Management of Complex Cardiovascular Problems Management of Complex Cardiovascular Problems FOURTH EDITION EDITED BY Thach Nguyen, MD, Moo-Hyun Kim, MD, FACC FSCAI FACC Director of Cardiovascular Research Methodist Hospital Merrillville IN 46410 Associate Professor of Medicine Director, Cardiology Department Dong A University Busan, Korea Dayi Hu, MD FACC FHRS FESC Director of the Intervention Center at Peking University People’s Hospital, President, Chinese College of Cardiovascular Physician (CCCP), Beijing, China Shao Liang Chen MD Professor of Cardiology Professor of Internal Medicine Deputy President, Nanjing First Hospital, Nanjing Medical University Director of Catheterization Laboratories, Nanjing First Hospital Chief of Cardiology Nanjing First Hospital Nanjing, China Cindy Grines, MD Vice President Academic and Clinical Affairs, Detroit Medical Center Heart Hospital Detroit, MI ASSOCIATE EDITOR Faisal Latif, MD Associate Professor of Medicine, University of Oklahoma, OKC, OK This edition first published 2016 © 2016 by John Wiley & Sons Ltd Registered office: John Wiley & Sons, Ltd, The Atrium, Southern Gate, Chichester, West Sussex, PO19 8SQ, UK Editorial offices: 9600 Garsington Road, Oxford, OX4 2DQ, UK The Atrium, Southern Gate, Chichester, West Sussex, PO19 8SQ, UK 111 River Street, Hoboken, NJ 07030-5774, USA For details of our global editorial offices, for customer services and for information about how to apply for permission to reuse the copyright material in this book please see our website at www.wiley.com/wiley-blackwell The right of the author to be identified as the author of this work has been asserted in accordance with the UK Copyright, Designs and Patents Act 1988 All rights reserved No part of this publication may be reproduced, stored in a retrieval system, or transmitted, in any form or by any means, electronic, mechanical, photocopying, recording or otherwise, except as permitted by the UK Copyright, Designs and Patents Act 1988, without the prior permission of the publisher Designations used by companies to distinguish their products are often claimed as trademarks All brand names and product names used in this book are trade names, service marks, trademarks or registered trademarks of their respective owners The publisher is not associated with any product or vendor mentioned in this book It is sold on the understanding that the publisher is not engaged in rendering professional services If professional advice or other expert assistance is required, the services of a competent professional should be sought The contents of this work are intended to further general scientific research, understanding, and discussion only and are not intended and should not be relied upon as recommending or promoting a specific method, diagnosis, or treatment by health science practitioners for any particular patient The publisher and the author make no representations or warranties with respect to the accuracy or completeness of the contents of this work and specifically disclaim all warranties, including without limitation any implied warranties of fitness for a particular purpose In view of ongoing research, equipment modifications, changes in governmental regulations, and the constant flow of information relating to the use of medicines, equipment, and devices, the reader is urged to review and evaluate the information provided in the package insert or instructions for each medicine, equipment, or device for, among other things, any changes in the instructions or indication of usage and for added warnings and precautions Readers should consult with a specialist where appropriate The fact that an organization or Website is referred to in this work as a citation and/or a potential source of further information does not mean that the author or the publisher endorses the information the organization or Website may provide or recommendations it may make Further, readers should be aware that Internet Websites listed in this work may have changed or disappeared between when this work was written and when it is read No warranty may be created or extended by any promotional statements for this work Neither the publisher nor the author shall be liable for any damages arising herefrom Library of Congress Cataloging-in-Publication Data: Names: Nguyen, Thach, editor | Hu, Dayi, editor | Chen, Shao Liang, editor | Kim, Moo-Hyun (Cardiologist), editor | Grines, Cindy, editor Title: Management of complex cardiovascular problems / edited by Thach Nguyen, Dayi Hu, Shao Liang Chen, Moo-Hyun Kim, Cindy Grines ; associate editor, Faisal Latiff Description: Fourth edition | Chichester, West Sussex, UK ; Hoboken, NJ : John Wiley & Sons Inc., 2016 | Includes bibliographical references and index Identifiers: LCCN 2015035763 (print) | LCCN 2015036342 (ebook) | ISBN 9781118965030 (cloth) | ISBN 9781118965047 (Adobe PDF) | ISBN 9781118965054 (ePub) Subjects: | MESH: Cardiovascular Diseases–therapy | Evidence-Based Medicine Classification: LCC RC671 (print) | LCC RC671 (ebook) | NLM WG 120 | DDC 616.1/2–dc23 LC record available at http://lccn.loc.gov/2015035763 A catalogue record for this book is available from the British Library Wiley also publishes its books in a variety of electronic formats Some content that appears in print may not be available in electronic books Cover image: gettyimages.com © Janulla Set in 8/10pt Frutiger Light by Aptara Inc., New Delhi, India 2016 Contents List of Contributors, vii Foreword to the Third Edition, xvii Preface, xix Acknowledgements, xxi Hyperlipidemia, Vien T Truong, Kim N Huynh, Tam Ngo, Sara Shah, Hau Van Tran, Chisalu Nchekwube, Nabeel Ali and Faisal Latif Hypertension, 30 Udho Thadani and Nguyen Duc Cong Stable Coronary Artery Disease, 50 ´, Toan, ` ` Leˆ Mohammed Haris Umer Usman, Leˆ Hoang Duc ˆ Thi Ngo.c Tram, Huynh Thi Thu Truc, ` ´ An Huynh and Aman Amanullah Acute Coronary Syndrome, 86 Udho Thadani, Quang Tuan Nguyen and Han Yaling ST Segment Elevation Myocardial Infarction, 113 Thach Nguyen, Xu Bo, Faisal Latif, Ho Thuong Dung, Duane Pinto, Pham Manh Hung, Michael Gibson and Runlin Gao Heart Failure (Stages A, B and C), 141 Dan Le, Trong Ha Le, Vo˜ Minh Viê t, Bao V Ho, Tuan D Nguyen, Khalid Numan Al Azza, Hau Van Tran and Gianluca Rigatelli Acute Decompensated and Chronic Stage D Heart Failure, 169 Patrick Campbell, Selim R Krim, Thach Nguyen, Marvin Eng, Yidong Wei and Hau Van Tran and Hector Ventura vi Contents Atrial Fibrillation, 198 Mihail Gabriel Chelu, Ali Oto, Tuan D Nguyen, Phan Dinh Phong, Tung Mai, Tom Bump and Rajasekhar Nekkanti Ventricular Tachycardia, 233 Sorin Lazar, Bao V Ho, Phillip Tran, Pham Nhu Hung, Thomas Bump and Evgeny Shlyakhto 10 Syncope, 266 Christopher M Bianco, Rajasekhar Nekkanti, Faisal Latif, Phan Nam Hung, Phillip Tran, Hy Tat An and Thach Nguyen 11 Aortic Stenosis, 299 Rajiv Goswami, Phillip Tran, Nguyen Lan Hieu, Aravinda Nanjundappa and Neal Kleiman 12 Mitral Regurgitation, 329 Deepak Joshi, Rajasekhar Nekkanti, Marvin H Eng, Madhur Roberts, Ngoc Quang Nguyen, Xian Kai Li and Michael Rinaldi 13 Cardiovascular Problems in Elderly Patients, 364 Daniel E Forman and Nanette Wenger 14 Cardiovascular Problems in Women, 379 Kahroba Jahan, Ainol Shareha Sarar, Nisa Arshad, Nguyen Phuc Nguyen, Amsa Arshad, Sajaj Agarwal, Thach Nguyen and Kwan Lee Index, 406 List of Contributors NABEEL ALI, MD Xavier University School of Medicine, Aruba HY TAT AN MS Class of 2020 Tan Tao University School of Medicine Tan Duc E-City, Duc Hoa – Long An Vietnam KHALID NUMAN AL AZZA, MD Jordan University of Science and Technology Irbid, Jordan AMAN M AMANULLAH, MD, PhD, FACC, FAHA Clinical Professor of Medicine Sidney Kimmel Medical College of Thomas Jefferson University Section Chief, Noninvasive Cardiology, Albert Einstein Medical Center Philadelphia, PA 19141 AMSA ARSHAD, MD Xavier University School of Medicine, Aruba NISA ARSHAD, MD Xavier University School of Medicine, Aruba CHRISTOPHER M BIANCO, MD Cardiology Fellow The Brody School of Medicine at East Carolina University Greenville, NC THOMAS BUMP, MD Clinical Associate Professor, University of Chicago Clinical Assistant Professor, University of Illinois at Chicago Chicago, IL PATRICK T CAMPBELL, MD Advanced Heart Failure Fellow Section of Cardiomyopathy & Heart Transplantation Ochsner Heart and Vascular Center, New Orleans MIHAIL G CHELU, MD, PHD, FHRS Assistant Professor University of Utah School of Medicine Electrophysiology Division Salt Lake City, UT viii List of Contributors SHAO LIANG CHEN, MD, PhD, FACC Professor of Cardiology Professor of Internal Medicine Deputy President, Nanjing First Hospital, Nanjing Medical University Director of Catheterization Laboratories, Nanjing First Hospital Chief of Cardiology, Nanjing First Hospital Nanjing, China NGUYEN DUC CONG, MD, PhD Professor of