassium channels, in cardiac contraction, 128–129, 129f, 130f PPAR-alpha agonists, 348 Prasugrel for ischemic heart disease, 401 for STEMI, 427 for UA/NSTEMI, 411t, 412 Pravastatin, for hyperlipidemia, 373t Prazosin for hypertension, 461t for Raynaud’s phenomenon, 484 Precordial thump, 334 Prednisone, for idiopathic acute pericarditis, 278 Preeclampsia, treatment of, 465t Preexcitation macroreentry, 166 Pregnancy cardiomyopathy in, 260–261, 588, 606 congenital heart disease and, 207, 211 edema in, 59 folate requirement in, 17 heart murmurs in, 85 hypertension in, 456t, 458 mitral stenosis in, 587–588, 605–606 Prehypertension, 450, 450t, 459, 593, 612 Preload, 6f, 13, 14t Premature atrial contractions, palpitations in, 61 Premature ventricular contractions, palpitations in, 61 Presacral edema, 188 637 Pressure-natriuresis phenomenon, 445 Presystolic accentuation, 84 PR interval, 128 Prinzmetal’s variant angina, 387, 401, 413–414 Proarrhythmia, 330 Procainamide for accessory pathway-mediated tachycardia, 167 action of, 135t adverse effects of, 160t for atrial fibrillation, 157 for atrial tachycardia, 164 for Brugada syndrome, 179 for cardiac arrest, 335 dosage of, 158t, 159t indications for, 158t, 159t for pharmacologic cardioversion, 162 pharmacology of, 158t, 159t for ventricular tachycardia, 171, 430 Progestins, adverse effects of, 58t Propafenone action of, 135t adverse effects of, 160t for atrial fibrillation, 157 dosage of, 159t indications for, 159t for multifocal atrial tachycardia, 162 pharmacology of, 159t for ventricular tachycardia, 171 Propranolol for aortic dissection, 473 for hypertension, 461t for ischemic heart disease, 399t Proprotein convertase subtilisin/kexin type (PCSK9), 358t, 360 Prostacyclin, functions of, 4, Prostacyclin therapy, 493–494 Prostate cancer, lymphedema in, 488 Prostate-specific antigen (PSA), 558t Prosthetic heart valve endocarditis in etiology of, 295, 295t late-onset, 298 treatment of, 302t, 304, 306 murmurs in, 75 Protein(s), lipoprotein-associated, 353–355 Protein C, reference values for, 551t Protein kinase A, Protein kinase G, Protein S, reference values for, 551t Proteinuria, 58, 60 Pseudoaneurysm(s), aortic, 467 Pseudohypertension, 465 Pseudohypoaldosteronism type II (Gordon’s syndrome), 456t Pseudoxanthoma elasticum, 64 Psoriatic arthritis aortic aneurysm in, 469 aortitis in, 292–293, 474 638 PSRA (poststreptococcal reactive arthritis), 312 Psychiatric/psychological disorders chest pain in, 35t, 37 palpitations in, 61 Pulmonary arterial hypertension (PAH), 491, 492t in collagen vascular disease, 494 conditions associated with, 492t, 494–495 familial, 491 idiopathic (primary), 491–492, 492t, 575, 596 natural history of, 492 pathobiology of, 491, 492f portal hypertension and, 494–495 in systemic-to-pulmonary shunt, 494 treatment of, 493–494, 493t calcium channel blockers, 493 endothelin receptor antagonists, 493 lung transplantation, 494 phospodiesterase-5 inhibitors, 493 prostacyclins, 493–494 Pulmonary artery catheter in cardiogenic shock, 323 in pulmonary edema, 325 Pulmonary artery wedge pressure, 67 Pulmonary capillary hemangiomatosis, 492t, 495 Pulmonary capillary wedge pressure, in cardiogenic shock, 320, 321 Pulmonary edema cardiogenic, 47–48, 325 chest radiography in, 48 clinical features of, 325 complications of, 327 cyanosis in, 52 diagnosis of, 325 differential diagnosis of, 47–48 dyspnea in, 44t, 45 echocardiography in, 325 etiology of, 48t hemodynamic patterns in, 323t high-altitude, 47, 49, 327 noncardiogenic, 47, 48t, 325 pathophysiology of, 47–48 physical examination in, 47–48 pulmonary artery catheter in, 325 reexpansion, 327 treatment of, 322f, 326–327 in upper airway obstruction, 327 Pulmonary embolism (PE) chest pain in, 34t, 35t, 37, 40 diagnosis of cardiac biomarkers, 408 ECG, 510f dyspnea in, 46 Pulmonary fibrosis, dyspnea in, 43t, 45 Pulmonary