Netter’s Cardiology 2nd edition Edited by MARSCHALL S RUNGE, MD, PhD GEORGE A STOUFFER, MD CAM PATTERSON, MD, MBA Illustrations by Frank H Netter, MD CONTRIBUTING ILLUSTRATORS Carlos A G Machado, MD John A Craig, MD David J Mascaro, MS Enid Hatton Steven Moon, MA Kip Carter, MS, CMI Tiffany S DaVanzo, MA, CMI 1600 John F Kennedy Blvd Ste 1800 Philadelphia, PA 19103-2899 NETTER’S CARDIOLOGY, SECOND EDITION ISBN: 978-1-4377-0637-6 ISBN (online): 978-1-4377-0638-3 Copyright © 2010 by Saunders, an imprint of Elsevier Inc All rights reserved No part of this publication may be reproduced or transmitted in any form or by any means, electronic or mechanical, including photocopying, recording, or any information storage and retrieval system, without permission in writing from the Publisher Details on how to seek permission, further information about the Publisher’s permissions policies and our arrangements with organizations such as the Copyright Clearance Center and the Copyright Licensing Agency, can be found at our Web site: www.elsevier.com/permissions This book and the individual contributions contained in it are protected under copyright by the Publisher (other than as may be noted herein) Notices Knowledge and best practice in this field are constantly changing As new research and experience broaden our understanding, changes in research methods, professional practices, or medical treatment may become necessary Practitioners and researchers must always rely on their own experience and knowledge in evaluating and using any information, methods, compounds, or experiments described herein In using such information or methods they should be mindful of their own safety and the safety of others, including parties for whom they have a professional responsibility With respect to any drug or pharmaceutical products identified, readers are advised to check the most current information provided (i) on procedures featured or (ii) by the manufacturer of each product to be administered, to verify the recommended dose or formula, the method and duration of administration, and contraindications It is the responsibility of practitioners, relying on their own experience and knowledge of their patients, to make diagnoses, to determine dosages and the best treatment for each individual patient, and to take all appropriate safety precautions To the fullest extent of the law, neither the Publisher nor the authors, contributors, or editors, assume any liability for any injury and/or damage to persons or property as a matter of products liability, negligence or otherwise, or from any use or operation of any methods, products, instructions, or ideas contained in the material herein Previous edition copyrighted 2004 Library of Congress Cataloging-in-Publication Data Netter’s cardiology / edited by Marschall S Runge, George A Stouffer, Cam Patterson ; illustrations by Frank H Netter ; contributing illustrator, Carlos A G Machado.—2nd ed p ; cm Other title: Cardiology Includes bibliographical references and index ISBN 978-1-4377-0637-6 Cardiology Cardiovascular system—Diseases I Runge, Marschall S II Stouffer, George A III Patterson, Cam IV Netter, Frank H (Frank Henry), 1906-1991 V Title: Cardiology [DNLM: Cardiovascular Diseases Diagnostic Techniques, Cardiovascular WG 120 N474 2011] RC667.N47 2011 616.1′2—dc22 2010005892 Netter Director: Anne Lenehan Editor: Elyse O’Grady Editorial Assistant: Julie Goolsby Project Manager: David Saltzberg Design Manager: Steven Stave Illustrations Manager: Karen Giacomucci Marketing Manager: Jason Oberacker Working together to grow libraries in developing countries www.elsevier.com | www.bookaid.org | www.sabre.org Printed in China Last digit is the print number: About the Editors Marschall S Runge, MD, PhD, was born in Austin, Texas, and was graduated from Vanderbilt University with a BA in General Biology and a PhD in Molecular Biology He received his medical degree from the Johns Hopkins School of Medicine and trained in internal medicine at Johns Hopkins Hospital He was a cardiology fellow and junior faculty member at Massachusetts General Hospital Dr Runge’s next position was at Emory University, where he directed the Cardiology Fellowship Training Program He then moved to the University of Texas Medical Branch in Galveston, where he was Chief of Cardiology and Director of the Sealy Center for Molecular Cardiology He came to the University of North Carolina (UNC) in 2000 as Chair of the Department of Medicine He is currently the Charles Addison and Elizabeth Ann Sanders Distinguished Professor of Medicine and Chair of the Department of Medicine In addition, in 2004, Dr Runge was appointed President of UNC Physicians and Vice Dean for Clinical Affairs Dr Runge is board-certified in internal medicine and cardiovascular diseases and has spoken and published widely on topics in clinical cardiology and vascular medicine He maintains an active clinical practice in cardiovascular diseases and medicine in addition to his teaching and administrative activities in the Department of Medicine and the UNC School of Medicine George A Stouffer, MD, was born in Indiana, Pennsylvania, and was graduated from Bucknell University and the University of Maryland School of Medicine He completed his internal medicine residency, cardiology fellowship, and interventional cardiology fellowship at the University of Virginia During his cardiology fellowship, he completed a 2-year National Institutes of Health research fellowship in the laboratory of Gary Owens at the University of Virginia He was on the faculty at the University of Texas Medical Branch from 1995 to 2000, where he became an associate professor and served as Co-Director of Clinical Trials in the Cardiology Division and as Associate Director of the Cardiac Catheterization Laboratory He joined the faculty at the University of North Carolina in 2000 and currently serves as the Henry A Foscue Distinguished Professor of Medicine and Director of the Cardiac Catheterization Laboratory Dr Stouffer’s main focus is clinical cardiology with an emphasis on interventional cardiology, but he is also involved in clinical and basic science research His basic science research is in the areas of regulation of smooth muscle cell growth, the role of the smooth muscle cytoskeleton in regulating signaling pathways, thrombin generation, and renal artery stenosis Cam Patterson, MD, MBA, was born in Mobile, Alabama He was a Harold Sterling Vanderbilt Scholar and studied Psychology and English at Vanderbilt University, graduating summa cum laude He participated in the Honors Research Program at Vanderbilt and conducted research in behavioral pharmacology during that time Dr Patterson attended Emory University School of Medicine, graduating with induction in the Alpha Omega Alpha Honor Society, and completed his residency in Internal Medicine at Emory University Hospitals He became the youngest-ever Chief Resident at Grady Memorial Hospital at Emory University in 1992, supervising over 200 house officers in four hospitals He completed years of research fellowship under the guidance of Edgar Haber at the Harvard School of Public Health, developing an independent research program in vascular biology and angiogenesis that was supported by a National Institutes of Health fellowship In 1996, he accepted his first faculty position at the University of Texas Medical Branch, and in 2000, Dr Patterson was recruited to the University of North Carolina at Chapel Hill to become the founding director of the UNC McAllister Heart Institute In 2005, he also became Chief of the Division of Cardiology at UNC Dr Patterson is the Ernest and Hazel Craige Distinguished Professor of Cardiovascular Medicine, and he has been recognized at UNC with the Ruth and Phillip Hettleman Prize for Artistic and Scholarly Achievement He is an Established Investigator of the American Heart Association and a Burroughs Wellcome Fund Clinical Scientist in Translational Research He is a member of several editorial boards, including Circulation and Journal of Clinical Investigation, and is an elected member of the American Society of Clinical Investigation and the Association of University Cardiologists Dr Patterson maintains active research programs in the areas of angiogenesis and vascular development, cardiac hypertrophy, protein quality control, and translational genomics and metabolomics He is also the director of the Cardiac Genetics Clinic He received his MBA from the UNC Kenan-Flagler School of Business in 2008 Preface The first edition of Netter’s Cardiology was an effort to present to clinicians the ever-increasing amount of medical information on cardiovascular diseases in a concise and highly visual format The challenge that clinicians face in “keeping up” with the medical literature has continued to grow in the years since the first edition of Netter’s Cardiology This need to process the everexpanding medical information base and apply new findings to the optimal care of patients is acute in all areas of medicine, but perhaps it is most challenging in disciplines that require practitioners to understand a broad spectrum of evidence-based medicine, such as the field of cardiovascular diseases The explosion of medical knowledge is also a very real educational issue for learners at all levels—students, residents, practicing physicians— who must rapidly determine what is and is not important, organize the key information, and then apply these principles effectively in clinical settings For the second edition of Netter’s Cardiology, our goal was to produce an improved text that keeps these issues in clear focus and also addresses important clinical areas that were not well covered in the first edition or in many other cardiology texts To accomplish this expansion while maintaining a concise text that could be used as a ready reference, we again avoided exhaustive treatment of topics We also have made every effort to present the essential information in a readerfriendly format that increases the reader’s ability to learn the key facts without getting lost in details that can obfuscate the learning process After a careful review of reader comments about the first edition, we made some substantial changes to achieve our educational goals Chapters were added and topics expanded to address reader concerns about the lack of coverage of a number of important topics commonly encountered in clinical practice Examples include these new chapters: Chest Radiography, Echocardiography, Stress Testing and Nuclear Imaging, Cardiac Computed Tomography and Magnetic Resonance Imaging, Left and Right Heart Catheterization, Identifying the Patient at High Risk for Acute Coronary Syndrome: Plaque Rupture and “Immediate Risk,” Cardiogenic Shock after Myocardial Infarction, Stress-Induced Cardiomyopathy, Supraventricular Tachycardia, Sleep Disorders and the Cardiovascular System, Cardiovascular Toxicity of Noncardiac Medications, and Sudden Cardiac Death in Athletes The chapter subheadings of “Optimum Treatment” and “Avoiding Treatment Errors” are new additions that address concerns about therapeutic errors that can lead to patient harm We also added boxes and algorithms that provide in an easy-to-read format quick overviews of critical diagnostic and therapeutic information covered in the text (See the sample algorithm on the following page.) References are annotated in the second edition of Netter’s Cardiology to guide the reader to a more in-depth review, if considered necessary As in the first edition, the contributing authors have taken advantage of the genius of Frank Netter by carefully selecting the best of his artwork to illustrate the most important clinical concepts covered in each chapter When Netter artwork was unavailable or difficult to apply to illustrate modern clinical concepts, we again utilized the great artistic talents of Carlos A G Machado, MD, to create new artwork or to skillfully edit and update some of Frank Netter’s drawings The combination of Dr Machado’s outstanding skills as a medical artist and his knowledge of the medical concepts being illustrated was an invaluable asset As in the first edition, we chose to use authors from the University of North Carolina School of Medicine at Chapel Hill or those with close ties to the university This allowed us to select authors who are clinical authorities, many of whom are also well known for their national and international contributions All have active clinical practices that require daily use of the information covered in their chapters, and all are well aware of the approach to patient management utilized by their peers at other institutions and in other practice settings Many of the contributing authors of the first edition have continued on as second-edition authors and have provided updates Each author, whether a previous contributor or not, was given clearly defined guidelines that emphasized the need to distill the large amount of complex information in his or her field and to present it concisely in a carefully prescribed format maintained across all chapters The result is a text that is truly clinically useful and less of a compendium than is commonly the case in many medical texts We believe that the changes we have made in the second edition substantially improve Netter’s Cardiology and ensure that it will continue to be a highly useful resource for all physicians, both generalists and subspecialists, who need to remain current in cardiology—from trainees to experienced practitioners Whether we have succeeded will obviously be determined by our readers Based on our experience with the revision of the first edition, we welcome the comments, suggestions, and criticisms of readers that will help us improve future editions of this work vi  Preface Algorithms have been color coded for quick reference Algorithm for Evaluating Patients in Whom Renal Artery Stenosis Is Suspected Clinical findings associated with renal artery stenosis Present Absent Noninvasive evaluation (duplex ultrasonography of renal arteries, magnetic resonance angiography, or computed tomographic angiography) Follow clinically Treat risk factors Renal artery stenosis present Renal artery stenosis absent Nuclear imaging to estimate fractional flow to each kidney Follow clinically Treat risk factors Unilateral renal artery stenosis and asymmetric perfusion present Unilateral renal artery stenosis and symmetric perfusion present Follow clinically Treat risk factors Orange ϭ test Blue ϭ all other Bilateral renal artery stenosis present Green ϭ treatment options Consider revascularization Marschall S Runge, MD, PhD Charles Addison and Elizabeth Ann Sanders Distinguished Professor of Medicine Professor and Chair, Department of Medicine The University of North Carolina School of Medicine Chapel Hill, North Carolina George A Stouffer, MD Henry A Foscue Distinguished