Medicine Director of Thong Nhat Hospital Director of Geriatric Department of Pham Ngoc Thach Medical University Vice Director of Geriatric Department, The University of Medicine and Pharmacy Vice Director Department of Internal Medicine, School of Medicine, the National University of Hochiminh City, Hochiminh City, Vietnam VIJAY DAVE, MD Director of Medical Education St Mary Medical Center Hobart, IN HO THUONG DUNG, MD, PhD, FSCAI Vice Director of Thong Nhat Hospital, HCM City Vice Chairman of Interventional Cardiology Association of HCM City Hochiminh City, Vietnam MARVIN H ENG, MD Structural Heart Disease Fellowship Director Center for Structural Heart Disease, Division of Cardiology Henry Ford Health System, Detroit, MI DANIEL FORMAN, MD Professor of Medicine, University of Pittsburgh Chair, Geriatric Cardiology Section, University of Pittsburgh Medical Center Director, Cardiac Rehabilitation, VA Pittsburgh Healthcare System Pittsburgh, PA RUNLIN GAO, MD, FACC, FESC, FSCAI Professor of Medicine Member, Chinese Academy of Medical Sciences Chief Cardiologist, Fuwai Hospital Beijing, China 414 Index 3-Dimensional echocardiography (3DE), 334, 339 Direct current cardioversion (DCCV), 209–210 Direct thrombin inhibitors (DTI) for ACS, 98–99 during primary PCI, 122 Disopyramide, 219t, 220 Distress, 171 Diuretic Optimization Strategies Evaluation (DOSE) trial, 179 Diuretics hydralazine/dinitrate isosorbide, 159t Dobutamine, 59, 190 Dofetilide, 210, 211t, 220t, 221 Doxazosin, 41 Dronaderone, 219t Drug-eluting stent (DES) implantation, 72 Dual antiplatelet therapy (DAPT), 72–73 bleeding calculator, 74t Duke Activity Status Index (DASI), 384, 385t Duke Treadmill Scores (DTS), 58, 389, 389t Echocardiography, 56–57, 332 exercise, 58–59 stress, 59–60 Edoxaban, 214 Efficacy and Safety of Subcutaneous Enoxaparin in Non-Q Wave Coronary Events (ESSENCE) trial, 98 Elderly patients, cardiovascular problems in, 365 care, skill-sets required for, 365t challenges in treatment of, 365–366 frailty index of, 368–369, 369t high-risk markers of, 367 high-risk predictors of, 367 management, 370–375 for acute coronary syndrome, 372 aging, 375 for chronic coronary heart disease, 374–375 for coronary heart disease, 371–372 decisions, 375 for NSTEMI, 373–374 polypharmacy, 371 for STEMI, 372–373 signs of, 368 strategic mapping for goals of treatment, 366–367 holistic approach, 367 tiered management, 367 symptoms of, 368 testing for biomarkers, 369 exercise stress, 369–370 pharmacological stress, 370 Electrocardiogram, 56 Electrocardiographic artifact, 241–242 Electrocardiography, 237–240, 239t Electrophysiologic Study Versus Electromagnetic Monitoring (ESVEM) trial, 251, 259 Electrophysiology study (EPS), 286–287, 287t Enalapril, 150t ENGAGE AF-TIMI 48 trial, 224 Eplerenone in Mild Patients Hospitalization and Survival Study in HF (EMPHASIS-HF) trial, 162 EVEREST trial, 345–346 Exercise stress testing (EST), 286, 369–370 Ezetimibe, 13 Fibrates, 23 Flecainide, 211t, 212, 219t, 220 Fludrocortisone, 288, 292 Index Framingham Risk Score, 383 FREEDOM trial, 77–78 Functional mitral regurgitation, 348–351 Glycoprotein 2b3a inhibitors (GPI), 126 for acute coronary syndrome, 97 HAS-BLED Risk Score, 213, 214t HDL-C efflux capacity, Head up tilt testing (HUTT), 285–286, 285t Heart Failure: A Controlled Trial Investigating Outcomes of Exercise Training study, 153 Heart failure (HF) ACCF/AHA diuretics recommendations for hospitalized patients with, 180t and ACS, 103 acute decompensated heart failure (See Acute decompensated heart failure (ADHF)) advanced, evaluation of, 184t and CAD, 52 diagnoses of, 178t dosage of medications in, 150t guideline directed medical therapy (GDMT) for, 159t and hyperlipidemia, 21 instructions for patients with, 149t IV inotropes for, 190, 191t precipitating factors of, 150–151, 151t prevention of, 151–152, 151t revascularization for, 164 stage A (See Asymptomatic heart failure) stage B (See Asymptomatic left ventricular remodeling) 415 stage C (See Stage C heart failure) stage D (advanced) (See Stage D (advanced) heart failure) ultrafiltration for, 190–191, 191t Heart healthy diet, 11 HEAT PPCI trial, 122–123 Hemodialysis, 18–19 Heparin, 89, 118 High-sensitivity C-reactive protein (hs-CRP), 54 Home visits, 186 HTN α-blockers, 38–39 Hydralazine, 162 Hyperlipidemia, ASCVD risk estimator for, 4–5 challenges in treatment of, diagnostic tests for, 7–8 diet drinks in, 