function tests in pulmonary hypertension, 490 reference values for, 571t Index Pulmonary hypertension, 490 in alveolar hypoventilation, 496 anorexigen-induced, 495 arterial See Pulmonary arterial hypertension cardiac catheterization in, 490–491, 580, 599 chest pain in, 35t chest radiography in, 490 in chronic obstructive pulmonary disease, 496 clinical classification of, 492t diagnosis of, 490–491, 491f dyspnea in, 44, 46, 490 ECG in, 490, 510f echocardiography in, 490 etiology of, 490 heart sounds in, 70f, 490 in HIV infection, 497 in interstitial lung disease, 496 with lung disease and hypoxemia, 495–496 in mitral stenosis, 220–221, 495, 586, 604 pathophysiology of, 490 perfusion lung scan in, 490 in pulmonary capillary hemangiomatosis, 495 pulmonary function tests in, 490 Raynaud’s phenomenon in, 484 in sarcoidosis, 497 in schistosomiasis, 497 in sickle cell disease, 497 in sleep-disordered breathing, 496 thromboembolic, 496 tricuspid regurgitation in, 490 venous See Pulmonary venous hypertension Pulmonary rehabilitation, for dyspnea, 47 Pulmonary vasodilator reactivity, 491 Pulmonary veins, anomalous drainage of, 522f Pulmonary veno-occlusive disease, 492t, 495 Pulmonary venous hypertension, 492t left ventricular dysfunction and, 495 in mitral valve disease, 495 in pulmonary veno-occlusive disease, 495 Pulmonic regurgitation clinical features of, 245 etiology of, 220t, 245 murmur in, 73–74, 84, 245 treatment of, 245 Pulmonic stenosis congenital, 215 etiology of, 220t, 245 murmur in, 71, 77f, 80, 81f, 215 Pulse assessment of, 67–69, 68f, 69 in cardiac tamponade, 276–277 in peripheral artery disease, 69, 477 in tachyarrhythmia, 151 Pulseless electrical activity cardiac arrest/sudden cardiac death in, 328–329 treatment of, 336, 336f Pulse pressure, 443 Pulsus alternans, 68–69 Pulsus paradoxus, 45, 68, 590, 608 Pulsus parvus et tardus, 68, 233 Purkinje fibers, 19, 128 Pyridoxine (vitamin B6) deficiency of, atherosclerosis in, 290 reference range for, 562t QRS complex in arrhythmias, 134 normal, 90, 91f, 92, 92f, 93f, 128 QT interval, variability, 133 Quincke’s pulsations, of nailbed, 83–84 Quinidine action of, 135t adverse effects of, 160t for Brugada syndrome, 179 dosage of, 158t, 159t indications for, 158t, 159t pharmacology of, 158t, 159t for short QT syndrome, 178 for ventricular tachycardia, 171 Q wave characteristics of, 90 in myocardial infarction, 96–97, 97f, 503f, 507f RAA system See Renin-angiotensinaldosterone (RAA) system Rad, 573t Radial artery, for PCI access, 434 Radiation-derived units, 573t Radiation dose, 573t Radiation therapy, adverse effects of cardiovascular, 268, 280 lymphedema, 488, 488t pericarditis, 280 Radiofrequency ablation, for varicose veins, 487 Rales, 187 Ramipril for heart failure, 191t for hypertension, 461t Ranolazine, for ischemic heart disease, 402 Raynaud’s disease, 45, 483–484 Raynaud’s phenomenon, 483 clinical features of, 483 cyanosis in, 52 localized hypoxia in, 50 pathophysiology of, 483 Index secondary causes of, 483t, 484 treatment of, 484 Reactive arthritis (Reiter’s syndrome) aortic aneurysm in, 469 aortitis in, 292–293, 474 after streptococcal infections, 312 Reactive hyperemia, 483 Reactive oxygen species (ROS), in endothelium, Reduviid bugs, 258 Reentry, 132, 132f, 153 excitable gap, 132f, 133 functional, 133 leading circle, 133 Refeeding edema, 59 Reference values, for clinical laboratory tests See Clinical laboratory tests, reference values for Regional wall motion abnormality in ischemic heart disease, 394 in myocardial infarction, 432 Rehabilitation, pulmonary, 47 Reiter’s syndrome See Reactive arthritis (Reiter’s syndrome) Relapsing polychondritis aortic aneurysm in, 469 aortitis in, 474 auricular chondritis in, 64 saddle-nose deformity in, 64 Rem, 573t Renal artery stenosis, 453 Renal disease/failure See Chronic kidney disease (CKD) Renal vein, renin ratio, 453 