Professor of Medicine Chief of Clinical Cardiology Director, C.V Richardson Cardiac Catheterization Laboratory Director, Interventional Cardiology Division of Cardiology The University of North Carolina School of Medicine Chapel Hill, North Carolina Cam Patterson, MD, MBA Ernest and Hazel Craige Distinguished Professor of Medicine Professor of Medicine, Pharmacology, and Cell and Developmental Biology Chief, Division of Cardiology Director, UNC McAllister Heart Institute Associate Chair for Research, Department of Medicine The University of North Carolina School of Medicine Chapel Hill, North Carolina About the Artists Frank H Netter, MD Frank H Netter was born in 1906 in New York City He studied art at the Art Student’s League and the National Academy of Design before entering medical school at New York University, where he received his MD degree in 1931 During his student years, Dr Netter’s notebook sketches attracted the attention of the medical faculty and other physicians, allowing him to augment his income by illustrating articles and textbooks He continued illustrating as a sideline after establishing a surgical practice in 1933, but he ultimately opted to give up his practice in favor of a full-time commitment to art After service in the United States Army during World War II, Dr Netter began his long collaboration with the CIBA Pharmaceutical Company (now Novartis Pharmaceuticals) This 45-year partnership resulted in the production of the extraordinary collection of medical art so familiar to physicians and other medical professionals worldwide In 2005, Elsevier Inc purchased the Netter Collection and all publications from Icon Learning Systems Now over 50 publications featuring the art of Dr Netter are available through Elsevier Inc (in the United States: www us.elsevierhealth.com/Netter; outside the United States: www elsevierhealth.com) Dr Netter’s works are among the finest examples of the use of illustration in the teaching of medical concepts The 13-book Netter Collection of Medical Illustrations, which includes the greater part of the more than 20,000 paintings created by Dr Netter, has become one of the most famous medical works ever published The Netter Atlas of Human Anatomy, first published in 1989, presents the anatomic paintings from the Netter Collection Now translated into 16 languages, it is the anatomy atlas of choice among medical and health professions students the world over The Netter illustrations are appreciated not only for their aesthetic qualities but, more importantly, for their intellectual content As Dr Netter wrote in 1949, “clarification of a subject is the aim and goal of illustration No matter how beautifully painted, how delicately and subtly rendered a subject may be, it is of little value as a medical illustration if it does not serve to make clear some medical point.” Dr Netter’s planning, conception, point of view, and approach are what inform his paintings and what makes them so intellectually valuable Frank H Netter, MD, physician and artist, died in 1991 Learn more about the physician–artist whose work has inspired the Netter Reference Collection: www.netterimages com/artist/netter.htm Carlos A G Machado, MD Carlos A G Machado was chosen by Novartis to be Dr Netter’s successor He continues to be the main artist who contributes to the Netter Collection of Medical Illustrations Self-taught in medical illustration, cardiologist Carlos A G Machado has contributed meticulous updates to some of Dr Netter’s original plates and has created many paintings of his own in the style of Netter as an extension of the Netter Collection Dr Machado’s photorealistic expertise and his keen insight into the physician–patient relationship inform his vivid and unforgettable visual style His dedication to researching each topic and subject he paints places him among the premier medical illustrators at work today Learn more about his background and see more of his art at: www.netterimages.com/artist/machado.htm Acknowledgments This second edition of Netter’s Cardiology benefited enormously from the hard work and talent of many dedicated individuals First, we thank the contributing authors All are current or former faculty members at the University of North Carolina School of Medicine, Chapel Hill, or have close ties to the institution Without their intellect, dedication, and drive for excellence, Netter’s Cardiology, 2nd edition, could not have been published We had a solid foundation on which to build the second edition, thanks to the hard work of the first-edition contributing authors, many of whom we were fortunate to have continue on to this edition We are also grateful for the invaluable editorial contribution that Dr E Magnus Ohman made to the first edition Special recognition goes to John A Craig, MD, and Carlos A G Machado, MD They are uniquely talented physician– artists who, through their work, brought to life important concepts in medicine in the new and updated figures included in this text Anne Lenehan, Elyse O’Grady, Marybeth Thiel, and Julie Goolsby at Elsevier were instrumental in helping us make a very good first edition more comprehensive and more focused in its second edition We are also indebted to Ms Angela Clotfelter-Rego, whose superb organizational skills helped make this text a reality Special thanks go to Carolyn Kruse for excellent editing and Dr Deborah Montague for invaluable reviewing and updating of the pharmacologic information We would especially like to acknowledge our families: our wives—Susan Runge, Meg Stouffer, and Kristine Patterson— whose constant support, encouragement, and understanding made completion of this text possible; our children—Thomas, Elizabeth, William, John, and Mason Runge; Mark, Jeanie, Joy, and Anna Stouffer; and Celia, Anna Alyse, and Graham Patterson—who inspire us and remind us that there is life beyond the computer; and, finally, our parents—whose persistence, commitment, and work ethic got us started on this road many, many years ago 636  Index Blood pressure (Continued) management of, for coronary heart disease, 101–102 measurement of, 402b systolic, in lower extremity peripheral vascular disease, 389 Blood tests in restrictive cardiomyopathy, 166–167 in syncope, 265 “Blue toe syndrome,” 425 Bosentan for pulmonary hypertension, 544t Brachiocephalic stenosis, endovascular therapy for, 414–415 Bradyarrhythmias, 215–222 diagnostic approach for, 220 etiology and pathogenesis of, 215–220, 216b, 217f atrioventricular block and, 216–219, 218f chronic multifascicular blocks and, 219–220, 219b, 220t sinus node dysfunction and, 215 future directions for, 222 management and therapy for, 220 avoiding treatment errors and, 220 optimum treatment and, 220, 220t–222t Bradycardia, sinus, inappropriate, 215 Brain natriuretic peptide, 23 Addison’s disease and, 521 in heart failure, 189 Breast cancer, metastatic to heart, 538–539 Breastfeeding, cardiovascular drugs and, 497 Broken heart syndrome See Stress-induced cardiomyopathy Brucella endocarditis, 325 Brugada syndrome, sudden cardiac death in, 254f, 255–256 “BT shunt,” 457 Buerger’s disease, peripheral vascular disease and, 389 Bumetanide for heart failure, 192 Bundle branch block in systemic lupus erythematosus, 529 C CABG See Coronary artery bypass grafting Caffeine, 556 Calcium, serum, QT interval and, 36, 36f Calcium channel blockers See also specific drugs for atrial fibrillation, 235–236 for hypertension, 401–402, 403t in pregnancy, 494 for restrictive cardiomyopathy, 171–172 Calcium gluconate for hypokalemic periodic paralysis, 511 Cancer cardiac primary, 538, 538t secondary, 538–539, 539f pericardial effusion due to, 367, 369 Candesartan for heart failure, 192t, 194 Candida endocarditis, 328 Captopril for heart failure, 192t Captopril renal scan in renal artery stenosis, 393, 394f Carbomedics bileaflet valve, 353, 355f Carbon monoxide, cardiovascular effects of, 630 Carcinoid heart disease restrictive cardiomyopathy due to, 164 treatment of, 172 tricuspid stenosis due to, 319 Cardiac arrest See Sudden cardiac death Cardiac auscultation, 10–11, 12f Cardiac blood pool multigated acquisition in dilated cardiomyopathy, 150 Cardiac catheterization, 28–29, 29f in aortic regurgitation, 302, 303f in constrictive pericarditis, 367, 380–381 left heart, 81–83, 82f–84f future directions for, 83 in pericardial tamponade, 381 in pulmonary hypertension, 543t in restrictive cardiomyopathy, 167t, 170 right heart, 79–81 complications of, 80 contraindications to, 80 data obtained from, 80–81, 81t future directions for, 83 indications for, 79, 80b in stress-induced cardiomyopathy, 209, 209f Cardiac chamber evaluation, cardiac computed tomography for, 63–64 Cardiac computed tomography, 61–65 clinical examples of, 64, 64f clinical indications for, 62–64 cardiac chamber and valvular evaluation as, 63–64 congenital heart disease as, 64 coronary artery calcium score as, 62–63, 62f, 63b, 64f evaluation of aortic and pulmonary disease as, 64 evaluation of intracardiac and extracardiac structures as, 64 data acquisition techniques for, 62 future directions for, 65 limitations of, 65 technology of, 61–62 Cardiac CTA, 59 Cardiac index, calculation of, 80 Cardiac magnetic resonance imaging, 59, 65–69 clinical indications for, 65–68 aortic disease as, 66 cardiac masses as, 68, 68f cardiomyopathy as, 67, 67f congenital heart disease as, 68 coronary artery bypass grafting imaging as, 68 ischemic heart disease as, 66–67, 66f pericardial disease as, 67 pulmonary vascular disease as, 68 valvular heart disease as, 67–68 ventricular function evaluation as, 65–66, 66f complications of, 69 in congenital heart disease, 439 data acquisition sequences and techniques for, 65 in dilated cardiomyopathy, 150–151 future directions for, 69 risks with, 69 safety of, 69 in stress-induced cardiomyopathy, 210 technology of, 65 Cardiac masses See also Cardiac tumors; specific masses cardiac computed tomography to evaluate, 64 as cardiac magnetic resonance imaging indication, 68, 68f Cardiac MRI See Cardiac magnetic resonance imaging Cardiac neurotransmission imaging, 59–60 Cardiac outflow obstruction, syncope due to, 261, 262t Cardiac output during postpartum period, 489 during pregnancy, 489 Cardiac remodeling, cardiomyopathy and, 145, 146f Cardiac resynchronization therapy for dilated cardiomyopathy, 152 Cardiac stress imaging, 53–56 See also specific techniques image interpretation and, 56t, 57f imaging protocols for, 55–56 radiotracers for, 53–54 SPECT-CT, PET-CT, and hybrid imaging and, 56 Cardiac surgery See also specific surgeries for congenital heart disease See Congenital heart disease, surgical treatment of for infective endocarditis, 329 palliative, for congenital heart disease, 457–458, 458f–459f pediatric, development of, 457 for valvular heart disease See Valvular heart disease, surgical treatment of Cardiac tamponade See Pericardial tamponade Cardiac transplantation, 197–205 for dilated cardiomyopathy, 152 donor procedure for, 198, 199f donor-recipient matching for, 197–198 donors for, 197 for hereditary cardiomyopathy, 179–180 for hypertrophic cardiomyopathy, 159 indications for, 197 postoperative management for, 200–201 recipient procedure for, 198–200 biatrial, 198, 199f bicaval, 199–200, 200f for restrictive cardiomyopathy, 172 results of, 201 Cardiac tumors, 535–540 benign, primary, 535–537, 536t clinical presentation of, 535 diagnostic approach for, 535 differential diagnosis of, 535 future directions for, 539 in HIV/AIDS, 557 malignant primary, 538, 538t secondary, 538–539, 539f management and therapy for, 539 Cardioembolic stroke, interventional approaches for, 413–414, 415f Cardiogenic shock, 135–141 clinical presentation of, 138 diagnostic approach for, 138 differential diagnosis of, 135 etiology of, 135 future directions for, 139 management and therapy for, 138–139 avoiding treatment errors and, 139 optimum treatment and, 138–139, 138f–140f pathogenesis of, 135–138 free wall rupture and, 136–138 mitral regurgitation and, 136, 137f predominant left ventricular failure and, 135, 136f right ventricular failure and, 135–136, 137f ventricular septal rupture and, 136 right heart catheterization in, 81t Cardiomyopathy alcoholic, 512, 554–555 anthracycline-induced, 571 arrhythmogenic right ventricular dysplasia and sudden cardiac death in, 253–254, 254f ventricular tachycardia in, management and therapy for, 247 as cardiac magnetic resonance imaging indication, 67, 67f constrictive See Restrictive cardiomyopathy in diabetes mellitus, 524 Index  637 Cardiomyopathy (Continued) dilated See Dilated cardiomyopathy familial, heart failure due to, 187 hereditary, 175–180 clinical presentation of, 176–179 diagnostic approach for, 179 differential diagnosis of, 179 etiology and pathogenesis of, 175–176 future directions for, 180 management and therapy for, 179–180 hydroxychloroquine-induced, 571 hypertrophic See Hypertrophic cardiomyopathy idiopathic, heart failure due to, 187 peripartum, 181, 495 restrictive See Restrictive cardiomyopathy stress-induced See Stress-induced cardiomyopathy Takotsubo, 207 See also Stress-induced cardiomyopathy trastuzumab-induced, 571 CardioSeal Double-Umbrella Occluder, 454 Cardiovascular diseases See also Congestive heart failure; Coronary artery disease; Hypertension; Stroke incidence of, 15 Cardiovascular examination, components of, 8–10, 10f Cardiovascular medications See specific drugs and drug types Cardiovascular risk assessment, 589–590 Framingham risk scores and, 590 global estimates of coronary heart disease risk and, 589 methods of, 589–590 relative versus absolute risk and, 589 Cardiovascular risk factors, 4, 5b, 589 for atherosclerosis, 85, 86f in HIV/AIDS, 559–560 categories of, 589, 590b in coronary artery disease, 18f modification of, for atherosclerosis, 21 screening and management in medical practice, 592–593 for sudden cardiac death, 251 Cardioversion for ventricular tachycardia, 244 Carillon Mitral Contour System, 345 Carney’s complex, 536 Carnitine deficiency, heart and, 511 Carotid artery disease, 391–393 See also specific conditions clinical presentation of, 391–392 diagnostic approach for, 392–393 Carotid artery stenosis, 427 clinical presentation of, 427 interventional approaches for, 413, 414f surgical treatment of, 427 Carotid endarterectomy, 427 for atherosclerosis of extracranial carotid artery, 504, 504f Carotid intima-media thickness in atherosclerosis, 591f in preventive cardiology, 593–594 Carotid pulses in cardiac examination, 10f Carvedilol for heart failure, 192t Carvedilol-CR for heart failure, 192t Catecholamine reuptake inhibitors, hypertensive crisis due to, 522 Catheter ablation, 279–285 of atrial fibrillation, 239, 282–284 electrical isolation of pulmonary veins and, 284 refractory, for rate control, 284 success and complications of, 284 Catheter ablation (Continued) of atrioventricular bypass tracts, 280–281, 281f