11 HDL-C efflux capacity in, high-risk markers for, 4–7 in ACC/AHA ASCVD risk estimator, 5t start of statin therapy, 6t treatment to patients with risk of 7.5%, lipid level in, management of, ACC/AHA guidelines, patients not on, 18–22, 18t combination therapy, 12–14, 12t with hemodialysis, 18–19 investigative questions from patient’s perspective, lifestyle modification, 11 non-hemodialysis, 18–19, 20t patients with ASCVD risk of less than 7.5%, 22 patients with CKDs, 18–21 patients with diabetes, 21 patients with heart failure, 21 patients younger than 40 years, 21–22 416 Index Hyperlipidemia (Continued) pregnant women, 22 race/ethnicity, 22 selection of patients, schema for, 10f statin therapy, 11–12, 12t, 14–18 (See also Statin therapy) therapy, strategic mapping for, predictors, 6–7, 7t SHARP trial for, 19 signs for, statin therapy benefit groups for, 3t strategic mapping for, symptoms for, US patients, risk calculator for, Hypertension (HTN), 31 and AS, 321 African Americans, 37–38 antihypertensive medications, compliance with, 41–42 in aortic stenosis, 39 blood pressure readings in, 33–34 causes of, 32–33 challenges in treatment of, 31–32 and chronic kidney disease, 40 and diabetes mellitus, 39–40 high-risk markers of, 32 high-risk predictors of, 32 history and physical examination in, 32 hypertensive urgency, 41 investigations in, 32–33 management of in African Americans, 37–38 aldosterone blockers, 39 beta-blockers for, 38–39 lifestyle modifications, 35 in non-African American, 37 pharmacologic treatment, 35–37 in non-African American patients, 37 during pregnancy, 42 resistant, 41–42 routine monitoring of ambulatory BP, 34 secondary causes of, 42–43, 42t medications, 42–43 obstructive sleep apnea, 43 self-measurement of BP in, 34 signs for, 33 symptoms for, 33 testing in, 34–35 vs chest pain, 173 Hypertryglyceridemia management, 22–27 in Asians, 26–27 of children and young adults in family of patients with, 25–26 fibrates and statin, 23 in HIV patients taking protease inhibitor, 24–25 of low HDL-C, 24 in patients with liver disease, 24, 25t statin and niacin, 23–24 statin therapy, 26 treatment of high triglyceride (TG) levels, 22, 23t Hyponatremia, 183 Hypotension, 171–172 orthostatic, 278–279 Ibutilide, 210, 211t Idarucizumab, 225 Implantable cardiac defibrillator (ICD) trials for primary prevention of SCD, 254t–255t for secondary prevention of SCD, 256t Index Implantable loop recorders (ILRs), 285 IMPROVE-IT trial, 13–14, 100 International Study of Comparative Health Effectiveness with Medical and Invasive Approaches (ISCHEMIA) study, 75 Intravenous (IV) diuretics for HF, 179–181, 180t Invasive versus Conservative Treatment in Unstable coronary Syndromes (ICTUS) trial, 101–102 ISAR-TRIPLE trial, 225 Ischemic heart disease (IHD), 380 challenges in treatment of, 380–381 conditional probability calculation for, 383 differential diagnoses of, 384, 386t Duke Activity Status Index for, 384, 385t Framingham Risk Score for, 383 high-risk markers, 381, 381t management ACS in pregnancy, 397–398 of acute coronary syndrome, 394–395 coronary artery bypass graft surgery, 397 drug-eluting stents, 396 invasive treatment, 395–396 percutaneous coronary interventions, complications of, 396–397 primary prevention, 393–394 secondary prevention, 394 STEMI, 397 pretest probability calculations for, 382–384, 384t risk stratification, 385t signs of, 382 417 strategic mapping of, 381–382 symptoms of, 382 testing modalities for cardiac computed tomography angiography, 392–393 coronary angiography, 393 electrocardiogram, 386 exercise stress test, 387–388, 390 myocardial perfusion imaging, 390 radiation, 391–392, 392t SPECT myocardial perfusion imaging (MPI), 391, 391t stress echocardiography, 390, 391t ST-T segment changes, 388–389 ISSUE Double-blind, randomized placebo-controlled study, 293 Labetalol, 42 Left bundle branch block (LBBB), 60, 238 Left ventricular dysfunction, 74–75 Lipid level in hyperlipidemia, in ODYSSEY ALTERNATIVE trial, 15t in hypertension, 34 Lisinopril, 129t Long QT syndrome, 244–246, 246t, 252–253 Losartan, 150t Lotus aortic valve system, 314 Low flow–low gradient aortic stenosis, 317–319 Low molecular weight heparin (LMWH) for acute coronary syndrome, 98 for STEMI, 121 for stroke prevention, 207, 215t 418 Index Macrolide antibiotics, 18 Malignant syncope, 277 MATCH trial, 126 Metabolic equivalent of task (MET), 58 Methyldopa, 42 Metoprolol