Clinical cardiology, current practice guidelines demosthenes g katritsis

Clinical Cardiology This page intentionally left blank Clinical Cardiology Current Practice Guidelines Demosthenes G Katritsis, MD, PhD, FRCP, FACC Athens Euroclinic, Athens, Greece Bernard J Gersh, MB, ChB, DPhil, FRCP, FACC Mayo Medical School, Rochester, MN, USA A John Camm, MD, FRCP, FACC St George’s University of London, UK Great Clarendon Street, Oxford, OX2 6DP, United Kingdom Oxford University Press is a department of the University of Oxford It furthers the University’s objective of excellence in research, scholarship, and education by publishing worldwide Oxford is a registered trade mark of Oxford University Press in the UK and in certain other countries © Oxford University Press 2013 The moral rights of the authors have been asserted First Edition published in 2013 Impression: All rights reserved No part of this publication may be reproduced, stored in a retrieval system, or transmitted, in any form or by any means, without the prior permission in writing of Oxford University Press, or as expressly permitted by law, by licence or under terms agreed with the appropriate reprographics rights organization Enquiries concerning reproduction outside the scope of the above should be sent to the Rights Department, Oxford University Press, at the address above You must not circulate this work in any other form and you must impose this same condition on any acquirer Published in the United States of America by Oxford University Press 198 Madison Avenue, New York, NY 10016, United States of America British Library Cataloguing in Publication Data Data available Library of Congress Control Number: 2013944647 ISBN 978–0–19–968528–8 Printed in Italy by L.E.G.O S.P.A Lavis TN Oxford University press makes no representation, express or implied, that the drug dosages in this book are correct Readers must therefore always check the product information and clinical procedures with the most up-to-date published product information and data sheets provided by the manufacturers and the most recent codes of conduct and safety regulations The authors and the publishers not accept responsibility or legal liability for any errors in the text or for the misuse or misapplication of material in this work Except where otherwise stated, drug dosages and recommendations are for the non-pregnant adult who is not breast-feeding Foreword Over the years I have had the pleasure of writing forewords for a number of books that I considered to be timely and to fulfill important objectives Without hesitation, I would say that Clinical Cardiology: Current Practice Guidelines, by D.G Katritsis, B.J Gersh, and A.J Camm, is the most outstanding book for which I have had the pleasure to write a foreword Further, this is probably the book that better serves the cardiovascular specialist in day-to-day practice than any other written in the last two decades This is not just a textbook; it is an extraordinary “toolkit” in the context of an evidencebased cardiovascular practice in the midst of rapidly evolving scientific knowledge and guidelines Because of the need to integrate current knowledge on evidence-based cardiology, about three years ago, under the auspices of the American Heart Association, we published a book that included the most recent guidelines by both the ACCF/AHA and the ESC I believe that such integration was a step forward for the practicing cardiologist; indeed, in a “synopsis” fashion, this aspect is well served in Clinical Cardiology: Current Practice Guidelines However, in the excellent compendium of my colleagues, three new components are incorporated, which we can describe as the “jewel” of the book: a very succinct definition, classification, pathophysiology, diagnosis, management, and need of specific clinical investigation (including genetics and molecular biology) of the various disease entities; a regularly updated online version on the most recent developments; and, most importantly a “user friendly, at a glance” presentation These additional three components, that make Clinical Cardiology: Current Practice Guidelines so unique, deserve a brief description 1) In regard to the various disease entities, general textbooks tend to employ, from definition to management, a rather long and descriptive format In contrast, Clinical Cardiology: Current Practice Guidelines consolidates many of the topics, regardless of their complexity, from definition to management, in a clear, concise and instructive way, intermixed with the most recent guidelines Thus, over 600 easily accessible tables dissect and summarize the key points of all the latest ACCF/AHA and ESC guidelines 2) Rapidly evolving scientific knowledge, including the value of new diagnostic and management approaches and their incorporation in practicing guidelines, makes it difficult for the cardiovascular specialist to be aware of the latest clinical evidence-base Written by three leading authorities in the field, its biannually updated online version provides the solution 3) A novelty of this book is the “user-friendly, at glance” way of presentation that it makes it very useful to the practicing cardiovascular specialist Useful because of its combination of succinctness and clarity, the book is up to date in every aspect of the cardiovascular science, and particularly on the most recent recommendations from both sides of the Atlantic Thus, these recommendations are summarized in tables derived from the guideline documents and incorporated in the appropriate diagnostic or management sections of the 85 comprehensive chapters For example, when confronted with complicated clinical issues that appear in everyday clinical practice (such as modern antiplatelet therapy of ACS, differential diagnosis of wide complex tachycardia, or management of stable CAD in view of COURAGE, FREEDOM or STICH) physicians consult general textbooks or, often several journal articles, in order to obtain this information in a rather loose form In contrast, Clinical Cardiology: Current Practice Guidelines consolidates such topics in a summarized, succinct, and clear way This book is a tribute to the skill of the three editors who also served as the only authors This limited, but unified and hardworking internationally known authorship is, without doubt, a great part of the success It is with great pleasure that I pen these words to relate my enthusiasm for their work as a remarkable addition to the cardiovascular field Valentin Fuster Physician-in-Chief, Mount Sinai Medical