of atrioventricular nodal reentrant tachycardia, 279–280, 280f avoiding treatment errors and, 285 energy sources for, 279, 280t of focal atrial tachycardia, 280t, 282 future directions for, 285 of macroreentrant atrial tachycardia, 282, 283f for atypical atrial flutter, 280t, 282 for typical atrial flutter, 282 of ventricular tachycardia, 284–285 macroreentrant, 285 CCR5 antagonists, cardiovascular disease and, 560 CCT See Cardiac computed tomography Cefazolin for infective endocarditis, 330t Ceftriaxone for infective endocarditis, 330t Central sleep apnea, 567 Cerebral arterial occlusive disease, interventional approaches for, 413 Cerebrovascular accident pattern, 36 Cerebrovascular disorders, syncope due to, 262, 262t CHADS2, 236, 237f Chagas’ disease, myocarditis due to, 181 treatment of, 185 CHD (coronary heart disease) See Ischemic heart disease Chemotherapy, cardiotoxicity from, 557 Chest examination, 8–9 Chest pain/discomfort See also Angina cardiac computed tomography to evaluate, 64, 64f coronary angiography to evaluate, 73–75, 76f in coronary artery disease, 97, 99f differential diagnosis of, 3–6, 4b–6b, 5f, 97–98 imaging for assessment of, 58–59 during pregnancy, differential diagnosis of, 491 with ST-elevation myocardial infarction, 115 in stress-induced cardiomyopathy, 207 Chest radiography, 41–43 in aortic regurgitation, 300–301 in aortic stenosis, 292 clinical applications of, 42–43 in congenital heart disease, 438–439, 438f in constrictive pericarditis, 366, 366f, 379 future directions for, 43 limitations of, 43 normal anatomy on, 32f, 41–42, 43f in pericardial effusion, 369 in pericardial tamponade, 379 in pulmonary hypertension, 543t in pulmonary thromboembolism, 547 in restrictive cardiomyopathy, 167, 167t safety considerations for, 41 technical aspects of, 41–42 in tricuspid stenosis, 320–321 Chest radiography in ST-elevation myocardial infarction, 117 Cheyne-Stokes respiration, 567, 567f Children See Congenital heart disease; Pediatric patients Cholestyramine for dyslipidemias, 624 Churg-Strauss syndrome, endomyocardial fibrosis in, 163 Chvostek’s sign in hypokalemia alkalosis, 522f Cigarette paper scars in Ehler-Danlos syndrome, 9f CK See Creatine kinase CK-MB See Creatine kinase MB isoenzyme Claudication, lower extremity, 425 endovascular therapy for, 416, 417f Clopidogrel for coronary heart disease, 102–103 for ST-elevation myocardial infarction, 119–120 CMRI See Cardiac magnetic resonance imaging Coapsys device, 349, 349f Coarctation of the aorta balloon angioplasty for, 449–451, 450f chest radiography in, 43 echocardiography in, 443, 444f exercise testing in, 475 hypertension and, 407f Cocaine use, 554f, 555 myocarditis due to, 181 Colchicine for acute pericarditis, 362 Colesevelam for dyslipidemias, 624 Colestipol for dyslipidemias, 624 Commissurotomy, surgical, percutaneous balloon mitral valvuloplasty compared with, 344–345 Commotio cordis, sudden cardiac death due to, 256, 577–578, 580f Complete heart block, 218–219, 219f electrocardiography in, 38f exercise testing in, 476 postoperative, 470, 470f, 471t Computed tomography, 28, 28f in constrictive pericarditis, 365–367, 380 electron-beam, 61 in atherosclerosis, 591f in preventive cardiology, 593 screening for coronary artery disease using, 89 multidetector, 61–62 in pericardial effusion, 369 in pericardial tamponade, 380 PET-CT and, 56 in restrictive cardiomyopathy, 167t, 170 SPECT-CT and, 56 Computed tomography angiography, 61–62 in abdominal aortic aneurysms, 395, 395f–396f cardiac, 59 in carotid artery disease, 392–393 in lower extremity peripheral vascular disease, 390–391 in renal artery stenosis, 393 screening asymptomatic patients with, 65 Conduction, age-related changes in, 499–500 Conduction abnormalities intraventricular, electrocardiographic criteria for, 33 rate-dependent aberrant ventricular conduction as, electrocardiographic criteria for, 33 in systemic lupus erythematosus, 529 Congenital heart disease, 433–439 See also specific conditions acyanotic, arrhythmias in, 467–470 arrhythmias in, 465–472, 466f in acyanotic congenital heart disease, 467–470 in cyanotic congenital heart disease, 465–467 future directions for, 471–472, 471t postoperative complete heart block and, 470, 470f cardiac computed tomography in, 64 as cardiac magnetic resonance imaging indication, 68 catheter-based treatment of, 447–455 balloon angioplasty and stent placement as, 447–451, 450f balloon atrial septostomy as, 447, 448f balloon valvuloplasty as, 447, 448f 638  Index Congenital heart disease (Continued) future directions for, 454 transcatheter closure of congenital shunts as, 451–454, 451f–454f clinical indications for medical or surgical intervention in, 433–435, 435f–437f coronary artery anomalies associated with, 481–486, 483f future directions for, 485–486 cyanotic, arrhythmias in, 465–467 echocardiography in, 441–446 in atrial septal defect, 442, 442f in atrioventricular septal defect, 442–443, 443f in coarctation of the aorta, 443, 444f future directions for, 445–446 in pulmonary atresia, 444, 445f in single ventricle, 445, 446f in tetralogy of Fallot, 444, 444b, 445f in total anomalous pulmonary venous return, 444 in transposition of the great arteries, 443–444 transthoracic, 441–442 in ventricular septal defect, 442, 443f exercise testing in, 473–476, 474f characteristic pathologic responses in, 475–476 future directions for, 476 normal responses of children to exercise and, 473–475 initial noninvasive assessment in, 435–439 chest radiography in, 438–439, 438f future directions for, 439 history taking in, 435–436 physical examination in, 437–438, 437f pregnancy in, 491–492, 492t risk stratification in, 433 surgical treatment of, 457–464 for atrial septal defects, 459–460, 461f for atrioventricular septal defects, 460 avoiding treatment errors and, 463–464 future directions for, 464 palliative procedures for, 457–458, 458f–459f for patent ductus arteriosus, 459 for single-ventricle lesions, 458–459 for tetralogy of Fallot, 460–462, 462f for total anomalous pulmonary venous return, 462 for transposition of the great arteries, 462, 463f for truncus arteriosus, 462–463, 463f for ventricular septal defects, 459, 460f transthoracic echocardiography in, 45 Congestive heart failure exercise and, 614–616, 615f in older adults, 502 Conjunctivitis in Kawasaki’s disease, 477 Connective tissue disorders, 527–534 See also specific disorders diagnostic approach for, 533 differential diagnosis of, 533 drug-induced, 533 etiologies of, 527 future directions for, 534 heart in, 527–534 secondary causes of cardiovascular disease and, 531–532 management and therapy for, 533–534 avoiding treatment errors and, 534 optimum treatment and, 533–534 Constrictive cardiomyopathy See Restrictive cardiomyopathy Constrictive pericarditis, 363–367 clinical presentation of, 364 pericardial tamponade compared with, 379t diagnostic approach for, 366–367, 366f, 379–381 differential diagnosis of, 364–366 etiology and pathogenesis of, 363–364, 365t, 366f hemodynamics in, 372–375 echo-Doppler measurements and, 374–375, 377f pericardial tamponade compared with, 375–376, 378t pressure measurements and, 372–374, 374f, 375t, 376f intracardiac pressure in, 373f management and therapy for, 367 physiology of, 165–166, 166f right heart catheterization in, 81t Contrast agents for magnetic resonance imaging, 27–28, 28f Contrast echocardiography, 26f CoreValve, 340, 340f Coronary aneurysms in Kawasaki’s disease, 478f Coronary angiography diagnostic, 71–77 for chest pain evaluation, 73–75, 76f complications of, 77, 77t contraindications to, 75–76 coronary anatomy and anomalies and, 71, 72f future directions for, 77 indications for, 73–75, 76t limitations of, 76–77 technique for, 71–73, 73b, 73f–75f in ischemic heart disease, 130 for Kawasaki’s disease, 479, 480f screening for coronary artery disease using, 89 Coronary arteries anatomy of, 71, 72f anomalies of, 71, 72f See also specific anomalies associated with congenital heart disease, 481–486, 483f in athletes, sudden cardiac death due to, 577 sudden cardiac death associated with, 254–255, 255f arteriographic views of, 137f in atherosclerosis, 137f in Kawasaki’s disease, 478f Coronary arteriography, 137f in atherosclerosis, 20, 20f Coronary artery bypass grafting, 129–133, 130b, 131f for atherosclerosis, 20–21 avoiding treatment errors with, 132 for dilated cardiomyopathy, 152 future directions for, 132–133, 133f for heart failure, 190–191 imaging for, cardiac magnetic resonance imaging for, 68 indications for, 104, 130–132, 130b for non–ST-elevation myocardial infarction, 113 off-pump, 130–132, 131f optimum treatment and, 131–132 percutaneous coronary intervention compared with, 126 for coronary artery disease, 104 remote-access, 132–133, 133f stenting compared with, for coronary artery disease, 104 Coronary artery calcium score as indication for cardiac computed tomography, 62–63, 62f, 63b, 64f Coronary artery disease, 97–105 acute coronary syndromes and See Acute coronary syndromes atherosclerotic See Atherosclerosis chest radiography in, 42 clinical presentation of, 97, 99f in connective tissue diseases, 532 coronary angiography to evaluate, 73 detection of, exercise stress testing for, 51 diagnostic approach for, 98–100, 99b, 100f–102f differential diagnosis of, 97–98 etiology and pathogenesis of, 97, 98f future directions for, 105 homocysteine and, 529 management and therapy for, 100–105 angiotensin-converting enzyme inhibitors for, 103 antiplatelet therapy for, 102–103 avoiding treatment errors and, 104–105 β-blockade for, 103 hyperlipidemia treatment and, 104 nitrates for, 103 optimum treatment and, 100–104, 103f revascularization indications and, 104 in older adults, 502–503 risk factors in, 18f screening tests for, 87–89 coronary angiography as, 89 electrocardiography as, 87–89, 88f electron-beam computed tomography as, 89 nuclear imaging as, 89 stress electrocardiography as, 89 sedentary lifestyle and, 531–532 ventricular tachycardia in, management and therapy for, 247 Coronary artery fistulas, 483–484 Coronary Doppler flow wire with percutaneous coronary intervention, 126 Coronary heart disease See Ischemic heart disease Coronary revascularization See Coronary artery bypass grafting; Percutaneous coronary intervention; Revascularization Coronary sinus techniques, transcatheter, 346–348, 347f Coronary stenosis, 97, 99f in Kawasaki’s disease, 478f Corrigan’s pulse, 302t Corticosteroids for hypereosinophilic syndrome, 172 Costello’s syndrome, 155 Counting of cardiovascular risk factors, 589–590 C-reactive protein in preventive cardiology, 594 Creatine kinase (CK) in non–ST-elevation myocardial infarction, 110–111, 110f in ST-elevation myocardial infarction, 116–117 Creatine kinase MB isoenzyme (CK-MB) in non–ST-elevation myocardial infarction, 110–111, 110f in ST-elevation myocardial infarction, 116–117 CT See Computed tomography CTA See Computed tomography angiography Culture-negative endocarditis, 328 antimicrobial therapy for, 330t Cushing’s disease, cardiovascular manifestations of, 519 Cushing’s syndrome, cardiovascular manifestations of, 519, 520f Index  639 Cutting balloon with percutaneous coronary intervention, 126 Cyanosis, 437 examination for, 8–9 Cyanotic heart disease, 433 arrhythmias in, 465–467 signs of, Cyclic citrullinated peptide, antibodies to, in rheumatoid arthritis, 527–528 Cyclosporine for myocarditis, 185 Cysts, pericardial (springwater), 537 D Danon’s disease, heart and, 510 Daunorubicin, cardiovascular toxicity of, 571 DCM See Dilated cardiomyopathy d-Dimer in pulmonary thromboembolism, 549, 549t De Musset’s sign, 302t Delayed hyperenhancement protocols for cardiac magnetic resonance imaging, 66–67 Delivery, physiological changes during, 489 Depolarization, abnormalities in sequence of, electrocardiographic criteria for, 33 Dermatomyositis, cardiac manifestations of, 530, 531f Desquamation in Kawasaki’s disease, 477 Dextrocardia, diagnosis of, 10 Diabetes mellitus cardiovascular disease in myocardial infarction in, 597–598 patient evaluation in, 597 in special populations, 597–599, 598f cardiovascular manifestations of, 523–524 as coronary risk equivalent, exercise and, 614 glucose control in, for coronary heart disease, 101–102 vasculopathy in, complications of, 425, 425f Diagnostic testing, 23–30 See also specific conditions and techniques for assessing anatomy, 23 for assessing function, 23 avoiding errors in, 29–30 future directions for, 30 Diastolic heart failure etiology and pathogenesis of, 188, 189f treatment of, 171–172, 171b Diet therapy for dyslipidemias, 621, 622f Diffuse B-cell lymphomas, cardiac, 538 Digital subtraction angiography in abdominal aortic aneurysms, 395 in renal artery stenosis, 393 Digitalis for dilated cardiomyopathy, 151–152 Digoxin for atrial fibrillation, 235–236 for heart failure, 192 Dilated cardiomyopathy, 145–153 alcohol abuse and, 571 clinical presentation of, 148–149, 148f–149f, 149t diagnostic approach for, 149–151, 151t differential diagnosis of, 149, 150f ethanol-induced, 571 etiology and pathogenesis of, 145–148, 146f–148f, 146t familial, 175, 177t, 178f autosomal-dominant transmission of, 175 mitochondrial inheritance of, 175 X-linked transmission of, 175 future directions for, 152 in HIV/AIDS, 557, 558f idiopathic, sudden cardiac death in, 251–252 Dilated cardiomyopathy (Continued) management and therapy for, 151–152 avoiding treatment errors and, 152 optimum treatment and, 151–152 right heart catheterization in, 81t ventricular tachycardia in, management and therapy for, 247 Diltiazem for atrial fibrillation, 235–236 Diphtheria dilated cardiomyopathy and, 148f myocarditis due to, 181, 183f Diphtheria antitoxin for myocarditis, 185 Diphtheric polyneuropathy, heart and, 513 Dipyridamole, myocardial perfusion imaging using, 54 Direct renin inhibitors for hypertension, 402 Direct thrombin inhibitors for non– ST-elevation myocardial infarction, 111 Distal myopathy, heart and, 510 Diuretics for dilated cardiomyopathy, 151–152 for heart failure, 192–193, 192t for hereditary cardiomyopathy, 179 for hypertension, 401–402, 403t for restrictive cardiomyopathy, 171–172 Dobutamine for heart failure, 193 myocardial perfusion imaging using, 54–55 Dofetilide for atrial fibrillation, 236–239 Dominant mutation, 605b Doppler imaging in constrictive pericarditis, 374–375, 376f–377f, 379 coronary Doppler flow wire and, with percutaneous coronary intervention, 126 in lower extremity peripheral vascular disease, 390, 390f in renal artery stenosis, 393, 408 in restrictive cardiomyopathy, Doppler filling patterns and, 168–169, 168f, 170f tissue, 23–25, 45 in constrictive pericarditis, 375 in tricuspid stenosis, 320–321 Down’s syndrome atrioventricular septal defects with, 460 signs of, 8, 9f Doxorubicin cardiovascular toxicity of, 571 restrictive cardiomyopathy due to, 164 Dressler’s syndrome after myocardial infarction, 120–121 Dronedarone