succinct, 150t Metoprolol tartrate, 129t Midodrine, 288, 289, 291 Milrinone, 190 Mineralocorticoid receptor antagonists (MRA), 161 in HF, 159t MitraClip® , 344, 345–347 anatomical indications of, 346t contraindications for, 347t Mitral annulus ventricular tachycardia, 244 Mitral regurgitation (MR), 330 cardiac catheterization for, 340 cardiac magnetic resonance imaging for, 339–340 challenges in treatment of, 330–331 3D echocardiography in, 334, 339, 341 diagnosis, strategies for, 331–332, 331t echocardiography techniques for evaluating severity of, 335t–337t exercise echocardiography for, 339 exercise stress testing for, 339 high-risk markers of, 332 high-risk predictors of, 332 management activities for, 342 of acute MR, 351–356 (See also Acute mitral regurgitation) of advanced left ventricular dysfunction, 347 of atrial fibrillation, 347–348 of elderly patients, 348 endocarditis prophylaxis, 348 follow-up for, 342 of high-risk patient populations, 342–343 medical therapy for, 341 percutaneous therapy for, 344–346, 345f during pregnancy, 348 of primary MR, 341–348 repair vs replacement, 343–344, 344t of secondary MR, 348–351 (See also Secondary mitral regurgitation) strategies for, 331–332, 331t surgery for, 342, 343t Seller’s grade for, 340t signs of, 333, 333t specific and supportive signs and quantitative parameters in grading severity of, 338t symptoms of, 332, 333t trans-esophageal echocardiography in, 334 transthoracic echocardiography in, 334, 341 Morphine, 120 Multicenter Automatic Defibrillator Implantation (MADIT)-II trial, 250 Multicenter Automatic Defibrillator Implantation Trial with Cardiac Resynchronization Therapy (MADIT-CRT) trial, 154 Multicenter Unsustained Tachycardia (MUSTT) trial, 251 Multi-Ethnic Study of Atherosclerosis (MESA) trial, 392 Myocardial perfusion imaging (MPI), 59 Index for patients with no known CAD, 60 for patients with prior CAD, 60–61 pharmacological, 60 Neprilysin, 160–161 Nesiritide, 181 Niacin therapy, 23–24 Nifedipine, 68 Nitrates, 162, 163 Nitroglycerin, 181 in ACS, 89, 100, 101 in CAD, 66–67 Nitroprusside, 182, 355 Non-cardiac chest pain, 55 Non-cardiac problems, 52t Non-ST segment elevation (NSTE)-ACS, 87–88, 89, 90 See also Acute coronary syndrome (ACS) antiplatelet therapy, duration of dual, 104–105, 105t factors indicating of, 91t and illicit drugs, 104 and non-significant obstructive CAD, 103–104 and normal coronary arteries, 104 Novel oral anticoagulants (NOAC), 203, 207, 209, 214 efficacy and risk of, 217t in patient receiving NSAID, 227 for patients with high risk of bleeding, 224 reversal agents for, 225 role of, 226 Obstructive sleep apnea, 43 ODYSSEY ALTERNATIVE trial, 14, 15t Optimal Antiplatelet Strategy for Interventions (OASIS) trial, 99 419 Optimal medical therapy (OMT), 65 end-goals of at years, 66t how to achieve?, 65–66 nitroglycerin in, 66–67 Oral anticoagulants (OAC), 123, 203 Orthostatic hypotension, 174, 278–279 Outflow tract ventricular tachycardia, 243 PARADIGM-HF trial, 160–161 Paravalvular aortic regurgitation, 315–316, 316t Paroxetine, 292 Percutaneous coronary intervention (PCI), 66 antiplatelet therapy after, 72–73 benefits, 130t in non-IRA in STEMI patients, 132–133 for patient after CABG, 77 in patients with STEMI, bleeding and thrombotic problems, 133 vs CABG, 75–76 Pharmacologic cardioversion for AF, 210, 211t Physical Counterpressure Maneuvers trial (PC-Trial), 288 Placement of Aortic Trans-catheter Valves (PARTNER) trial, 301, 311, 312, 312t Platelet Inhibition and Patient Outcomes (PLATO) trial, 96, 124, 127 Polymorphic ventricular tachycardia, 244–247 Brugada syndrome, 247 long QT syndrome, 244–246, 246t short QT syndrome, 246–247 420 Index Portico percutaneous heart valve system, 314 PORTICO trial, 314 Postural orthostatic tachycardia syndrome (POTS), 279 Pradaxa, 225 Prasugrel, 125, 226 for acute coronary syndrome, 96–97 Pravastatin or Atorvastatin Evaluation and Infection Therapy–Thrombolysis in Myocardial Infarction (PROVE-IT-TIMI) 22 trial, 99 Praxbind, 225 Pregnancy ACS in, 397–398 hypertension during, 42 mitral regurgitation during, 348 Prevention of Syncope trial (POST), 291 Preventive Angioplasty in Myocardial Infarction (PRAMI) study, 132–133 PROMISE trial, 63 Propafenone, 211t, 212, 219t, 220 P2 Y12 inhibitors, 124, 126 Quinidine, 219t, 253 Ramipril, 129t, 150t Ranolazine, 69 Ranolazine for Incomplete Vessel Revascularization (RIVER-PCI) trial, 69 Reasons for