Renin plasma aldosterone to plasma renin activity, 454 renal vein renin ratio, 453 synthesis and secretion of, 446–448 Renin-angiotensin-aldosterone (RAA) system in blood pressure regulation, 446–448, 447f in edema, 55 in heart failure pathogenesis, 184, 184f, 185f Renovascular hypertension, 446–448, 451t, 452–454, 459 Reserpine, for hypertension, 461t Respiratory alkalosis, in hypoxia, 51 Respiratory center, 51 Respiratory disorders, dyspnea in, 44, 44t Respiratory drive, 42 Respiratory failure, hypoxia in, 49–50 Respiratory rate, 45 Respiratory sinus arrhythmia, 526f Restenosis, 403–404, 434 clinical features of, 437–438 incidence of, 437–438 mechanism of, 435f, 438 Restrictive cardiomyopathy in amyloidosis, 265–266, 266f, 267f clinical features of, 249t, 277t differential diagnosis of, 277t, 282, 589, 607 endomyocardial, 268 etiology of, 265, 265t fibrotic, 268 infiltrative, 265–266, 266f, 267f metabolic disorders and, 254t, 265t, 266–268, 267f Reteplase for acute arterial occlusion, 481 for myocardial infarction, 423 Retinopathy, hypertensive, 459 Retroperitoneal fibrosis, 468t Rhabdomyoma, cardiac, 286 Rheumatic fever, 309 cardiac complications of aortic valve disease, 231 diagnosis of, 313t heart failure, 314 mitral regurgitation/stenosis, 84, 219, 310–311, 311f, 587–588, 598, 605–606 pathogenesis of, 311f pericarditis, 279 SA node dysfunction in, 138t, 139 in children, 310f chorea and, 312, 314, 610 clinical features of, 310–312, 591, 610 diagnosis of, 312–313, 313t, 314t differential diagnosis of, 312 epidemiology of, 309, 310f fever in, 312 global considerations, 247, 309, 310f group A streptococcal infection and, 312 host factors in, 309–310 immune response in, 310, 311f joint involvement in, 311–312 organism factors in, 309 pathogenesis of, 309–310, 311f prevention of, 315 prognosis of, 314–315 recurrent, 591–592, 610 skin manifestations of, 312 treatment of, 313–314 antibiotics, 313–314 bed rest, 314 IVIg, 314 NSAIDs, 314 salicylates, 314 Rheumatoid arthritis cardiovascular disease and, 290t, 292 aortic aneurysm, 469 aortitis, 474 AV conduction block, 143, 143t SA node dysfunction, 139 Raynaud’s phenomenon in, 484 Riboflavin (vitamin B2), 562t 639 Rifampin, for infective endocarditis, 302t Right atrial overload, ECG in, 93f Right bundle branch, 142 Right bundle branch block conditions associated with, 95 ECG in, 94–95, 94f, 503f, 504f, 528f heart sounds in, 70f Right heart catheterization, 579–580, 599 Right-to-left shunt, intrapulmonary, 50 Right ventricular failure/infarction cardiogenic shock in, 321, 325 clinical features of, 277t differential diagnosis of, 277t in STEMI, 429 Right ventricular hypertrophy, ECG in, 507f Right ventricular outflow tract obstruction in pulmonic stenosis, 215 in tetralogy of Fallot, 215–216 in ventricular septal defect, 211 Romaña’s sign, 317 ROS (reactive oxygen species), in endothelium, Rosuvastatin, for hyperlipidemia, 373t Rotational atherectomy, 436 Rubella (German measles), congenital, 215 Rubella embryopathy, 215 R wave, 90 Saccular aneurysm, 467, 468 SA (sinoatrial) conduction time, 141 Saddle-nose deformity, 64 Salicylates, for rheumatic fever, 314 Salmonella spp infections, in aortitis, 474 Salt intake, hypertension and, 444 Salt-wasting disorders, blood pressure in, 445 SA (sinoatrial) node, 128, 137–139 SA (sinoatrial) node disease/dysfunction See Sinoatrial (SA) node disease/ dysfunction Saphenous vein bypass graft, 479 Sarcoidosis, clinical features of cardiac, 290t AV conduction block, 143, 143t myocarditis, 259–260, 260f ventricular arrhythmia, 174t pulmonary hypertension, 492t, 497 Sarcoma, cardiac, 284t, 286 Sarcomere, 9, 251t Sarcoplasmic reticulum, 11, 13f Scalene maneuver, 482 Scavenger receptors, 341f, 342 Schistosomiasis, pulmonary features of, 492t, 497 Scimitar syndrome, 111f Scintigraphy, adrenal, 455 Sclerodactyly, 484 “Sclerosis of the left