Practical Cardiovascular Medicine. Elias B. Hanna

the end, even if all men went astray and you were left the only one faithful.

       Fyodor Dostoevsky, The Brothers Karamazov

      Practical Cardiovascular Medicine is a comprehensive yet practical review of all fields of cardiovascular medicine. It addresses various cardiac diseases and presentations using both pathophysiology and clinical evidence, and expands from basic concepts to advanced ones. It should therefore prove useful to experienced physicians as well as trainees. In fact, there is a particular emphasis on the knowledge gaps of cardiologists and cardiology fellows. Organizing fellowship conferences and working with cardiology and interventional cardiology fellows has helped me perceive common deficiencies and focus on them.

      Colleagues who read the book will find that it provides them with an in-depth understanding that translates into better patient management. My aim has also been to improve on pre-existing knowledge of pathophysiology and clinical trials. The book follows a comprehensive yet easy, practical, and illustrated flow. To facilitate learning, bottom-line approaches are consistently provided throughout the 38 chapters. There is an extra emphasis on concepts that are frequently misunderstood by practitioners.

      Throughout, I have tried to answer daily, practical questions that may not be addressed in any other book. Even classic topics, such as ST-segment elevation myocardial infarction, heart failure, arrhythmias, atrial fibrillation, cardiac catheterization, or electrocardiography are discussed from a different, fresh, and contemporary viewpoint. The book is comprehensive, and many of its chapters could even stand alone as separate books.

      In order to consolidate the understanding of complex topics, review questions with detailed answers are provided at the end of clinical chapters, mainly in a clinical vignette format (approximately 400 questions overall). The book will serve cardiologists and cardiology fellows, but will also be valuable to internists, internal medicine residents, and all professionals caring for patients with cardiovascular disease. I have written this book in an effort to embrace the magic and evolving depths of cardiovascular diseases. It is written with love, and with the hope of improving patients’ outcomes.