the Geographic And Racial Differences in Stroke (REGARDS) study, Re-entrant monomorphic ventricular tachycardia, 242 Regurgitant fraction calculating, 341t RE-LY trial, 227 Renal artery stenosis, stenting for, 42 Renal dysfunction, during STEMI, 131–132 Renal failure, 183 Renin-angiotensin-aldosterone system blockers, 70–71 REPRISE study, 314–315 RESHAP-HF study, 347 Resistant hypertension, 41–42 Resynchronization Defibrillation for Ambulatory Heart Failure (RAFT) trial, 164 Reynolds Risk Score, 383 Rivaroxaban, 214, 226 Rivoraxaban, for stroke prevention, 216t Rosuvastatin, 88 SAPIEN heart-valve system, 311 SAPIEN XT, 313 SCN5A gene, 245 Secondary mitral regurgitation, 348–351 challenges in treatment of, 349 from ischemic papillary muscle dysfunction, 350–351 medical therapy for, 349–351 surgery in, 351 Selective serotonin reuptake inhibitors (SSRI), 292 Self-measurement of BP, 34 Seller’s grade for MR, 340t SHARP trial for hyperlipidemia, 19 Shortness of breath (SOB), 156, 172–173 Short QT syndrome, 246–247 SIMPLICITY trial, 41 Single photon emission computed tomography (SPECT), 59 Single vessel coronary artery disease, 72 Sinus rhythm, drugs for maintenance of, 219t–220t Index Society for Thoracic Surgery (STS) score, 301–302 Sodium channel blocking drugs, 245 Sotalol, 219t, 221 Spironolactone, 162 SPRINT trial, in blood pressure, 36–37 Stable coronary artery disease See Coronary artery disease (CAD) Stage A heart failure See Asymptomatic heart failure Stage C heart failure, 155 challenges in treatment of, 155 diagnostic testing, 157–158 cardiopulmonary stress testing, 158 invasive hemodynamic measurements, 158 fluid checking in patients with, 157 and fluid restriction, 156 high-risk markers of, 156 high-risk predictors of, 156 management aldosterone antagonists, 161–162 angiotensin converting enzyme inhibitor for, 158–160, 159t ARB, 160–161 beta-blockers for, 161 device therapy, 163–164 digoxin for atrial fibrillation, 162–163 guideline directed medical therapy (GDMT) for, 159t iron for anemia, 164–165 long-acting nitrates, 163 neprilysin inhibition, 160–161 revascularization, 164 vasodilators (hydralazine and nitrates), 162 421 signs for, 157 and sodium diet, 156 strategic mapping for, 155 symptoms for, 156 Stage D (advanced) heart failure cardiac transplant, indications for, 193t end of life care, 193–194 heart transplantation for, 193 inotrope therapy for, 190, 191t management, 189, 190t mechanical circulatory support for, 191–192, 192t palliative therapy for, 193–194 ultrafiltration in, 190–191, 191t Statin therapy, 11–12, 128t adverse effects of, 15–16 benefit groups, 3t CKD patients response in, 20–21 clarithromycin and, 17 with diabetes, risk of development, 16–17 and ezetimibe combination, 13, 13t fibrates and, 23 high-risk markers for, 6t for hypercholesterolemia in children, 26 and niacin, 23–24 patients intolerant of, 14–15 ranks, 12t toxicity from macrolide antibiotics, 18 Stress echocardiography, 59 appropriate use criteria (AUC) for, 59–60 Stress tests, 57–58 Structured telephone support, 186–187 ST segment elevation myocardial infarction (STEMI), 87, 88, 114 blood tests for, 118 challenges in treatment of, 115 422 Index ST segment elevation myocardial infarction (STEMI) (Continued) ECG for, 118 false alarms for, 117 high-risk markers of, 115, 116t high-risk predictors of, 115, 116t history and physical examination in, 115 identification of high-risk patients, 115 interventional service for, 124t management of angiotensin converting enzyme inhibitors, 127–128 angiotensin receptor blockers, 127–128 anticoagulants during primary PCI, 122–123 antiplatelet therapy, residual risk after, 126–127 beta-blockers for, 127 comprehensive, 128–129, 129t comprehensive care for, 130t diabetes mellitus during, 131 glycoprotein 2b3a inhibitor for, 126 indicators of excellence, 124, 124t morphine for, 120 oral anticoagulants for, 123 patients with bleeding, 134 patients with concurrent stroke, 134–135 patients with recent non-cardiac surgery, 134 PCI after thrombolytic therapy, 129–131 PCI in, 122t, 131, 132–133 prasugrel in, 125 preferential, 129–135 primary percutaneous coronary intervention, 121–122 P2 Y12 inhibitors for, 124 questions to discuss with clinicians before treatment, 119t renal dysfunction, 131–132 statin therapy for, 128, 128t strategies for patients, 116t thrombectomy for, 124 thrombolytic therapy for, 120, 121t ticagrelor for, 120 