cardioskeleton,” 143 Sclerotherapy, for varicose veins, 487 Sedation, for myocardial infarction, 426 640 Selenium deficiency of, 262 reference range for, 562t Sensory afferents, 42–43 Sepsis/septic shock, hemodynamic patterns in, 323t Septum primum, 208 Septum secundum, 208 Shingles (herpes zoster), chest pain in, 34t Shock cyanosis in, 52 hypoxia in, 50 Short QT syndrome, 151, 177t, 178 Shoulder, pain in, 38 Sibutramine, for metabolic syndrome, 382 Sickle cell anemia, pulmonary hypertension in, 497 Sick sinus syndrome ECG in, 528f SA node dysfunction in, 138t, 139 thromboembolism in, 580, 599–600 Sievert (Sv), 573t Sildenafil adverse effects of, 493 interaction with nitrates, 410, 421, 493 for pulmonary hypertension, 493 Simvastatin, 373t Single photon emission computed tomography (SPECT), 518f advantages and disadvantages of, 109t in assessment of myocardial metabolism and viability, 109 in assessment of myocardial perfusion and coronary artery disease, 107–109, 109f in assessment of ventricular function, 109 Single ventricle, 217 Sinoatrial (SA) conduction time, 141 Sinoatrial (SA) node, 128, 137–139 Sinoatrial (SA) node disease/dysfunction, 137 clinical features of, 39–140, 137 diagnostic testing in, 141 ECG in, 140–141, 140f epidemiology of, 137 etiology of, 138t, 139 extrinsic, 138t, 139, 600 inherited forms of, 139 intrinsic, 138t, 139, 600 pacemaker for, 148, 149t treatment of, 141–142, 580, 600 Sinus arrest, 140 Sinus bradycardia mechanism of, 131t in myocardial infarction, 431 Sinus exit block, 140, 140f Sinus node, 140f, 141 Sinus node recovery time, 141 Sinus of Valsalva aneurysm, 212 Index Sinus pause, 140, 140f Sinus tachycardia, 155 ECG in, 155, 163f, 502f, 527f inappropriate, 155 mechanism of, 131t, 132 physiologic, 155, 581, 600–601 treatment of, 155, 581, 600–601 Sinus venosus, 208, 209 Sirolimus in drug-eluting stents, 436, 437f therapeutic monitoring of, 561t Sitosterolemia, 358t, 360 Skin in cardiovascular system examination, 64 in cyanosis, 51 SLE See Systemic lupus erythematosus (SLE) Sleep apnea, SA node dysfunction in, 138t, 139 Sleep-disordered breathing syndrome, 492t, 496 Sleeping sickness (human African trypanosomiasis), 258–259 Sliding filament model, for muscle contraction, 10–11 Smoking atherosclerosis and, 351 cardiovascular disease and, 25 ischemic heart disease and, 398 peripheral artery disease and, 478 Smoking cessation for atherosclerosis prevention, 351 in ischemic heart disease treatment, 398 in peripheral artery disease, 478 in thromboangiitis obliterans, 480 Smooth muscle, vascular, 448 in atherosclerosis, 343 calcium in, 5–6, 6f contraction of, 6–7, 6f control of cell tone, functions of, 5–7 structure of, 3f Sodium blood pressure regulation and, 445 in cardiac contraction, 11 intake, hypertension and, 444 renal transport of, 445 Sodium channel, 129, 130f Sodium current, in cardiac action potential, 129f Sodium restriction for heart failure, 190 for hypertension, 460, 460t Sodium retention, edema and, 55, 56f Solid organ transplantation donor allocation system for, 202 heart See Cardiac transplantation lung, for pulmonary hypertension, 494 Somatization, 61 Sotalol action of, 135t adverse effects of, 160t for atrial fibrillation, 157 dosage of, 159t indications for, 159t pharmacology of, 159t for ventricular tachycardia, 171, 172, 173 SPECT See Single photon emission computed tomography (SPECT) SPECT (single photon emission computed tomography), 518f Spirometry, reference values for, 571t Spironolactone adverse effects of, 194, 462 for heart failure, 191t, 194 for hypertension, 452, 461t, 462 Splenic abscess, in infective endocarditis, 307 Square root sign, 280 Staphylococcal infections in aortitis, 474 in endocarditis See Infective endocarditis, staphylococcal Staphylococcus lugdunensis infections, 296 Starling forces, 54 Statins adverse effects of, 373t hepatotoxicity, 372 