for atrial fibrillation, 238 Drugs of abuse See Substance abuse therapeutic See Medications; specific drugs and drug types Dual AV nodal physiology, 223 Duchenne’s muscular dystrophy, heart and, 507, 508f Duke criteria for infective endocarditis, 325 Duke Treadmill Score, screening for coronary artery disease using, 87 Duroziez’s sign, 302t Dysautonomia in systemic lupus erythematosus, 529 Dyslipidemias, 619–625 diagnostic approach for, 619–620, 620f hereditary hypercholesterol as, signs of, 99, 100f in HIV/AIDS cardiovascular disease and, 559 management and therapy for, 560 management and therapy for, 620–624 avoiding treatment errors and, 624 drug therapy in, 621–624, 623f Dyslipidemias (Continued) future directions for, 624 for hyperlipidemia, 104, 524 optimum treatment and, 620–624, 621f plasmapheresis in, 624 specific management and, 621, 622f in women, 599–601 Dysphagia in polymyositis/dermatomyositis, 531f Dyspnea as anginal equivalent, etiology of, 6, 6f, 7t Dystrophinopathies, heart and, 507–510, 508f E Early repolarization, 35 EBCT See Electron-beam computed tomography Ebstein’s malformation, arrhythmias in, 467, 469f, 471t ECG See Electrocardiography Echocardiography, 23–25, 24f–26f, 45–49 in anomalous origin of the left coronary artery from the pulmonary artery, 481 in aortic regurgitation, 301–302, 303f in aortic stenosis, 292–293, 292f, 293t B-mode, in constrictive pericarditis, 375 in cardiogenic shock, 138 in congenital heart disease See Congenital heart disease, echocardiography in; specific conditions in constrictive pericarditis, 366–367 contrast, 24, 26f, 47–48 in dilated cardiomyopathy, 150 Doppler See Doppler imaging exercise, 26f fetal, 441 future directions for, 49 handheld, 13 in hypertrophic cardiomyopathy, 157–158, 157f–158f impact of, 10–11 in infective endocarditis, 328–329, 329f intracardiac, 48 for Kawasaki’s disease, 479 limitations of, 48 in mitral valve prolapse, 314, 315f in pericardial effusion, 369 in pericardial tamponade, 380, 380t in pulmonary hypertension, 543t in pulmonic regurgitation, 323 in pulmonic stenosis, 322 in restrictive cardiomyopathy, 167–169, 167t Doppler filling patterns and, 168–169, 168f, 170f in ST-elevation myocardial infarction, 117 stress, 46–47 in syncope, 265 three-dimensional, 25, 48 transducer positions for, 46f transesophageal, 24, 24f, 46 in congenital heart disease, 441 in constrictive pericarditis, 375 in infective endocarditis, 328, 329f limitations of, 48 positions for, 25f transthoracic, 45–46, 46f–47f clinical applications of, 45 in congenital heart disease, 441–442 in infective endocarditis, 328, 329f M-mode, 45, 47f with pharmacologic agents, 47 in pulmonary thromboembolism, 547 in stress-induced cardiomyopathy, 209–210 two-dimensional, 45, 46f–47f in tricuspid stenosis, 319 640  Index Eclampsia, 407f, 494–495, 496f Ectopia lentis in Marfan’s syndrome, 299f Ectopic atrial rhythm, 33f Ectopic ventricular beats, electrocardiographic criteria for, 33 Edwards SAPIEN valve, 340, 340f Edwards MONARC device, 345, 347–348, 347f–348f Edwards-Carpentier valve, 355f Efavirenz, cardiovascular disease and, 559 Ehlers-Danlos syndrome peripheral vascular disease and, 389 signs of, 8, 9f Eisenmenger’s syndrome, pregnancy in, 492 Elderly persons See also Aging cardiovascular disease in, 599, 600f syncope in, 268 Electrocardiographic monitoring, Holter, 23 in syncope, 265–266 Electrocardiography, 23, 31–39 in acute ischemia and infarction, 36–37, 37f in acute pericarditis, 361–362, 365f in aortic stenosis, 292, 470 arrhythmias and, 37, 38f in atherosclerosis, 19–20 in athletes, 580–581 in atrial septal defect, 468–469 in atrial tachycardia, 228–229, 229f in atrioventricular nodal reentrant tachycardia, 225, 225f–226f, 226t in atrioventricular reentrant tachycardia, 227–228, 228f in atrioventricular specific diagnosis of, 470 in complete heart block, postoperative, 470, 470f in constrictive pericarditis, 366, 379 in Ebstein’s malformation, 467, 469f exercise, 23 screening for coronary artery disease using, 87–89, 88f in exercise stress testing, 51, 52f future directions for, 38 Holter, 23 in hypertrophic cardiomyopathy, 157 leads for, 31, 32f in mitral valve prolapse, 314–315 in non–ST-elevation myocardial infarction, 108f, 109 in patent ductus arteriosus, 469 in pericardial effusion, 369 in pericardial tamponade, 379 in pulmonary stenosis, 470 in pulmonary thromboembolism, 545f, 547 in pulmonic stenosis, 322 QT abnormalities on, 35–36, 36f reference lines for, 32f resting, screening for coronary artery disease using, 87 in restrictive cardiomyopathy, 166, 167t in ST-elevation myocardial infarction, 116, 117f in stress-induced cardiomyopathy, 208 in syncope, 265, 266f in tetralogy of Fallot, 465, 467f in transposition of the great arteries D-transposition as, 465 L-transposition as, 470 in tricuspid atresia, 465–467, 469f in tricuspid stenosis, 319, 321f in ventricular septal defect, 467–468 in ventricular tachycardia, 241–242, 243f–244f waveform and, 31–35, 33f P wave and, 31, 33f PR interval and, 32 QRS complex and, 32–34, 34f Electrocardiography (Continued) ST segment and, 34–35 T wave and, 34–35 U wave and, 35, 35f Electrolyte disorders, heart and, 510–511 Electromagnetic interferences with pacemakers and implantable cardioverterdefibrillators, 273–275 Electron-beam computed tomography, 61 in atherosclerosis, 591f in preventive cardiology, 593 screening for coronary artery disease using, 89 Electrophysiological studies, 29 See also Electrocardiography in syncope, 266–267 Emboli See also Pulmonary thromboembolism from cardiac tumors, 535 in infective endocarditis, 325, 326f with percutaneous coronary intervention, 124 prevention of, 125–126, 125f Emery-Dreifuss muscular dystrophy, heart and, 507–508 Enalapril for dilated cardiomyopathy, 151–152 for heart failure, 192t Enalaprilat for hypertensive emergencies, 403t Endocardial cushion defects, 461f Endocardial leads for pacemakers and implantable cardioverter-defibrillators, 272 Endocarditis eosinophilic See Eosinophilic endocarditis infective, in HIV/AIDS, 558 thrombotic, nonbacterial, in HIV/AIDS, 558 Endocrine diseases See also specific disorders cardiovascular manifestations of, 515–525 future directions for, 524 Endomyocardial biopsy in dilated cardiomyopathy, 150 in restrictive cardiomyopathy, 171 in stress-induced cardiomyopathy, 210 Endomyocardial fibrosis, restrictive cardiomyopathy due to, 162–163, 163f Endothelial injury, atherosclerotic pathogenesis and, 15, 16f–17f Endothelin, Addison’s disease and, 521 Endovascular aneurysm repairs for abdominal aortic aneurysms, 421–422 Endovascular therapy for abdominal aortic aneurysms, 421–422 for peripheral arterial disease, 413–419 future directions for, 418, 418f lower extremity, 416 stroke as, 413–414, 414f–415f upper extremity, 414–415 of visceral arteries, 415–416 Enterococcal endocarditis, 327 antimicrobial therapy for, 330t Environmental effects, 605b Eosinophilic endocarditis, 162–163 Ephedrine, 556 Episcleritis, nodular, with scleromalacia, in rheumatoid arthritis, 528f Eplenerone for dilated cardiomyopathy, 151–152 for heart failure, 192t Epoprostenol for pulmonary hypertension, 544t Erectile dysfunction in hypertrophic cardiomyopathy, management of, 159 Ergot alkaloids, cardiovascular toxicity of, 572, 573f Ergotamine, cardiovascular toxicity of, 572, 573f Erythema in polymyositis/dermatomyositis, 531f Esmolol for hypertensive emergencies, 403t Ethanol alcohol use and, 553–555, 554f alcoholic cardiomyopathy and, 512, 554–555 cardiovascular toxicity of, 571 septal ablation using, for hypertrophic cardiomyopathy, 159–160 Ethnicity, cardiovascular disease and, 601 Etravirine, cardiovascular disease and, 559 EVARs See Endovascular aneurysm repairs Event monitors in syncope, 265–266 Exercise, 609–617 See also Athletes in congestive heart failure, 614–616, 615f for coronary heart disease, 100–101 definition of, 609 for dyslipidemias, 621, 622f effects on cardiovascular health, 613–614 blood pressure and, 614 lipids and, 613–614 metabolic syndrome and diabetes and, 614 oxygen supply and demand and, 613, 613b future directions for, 616 obesity and, 611 primary prevention and, 609–611, 610f secondary prevention and, 611–613, 612f women and, 611 Exercise echocardiography, 26f Exercise stress testing, 51–53, 52f in asymptomatic patients, ACC/AHA guidelines for, 89, 90t for atherosclerosis, 20 bicycle-based, 51 in congenital heart disease, 473–476, 474f characteristic pathologic responses in, 475–476 future directions for, 476 normal responses of children to exercise and, 473–475 contraindications to, 53 Exercise tolerance, decreased, as anginal equivalent, Ezetimibe for dyslipidemias, 623f, 624 F Fabry’s disease restrictive cardiomyopathy due to, 164 treatment of, 172 Facioscapulohumeral muscular dystrophy, heart and, 509 Fascicular blocks, electrocardiographic criteria for, 33 Fascicular tachycardia, management and therapy for, 248 Fast-slow tachycardia, 223 Fatigue as anginal equivalent, Fatty acid imaging, 59 Fatty streaks, formation of, 15, 16f, 129 18 F,2-deoxyglucose (FDG) as perfusion marker, 58 Felodipine for heart failure, 193 Felty’s syndrome, cardiac manifestations of, 531–532 Femoral aneurysms, 424 clinical presentation of, 424 surgical treatment of, 424 Femoropopliteal vessels, atherosclerosis of, 425 Fenfluramine, cardiovascular toxicity of, 571–572, 572f Fenofibrate for dyslipidemias, 624 Fenoldopam for hypertensive emergencies, 403t Fetal echocardiography, 441 Fever in Kawasaki’s disease, 477 Fibrate for triglyceride elevation, 104 Fibric acids for dyslipidemias, 623f, 624 Index  641 Fibrinolytic agents for ST-elevation myocardial infarction, 117–118 Fibroelastomas, papillary, 536t, 537 Fibromas, cardiac, 536t, 537 Fibrosarcomas, cardiac, 538t Fibrous plaque, atherosclerotic See Atherosclerotic plaque Fibrous subaortic stenosis, 156f Fick principle, 80 Fitness, definition of, 609 Flecainide for atrial fibrillation, 236–238 for premature ventricular complexes, 248–249 for ventricular tachycardia, nonsustained, 248 Fluorine-18–labeled perfusion tracers, 54 Focal atrial tachycardia, catheter ablation of, 280t, 282 electrical isolation of pulmonary veins and, 284 success and complications of, 284 “Fontan physiology,” 457 Fontan procedure, 458, 459f exercise testing and, 475–476 Forrester classification, 148 Fosinopril for heart failure, 192t Framingham Risk Calculator, Framingham risk scores, 87, 91, 590, 592b Free wall rupture, cardiogenic shock and, 136–138 “French paradox,” 553–555 Friedreich’s ataxia, heart and, 512–513, 512f Fungal endocarditis, 328 Furosemide for heart failure, 192 G Gastroesophageal reflux disease, chest discomfort due to, 5–6 Gaucher’s disease restrictive cardiomyopathy due to, 164 treatment of, 172 Gemfibrozil for dyslipidemias, 624 Gene expression, molecular signatures of, 608 Gene therapy, angiogenic, for ischemic heart disease, 386 Genetic factors, 603–608, 604f, 605b in atherosclerosis, 605 disease etiology and, 603, 606f–607f future directions for, 608 in hypertrophic cardiomyopathy, 603–604, 607f in long QT syndrome, 604–605, 607f molecular signatures of gene expression and, 608 Genetic screening for acute coronary syndromes risk detection, 91–92 Genotype, 605b Gentamicin for infective endocarditis, 330t Geriatric patients See Aging; Elderly persons Gestational hypertension, 494 Giant cell arteritis cardiac manifestations of, 531 diagnosis of, 533 Giant cell myocarditis, 181 Glenn shunt, 457–458, 458f Glucose control in diabetic patients, for coronary heart disease, 101–102 Glucose for hypokalemic periodic paralysis, 511 Glycogen storage diseases, heart and, 511 Glycoprotein IIb/IIIa receptor antagonists for diabetes mellitus, myocardial infarction and, 597–598 for non–ST-elevation myocardial infarction, 111–113 with percutaneous coronary intervention, 123–124 Glycoprotein IIb/IIIa receptor antagonists (Continued) for ST-elevation myocardial infarction, 119–120 Gradient echo imaging for cardiac magnetic resonance imaging, 65 Gram-negative endocarditis, 327–328 Growth factors, age-related changes in, 502 Guillain-Barré syndrome, heart and, 513 H HACEK endocarditis, 325, 328 antimicrobial therapy for, 330t Hancock porcine valve, 355f Handheld echocardiography, 13 Handheld ultrasound imaging devices, 46 Hashimoto’s thyroiditis, 518 HCM See Hypertrophic cardiomyopathy HDL-C See Dyslipidemias; High-density lipoprotein cholesterol Head-up tilt-table test in syncope, 266 Health-related fitness, definition of, 609 Heart See also Cardiac entries; Cardiovascular entries anatomy of, 137f embryologic development of, 457 innervation of, 263f, 436f structural changes of, during pregnancy, 489 Heart failure, 187–195 clinical presentation of, 188f, 189 congestive, in older adults, 502 decompensated, prevention of, 145 diagnostic approach for, 189–190 defining etiology of heart failure and, 190 determining type and degree of left ventricular dysfunction and, 189–190, 190f diastolic etiology and pathogenesis of, 188, 189f treatment of, 171–172, 171b differential diagnosis of, 189, 189b etiology and pathogenesis of, 187–188 for diastolic heart failure, 188, 189f for systolic heart failure, 187, 188f exercise and, 614–616, 615f future directions for, 195 left, 148, 148f management and therapy for, 190–195, 191f avoiding treatment errors and, 194 comorbid disease and, 194–195 device therapy in, 194 for diastolic heart failure, 194 drug costs and, 192t, 194 nonpharmacologic, 194 optimum treatment and, 191–193, 192t in older adults, 502 pregnancy in, 494 right, 148, 149f systolic See also Dilated cardiomyopathy etiology and pathogenesis of, 187, 188f Heart sounds auscultation of, 10–11, 12f in constrictive pericarditis, 364 during pregnancy, 490–491 Heart valves See also Valvular heart disease; specific valve disorders age-related changes in, 499 Heart-lung transplantation for pulmonary hypertension, 545 HeartMate II, 203t, 204, 204f HeartMate XVE, 203–204, 203t, 204f Helex Septal Occluder, 452, 453f Hemangiomas, cardiac, 536t Hematomas with percutaneous coronary intervention, 124 Hemochromatosis restrictive cardiomyopathy due to, 164 treatment of, 172 Hemodynamic monitoring in cardiogenic shock, 138–139 Hemodynamics during delivery, 489 during pregnancy, 489 Hemorrhage with percutaneous coronary intervention, 124 retroperitoneal, with percutaneous coronary intervention, 124 Heparin for non–ST-elevation myocardial infarction, 111 with percutaneous coronary intervention, 123 for pulmonary thromboembolism, 549–550 unfractionated, for ST-elevation myocardial infarction, 120 Hereditary cardiomyopathy, 175–180 clinical presentation of, 176–179 diagnostic approach for, 179 differential diagnosis of, 179 etiology and pathogenesis of, 175–176 future directions for, 180 management and therapy for, 179–180 Heyde’s syndrome, 291 High-density lipoprotein cholesterol See also Dyslipidemias in diabetes