      Elias B. Hanna

Abbreviations

3Dthree-dimensionalAADantiarrhythmic drugAAAabdominal aortic aneurysmABIankle–brachial indexACCAmerican College of CardiologyACCPAmerican College of Chest PhysiciansACE-Iangiotensin converting enzyme inhibitorACSacute coronary syndromeACTactivated clotting timeADHFacutely decompensated heart failureADPadenosine diphosphateAFatrial fibrillationAflutteratrial flutterAHAAmerican Heart AssociationAIaortic insufficiencyAIVRaccelerated idioventricular rhythmAMacute marginalANAantinuclear antibodiesAoaortaAoVaortic valveAPaccessory pathwayAPanteroposterior viewARBangiotensin-II receptor blockerARDSacute respiratory distress syndromeARNIangiotensin receptor-neprilysin inhibitorARVCarrhythmogenic right ventricular cardiomyopathyARVDarrhythmogenic right ventricular dysplasiaASaortic stenosisASDatrial septal defectATanterior tibial arteryATatrial tachycardiaAT1 receptortype 1 receptor of angiotensin 2AT2 receptortype 2 receptor of angiotensin 2AT IIIantithrombin IIIIAVatrioventricularAV blockatrioventricular blockAVAaortic valve areaAVNRTatrioventricular nodal reentrant tachycardiaAVRaortic valve replacementAVRTatrioventricular reciprocating tachycardiaBBBbundle branch blockBiPAPbilevel positive airway pressureBiVbiventricularbiVADbiventricular assist deviceBMSbare-metal stentBNPbrain natriuretic peptideBPblood pressurebpmbeats per minutesBSAbody surface areaBUNblood urea nitrogenCacalciumCABGcoronary artery bypass graftingCADcoronary artery diseaseCathcatheterizationCBCcomplete blood countCCBcalcium channel blockersCEAcarotid endarterectomyCIAcommon iliac arteryCKcreatine kinaseCK-MBcreatine kinase MBCKDchronic kidney diseaseCHFcongestive heart failureCOcardiac outputCOPDchronic obstructive pulmonary diseaseCPAPcontinuous positive airway pressureCRPC-reactive proteinCRTcardiac resynchronization therapyCTcomputed tomographyCTAcomputed tomography angiographyCTIcavotricuspid isthmusCTOchronic total occlusionCTPHchronic thromboembolic pulmonary hypertensionCVPcentral venous pressureCWcontinuous wave DopplerCYP450 cytochrome P450CXRchest X-rayDADdelayed afterdepolarizationDAPTdual antiplatelet therapyDBPdiastolic blood pressureDC cardioversionR-wave synchronized direct-current cardioversionDCMdilated cardiomyopathyDESdrug-eluting stentDgdiagonal branchDHPdihydropyridine (calcium channel blocker)dP/dtdelta pressure/delta time (sharpness of rise in pressure over time)DTIdirect thrombin inhibitorDTSDuke treadmill scoreDVTdeep vein thrombosisEaarterial elastanceEADearly afterdepolarizationECGelectrocardiogramechoechocardiogramECMOextracorporeal membrane oxygenationEDemergency departmentEesend-systolic elastanceEFejection fractionEIAexternal iliac arteryEPelectrophysiologicalEROeffective regurgitant orificeESCEuropean Society of CardiologyESPVREnd-systolic pressure volume relationshipESRerythrocyte sedimentation rateESRDend-stage renal diseaseFFRfractional flow reserveFiO2fraction of inspired oxygenFMDfibromuscular dysplasiaGFRglomerular filtration rateGIgastrointestinalGPIglycoprotein IIb–IIIa inhibitorHbhemoglobinHbA1cglycosylated hemoglobinHCMhypertrophic cardiomyopathyHCTZhydrochlorothiazideHDLhigh-density lipoproteinHFheart failureHFpEFheart failure with preserved ejection fractionHFrEFheart failure with reduced ejection fractionHITheparin-induced thrombocytopeniaHIVHuman immunodeficiency virusHOCMhypertrophic obstructive cardiomyopathyHRheart ratehs-CRPhigh sensitivity C-reactive proteinHTNhypertensionIABPintra-aortic balloon pumpICDimplantable cardioverter defibrillatorICUintensive care unitINRinternational normalized ratioISTinappropriate sinus tachycardiaIVintravenous or intravenouslyIVCinferior vena cavaIVC-isovolumic contractionIVCTisovolumic contraction timeIVRisovolumic relaxationIVRTisovolumic relaxation timeIVUSintravascular ultrasoundJVDjugular venous distensionJVPjugular venous pressureKpotassiumLAleft atriumLAAleft atrial appendageLAFBleft anterior fascicular blockLADleft anterior descending arteryLAOleft anterior obliqueLBBBleft bundle branch blockLCxleft circumflex coronary arteryLDLlow-density lipoproteinLHCleft heart catheterizationLIMAleft internal mammary arteryLLSBleft lower sternal borderLMleft main coronary arteryLMNAlamin A/CLMWHlow-molecular-weight heparinLPFBleft posterior fascicular blockLUSBleft upper sternal borderLVleft ventricle or left ventricularLVADleft ventricular assist deviceLVEDDleft ventricular end-diastolic diameterLVEDPleft ventricular end-diastolic diameterLVEFleft ventricular ejection fractionLVESDleft ventricular end-systolic diameterLVHleft ventricular hypertrophyLVOTleft ventricular outflow tractMAPmean arterial pressureMATmultifocal atrial tachycardiaMETmetabolic equivalent of taskmphmiles per hourMImyocardial infarctionMRmitral regurgitationMRAmagnetic resonance angiographyMRImagnetic resonance imagingMSmitral stenosisMVmitral valveMV O2mixed venous oxygen saturationMVAmitral valve areaMVPmitral valve prolapseMVRmitral valve replacementNasodiumNOnitric oxideNSAIDnon-steroidal anti-inflammatory drugNSTEMInon-ST-segment elevation myocardial infarctionNSVTnon-sustained ventricular tachycardiaNT pro-BNPamino-terminal pro-brain natriuretic peptideNTGnitroglycerinNYHANew York Heart AssociationOCToptical coherence tomographyOMobtuse marginal branch of the left circumflexPpressurePApulmonary arterial or pulmonary arteryPA O2pulmonary arterial oxygen saturationPACpremature atrial complexPaCO2partial pressure of carbon dioxide in arterial bloodPADperipheral arterial diseasePAHpulmonary arterial hypertensionPAIplasminogen activator inhibitorPaO2arterial oxygen pressurePAO2alveolar oxygen pressurePCIpercutaneous coronary interventionPCSK9Proprotein convertase subtilisin/kexin type 9PCWPpulmonary capillary wedge pressurePDApatent ductus arteriosusPDAposterior descending artery branch of the right coronary artery or left circumflexPEpulmonary embolismPEApulseless electrical activityPETpositron emission tomographyPFOpatent foramen ovalePFTpulmonary function testingPHpulmonary hypertensionPHTpressure half-timePISAproximal isovelocity surface areaPJRTpermanent junctional reciprocating tachycardiaPLBposterolateral ventricular branches of the right coronary artery or left circumflexPMpacemakerPMBVpercutaneous mitral balloon valvuloplastyPMTpacemaker-mediated tachycardiaPNDparoxysmal nocturnal dyspneaPOTSpostural orthostatic tachycardia syndromePPDpurified protein derivative for Mycobacterium tuberculosisPPIproton pump inhibitorPPMpatient-prosthesis mismatchPRpulmonic regurgitationPSpulmonic stenosisPTposterior tibial arteryPTTpartial thromboplastin timePVloop pressure–volume loopPV O2pulmonary venous oxygen saturationPVARPpost-ventricular atrial refractory periodPVCpremature ventricular complexPVRpulmonary vascular resistancePWpulsed wave DopplerQppulmonary blood flowQssystemic blood flowQTccorrected QT intervalRAright atrium or right atrialRAASrenin-angiotensin-aldosterone systemRAOright anterior obliqueRASrenal artery stenosisRBBBright bundle branch blockRCAright coronary arteryRHCright heart catheterizationRIMAright internal mammary arteryrPAreteplaserpmrevolutions per minuter-tPArecombinant