myopathy, 372 anti-inflammatory effect of, 350–351, 351f for intermittent claudication, 478 LDL-lowering effect of, 347–348, 351f for lipoprotein disorders, 372, 373t for metabolic syndrome, 349, 383 for UA/NSTEMI, 411, 413 STEMI See ST-segment elevation myocardial infarction (STEMI) Stent(s) coronary artery characteristics of, 435f, 436 drug-eluting, 403–404, 436 restenosis in, 403–404, 437–438, 544–545, 544f, 545f, 545V vascular for aortic dissection, 473 for peripheral artery disease, 479 for renal artery stenosis, 453 Still’s murmur, 81 Stool analysis, reference values for, 564t Streptococcal infections in aortitis, 474 in endocarditis, 295t, 302t, 304 global considerations, 247 Streptokinase adverse effects of, 424 for myocardial infarction, 424 Stress echocardiography, 101t, 105–106, 106f, 394, 518V Stress electrocardiography in arrhythmia evaluation, 134 in ischemic heart disease, 391f, 392f, 393t Index in myocardial infarction, 408 pharmacologic, 394 Stroke aspirin for prevention of, 350 atrial fibrillation and, 157–158, 157t circadian variations in, 451 deaths from, 25t hypertension and, 448, 466 treatment of, 465t, 466 Stroke volume, 6f, 13f, 14–15, 14t ST-segment elevation myocardial infarction (STEMI), 415 accelerated idioventricular rhythm in, 430–431 accelerated junctional rhythm in, 431 arrhythmia in, 417, 430–432 atrioventricular block in, 431–432 biomarkers in, 417–419, 418f cardiogenic shock in, 429 chest pain in, 416–417, 432 circadian variations in, 416 clinical features of, 416–417 complications of, 419, 428–432, 587, 605 ECG in, 96–98, 98t, 417, 502f, 503f, 541f echocardiography in, 419 epidemiology of, 415 heart failure and, 429 heart sounds in, 417 hemodynamic assessment in, 428–429 hypovolemia in, 429 left ventricular aneurysm in, 432 MRI in, 419 murmur in, 417 myocardial perfusion imaging in, 419 nonspecific reaction to, 419 nuclear cardiology in, 419 pain characteristics in, 416–417 painless, 417 pathophysiology of, 415–416 pericarditis in, 432 physical examination in, 417 recurrent, 433 right ventricular infarction in, 429 risk factors for, 416 risk stratification and management after, 432–433 secondary prevention after, 433 sinus bradycardia in, 431 supraventricular arrhythmias in, 431 TIMI grading system, 423 treatment of, 465t ACE inhibitors, 427–428 activity restriction, 426 antiplatelet agents, 420, 426–427 antithrombotic therapy, 426–427 ARBs, 428 beta blockers, 421, 427 bowel management, 426 diet therapy, 426 in emergency department, 420–421, 610–611 fibrinolytic therapy, 422f, 423–424 hospital phase, 426 implantable cardioverter-defibrillator, 430, 431f integrated approach to, 424, 425f limitation of infarct size, 421–422, 610 management strategies, 344, 422f morphine, 421 nitrates, 421, 428 oxygen therapy, 420–421 pacemaker, 431–432 pain control, 421 PCI See Percutaneous coronary interventions (PCI) prehospital care, 419–420, 422f reperfusion therapy, 421–722, 422f sedation, 426 ventricular aneurysm in, 432 ventricular dysfunction in, 428 ventricular fibrillation in, 419, 430 ventricular premature beats in, 430 ventricular tachycardia in, 430 Subaortic stenosis, 213 Subarachnoid hemorrhage, ECG in, 98, 99f Subfascial endoscopic perforator surgery, 488 Sudden cardiac death, 152, 328, 329t epidemiology of, 329–330, 331f etiology of, 329–330, 330t, 592, 611 functional contributing factors in, 329–330, 330t genetic factors in, 329–330 pathology of, 330 prediction of, 331–333, 332f prevention of, 331–333, 332f, 337 structural causes of, 329–330, 330t in young athletes, 333 Sulfhemoglobin, 51 Superior vena cava obstruction, 60 Superoxide dismutase, 342 Supraventricular arrhythmia in myocardial infarction, 431 palpitations in, 61 Supraventricular tachyarrhythmias accessory-pathway mediated tachycardias, 166–167, 166f atrial fibrillation See Atrial fibrillation atrial flutter See Atrial