mellitus, 524 Highly active antiretroviral therapy, cardiovascular toxicity of, 572 High-speed rotational atherectomy with percutaneous coronary intervention, 125, 125f Hill’s sign, 302t Hispanics, cardiovascular disease in, 601 History taking, 3–8 ascites in, 7–8 chest discomfort in, 3–6, 4b–6b dyspnea in, 6, 6f, 7t palpitations in, peripheral edema in, 7–8 syncope in, 7b, HIV/AIDS, cardiac diseases in, 557–561, 558f atherosclerotic, 558–560 clinical presentation of, 557–558 etiology and pathogenesis of, 557 future directions for, 560 lipid abnormal management and therapy and, 560 HMG-CoA reductase inhibitors See Statins Holter monitoring, 23 in syncope, 265–266 Homocysteine, coronary artery disease and, 529 Homocysteinuria, peripheral vascular disease and, 389 Hormone replacement therapy as cardiovascular risk factor, 599–601 Hufnagel valve, 353, 354f Human immunodeficiency virus See HIV/AIDS Hurler’s syndrome, restrictive cardiomyopathy due to, 164 Hydralazine for dilated cardiomyopathy, 151–152 for heart failure, 191–192, 192t for hypertension, in pregnancy, 494 for hypertensive emergencies, 403t Hydrochlorothiazide for heart failure, 192 Hydroxychloroquine, cardiovascular toxicity of, 571 Hydroxymethylglutaryl-coenzyme A reductase inhibitors See Statins Hydroxyurea for hypereosinophilic syndrome, 172 642  Index Hypercholesterol, hereditary, signs of, 99, 100f Hypereosinophilic syndrome, treatment of, 172 Hyperkalemia, heart and, 510f Hyperlipidemia, treatment of, 104, 524 Hyperparathyroidism, cardiovascular manifestations of, 519 Hypersensitivity reactions, myocarditis due to, 181 Hypertension, 397–404, 398b, 398t alcohol use and, 555 clinical presentation of, 397–398, 399f–401f consequences of, 397 diagnostic approach for, 399–400, 401b–402b differential diagnosis of, 398, 399b dilated cardiomyopathy and, 145, 147f essential, 398 etiology and pathogenesis of, 397, 398f, 405–408, 407f future directions for, 403 gestational, 494 heart failure due to, 187, 189f hypertrophic cardiomyopathy and, 156f as indication for revascularization, in atherosclerotic renal artery stenosis, 410–411 management and therapy for, 400–403 avoiding treatment errors and, 402–403 optimum treatment and, 400–402, 402b, 403t in older adults, 599 in pregnancy, 494–495, 495t, 496f pulmonary See Pulmonary hypertension renal artery disease causing, 405, 406f See also Renal artery stenosis Hypertensive crises, drugs precipitating, 522 Hyperthyroidism, cardiovascular manifestations of, 516–518, 517f Hypertrophic cardiomyopathy, 155–160, 156f in athletes, sudden cardiac death due to, 575–577, 576f clinical presentation of, 155, 164 clinical syndromes and variants of, 155 diagnostic approach for, 157–158 cardiac catheterization and, 158 echocardiography and, 157–158, 157f–158f electrocardiography and, 157 exercise and, 158 physical examination and, 157 differential diagnosis of, 155–157, 157f epidemiology of, 155 etiology and pathogenesis of, 155, 156f familial, 175–176, 176t, 178f future directions for, 160 genetics of, 603–604, 607f management and therapy for, 158–160 alcohol ablation of septum in, 159–160 avoiding treatment errors and, 159 for erectile dysfunction, 159 implantable cardioverter defibrillator in, 159, 159b medical management and, 158–159 optimum treatment and, 158–159 permanent pacing in, 159 surgical, 159 obstructive, 155 aortic stenosis in, 289 right heart catheterization in, 81t sudden cardiac death in, 252–253, 254f ventricular tachycardia in, management and therapy for, 247 Hypertrophic subaortic stenosis, 155, 156f Hypoadrenalism, cardiovascular manifestations of, 519–521 Hypocalcemia, QT interval and, 36, 36f Hypokalemic periodic paralysis, heart and, 510–511, 510f Hypoperfusion, dilated cardiomyopathy and, 148 Hypopituitarism, cardiovascular manifestations of, 515 Hypoplastic left heart syndrome echocardiography in, 445, 446f Norwood correction of, 458f surgical treatment of, 458–459 Hypotension, orthostatic, syncope due to, 261, 262t, 264f Hypothyroidism, cardiovascular manifestations of, 518–519 Hypoventilation, obesity, 567–568 Hypoxemia in congenital heart disease, 433–435 I IABP See Intra-aortic balloon pumping ICDs See Implantable cardioverterdefibrillators iCoapsys device, 349 Idarubicin, cardiovascular toxicity of, 571 Idiopathic hypertrophic subaortic stenosis, 289 Idioventricular left ventricular tachycardia, management and therapy for, 248 Idioventricular rhythm, accelerated, management and therapy for, 248 Iliac artery stenosis, endovascular therapy for, 416, 417f Iloprost for pulmonary hypertension, 544t Immunosuppressive therapy cardiac effects of, 533–534 following cardiac transplantation, 201 for myocarditis, 185 Implantable cardioverter-defibrillators for dilated cardiomyopathy, 152 electromagnetic interference and, 273–275 future directions for, 274f, 275 for heart failure, 194 for hereditary cardiomyopathy, 179 for hypertrophic cardiomyopathy, 159, 159b implantation of, 272–273, 276f–277f indications for, 271 long-term follow-up with, 273 for myocardial infarction prevention, 121 postimplantation care for, 273 for sudden cardiac death prevention, 256–258, 257t indications for, 258, 258b primary, 256–258 secondary, 258 technology of, 272, 275f for ventricular tachycardia, 245–246 in arrhythmogenic right ventricular cardiomyopathy, 247 in dilated cardiomyopathy, 247 in hypertrophic cardiomyopathy, 247 nonsustained, 248 in sarcoidosis, 247 Impulse formation, age-related changes in, 499–500 Infectious agents atherosclerosis and coronary heart disease and, 594 bacterial, myocarditis due to, 181, 182f–183f endocarditis and See Infective endocarditis viral, dilated cardiomyopathy and, 147–148, 148f Infectious myocarditis, 181–182, 182f–183f treatment of, 185 Infective endocarditis, 325–331 aortic stenosis and, 293 clinical presentation of, 325, 326f–327f culture-negative, 328, 330t diagnostic approach for, 325–328 Infective endocarditis (Continued) differential diagnosis of, 325 echocardiography in, 328 enterococcal, 327, 330t etiology and pathogenesis of, 325 fungal, 328 future directions for, 330–331 gram-negative, 327–328 HACEK, 325, 328, 330t in HIV/AIDS, 558 management and therapy for, 328–330 antimicrobials in, 328, 330t avoiding treatment errors and, 329–330 echocardiography and, 328–329 optimum treatment and, 328–329 prophylaxis and, 330 surgical, 329 microbiology of, 325 in HIV/AIDS, 558 prevention of, during pregnancy, 494 prosthetic valve, 328, 330t staphylococcal, 326, 330t streptococcal, 330t Inferior vena cava filters for pulmonary thromboembolism, 550 Inflammation, chronic amyloidosis and, 531–532 coronary heart disease and, 531–532 Inflammatory bowel disease, arthritis associated with, cardiac manifestations of, 529 Inflammatory myopathy cardiac manifestations of, 528t–529t heart and, 511–512 Inflammatory response, atherosclerotic pathogenesis and, 15, 18f Infrainguinal occlusive disease, surgical treatment of, 427 Injury current, 37 Inotropes for heart failure, 193 for hereditary cardiomyopathy, 179 Insulin for hypokalemic periodic paralysis, 511 Insulin resistance in HIV/AIDS, cardiovascular disease and, 560 Integrase inhibitors, cardiovascular disease and, 560 Intermittent porphyria, acute, heart and, 513 Intra-aortic balloon pumping in cardiogenic shock, 139, 139f Intracardiac pressure, 371, 372f Intrapericardial pressures, 371, 372f Intravascular ultrasound, 48 for acute coronary syndromes risk detection, 92–93, 93f with percutaneous coronary intervention, 126, 127f Intravenous drug use, 554f, 555 Intravenous immunoglobulin for Kawasaki’s disease, 479 for myocarditis, 185 Intraventricular conduction abnormalities, electrocardiographic criteria for, 33 Iridocyclitis in ankylosing spondylitis, 530f Ischemic heart disease acute, electrocardiography in, 36–37, 37f angiogenesis and, 385–387 as cardiac magnetic resonance imaging indication, 66–67, 66f chest discomfort in, 3–4, 115 clinical presentation of, 129 cocaine-induced, 555 differential diagnosis of, 129 dilated cardiomyopathy and, 145 See also Dilated cardiomyopathy during exercise stress testing, 51, 52f Index  643 Ischemic heart disease (Continued) exertional, hypertension and, 397 mitral regurgitation due to, 311 prior probability of, rest-induced, risk assessment for, 591f sudden cardiac death in, 251 in women, 599, 600f Isometric exercise in cardiac examination, 13f Isosorbide dinitrate for heart failure, 191–192, 192t IVIG See Intravenous immunoglobulin IVUS See Intravascular ultrasound J Jugular venous pulsation, examination of, 9–10 K Kaposi’s sarcoma, 538 in HIV/AIDS, 557 Kawasaki’s disease, 477–480 cardiac manifestations of, 531 clinical presentation of, 477, 478f diagnostic approach for, 478, 479b differential diagnosis of, 478–479 etiology and pathogenesis of, 477, 478f future directions for, 479–480 management and therapy for, 479 avoiding treatment errors and, 479 optimum treatment and, 479, 480f Kearns-Sayre syndrome, heart and, 511 Kussmaul’s sign in constrictive pericarditis, 364, 373, 377–379 L Labetalol for hypertension in pregnancy, 494 for hypertensive emergencies, 403t Labor, physiological changes during, 489 Large-vessel arteritis, cardiac manifestations of, 531 LDL-C See Dyslipidemias; Low-density lipoprotein cholesterol Leber’s hereditary optic neuropathy, heart and, 511 Left bundle branch block, electrocardiographic criteria for, 33 Left heart catheterization, 81–83, 82f–84f future directions for, 83 Left heart failure, 148, 148f Left ventricular aneurysms after myocardial infarction, 120–121 Left ventricular diastolic filling, age-related changes in, 499 Left ventricular dysfunction cardiogenic shock secondary to See Cardiogenic shock determining type and degree of, 189–190, 190f ST-elevation myocardial infarction and, 115 Left ventricular ejection fraction, age-related changes in, 499 Left ventricular failure, cardiogenic shock and, 135, 136f Left ventricular hypertrophy aerobic training and, 580f hypertensive, 397, 400f Left ventricular outflow tract obstruction, exercise testing in, 475 Left ventriculography, 81, 82f–83f Leiomyosarcomas, cardiac, 538t Leisure activity, definition of, 609 Leriche’s syndrome, 389, 425 Lifestyle modification for hereditary cardiomyopathy, 179 for hypertension prevention and control, 401, 402b for myocardial infarction prevention, 121 for neurally mediated syncope, 267 Limb girdle muscular dystrophy, heart and, 509–510 Lipid(s) See also Dyslipidemias; High-density lipoprotein cholesterol; Low-density lipoprotein cholesterol exercise and, 613–614 Lipid storage myopathy, heart and, 511 Lipomas, cardiac, 536t, 537 Liposarcomas, cardiac, 538t Lisinopril for heart failure, 192t Liver transplantation for amyloidosis, 172 Liver-heart transplantation for amyloidosis, 172 Loeys-Dietz syndrome, peripheral vascular disease and, 389 Löffler’s endocarditis See Eosinophilic endocarditis Long QT syndrome genetics of, 604–605, 607f sudden cardiac death in, 254f, 255 Long RP tachycardia, 225, 226f Loop diuretics for dilated cardiomyopathy, 151–152 Loop recorders in syncope, 265–266 Lopinavir, cardiovascular disease and, 559 Losartan for heart failure, 192t Low-molecular-weight heparin for non– ST-elevation myocardial infarction, 111 Low-density lipoprotein cholesterol See also Dyslipidemias in diabetes mellitus, 523–524 elevated, in older adults, 599 exercise and, 613 Low-output syndrome, 193 Lung cancer, metastatic to heart, 538–539 Lung transplantation for pulmonary hypertension, 545 LVH See Left ventricular hypertrophy Lyme myocarditis treatment of, 185 Lymphadenopathy, cervical, in Kawasaki’s disease, 477 Lymphomas, cardiac, 535, 538t diffuse B-cell, 538 in HIV/AIDS, 557 non-Hodgkin’s, 538 M Ma huang, 556 Macroreentrant atrial tachycardia, catheter ablation of, 282, 283f for atypical atrial flutter, 280t, 282 for typical atrial flutter, 282 Magnetic resonance angiography in abdominal aortic aneurysms, 395 in atherosclerosis, 591f in carotid artery disease, 392–393 in lower extremity peripheral vascular disease, 391, 391f in preventive cardiology, 593 in renal artery stenosis, 393 Magnetic resonance imaging, 27–28, 27f–28f cardiac See Cardiac magnetic resonance imaging in constrictive pericarditis, 365–367, 380 contrast agents for, 27–28, 28f in pericardial effusion, 369 in pericardial tamponade, 380 in restrictive cardiomyopathy, 167t, 170 Malignancy(ies) cardiac primary, 538, 538t secondary, 538–539, 539f pericardial effusion due to, 367, 369 Maneuvers in cardiac examination, 11–13, 13f Marfan’s syndrome aortic regurgitation in, 297, 299f in athletes, sudden cardiac death due to, 579 peripheral vascular disease and, 389 pregnancy in, 492 signs of, 8, 9f Maze procedure for atrial fibrillation, 238f, 239 McLeod’s syndrome, heart and, 510 MDCT See Multidetector computed tomography Mechanical circulatory support devices (MCSDs), 201–205 FDA-approved, 203–204, 203t, 204f future directions for, 205 indications for, 201–203, 202f patient selection for, 201–203 results with, 204–205 Medications cardiovascular See also specific drugs and drug types sleep and, 568 noncardiac See also specific drugs and drug types cardiovascular toxicity of, 571–573, 572b Medtronic freestyle valve, 355f Medtronic-Hall pivoting disk valve, 353, 355f Melanomas, metastatic to heart, 538–539 Mesenteric ischemia endovascular therapy for, 415–416 surgical treatment of, 428 Mesotheliomas cardiac, 538t pericardial, 538 Metabolic factors in cardiovascular disease, 605–608 Metabolic syndrome, 619–620, 620f exercise and, 614 signs of, 99, 99b Meta-iodobenzylguanidine scanning, 59–60 Metastatic disease, cardiac, 538–539, 539f Methotrexate, cardiac pathology associated with, 531 Methyldopa for hypertension in pregnancy, 494 Methysergide, cardiovascular toxicity of, 572, 573f Metoprolol succinate for dilated cardiomyopathy, 151–152 for heart failure, 192t Metoprolol tartrate for heart failure, 192t Mexiletine for hypokalemic periodic paralysis, 511 MI See Myocardial infarction; Non–STelevation myocardial infarction; ST-elevation myocardial infarction MIBG scanning See Meta-iodobenzylguanidine scanning Microbubbles in contrast echocardiography, 47–48 Milrinone for heart failure, 193 Mineralocorticoid disorders, cardiovascular manifestations of, 521, 522f Mitochondrial disorders, heart and, 511 MitraClip, 345, 346f Mitral annuloplasty percutaneous, direct and indirect techniques for, 348–349 transvenous, percutaneous, 345 Mitral edge-to-edge repair, percutaneous, 345, 346f 644  Index Mitral regurgitation, 345–349 cardiogenic shock and, 136, 137f clinical presentation of, 306–307 differential diagnosis of, 307 etiology and pathogenesis of, 305, 308f–309f future directions for, 312 grading of, left heart catheterization for, 81 hypertrophic cardiomyopathy and, 157 management and therapy for, 311–312 avoiding treatment errors and, 311–312, 312f optimum treatment and, 311 in older adults, 503 