unfractionated heparin for, 121 upstream, 118–120 signs for, 118 symptoms for, 117–118 Studies of Left Ventricular Dysfunction (SOLV) trial, 149 Sudden cardiac death (SCD), 253 ICD trials for primary prevention of, 254t–255t, 256–257, 256t Superior Yield of the New Strategy of Enoxaparin, Revascularization and Glycoprotein IIb/IIIa Inhibitors (SYNERGY) trial, 98 Supraventricular tachycardia with wide QRS complexes, 242 Surgery for aortic valve replacement (SAVR), 302, 308–309, 308t, 311 Surgical Treatment for Ischemic Heart Failure (STICH) trial, 74–75, 351 SURTAVI trial, 320 Susceptible terrain, 270, 271, 272t Syncope, 268 after exercise, 276 arrhythmia-related, causes of, 274t causes of, 268–269 caveats for cardiac, 277 Index challenges in treatment of, 268 convulsive, 274–275 differential diagnoses of seizure from, 275 in elderly age, 273 during exercise, causes of, 276t high-risk markers of, 269 high-risk predictors of, 269, 270t hypovolemic, 272t investigation(s), 270–281 of activities surrounding event, 276 age, 272–273 cardiovascular examination, 279–280 of carotid sinus massage, 280–281 of event description, 277 during exercise, 276t of family history, 275 of medications, 275 neurologic examination, 280 of orthostatic hypotension, 278–279 of pertinent medical history, 274–275 of post-syncope symptoms (symptoms on awakening), 278 of precipitating events, 276 presence of cardiac disease, 273–274, 274t previous episodes, 278 prodromal symptoms, 277–278 of provocating situation, 277 of related morbidity, 278 susceptible terrain, 270, 271, 272t malignant, 277 management beta-blockers in, 291 cardiac pacing, 292 midodrine for, 291 423 non-pharmacological measures, 288, 289f, 290f orthostatic hypotension, 287–288 pharmacologic therapy, 288–289, 291–292 neurally mediated, 272t non-cardiac, 274 in patients with structural heart disease, 274 questions to guide tests, 269t rules of thumb when ordering test, 269 testing echocardiography, 284 electrophysiology study, 286–287, 287t exercise stress testing, 286 holter and ‘event’ monitoring, 284 implantable loop recorders, 285 observational, 283–284, 284t sequential, strategy for, 283t strategic mapping, 282–283 tilt table testing, 285–286, 285t working diagnoses, 281–282 Synergy between Percutaneous Coronary Intervention with Taxus and Cardiac Surgery (SYNTAX) trial, 76–77 Systolic blood pressure, 38 Thiazide-type diuretic, 37, 38 Thienopyridines, for acute coronary syndrome, 95–96 Thrombolytic therapy, 120 absolute contraindications, 121t relative contraindications, 121t Thrombus Aspiration in ST-Elevation Myocardial Infarction in Scandinavia (TASTE) trial, 124 424 Index Ticagrelor, 120, 125, 226 for acute coronary syndrome, 96 Tilt training, 288, 289f TIME-CHF trial, 179 Torsades de pointes, 244, 245 Trandolapril, 129t, 150t Trans-catheter aortic valve replacement (TAVR) for AS, 311–314 and coronary artery disease, 319–321 low flow–low gradient aortic stenosis for, 317–319 paravalvular aortic regurgitation, 315–316, 316t patient selection for, 317 pitfalls in, 315–321 stroke and, 317 Trans-esophageal echocardiography (TEE), 205, 334 Transthoracic echocardiography (TTE), 331–332, 334, 354 Treat Angina With Aggrastat and Determine the Cost of Therapy With an Invasive or Conservative Strategy (TACTICS-TIMI 18) trial, 372 TRITON TIMI-38 study, 125 TRITON trial, 127 Typical angina (definite), 55 Unfractionated heparin (UFH) for acute coronary syndrome, 98 for STEMI, 118, 121 for stroke prevention, 207, 215t UNLOAD trial, 190–191 US patients, risk calculator for hyperlipidemia, Valsartan, 129t, 150t Valsartan in Acute Myocardial Infarction (VALIANT) trial, 127 Vasodilators, 181 Ventricular fibrillation (VF), 234 Ventricular tachycardia (VT), 234 challenges in treatment of, 234 diagnoses, 241 bundle branch re-entry ventricular tachycardia, 242–243 electrocardiographic artifact, 241–242 mitral annulus ventricular tachycardia, 244 outflow tract ventricular tachycardia, 243 papillary muscle, 244 polymorphic ventricular tachycardia, 244–247 re-entrant monomorphic ventricular tachycardia, 242 supraventricular tachycardia with wide QRS complexes, 242 verapamil-sensitive fascicular tachycardia, 243 EKG features of, 239t high-risk predictors of, 235, 236t high-risk profiling of, 235 management of acute, 248–249 amiodarone for, 252 beta-blockers for, 250–251 Brugada syndrome, 253 calcium channel antagonists for, 251 