flutter atrial premature complexes, 153, 154, 154f atrial tachycardia See Atrial tachycardia atrioventricular nodal tachycardias, 164–165 junctional premature complexes, 154 mechanism of, 152–153 sinus tachycardia See Sinus tachycardia Surgical ablation, for atrial fibrillation, 159–161 641 S wave, 90 Sydenham’s chorea, 312 Sympathectomy, for Raynaud’s phenomenon, 484 Sympatholytic agents, for hypertension, 461t, 463 Syncope in aortic stenosis, 233 in arrhythmias, 133, 134 in cardiovascular disease, 28–29 cough, 143 micturition, 143 in tachyarrhythmias, 151 vasovagal AV conduction block in, 143 pacemaker for, 148–149 Syphilis, secondary aortic aneurysm in, 468, 468t aortitis in, 474–475 AV conduction block in, 143, 143t Systemic lupus erythematosus (SLE) cardiac manifestations of, 139, 143, 143t, 279, 290t, 293 Raynaud’s phenomenon in, 484 Systemic sclerosis (scleroderma) AV conduction block in, 143, 143t cardiac involvement in, 268 Raynaud’s phenomenon in, 484 Systemic-to-pulmonary shunt, congenital, 492t, 494 Systemic vascular resistance, effect on murmurs, 86 Systolic blood pressure, 443, 450t, 458 Systolic click-murmur syndrome See Mitral valve prolapse Systolic murmurs See Heart murmurs Tachyarrhythmias, 151 asymptomatic, 152 in athletes, 179–180, 180t clinical features of, 151 definition of, 151 diagnostic tests in, 151–152, 152f ECG in, 152 mechanism of, 152–153, 153f supraventricular See Supraventricular tachyarrhythmias treatment of, 158t, 159t, 160t ventricular See Ventricular tachyarrhythmias; Ventricular tachycardia Tachycardia-bradycardia syndrome, 139 Tacrolimus, therapeutic monitoring of, 561t Tadalafil drug interactions of, 493 for pulmonary hypertension, 493 Takayasu’s arteritis, 468t, 469, 474 Tako-tsubo cardiomyopathy, 264–265 642 Tangier disease (ABCA1 deficiency) clinical features of, 366 genetic factors in, 342 oral manifestations of, 64 pathogenesis of, 365–366 Target lesion revascularization, 438 Target vessel revascularization, 438 TAVI (transcatheter aortic valve implantation), 236–237, 237f, 440, 545–547, 545V, 546f TB See Tuberculosis (TB) TEE See Transesophageal echocardiography (TEE) Telangiectasia(s), in cardiovascular disease, 64 Tenecteplase for acute arterial occlusion, 481 for myocardial infarction, 423 Terazosin for hypertension, 461t for Raynaud’s phenomenon, 484 Tetralogy of Fallot clinical features of, 215–216 hypoxia in, 50 imaging of, 16, 216f murmur in, 81f pathophysiology of, 215–216 treatment of, 216 ventricular tachycardia after, 176 TGF-β (transforming growth factor-β), in cardiac development, 17–18 Theophylline for SA node dysfunction, 141 therapeutic monitoring of, 562t Thiamine (vitamin B1) deficiency of, cardiac manifestations of, 52, 290, 290t, 588, 589t, 607 reference range for, 562t Thiazide diuretics action of, 191 for heart failure, 191 for hypertension, 460 Thiazolidinediones adverse effects of, 58t for insulin resistance in metabolic syndrome, 384 Thioredoxin, 342 Thoracic aortic aneurysm, 37, 469–470, 594, 613–614 See also Aortic aneurysm Thoracic outlet compression syndrome, 481–482 Thoratec LVAD, 204 Thrombectomy, percutaneous mechanical for acute arterial occlusion, 481 in STEMI, 540–541, 540V, 541f Thromboangiitis obliterans, 480, 484 Thrombocytosis, erythromelalgia in, 485 Thromboembolectomy, for acute arterial occlusion, 481 Index Thromboembolic disease acute arterial occlusion in extremity, 480 in myocardial infarction, 432 pulmonary hypertension in, 492t, 496 in sick sinus syndrome, 580, 599–600 Thromboendarterectomy, 479, 497 Thrombolytic therapy, for acute arterial occlusion, 481 Thrombomodulin, Thrombosis, endothelium in, Thrombotic thrombocytopenic purpura (TTP), Thromboxane A2, in myocardial infarction, 416 Thyroid disorders hypertension in, 457 lipoprotein metabolism effects on, 367 Thyrotoxicosis heart failure in, 584, 602 hypoxia in, 50 