pathophysiology of, 345 percutaneous intervention for direct and annuloplasty approaches for, 348–349, 348f–349f edge-to-edge repair as, 345, 346f indications for, 345 transcatheter coronary sinus techniques as, 346–348, 347f during pregnancy, 493t right heart catheterization in, 81t Mitral stenosis, 341–345 clinical presentation of, 305–306 diagnostic approach for, 308 differential diagnosis of, 307 etiology and pathogenesis of, 305, 306f–307f future directions for, 312 management and therapy for, 308–311 avoiding treatment errors and, 309–311 optimum treatment and, 308–309, 310t–311t in older adults, 503 pathophysiology of, 341, 342f percutaneous intervention for acute results and complications with, 344, 344t double-balloon techniques for, 342f, 343 indications for, 341–343, 343t Inoue balloon method for, 343–344 long-term results with, 344–345 surgical commissurotomy compared with, 344–345 technique for, 343–344 pregnancy in, 492–493, 493t right heart catheterization in, 81t Mitral valve, anatomy of, 136, 137f Mitral valve prolapse, 313–317 clinical presentation of, 313, 314f complications of, 315–316 diagnostic approach for, 314–315, 315f differential diagnosis of, 313–314 etiology and pathogenesis of, 313 future directions for, 317 management and therapy for, 316–317 avoiding treatment errors and, 316–317 optimum treatment and, 316 Mitral valve repair, 355 for mitral regurgitation, 311 Mitral valve replacement, 355 for mitral stenosis, 309, 310t–311t Mitral valvotomy, open, for mitral stenosis, 309 Mitralign System, 348 Mobitz type I block, 215–218, 218f Mobitz type II block, 215–218, 218f Mobius Leaflet Repair System, 345 Molecular imaging for acute coronary syndromes risk detection, 91, 92f Monoamine oxidase inhibitors, hypertensive crisis due to, 522 Morphine sulfate for non–ST-elevation myocardial infarction, 111 MPI See Myocardial perfusion imaging MRA See Magnetic resonance angiography MRI See Cardiac magnetic resonance imaging; Magnetic resonance imaging MUGA scanning See Multiple-gated acquisition scanning Müller’s sign, 302t Multidetector computed tomography, 61–62 Multifascicular blocks, chronic, 219–220, 219b, 220t Multigated radionuclide angiography in restrictive cardiomyopathy, 169–170 Multiple-gated acquisition scanning, 56–58, 58f clinical applications of, 58 Murmurs examination for, 11, 12f during pregnancy, 490–491 Muscle diseases See also specific diseases heart and, 507–512 future directions for, 513–514 Muscular dystrophy Becker’s, heart and, 507 dilated cardiomyopathy and, 148 Duchenne’s, heart and, 507, 508f Emery-Dreifuss, heart and, 507–508 facioscapulohumeral, heart and, 509 heart and, 507 limb girdle, heart and, 509–510 Muscular subaortic stenosis, 155 Mutations, 603, 605b, 606f MVP See Mitral valve prolapse Myocardial changes, age-related changes in, 499 Myocardial fibrosis, 397, 399f Myocardial infarction as atherosclerosis presentation, 17–18 cardiogenic shock after See Cardiogenic shock cocaine-induced, 555 electrocardiography in, 36–37, 37f manifestations of, 108f non–ST-elevation See Non–ST-elevation myocardial infarction in older adults, 502–503 in pregnancy, 497 protease inhibitors and, 572 ST-elevation See ST-elevation myocardial infarction Myocardial ischemia, 116f See also Ischemic heart disease Myocardial perfusion imaging, 53–55, 55f radionuclide, screening for coronary artery disease using, 89 stress, 26 contraindications to, 55 stress with, 54–55, 55f Myocardial viability, imaging for assessment of, 58 Myocarditis, 181–186 clinical presentation of, 181–182, 184b diagnostic approach for, 184, 184b, 185f differential diagnosis of, 184 etiology and pathogenesis of, 181, 182b, 182f–183f future directions for, 185–186 giant cell, 181 infectious, 181–182, 182f–183f treatment of, 185 management and therapy for, 184–185 avoiding treatment errors and, 185 optimum treatment and, 184–185 in rheumatoid arthritis, 527–528 in systemic lupus erythematosus, 529 Myocyte death, imaging to detect, 60 Myofibrillar myopathy, heart and, 510 Myomectomy, surgical, for hypertrophic cardiomyopathy, 159 Myopathy See also Cardiomyopathy; Dilated cardiomyopathy; Hypertrophic cardiomyopathy; Restrictive cardiomyopathy; Stress-induced cardiomyopathy alcoholic, heart and, 512 distal, heart and, 510 inflammatory cardiac manifestations of, 528t–529t heart and, 511–512 lipid storage, heart and, 511 myofibrillar, heart and, 510 Myotomy, ventricular, subaortic, for hypertrophic cardiomyopathy, 159 Myotonic dystrophy, heart and, 508, 509f Myxedema heart, 518f Myxomas, 536–537, 536f, 536t clinical presentation of, 536–537 management and therapy for, 537 N Nafcillin for infective endocarditis, 330t Narcotic abuse, 555–556 Native Americans, cardiovascular disease in, 601 Natriuretic peptides in dilated cardiomyopathy, 150 Neisseria gonorrhoeae infections, 328 Neovascularization, atherosclerosis and, 385 Nerve diseases See also specific diseases heart and, 512–513 future directions for, 513–514 Nesiritide for heart failure, 193 Neurally mediated syncope, 261, 262t, 263f treatment of, 267–268 Neurohormones age-related changes in, 502 exercise and, 615 Nevirapine, cardiovascular disease and, 559 New York Heart Association Classification of Heart Disease, 6–7, 7t Niacin for dyslipidemias, 624 for triglyceride elevation, 104 Nicotinic acid for dyslipidemias, 623f Nitrates See also specific drugs for coronary heart disease, 103 for dilated cardiomyopathy, 151–152 for heart failure, 192–193, 192t for non–ST-elevation myocardial infarction, 111 Nitric acid, 630 Nitrogen-13 ammonia for PET, 54 Nitrogen dioxide, cardiovascular effects of, 630 Nitroglycerin for heart failure, 193 for hypertensive emergencies, 403t Nitroprusside for heart failure, 193 for hypertensive emergencies, 403t NNRTIs See Nonnucleoside reverse transcriptase inhibitors Nodular episcleritis with scleromalacia in rheumatoid arthritis, 528f Nonbacterial thrombotic endocarditis in HIV/ AIDS, 558 Noncardiac medications See also specific drugs cardiovascular toxicity of, 571–573, 572b coronary artery, 572 future directions for, 572–573 myocardial, 571 valvular, 571–572 Noncompaction left ventricular, hereditary, 176 restrictive cardiomyopathy due to, 164 Index  645 Non-Hodgkin’s lymphoma cardiac, 538 in HIV/AIDS, 557 metastatic to heart, 538–539 Nonnucleoside reverse transcriptase inhibitors, cardiovascular disease and, 559 Non–rapid eye movement sleep, 563 Non–ST-elevation myocardial infarction, 107–113 clinical presentation of, 107 diagnostic approach for, 108–110 biochemical markers in, 109–110, 109f electrocardiography in, 108f, 109 history and physical examination and, 108–109 differential diagnosis of, 107–108 etiology and pathogenesis of, 107, 108f future directions for, 113 management and therapy for, 110–113 anticoagulant drugs for, 111 anti-ischemic agents for, 111 antiplatelet agents for, 111–113 avoiding treatment errors and, 112f, 113 revascularization for, 113 risk stratification and, 110–111 Nonsteroidal anti-inflammatory drugs See also specific drugs for acute pericarditis, 362 Nonsustained ventricular tachycardia, management and therapy for, 248 Noonan’s syndrome, pulmonic stenosis in, 321 Norwood procedure for correction of hypoplastic left-sided heart syndrome (HLHS), 458–459, 458f, 459f NREM sleep See Non–rapid eye movement sleep NSAIDs See Nonsteroidal anti-inflammatory drugs; specific drugs NSTEMI See Non–ST-elevation myocardial infarction NSVT See Nonsustained ventricular tachycardia Nuclear cardiac imaging in restrictive cardiomyopathy, 169–170 Nuclear ventriculography See Ventriculography, nuclear Nucleoside reverse transcriptase inhibitors, cardiovascular disease and, 559–560 NYHA class See New York Heart Association Classification of Heart Disease O OAVRT See Orthodromic atrioventricular reentrant tachycardia Obesity, exercise and, 611 Obesity hypoventilation, 567–568 Obstructive sleep apnea, 564–567, 564b–565b, 564f–565f, 564t cardiac disease and, 565 clinical presentation of, 566, 566b diagnostic approach for, 566 differential diagnosis of, 566 heart failure treatment and, 565 hypertension and, 564–565 management and therapy for, 566–567 avoiding treatment errors and, 567 optimum treatment and, 566–567, 566f in stroke, 566 Older adults See Aging; Elderly persons Orthodromic atrioventricular reentrant tachycardia, 227 Orthodromic reciprocating tachycardia, 227 Orthostatic hypotension, syncope due to, 261, 262t, 264f OSA See Obstructive sleep apnea Osteosarcomas, cardiac, 538t Ostium primum defects, surgical treatment of, 459–460 Ostium secundum defects, 452f surgical treatment of, 459–460, 461f Oxacillin for infective endocarditis, 330t Oxygen demand exercise and, 613 increased, conditions causing, 4, 5b Oxygen pulse, 475 Oxygen supply, exercise and, 613 Oxygen utilization age-related changes in, 501–502 measurement of, right heart catheterization for, 80 Oxygen-15 water for PET, 54 Ozone, cardiovascular effects of, 630 P P wave, 31, 33f in ventricular tachycardia, 242, 243f Pacemakers biventricular, indications for, 271, 273f electromagnetic interference and, 273–275 future directions for, 275 implantation of, 272–273 indications for, 271, 272f long-term follow-up with, 273 postimplantation care for, 273 technology of, 271 Pacing, permanent in atrioventricular blocks, indications for, 221t–222t in chronic bifascicular block, indications for, 220t for hypertrophic cardiomyopathy, 159 in sinus node dysfunction, indications for, 221t Paget-Schroetter’s syndrome, endovascular therapy for, 415 Palliative surgery for congenital heart disease, 457–458, 458f–459f Palpitations history of, during pregnancy, differential diagnosis of, 491 Papillary fibroelastomas, 536t, 537 Parathyroid disorders, cardiovascular manifestations of, 519 Paroxetine for neurally mediated syncope, 268 Particulate matter, cardiovascular effects of, 627–630, 629f Patent ductus arteriosus arrhythmias in, 469, 471t surgical treatment of, 459 transcatheter closure of, 451–454, 451f PCI See Percutaneous coronary intervention PCWP See Pulmonary capillary wedge pressure Pediatric patients See also Congenital heart disease syncope in, 268 Penicillin for infective endocarditis, 330t Percutaneous coronary intervention, 123–128 adjunctive pharmacologic therapy with, 123 for atherosclerosis, 20–21 complications of, 124 coronary artery bypass grafting compared with, 126 for coronary artery disease, 104 coronary Doppler flow wire and, 126 coronary lesion selection for, 128 cutting balloon and, 126 devices to protect against distal embolization and, 125–126, 125f devices to remove thrombus and, 126 Percutaneous coronary intervention (Continued) equipment for, 123, 124f–125f future directions for, 128 high-speed rotational atherectomy and, 125, 125f indications for, 126–128 intravascular ultrasound and, 126, 127f for non–ST-elevation myocardial infarction, 113 outcomes with, 123–124 patient selection for, 126–128 procedure for, 123 for ST-elevation myocardial infarction, 117–119, 120f usage statistics for, 124f Percutaneous septal sinus shortening (P3 system), 349 Pergolide, cardiovascular toxicity of, 572, 573f Pericardial cysts, 537 Pericardial disease, 361–370 See also specific conditions cardiac computed tomography to evaluate, 64 as cardiac magnetic resonance imaging indication, 67 future directions for, 370 Pericardial effusion, 367–370 clinical presentation of, 367–368, 368f diagnostic approach for, 369 differential diagnosis of, 368–369 etiology and pathogenesis of, 367 in HIV/AIDS, 557–558 management and therapy for, 369–370 avoiding treatment errors and, 369–370 optimum treatment and, 369 transthoracic echocardiography in, 45–46 Pericardial knock in constrictive pericarditis, 364 Pericardial mesotheliomas, 538 Pericardial sac, 362f Pericardial sclerosis, 369 Pericardial tamponade, 368, 368f clinical presentation of, constrictive pericarditis compared with, 379t diagnostic approach for, 379–381 hemodynamics in, 375–377, 378f constrictive pericarditis compared with, 375–376, 378t echo-Doppler features and, 377 pressure measurements and, 375–376, 378t intracardiac pressure in, 373f management and therapy for, 534 right heart catheterization in, 81t in systemic lupus erythematosus, 528–529 Pericardial window for pericardial effusion, 369, 534 Pericardiectomy for constrictive pericarditis, 367 Pericardiocentesis for pericardial effusion, 369 for pericardial tamponade, 534 Pericardiotomy, balloon, for pericardial effusion, 369 Pericarditis acute, 361–363 clinical presentation of, 361 diagnostic approach for, 361–362, 365f differential diagnosis of, 361 etiology and pathogenesis of, 361, 363f–364f management and therapy for, 362–363 constrictive See Constrictive pericarditis in HIV/AIDS, 557–558 management and therapy for, 534 purulent, 364f in rheumatoid arthritis, 527, 528f, 528t in systemic lupus erythematosus, 528–529 tuberculous, 364f 646  Index Pericardium anatomy of, 137f carcinomatous infiltration of, 364f Perindopril for heart failure, 192t Peripartum cardiomyopathy, 181, 495 Peripheral edema, history of, 7–8 Peripheral vascular disease, 389–396 abdominal aortic aneurysms as, 395 clinical presentation of, 395 diagnostic approach for, 395 carotid artery disease as, 391–393 clinical presentation of, 391–392 diagnostic approach for, 392–393 etiology and pathogenesis of, 389, 421, 422f future directions for, 395–396 interventional approaches for, 413–419 future directions for, 418, 418f for lower extremity disease, 416, 417f for stroke, 413–414, 414f–415f for upper extremity disease, 414–415 for visceral artery disease, 415–416 lower extremity, 389–391 clinical presentation of, 389 diagnostic approach for, 389–391 masking coronary heart disease, in older adults, 504, 505f pregnancy in, 492 renal artery stenosis as, 393 clinical presentation of, 393 diagnostic approach for, 393, 394f signs of, surgical treatment of, 421–429 for abdominal aortic aneurysms, 421–424, 423f for aortic dissections, 428 for carotid disease, 427 for femoral aneurysms, 424 future directions for, 428–429 for lower extremity atherosclerosis, 425–427, 425f–426f for popliteal aneurysms, 424 for thoracic aneurysms, 423f, 424 for visceral disease, 427–428 Permanent junctional reciprocating tachycardia, 227 Permanent pacing in atrioventricular blocks, indications for, 221t–222t in chronic bifascicular block, indications for, 220t for hypertrophic cardiomyopathy, 159 in sinus node dysfunction, indications for, 221t PET See Positron emission tomography Pharyngitis in Kawasaki’s disease, 477 Phase velocity mapping, 65 Phenotype, 603, 605b, 606f Phenoxybenzamine for hypertensive crises, 522 Phentermine, cardiovascular toxicity of, 571–572, 572f Pheochromocytoma, cardiovascular manifestations of, 521–522, 523f Photoplethysmography in lower extremity arterial disease, 425–426 Physical activity See also Athletes; Exercise definition of, 609 Physical examination, 