catheter ablation, 257–259, 258t class II and III anti-arrhythmic drugs for, 251 of coexisting precipitating factors, 249 electrical cardioversion in specific populations, 250t long QT syndrome, 252–253 Index questions to discuss with clinicians before treatment, 248t strategic mapping, 247–248 sudden cardiac death, 253, 254t–255t, 256–257, 256t signs for, 236–237 site origin of, 238 strategic mapping for, 235 symptoms for, 236 tests for, 237 cardiac imaging, 240–241 electrocardiography, 237–240, 239t electrophysiological testing, 241 exercise testing, 240–241 Ventriculography, 341t Verapamil, 68 Verapamil-sensitive fascicular tachycardia, 243 Vitamin K antagonist (VKA), 207 VT storm, 253 Waist circumference, 35 Warfarin, 121t, 123, 127 for stroke prevention, 215t Weight loss, 24 Wide complex tachycardia (WCT), 234, 235 WOEST trial, 225 Women, cardiovascular problems in, 380 challenges in treatment of, 380–381 conditional probability calculation for, 383 differential diagnoses of, 384, 386t 425 Duke Activity Status Index for, 384, 385t Framingham Risk Score for, 383 high-risk markers, 381, 381t management ACS in pregnancy, 397–398 of acute coronary syndrome, 394–395 coronary artery bypass graft surgery, 397 drug-eluting stents, 396 invasive treatment, 395–396 percutaneous coronary interventions, complications of, 396–397 primary prevention, 393–394 secondary prevention, 394 STEMI, 397 pretest probability calculations for, 382–384, 384t risk stratification, 385t signs of, 382 strategic mapping of, 381–382 symptoms of, 382 testing modalities for cardiac computed tomography angiography, 392–393 coronary angiography, 393 electrocardiogram, 386 exercise stress test, 387–388, 390 myocardial perfusion imaging, 390 radiation, 391–392, 392t SPECT myocardial perfusion imaging (MPI), 391, 391t stress echocardiography, 390, 391t ST-T segment changes, 388–389 Management of Complex Cardiovascular Problems, Fourth Edition Edited by Thach N Nguyen, Dayi Hu, Shao Liang Chen, Moo Hyun Kim and Cindy L Grines © 2016 John Wiley & Sons, Ltd Published 2016 by John Wiley & Sons, Ltd C Va PISA radius (r) RV = EROA x MR-VTI Reg Flow = 2π r2 x Va EROA = Reg Flow/PkVReg Va B D Va RV = 0.48cm2 X 125cm RV = 60 ml EROA = 0.48 cm2 r = 0.8 cm Va = 61.6 cm/s PkVreg = 521 cm/s r Figure 12.1 Proximal isovelocity surface area (PISA) approximation for effective orifice area (EROA) and regurgitant volume (RV) (A) Schematic of PISA calculation (B) Transesophageal interrogation of the regurgitant jet and measurement of the radius (r) of flow convergence (C) Measurement of MR peak velocity (PkVreg) and velocity time integral (MR-VTI) (D) Calculation for the EROA and RV based on measured values for this case Based on the calculations, the patient has severe MR Note that this example used the highest values, given the atrial fibrillation, there may be a need for averaging several beats Source: Zoghbi 2003 Reproduced with permission of Oxford University Press Chapter 12, Reference [5] A Figure 12.2 Multi-planar assessment of estimated regurgitant orifice area (EROA) using 3-dimensional (3D) Doppler (A and B) Systolic long-axis views are optimized to visualize the MR (MR) jet The largest systolic proximal isovelocity surface area (PISA) is used to adjust the short-axis plane (blue line) to obtain an en face view of the base of the PISA (C and D) (E) The color Doppler baseline is adjusted to 39.6 cm/s (F) Multiple orthogonal view can be generated (C and D, red planes) to obtain the largest 2-dimensional PFCR The radius, length, and width measurements are shown (A and D) and the longest PISA radius is shown (F) Source: Thavendiranathan et al 2012 Reproduced with permission of Elsevier Chapter 12, Reference [28] WILEY END USER LICENSE AGREEMENT Go to www.wiley.com/go/eula to access Wiley’s ebook EULA ... Management of Complex Cardiovascular Problems Management of Complex Cardiovascular Problems FOURTH EDITION EDITED BY Thach Nguyen, MD, Moo-Hyun Kim, MD, FACC FSCAI FACC Director of Cardiovascular. .. Assistant Professor University of Utah School of Medicine Electrophysiology Division Salt Lake City, UT viii List of Contributors SHAO LIANG CHEN, MD, PhD, FACC Professor of Cardiology Professor of Internal... University of Medicine and Pharmacy Vice Director Department of Internal Medicine, School of Medicine, the National University of Hochiminh City, Hochiminh City, Vietnam VIJAY DAVE, MD Director of