palpitations in, 61 Thyroxine therapy, adverse effects of, 61 Ticagrelor, 412, 427 TIMI frame count, 423 TIMI grading system, 423 TIMI myocardial perfusion grade, 423 TIMI risk score, 408, 409f Timolol, for ischemic heart disease, 399t Tirofiban in PCI, 434 for UA/NSTEMI, 411t Tissue plasminogen activator (tPA) for acute arterial occlusion, 481 for myocardial infarction, 423–424 Titin, 10–11 To-fro murmur, 85, 85f Torsades de pointes ECG in, 169f, 583, 583f, 602 mechanism of, 131t, 132, 152 in myocardial infarction, 430 treatment of, 583, 602 in ventricular tachycardia, 169 Torsemide for heart failure, 191t for pulmonary edema, 326 Toxoplasma gondii infection, cardiac features of, 143t, 259 Trandolapril, for heart failure, 191t Transcatheter aortic valve implantation (TAVI), 236–237, 237f, 440, 545–547, 545V, 546f Transesophageal echocardiography (TEE), 106 in atrial fibrillation, 157 in atrial septal defect, 210f clinical uses for, 101t in infective endocarditis, 299, 300f in murmur evaluation, 88 Transforming growth factor-β (TGF-β), in cardiac development, 17–18 Transposition of the great arteries AV conduction block in, 143 clinical features of, 216 hypoxia in, 50 pathophysiology of, 216 treatment of, 216 Transthoracic (transtracheal) echocardiography, in infective endocarditis, 299 Trastuzumab, cardiotoxicity of, 261–262 Trauma aortic, 287–288, 467, 469 chest, SA node dysfunction in, 138t chest wall, 79 Treprostinil, for pulmonary hypertension, 494 Triamterene, for hypertension, 460, 461t Trichinella/trichinellosis, 259 Tricuspid atresia, 217 Tricuspid regurgitation, 244 clinical features of, 244 ECG in, 244 echocardiography in, 244 etiology of, 220t, 244, 588, 606 murmur in, 77f, 79, 82, 597 in pulmonary hypertension, 490 treatment of, 245 Tricuspid stenosis, 242 clinical features of, 243–244 vs constrictive pericarditis, 281 ECG in, 244 echocardiography in, 244 etiology of, 220t, 242 heart sounds/murmur in, 74, 77f, 244 pathophysiology of, 242–243 treatment of, 244 Tricuspid valve, Ebstein anomaly of, 217 Tricyclic antidepressants (TCAs) adverse effects of, 451t overdosage/poisoning with, 516f Trifascicular block, 95, 150, 150t Trigeminy, 167 Triglycerides atherosclerosis and, 348 elevated, lipid disorders associated with, 361–363, 364t lowering level of, 347–348, 383 normal, elevated LDL–C and, 358–360, 358t of VLDLs, 356 Tropheryma whippelii See Whipple’s disease Tropomyosin, 10 Troponins, 39 in cardiac contraction, 9f, 10–11 defects in, 249 in heart failure, 189 in myocardial infarction STEMI, 418, 418f UA/NSTEMI, 408 Trypanosoma brucei See Sleeping sickness (human African trypanosomiasis) Index Trypanosoma cruzi, 316 See also Chagas’ disease Tuberculosis (TB) aortic aneurysm in, 468, 468t AV conduction block in, 143t endothelium in, extrapulmonary lymphedema, 488, 488t myocarditis, 259 pericardial, 278, 283 Tunica media, 2, Turner syndrome coarctation of the aorta in, 457 lymphedema in, 488 T wave, 92, 128, 134 T wave alternans, 169f Twiddler’s syndrome, 147 Tyrosine kinase inhibitors, adverse effects of, 262 Ultrasonography, coronary artery, 124, 124f United Network of Organ Sharing (UNOS), in cadaver donor selection, 202 Unstable angina/non-ST-segment elevation myocardial infarction (UA/ NSTEMI), 407 cardiac biomarkers in, 408 chest pain in, 35t, 36, 38–39, 39t clinical features of, 408 definition of, 407 diagnosis of, 408, 409f ECG in, 408, 542f, 543f pathophysiology of, 407 prognosis of, 408–409 risk stratification in, 408–409, 409f treatment of, 409–413 ACE inhibitors, 411 antithrombotic therapy, 411–412, 411t beta blockers, 410t, 411, 465t calcium channel blockers, 410t, 411 invasive vs conservative strategy, 412–413, 413t long-term management, 413 morphine sulfate, 410t nitrates, 410, 410t, 465t PCI See Percutaneous coronary interventions (PCI) statins, 411 Urinalysis, reference ranges for, 565–566t