8–13 cardiac auscultation in, 10–11, 12f components of, 8–10, 10f general inspection and vital signs in, 8, 9f Physical fitness, definition of, 609 Pickwickian syndrome, 567–568 Pituitary gland disorders, cardiovascular manifestations of, 515–516, 516t Plaque, fibrous, atherosclerotic See Atherosclerotic plaque Plasmapheresis for dyslipidemias, 624 Platelet inhibitors for ST-elevation myocardial infarction, 117–118 Pleural pressure, 371, 372f Pollution See Air pollutants, cardiovascular effects of Polyarteritis nodosa, cardiac manifestations of, 531 Polymorphic ventricular tachycardia, management and therapy for, 248 Polymorphism, 605b Polymyalgia rheumatica, diagnosis of, 533 Polymyositis, cardiac manifestations of, 530, 531f Polyneuropathy, diphtheric, heart and, 513 Pompe’s disease, heart and, 511 Popliteal aneurysms, 424 clinical presentation of, 424 surgical treatment of, 424 Positron emission tomography, 26–27, 27f in atherosclerosis, 591f PET-CT and, 56 radiotracers for, 53 Postinfectious arthritis, cardiac manifestations of, 529 Potassium, serum, QT interval and, 36 PR interval, 32 Precordium, palpation of, 10 Prednisone for myocarditis, 185 Preeclampsia, 407f, 490f, 494, 496f Pregnancy, 489–498 cardiovascular disease during acute myocardial infarction as, 497 cardiomyopathy as, 495–496 diagnostic approach for, 491 differential diagnosis of, 491 eclampsia as, 494–495, 496f future directions for, 497 hypertension as, 494–495, 495t, 496f management and therapy for, 497 preexisting disease states and, 491–494 pulmonary edema as, induced by tocolytic therapy, 496–497 supraventricular tachycardia as, 231 unique to pregnancy, 494–497, 495t, 496f cardiovascular drugs and, 497 in congenital heart disease, 491–492, 492t in Eisenmenger’s syndrome, 492 in heart failure, 494 labor and delivery and, physiologic changes during, 489 in Marfan’s syndrome, 492 normal, cardiac examination during, 490–491, 491t physiologic changes during, 489, 490f postpartum physiologic changes and, 489 in pulmonary vascular disease, 492 toxemia of, 407f in valvular Huntington’s disease, 492–494, 493t Premature atrial contractions, exercise testing in, 476 Premature ventricular contractions exercise testing in, 476 management and therapy for, 248–249 Preventive cardiology, 590–593, 592b barriers to, 593b future directions for, 593–594 Prior probability concept, Procainamide for ventricular tachycardia, 244–245 Propafenone for atrial fibrillation, 236–238 Propranolol for coronary heart disease, 103 for supraventricular tachycardia, 230 Prosthetic valve(s) first-generation, 353, 354f during pregnancy, 494 second-generation, 353, 355f Prosthetic valve endocarditis, 328 antimicrobial therapy for, 330t Prosthetic valve replacement algorithm for valve selection for, 356f issues with, 355 Prosthetic valve stenosis, 350 pathophysiology of, 350 percutaneous valve replacement for, 350 valvuloplasty for, 350 Protease inhibitors, cardiovascular disease and, 559, 572 Pseudoaneurysms with percutaneous coronary intervention, 124 Pseudomonas endocarditis, 327–328 Psoriatic arthritis, cardiac manifestations of, 529 Pulmonary artery atresia, coronary artery anomalies associated with, 485 Pulmonary artery band, 457 Pulmonary artery catheterization, 79 See also Right heart catheterization Pulmonary artery flow, increased, in congenital heart disease, 437–438, 437f Pulmonary artery pressure, 541, 542b estimation of, 542 measurement of, right heart catheterization for, 79 Pulmonary artery stenosis, balloon angioplasty for, 447–449, 450f Pulmonary atresia, echocardiography in, 444, 445f Pulmonary capillary wedge pressure, measurement of, right heart catheterization for, 79 Pulmonary edema as indication for revascularization, in atherosclerotic renal artery stenosis, 411 induced by tocolytic therapy, 496–497 Pulmonary embolism, cardiac computed tomography to evaluate, 64 Pulmonary fibrosis, cardiac manifestations of, 531–532 Pulmonary function testing in pulmonary hypertension, 543t Pulmonary hypertension, 541–545 anticoagulation for, 534 arterial, 542b associated with hypoxemia, 542b clinical presentation of, 541–542, 543f in congenital heart disease, diagnosis of, 437 in connective tissue diseases, 532 diagnostic approach for, 542, 543t–544t differential diagnosis of, 542 due to chronic thrombotic or embolic disease, 542b etiology and pathogenesis of, 541, 542b in HIV/AIDS, 557 management and therapy for, 542–545 optimum treatment and, 542–545 venous, 542b Pulmonary thromboembolism, 545–550 clinical presentation of, 546 diagnostic approach for, 546–549, 546f–548f, 549t differential diagnosis of, 546 etiology and pathogenesis of, 545 future directions for, 550 management and therapy for, 549–550 Index  647 Pulmonary thromboembolism (Continued) avoiding treatment errors and, 550 optimum treatment and, 549–550 Pulmonary valve replacement, percutaneous, 335–336 complications and early results with, 336 indications for, 335 intermediate-term results with, 336 technique for, 336 Pulmonary valve stenosis, 321–322, 333–336 arrhythmias in, 470 clinical presentation of, 321 diagnostic approach for, 322 etiology and pathogenesis of, 321, 322f exercise testing in, 475 infundibular, 460–462 management and therapy for, 322 balloon valvuloplasty in, 447, 448f percutaneous balloon pulmonary valvuloplasty in, 333–335, 335f percutaneous pulmonary valve replacement in, 335–336 pathophysiology of, 333, 334f during pregnancy, 492–493 Pulmonary valvular atresia, 448f Pulmonary valvuloplasty, balloon, percutaneous, 333–335, 335f indications for, 333 long-term results with, 334–335 short-term results and complications with, 334 technique for, 333–334 Pulmonary vascular disease as cardiac magnetic resonance imaging indication, 68 pathophysiology of, 435, 437f Pulmonary vein(s), electrical isolation by radiofrequency catheter ablation, 284 Pulmonary vein stenosis, cardiac computed tomography to evaluate, 64 Pulmonic regurgitation, 322–323 clinical presentation of, 322–323 diagnostic approach for, 323 etiology and pathogenesis of, 322 future directions for, 323 management and therapy for, 323 Pulmonic valvuloplasty, percutaneous, for pulmonic stenosis, 322 Purulent pericarditis, 364f PVD See Peripheral vascular disease Q QRS complex, 32–34, 34f in ventricular tachycardia, 241–242, 243f Quantum-Cor radiofrequency ablation, 349 Quinapril for heart failure, 192t Quincke’s sign, 302t R Race, cardiovascular disease and, 601 Radial artery occlusion with percutaneous coronary intervention, 124 Radiation therapy, restrictive cardiomyopathy due to, 163–164 Radiofrequency ablation, 349 for sudden cardiac death prevention, 258 Radionuclide testing, 25–27, 27f Radionuclide ventriculography See Ventriculography, nuclear Radiotracers for cardiac stress imaging, 53–54 Ramipril for coronary heart disease, 103 for heart failure, 192t Rapid eye movement sleep, 563 RAS See Renal artery stenosis Rash in Kawasaki’s disease, 477, 478f Rate-dependent aberrant ventricular conduction, electrocardiographic criteria for, 33 Reactive systemic disease, 161 Recessive mutation, 605b Refsum’s disease, heart and, 513 REM sleep See Rapid eye movement sleep Renal artery revascularization, 409–410, 410f–412f indications for, in atherosclerotic renal artery stenosis, 410–411 Renal artery stenosis, 393, 405–412 clinical presentation of, 393, 405, 407f diagnostic approach for, 393, 394f, 409, 409f differential diagnosis of, 405–409, 408f etiology and pathogenesis of, 405, 406f future directions for, 412 management and therapy for, 409–412 avoiding treatment errors and, 411–412 renal artery revascularization in, 409–410, 410f–412f natural history of, 405 Renal preservation as indication for revascularization in atherosclerotic renal artery stenosis, 411 Renal scans, captopril, in renal artery stenosis, 393, 394f Renin, 521 Renin inhibitors, direct, for hypertension, 402 Renin-angiotensin-aldosterone system, cardiomyopathy and, 145 Repolarization, early, 35 Restenosis following percutaneous coronary intervention, 124 Restless legs syndrome, 568, 568b Restrictive cardiomyopathy, 161–173 classification of, 162b clinical presentation of, 164 constrictive pericarditis versus, 364–365 diagnostic approach for, 166–171, 167t blood tests in, 166–167 cardiac catheterization in, 170–171 cardiac nuclear imaging in, 169–170 chest radiography in, 167 computed tomography in, 170 echocardiography in, 167–169, 168f, 170f electrocardiography in, 166 endomyocardial biopsy in, 171 magnetic resonance imaging in, 170 differential diagnosis of, 164–166 constrictive pericarditis physiology and, 165–166, 166f normal hemodynamics and, 164–165, 165f–166f restrictive cardiomyopathy physiology and, 166, 166f endomyocardial causes of, 162–164, 163f etiology and pathogenesis of, 161–164, 162b future directions for, 172–173 infiltrative causes of, 161–162 management and therapy for, 171–172 avoiding treatment errors and, 172 for diastolic heart failure, 171–172, 171b optimum treatment and, 171–172 noninfiltrative causes of, 161, 162f physiology of, 165–166, 166f right heart catheterization in, 81t Reteplase for ST-elevation myocardial infarction, 117–118 Retina, examination of, 8–9 Retroperitoneal hemorrhage with percutaneous coronary intervention, 124 Revascularization See also Coronary artery bypass grafting; Percutaneous coronary intervention for atherosclerosis, 20–21 for heart failure, 190–191 for non–ST-elevation myocardial infarction, 113 Reynolds Risk Score, 601 Rhabdomyomas, 536f, 536t cardiac, 537 Rhabdomyosarcomas, 536f cardiac, 538, 538t Rheumatic disease aortic regurgitation due to, 297, 298f aortic stenosis due to, 289 mitral stenosis due to, 305, 341 pregnancy in, 492–493 tricuspid stenosis due to, 319 Rheumatoid arthritis, cardiac manifestations of, 527–528, 528f, 528t–529t Rheumatoid factor, elevation of, 533 Rheumatoid nodules, 528f Rhythm control for atrial fibrillation, 236–239, 238f Right bundle branch block, electrocardiographic criteria for, 33 Right heart catheterization, 79–81 complications of, 80 contraindications to, 80 data obtained from, 80–81, 81t future directions for, 83 indications for, 79, 80b Right heart failure, 148, 149f Right ventricular dysplasia, arrhythmogenic, hereditary, 176, 178f, 178t Right ventricular failure, cardiogenic shock and, 135–136, 137f Right ventricular hypertrophy, 460–462 Right ventricular impulse, palpation of, 10 Right ventricular outflow tract ventricular tachycardia, management and therapy for, 247–248 Risk factor modification for atherosclerosis, 21 Ritonavir, cardiovascular disease and, 559 Ross procedure for aortic regurgitation, 303 Rubidium-82 chloride for PET, 53 S St Jude bileaflet valve, 353, 355f Salmonella endocarditis, 327 Saphenous vein grafts autologous, 427 obstructive disease in, percutaneous coronary intervention for, 128 Sarcoidosis imaging for assessment of, 58 myocarditis due to, 181, 183f restrictive cardiomyopathy due to, 161–162, 162f treatment of, 172 ventricular tachycardia in, management and therapy for, 247 Sarcomas, cardiac, 538 neurogenic, 538t synovial, 538t SCD See Sudden cardiac death Scleroderma, cardiac manifestations of, 528t–529t, 530, 532f Secondhand tobacco smoke, 629–630 Selective serotonin reuptake inhibitors for neurally mediated syncope, 268 Septal ablation, alcohol, for hypertrophic cardiomyopathy, 159 Septal sinus shortening, percutaneous, 349 648  Index Seronegative spondyloarthropathies, cardiac manifestations of, 529, 530f Serositis in systemic lupus erythematosus, 528–529 Shock cardiogenic See Cardiogenic shock vasodilatory, right heart catheterization in, 81t Sick sinus syndrome, 215 Sildenafil for erectile dysfunction, in hypertrophic cardiomyopathy, 159 for pulmonary hypertension, 544t Single ventricle, echocardiography in, 445, 446f Single-photon emission computed tomography image interpretation and, 56, 56t, 57f imaging protocols for, 55 SPECT-CT and, 56 Single-ventricle lesions, surgical treatment of, 458–459 Single-ventricle malformation, exercise testing in, 475–476 Sinoatrial exit block, 215, 217f Mobitz type I (Wenckebach), 215–218, 218f Mobitz type II, 215–218, 218f Sinus arrest, 215, 217f Sinus bradycardia, inappropriate, 215 Sinus node, depolarization of, 31 Sinus node dysfunction, 215 inappropriate sinus bradycardia and, 215 permanent pacing in, indications for, 221t sinoatrial exit block and, 215, 217f sinus arrest and, 215, 217f tachy-brady syndrome and, 215 Sinus venosus defects, 452f surgical treatment of, 459–460, 461f SLE See Systemic lupus erythematosus Sleep apnea central, 567 obstructive See Obstructive sleep apnea Sleep deprivation, 563 Sleep disorders, 563–569 breathing disorders as, 563–568, 564b cardiovascular medications and, 568 future directions for, 568 normal sleep physiology and, 563 restless legs syndrome as, 568, 568b sleep length and health and, 563 Slow-fast tachycardia, 223 Smeloff-Cutter valve, 353, 354f Smoking cessation for coronary heart disease, 100–101 Smooth muscle cells, atherosclerotic pathogenesis and, 15–17 Socioeconomic status, cardiovascular disease and, 601 Sotalol for atrial fibrillation, 236–239 for premature ventricular complexes, 248–249 for ventricular tachycardia in dilated cardiomyopathy, 247 nonsustained, 248 SPECT See Single-photon emission computed tomography “Spike-and-dome” pulse pattern in hypertrophic cardiomyopathy, 157 Spin echo imaging for cardiac magnetic resonance imaging, 65 Spironolactone for dilated cardiomyopathy, 151–152 for heart failure, 192t for hereditary cardiomyopathy, 179 for restrictive cardiomyopathy, 171–172 Spondyloarthropathies, seronegative, cardiac manifestations of, 529, 530f Sports See Athletes Springwater cysts, 537 Squatting in cardiac examination, 13f ST segment, 34–35 Standing in cardiac examination, 13f Staphylococcal endocarditis, 326 antimicrobial therapy for, 330t Starr-Edwards valve, 353, 354f Statins, 620–624, 621f, 623f for atherosclerosis, 21 for myocardial infarction prevention, 121 for ST-elevation myocardial infarction, 117–118 ST-elevation myocardial infarction, 115–121 clinical presentation of, 115, 116f diagnostic approach for, 116–117 cardiac markers in, 116–117 echocardiography in, 117 electrocardiography in, 116, 117f radiography in, 117 differential diagnosis of, 115 etiology and pathogenesis of, 115, 116f future directions for, 121 management and therapy for, 117–121 adjunctive therapy in, 119–120 avoiding treatment errors and, 119 for hemodynamic disturbances and arrhythmias, 120–121 optimum treatment and, 117–119, 118f–120f secondary prevention and, 121 Stem cells, atherosclerotic pathogenesis and, 17 STEMI See ST-elevation myocardial infarction Stenting of carotid artery, 413 coronary artery bypass grafting compared with, 104 for lower extremity peripheral artery disease, 416 to prevent restenosis, following percutaneous coronary intervention, 124 for ST-elevation myocardial infarction, 117–119, 