Center Director, Mount Sinai Heart ΠΑΝΤΕΣ ΑΝΘΡΩΠΟΙ ΤΟΥ ΕΙΔΕΝΑΙ ΟΡΕΓΟΝΤΑΙ ΦΥΣΕΙ All humans by nature desire to know Aristotle The Metaphysics Prologue The entire field of cardiovascular medicine has witnessed an era of rapid scientific progress, accompanied by continuous technological and applied innovation This occurs against a backdrop of increasing emphasis on the importance of evidence-based practice, and rapid development of guidelines by major professional societies The resultant expansion of our body of knowledge by evidence-based recommendations interjects a new set of challenges for the practicing clinician with ever-extensive clinical responsibilities In order to practice evidence-based medicine, information must be easily accessible and, more importantly, easily retrievable when the need arises; this may not always be easy with the current pace of dissemination of knowledge The rationale for writing this book reflects exactly this need, both ours and that of our potential readers: to organize our continually evolving knowledge on often diverse cardiology issues, in our environment of networked and facilitated communication In other words, to provide a clinical tool that can be used in everyday clinical practice as a concise guide to what we know and, more importantly, what we not know, and what we think we know To quote Mark Twain, “what gets us into trouble is not what we don’t know, it is what we know for sure that just ain’t so.” The prerequisites of informed clinical practice are: a satisfactory background of basic knowledge of disease entities, remaining up-to-date on important clinical trials and emerging scientific evidence that shape current diagnosis and therapy, and acquaintance with current practice guidelines from established professional societies such as the American College of Cardiology Foundation/American Heart Association (ACCF/AHA) and the European Society of Cardiology (ESC), among many others Each chapter of this book has therefore been structured around the following parts: A clear definition and modern classification of disease entities, followed by updated, focused information on recent developments on the epidemiology and pathophysiology of each condition Recent original articles and reviews from leading journals were consulted and a summary of the most relevant information is included Special care was taken not to omit the most recent information on medical genetics, an expanding and promising aspect A description of the clinical presentation of the disease, with instructions on necessary clinical investigations Clinical investigations are presented in the context of recent evidence that dictates their current value or obsolescence An effort has been made to include the very latest published knowledge on the clinical value of existing and evolving tests, based on recent randomized clinical trials and guidelines by both ACCF/AHA and ESC Recommendations on management as derived from the most recent evidence available to the authors Because of the comprehensive nature of guidelines offered by learned societies, it was decided to provide the most recent recommendations in a summarized, tabulated format These are not readily accessible since overlapping guidelines may appear on the same condition from different working groups, and updated documents are continually appearing Thus, all guideline documents and their updates published in the US and Europe were scrutinized and classified according to year of publication The most recent recommendations were defined, extracted and tabulated The resulting tables provided in the book offer the most recent recommendations on each disease entity by both ACCF/ AHA and ESC Where appropriate, new evidence that questions the validity of specific recommendations, as well as the opinions of established experts, and other data, such as FDA alerts are included Practical advice on “what and why to do” Therapies, drug doses and selection of procedures are presented in a clear and user-friendly way Carefully chosen references Major randomized clinical trials and seminal scientific studies that define evidencebased practice are included for further reference In addition, recent, scholarly reviews are provided, which together with the contents of the book should allow in-depth study of specific entities that may interest the individual reader Presentation of all recent guidelines Guidelines are referenced and presented separately in order to guide the reader to the most recent publications by ACCF/AHA and ESC An inherent disadvantage of a medical textbook is inability to keep up-to-date with recent developments To overcome the problem, the online version of this book will be updated, initially on a 6-monthly basis This book would have never been possible without the wholehearted support and commitment of Helen Liepman, our Senior Editor at Oxford University Press We are grateful for her acceptance of our view of a “next generation textbook” We also thank Imogen Lowe, Mark Knowles, and Richard Martin of Oxford University Press Their professionalism and assistance throughout the production process is much appreciated Demosthenes G Katritsis Bernard J Gersh A John Camm Contents List of abbreviations xxv Part Grown-up congenital heart disease Grown-up congenital heart disease: general principles Definition Epidemiology Aetiology Clinical problems in GUCH Imaging techniques and investigations Principles of management Ventricular septal defects Definition and classification Epidemiology Aetiology Pathophysiology Presentation 10 Physical examination 10 Investigations 10 Therapy 10 Pregnancy 11 Atrioventricular septal defects 12 Definitions and classification of AVSDs Ostium primum ASD 12 Atrial septal defects 15 Ostium secundum ASD 15 Sinus venosus defect 17 Patent foramen ovale 17 Patent ductus arteriosus 19 Definition 19 Epidemiology 19 Aetiology 19 Pathophysiology and natural history 20 Presentation 20 Physical examination 20 Investigations 20 Therapy 20 12 .. .Clinical Cardiology This page intentionally left blank Clinical Cardiology Current Practice Guidelines Demosthenes G Katritsis, MD, PhD, FRCP, FACC Athens... two-dimensional three-dimensional four-dimensional Dalton delayed after-depolarization dual oral antiplatelet therapy direct current direct current cardioversion dilated cardiomyopathy drug-eluting... informed clinical practice are: a satisfactory background of basic knowledge of disease entities, remaining up-to-date on important clinical trials and emerging scientific evidence that shape current