U wave, 92 Valproate/valproic acid, therapeutic monitoring of, 562t Valsalva maneuver for accessory pathway-mediated tachycardia, 167 heart murmurs and, 74t, 75, 86, 576, 597 Valsartan for heart failure, 191t for hypertension, 461t Valve area, measurement of, 121–122 Valvular heart disease See also specific conditions dyspnea in, 46 global burden of, 246–247 imaging tests for, 114t, 115 multiple and mixed, 245 murmurs in, 76 natural history of, 31 replacement and repair procedures for, 225t, 246, 588, 606 Vancomycin for infective endocarditis, 303 therapeutic monitoring of, 562t Varicose veins, 487 Vascular compliance, 448 Vascular remodeling, 448 Vascular resistance, measurement of, 121 Vascular tone, 9, 448 Vascular volume, effect on blood pressure, 444–445 Vasoconstriction cyanosis in, 52 localized hypoxia and, 50 Vasoconstrictor response, paradoxical, Vasoconstrictors, for acute heart failure, 197t, 198 Vasodilation as adaptation to hypoxia, 51 endothelium-dependent, 448 in exercising muscle, 15 Vasodilators for acute heart failure, 197, 197t adverse effects of, 59 for cor pulmonale, 200 for hypertension, 461t, 463 Vasopressin antagonists (vaptans), for acute heart failure, 198 Vasopressors, for cardiogenic shock, 324 Vasovagal stimulation, SA node dysfunction in, 138t Vaughan-Williams classification, of antiarrhythmic drugs, 134–135 Vegetations characteristics of, 294, 591, 609–610 mitral valve, 294f Venous disorders, of extremities, 486 chronic venous insufficiency, 487–488, 487f, 488t varicose veins, 487 venous thrombosis See Venous thromboembolism (VTE) Venous drainage, obstructed, 57 Venous hum, 85 Venous pressure, edema and, 57, 60 Venous return, 86 643 Venous thromboembolism (VTE), 486 See also Pulmonary embolism (PE) cyanosis in, 52 risk factors for, 486, 486t superficial, 486 treatment of, 486 Ventilation-perfusion mismatch/ heterogeneity in asthma, 44 in cardiogenic pulmonary edema, 48 in COPD, 44 in hypoxia, 50 Ventilatory muscles, 42 Ventilatory pump, disorders of, 42, 42f Ventricular dysplasia, arrhythmogenic, 174, 175f, 263, 264f Ventricular end-diastolic pressure, 13 Ventricular end-diastolic volume, 13f, 16 Ventricular fibrillation cardiac arrest/sudden cardiac death in, 328–329, 592, 611 in ischemic heart disease, 387 mechanism of, 133 in myocardial infarction, 419, 430 postresuscitation care, 336 treatment of, 170–172, 335–336, 336f Ventricular filling, assessment of, 15–16 Ventricular flutter, 169 Ventricular function, assessment of, 109–110 Ventricular function curve, 13 Ventricular premature beats in ischemic heart disease, 387 in myocardial infarction, 430 Ventricular premature complexes, 152, 154f, 167 Ventricular remodeling, 428 Ventricular septal defect (VSD) AV conduction block in, 143 erythrocytosis in, 211–212 murmur in, 73, 77f, 79–83 natural history of, 211–212 pregnancy and, 211 pulmonary hypertension and, 211 RV outflow tract obstruction in, 211 treatment of, 211–212 Ventricular septal rupture, 321, 323t, 325 Ventricular tachyarrhythmias accelerated idioventricular rhythm, 168 Brugada syndrome See Brugada syndrome long QT syndrome See Long QT syndrome short QT syndrome, 151, 177t, 178 ventricular premature complexes, 152, 154f, 167 ventricular tachycardia See Ventricular tachycardia ... Critical Care Medicine, Washington University School of Medicine, St Louis, Missouri [17] Panithaya Chareonthaitawee, MD Associate Professor of Medicine, Mayo Clinic College of Medicine, Rochester,... Institute; Director, Cardiovascular Clinical Research Center, New York University School of Medicine, New York, New York [28] Sharon A Hunt, MD, FACC Professor, Division of Cardiovascular Medicine, Stanford... Consultant, Division of Cardiovascular Diseases and Internal Medicine, Mayo Clinic College of Medicine, Rochester, Minnesota [12, 42] Patrick T O’Gara, MD Professor of Medicine, Harvard Medical