119f Steroids anabolic, 556 corticosteroids as, for hypereosinophilic syndrome, 172 Stokes-Adams syndrome, 262–263 “Strawberry tongue” in Kawasaki’s disease, 477 Streptococcal endocarditis, antimicrobial therapy for, 330t Streptokinase for ST-elevation myocardial infarction, 117–118 Stress echocardiography, screening for coronary artery disease using, 89 Stress myocardial perfusion imaging, 26 Stress testing exercise See Exercise stress testing risk of, 130 Stress-induced cardiomyopathy, 207–211, 208f diagnostic approach for, 208–210 biomarkers in, 209 cardiac catheterization in, 209, 209f cardiac magnetic resonance imaging in, 210 electrocardiography in, 208 endomyocardial biopsy in, 210 transthoracic echocardiography in, 209–210 differential diagnosis of, 207–208 etiology and pathogenesis of, 207 future directions for, 210 management and therapy for, 210 avoiding treatment errors and, 210 optimum treatment and, 210 Stroke cardioembolic, interventional approaches for, 413–414, 417f Stroke (Continued) carotid artery stenosis and, interventional approaches for, 413, 414f cerebral arterial occlusive disease and, interventional approaches for, 413 in older adults, 503–504, 504f Subaortic stenosis fibrous, 156f hypertrophic, 155, 156f Subclavian stenosis, endovascular therapy for, 414 Substance abuse, 553–556, 554f of alcohol, 553–555, 554f among athletes, 556 of cocaine, 554f, 555 future directions for, 556 of intravenous drugs, 554f, 555 of narcotics, 555–556 of tobacco, 553, 554f Sudden cardiac death, 251–260, 252b, 252f as atherosclerosis presentation, 18 in athletes, 575–585 avoiding treatment errors and, 582f, 583 causes of, 575–579 diagnostic approaches for, 580–583 future directions for, 583 structural changes of heart as result of intense training and, 578f, 579–580 diagnostic approach for, 256 differential diagnosis of, 251–256 etiology of, 251, 253f future directions for, 259 management and therapy for, 258–259 avoiding treatment errors and, 259 implantable cardioverter-defibrillator trials in, 256–258, 257t optimum treatment and, 258–259, 258b risk factors for, 251 in young athletes, 256 Sulfur dioxide, cardiovascular effects of, 630 Supraventricular tachycardia, 223–231 clinical presentation of, 223 differential diagnosis of, 223–229 atrial tachycardia and, 228–229, 229f atrioventricular nodal reentrant tachycardia and, 223–225, 224f–226f atrioventricular reentrant tachycardia and, 225–228, 227f–228f etiology and pathogenesis of, 223 future directions for, 231 management and therapy for, 229–231 avoiding treatment errors and, 231 optimum treatment and, 229–231, 230f in pregnancy, 231 prognosis of, 231 in special populations, 231 Surgical ablation for atrial fibrillation, 238f, 239 SVR See Systemic vascular resistance SVT See Supraventricular tachycardia Swan-Ganz catheter, 79 See also Right heart catheterization SynCardia CardioWest, 203, 203t Syncope, 261–269 with aortic stenosis, 289–290 cardiac arrhythmias causing, 261, 262t cardiac outflow obstruction causing, 261, 262t cerebrovascular disorders causing, 262, 262t clinical presentation of, 262–263, 264b diagnostic approach for, 264–267, 265f differential diagnosis of, 263–264 etiology and pathogenesis of, 261–262, 263f–264f future directions for, 268 history of, 7b, Index  649 Syncope (Continued) management and therapy for, 267–268 avoiding treatment errors and, 268 optimum treatment and, 267–268 for special populations, 268 neurally mediated (vasovagal), 261, 262t, 263f treatment of, 267–268 orthostatic hypotension causing, 261, 262t, 264f risk assessment for, 267, 267t Syndrome of inappropriate antidiuretic hormone, cardiovascular manifestations of, 516 Systemic lupus erythematosus cardiac manifestations of, 528–529, 528t–529t, 531–532 drug-induced, 533 treatment of, 534 Systemic vascular resistance measurement of, right heart catheterization for, 80 during pregnancy, 489 Systolic heart failure See also Dilated cardiomyopathy etiology and pathogenesis of, 187, 188f T T wave, 34–35 Tachy-brady syndrome, 215 Tachyphylaxis, nitrate therapy and, 103 Takayasu’s arteritis, cardiac manifestations of, 531 Takotsubo cardiomyopathy, 207 See also Stress-induced cardiomyopathy Tamponade See Pericardial tamponade Technetium-99m for cardiac stress imaging, 53–54 TEE See Transesophageal echocardiography Temporal artery biopsy in giant cell arteritis, 533 Tenecteplase for ST-elevation myocardial infarction, 117–118 Teratomas cardiac, 536t malignant, cardiac, 538t Tetralogy of Fallot, 435f, 483f arrhythmias in, 465, 467f, 471t coronary artery anomalies associated with, 485 echocardiography in, 444, 444b, 445f exercise testing in, 475 surgical treatment of, 460–462, 462f Thallium-201 for cardiac stress imaging, 53–54 Thiazide diuretics for hypertension, 401–402, 403t Thienopyridines for non–ST-elevation myocardial infarction, 111–112 Thoracic aneurysms, 424 clinical presentation of, 424 surgical treatment of, 424 Thoracic outlet syndrome, endovascular therapy for, 415 Thoratec implantable ventricular assist devices, 203, 203t Thoratec paracorporeal ventricular assist devices, 203, 203t Three-dimensional echocardiography, 25 Thrombi, removal of, with percutaneous coronary intervention, 126 Thrombin inhibitors, direct, for non–STelevation myocardial infarction, 111 Thromboangiitis obliterans, peripheral vascular disease and, 389 Thromboembolism prevention of, with atrial fibrillation, 236, 237f Thromboembolism (Continued) pulmonary See Pulmonary thromboembolism Thrombolysis in Myocardial Infarction scale, 71 Thrombolytic therapy for ST-elevation myocardial infarction, 117–118 Thrombosis with percutaneous coronary intervention, 123 Thrombotic endocarditis, nonbacterial, in HIV/ AIDS, 558 Thymomas, cardiac, 538t Thyroid disorders, cardiovascular manifestations of, 516–519 Thyrotoxicosis, amiodarone-induced, 518 TIMI scale, 71 Tipranavir, cardiovascular disease and, 559 Tobacco smoke, secondhand, 629–630 Tobacco use, 553, 554f Tocolytic therapy, pulmonary edema induced by, 496–497 Torsemide for restrictive cardiomyopathy, 171–172 Total anomalous pulmonary venous return echocardiography in, 444 surgical treatment of, 462 Toxin-induced neuropathies, heart and, 513 Trandolapril for heart failure, 192t Transesophageal echocardiography, 24, 24f, 46 in congenital heart disease, 441 in constrictive pericarditis, 375 in infective endocarditis, 328, 329f limitations of, 48 positions for, 25f Transient left ventricular apical ballooning See Stress-induced cardiomyopathy Transposition of the great arteries, 483f D-transposition as arrhythmias in, 465, 468f, 471t coronary artery anomalies associated with, 484f, 485 echocardiography in, 443–444 exercise testing in, 475 L-transposition as, arrhythmias in, 470, 471t repair of, technique for, 434f surgical treatment of, 462, 463f, 484f Transthoracic echocardiography See Echocardiography, transthoracic Trastuzumab, cardiovascular toxicity of, 571 Traube’s sign, 302t Treadmill stress testing See Exercise stress testing Treprostinil for pulmonary hypertension, 544t Triangle of Koch, anatomy of, 280f Tricuspid annuloplasty for tricuspid stenosis, 321 Tricuspid atresia arrhythmias in, 465–467, 468f, 471t surgical treatment of, 458 Tricuspid regurgitation, 319–321 clinical presentation of, 320 diagnostic approach for, 320–321 etiology and pathogenesis of, 319–320 management and therapy for, 321 Tricuspid stenosis, 319, 323, 349–350 clinical presentation of, 319, 320f differential diagnosis of, 319, 320b etiology and pathogenesis of, 319 management and therapy for, 319 pathophysiology of, 349–350 percutaneous catheter-based therapy for indications for, 350 procedure and results with, 350 Tricuspid valve repair, 355 Tricuspid valve replacement, percutaneous, 350 Tricyclic antidepressants, hypertensive crisis due to, 522 Trifascicular block, 219–220 Triglycerides, 619 See also Dyslipidemias elevation of, therapy for, 104 Troponins I and T, 25–27 in non–ST-elevation myocardial infarction, 110–111, 110f in ST-elevation myocardial infarction, 116–117 in stress-induced cardiomyopathy, 209 Trousseau’s sign in hypokalemia alkalosis, 522f Truncus arteriosus, surgical treatment of, 462–463, 463f TTE See Echocardiography, transthoracic Tuberculous pericarditis, 364f Tumor(s) adrenal medullary, cardiovascular manifestations of, 521–522, 523f cardiac See Cardiac tumors Tumor necrosis factor-α inhibitors, cardiac pathology associated with, 531 T-wave alternans in syncope, 267 U U wave, 35, 35f Ultrasound in abdominal aortic aneurysms, 395 Doppler See Doppler imaging duplex in carotid artery disease, 392, 392f in lower extremity peripheral vascular disease, 390, 390f handheld devices for, 46 intravascular, 48 for acute coronary syndromes risk detection, 92–93, 93f with percutaneous coronary intervention, 126, 127f venous, in pulmonary thromboembolism, 549 Unfractionated heparin for ST-elevation myocardial infarction, 120 United Network for Organ Sharing, 197–198 United States Preventive Service Task Force screening guidelines, 87f, 89–91, 90t V VADs See Ventricular assist devices Valsalva’s maneuver in cardiac examination, 13f Valsartan for heart failure, 192t Valvotomy balloon, for aortic stenosis, 294 mitral, open, for mitral stenosis, 309 Valvular evaluation, cardiac computed tomography for, 63–64 Valvular heart disease See also specific conditions as cardiac magnetic resonance imaging indication, 67–68 chest radiography in, 42 clinical presentation of, 354 diagnostic approach for, 354 differential diagnosis of, 354 dilated cardiomyopathy and, 145 etiology and pathogenesis of, 353–354 heart failure due to, 187 in older adults, 503 percutaneous catheter-based therapy for, 333–351 for aortic valve stenosis, 336–341 for bioprosthetic valve stenosis, 350 for mitral valve regurgitation, 345–349 for mitral valve stenosis, 341–345 for pulmonary valve stenosis, 333–336 for tricuspid valve stenosis, 349–350 pregnancy in, 492–494, 493t of prosthetic valves See Prosthetic entries in rheumatoid arthritis, 527, 528t 650  Index Valvular heart disease (Continued) surgical treatment of, 353–358 for aortic valves, 355, 356f avoiding treatment errors and, 355–357 first-generation prosthetic valves for, 353, 354f future directions for, 357 minimally invasive techniques for, 355–357, 357f for mitral and tricuspid valves, 355, 356f optimum treatment and, 354–355, 356f second-generation prosthetic valves for, 353, 355f in systemic lupus erythematosus, 529 transthoracic echocardiography in, 45 Valvular obstruction from cardiac tumors, 535 Valvuloplasty balloon, 447 for aortic stenosis, 447, 449f for pulmonary stenosis, 447, 448f percutaneous, for mitral stenosis in older adults, 503 Vancomycin for infective endocarditis, 330t Vascular examination, 9, 10f Vasculature, age-related changes in, 500–502, 501f Vasculitis See also Kawasaki’s disease cardiac manifestations of, 530–531 drug-induced, 533 Vasculogenesis, 387–388 Vasodilators for aortic regurgitation, 302 Vasodilatory shock, right heart catheterization in, 81t Vasoreactivity, coronary artery disease and, 97 Vasovagal syncope, 261, 262t, 263f treatment of, 267–268 Venous pulses in cardiac examination, 10f Ventilation/perfusion scans in pulmonary hypertension, 543t Ventilatory anaerobic threshold, 474–475 Ventricular assist devices, 201–205, 203t, 204f for dilated cardiomyopathy, 152 future directions for, 205 for hereditary cardiomyopathy, 179–180 results with, 204–205 Ventricular dyssynchrony, assessment of, 59 Ventricular ectopic beats, aging and, 500 Ventricular fibrillation in hypertrophic cardiomyopathy, sudden cardiac death and, 575 Ventricular function, evaluation of, as cardiac magnetic resonance imaging indication, 65–66, 66f Ventricular preexcitation, electrocardiographic criteria for, 33 Ventricular rate, control of, for atrial fibrillation, 235–236 Ventricular septal defect See also Tetralogy of Fallot arrhythmias in, 467–468, 471t echocardiography in, 442, 443f surgical treatment of, 459, 460f transcatheter closure of, 454, 454f Ventricular septal rupture, cardiogenic shock and, 136 Ventricular tachycardia, 241–249 catheter ablation of, 284–285 macroreentrant, 285 clinical presentation of, 242–244 diagnostic approach for, 244 differential diagnosis of, 241–242 electrocardiography in, 38f, 241–242, 243f–244f etiology and pathogenesis of, 241, 242f future directions for, 249 in hypertrophic cardiomyopathy, sudden cardiac death and, 575 idiopathic, catheter ablation of, 285 left, idioventricular, management and therapy for, 248 macroreentrant, catheter ablation of, 285 management and therapy for for accelerated idioventricular rhythm, 248 acute, 244–245, 245f avoiding treatment errors and, 245 longer-term, 245–249, 246f for monomorphic ventricular tachycardia, 246–248 for nonsustained ventricular tachycardia, 248 for polymorphic ventricular tachycardia, 248 for premature ventricular complexes, 248–249 monomorphic, management and therapy for, 246–248 nonsustained, management and therapy for, 248 polymorphic, management and therapy for, 248 Ventriculography, nuclear, in dilated cardiomyopathy, 150 Verapamil for atrial fibrillation, 235–236 for ventricular tachycardia, idioventricular, 248 Vessel wall stiffness, age-related changes in, 500–501, 501f Viacor PTMA, 345–347, 347f Viral infections, dilated cardiomyopathy and, 147–148, 148f Virchow’s triad, 545 Visceral artery disease, 427–428 clinical presentation of, 427–428 surgical treatment of, 428 V/Q lung scanning in pulmonary thromboembolism, 547–549 VSD See Ventricular septal defect VT See Ventricular tachycardia W Walker-Murdoch wrist sign in Marfan’s syndrome, 9f, 299f Warfarin during pregnancy, 494 Water-bottle heart, 379 Weight reduction for coronary heart disease, 101–102 “Wells Prediction Rules,” 546, 549t Wenckebach block, 215–218, 218f William’s syndrome, peripheral vascular disease and, 389 Wilson’s central terminal, 31 Wolff-Parkinson-White syndrome catheter ablation for, 280–281 exercise testing in, 476 prognosis of, 231 sudden cardiac death in, 256 treatment of, 230 Women cardiovascular disease in, 599–601, 600f coronary heart disease symptoms in, 599, 600f exercise and, 611 WPW See Wolff-Parkinson-White syndrome WPW pattern, 225–226, 227f X Xanthomatosis, hypercholesterolemic, 100f ... whose work has inspired the Netter Reference Collection: www.netterimages com/artist /netter. htm Carlos A G Machado, MD Carlos A G Machado was chosen by Novartis to be Dr Netter s successor He continues... Cataloging-in-Publication Data Netter s cardiology / edited by Marschall S Runge, George A Stouffer, Cam Patterson ; illustrations by Frank H Netter ; contributing illustrator, Carlos A G Machado. 2nd ed p ; cm... us.elsevierhealth.com /Netter; outside the United States: www elsevierhealth.com) Dr Netter s works are among the finest examples of the use of illustration in the teaching of medical concepts The 13-book Netter