Acute Coronary Syndromes-a Companion to Braunwald's Heart Disease-covers the state-of-the-art scientific and clinical information you need to rapidly evaluate and manage acute coronary syndromes. Dr. Pierre Theroux and his team of expert contributors present advances in diagnostic and imaging techniques such as biomarkers, nuclear cardiology, echocardiography, and multislice CT; secondary prevention; and new antiplatelet, anti-ischemic, and gene therapies.in print and online. Tap into the most definitive knowledge available from one of the leading experts in the field and a stellar cast of contributors. Understand the special considerations for the care of acute coronary syndromes in the emergency department and the coronary care unit. Effectively handle the treatment of special populations and chronic patients thanks to coverage of these challenges Access the fully searchable contents of the book online at expertconsult.com. See techniques and procedures in greater detail and clarity through the all-new full-color design. Approach treatment with a global perspective from the new section on Population-Based Perspective that discusses the INTERHEART study, insights from the REACH registry, lessons learned from European registries, and ACS in North America. Gain a comprehensive understanding of ACS through coverage of pathophysiology, molecular mechanisms, the role of the immune system, and brand-new chapters on cell necrosis and cell regeneration and pharmacogenetics in the section on Disease-Based Perspectives. Integrate the latest testing and treatment techniques into your practice thanks to new chapters on biomarkers in acute ischemic heart disease; the role of noninvasive testing in prognostic risk stratification; the culprit lesions and patient at risk; non-responsiveness to antiplatelet therapy; bleeding in the acute coronary syndromes; and the refractory patient.Covers the full spectrum of clinical management of ACS and the new scientific, diagnostic and treatment concepts
Author(s): Pierre Theroux MD
Edition: 2nd Edition
Publisher: Saunders
Year: 2010
Language: English
Pages: 449
Tags: Медицинские дисциплины;Кардиология;
Cover......Page 1
Front Matter......Page 2
ISBN: 9781416049272......Page 4
Copyright......Page 5
Dedication......Page 6
Contributors......Page 7
Foreword......Page 10
Preface......Page 11
LOOK FOR THESE OTHER TITLES IN THE BRAUNWALD’S HEART DISEASE FAMILY!......Page 15
A Florid Period......Page 16
Clinical Trials and Registries......Page 17
Evolving Profile of NSTEMI and STEMI......Page 18
The Future......Page 19
Lipoprotein-associated Phospholipase A2.......Page 20
Gene-based Research......Page 22
Cell Markers......Page 23
Diabetes......Page 24
Chronic Kidney Disease......Page 25
References......Page 27
Data Collection......Page 29
Association of Separate and Combined Risk Factors with Myocardial Infarction......Page 30
In Women and Men......Page 31
Smoking......Page 32
Dietary Patterns......Page 33
Future Directions......Page 34
References......Page 35
Baseline Demographics and Treatment of Traditional Risk Factors......Page 36
Clinical Outcomes......Page 38
References......Page 40
Historical Perspective and Lessons Learned from the Euro Heart Surveys on Acute Coronary Syndromes......Page 41
Euro Heart Surveys: Acute Coronary Syndromes I and II......Page 42
Conclusions......Page 45
References......Page 46
Gaps in Acute Coronary Syndrome Treatment......Page 47
CHAMP (Cardiac Hospitalization Atherosclerosis Management Program)......Page 48
NRMI (National Registry of Myocardial Infarction)......Page 50
NCDR-ACTION (National Cardiovascular Data Registry–Acute Coronary Treatment and Intervention Outcomes Network)......Page 51
Underusage of Recommended Medical Therapy......Page 52
Guideline Adherence and Improved Survival......Page 53
ACTION Registry–GTWG......Page 54
References......Page 55
Classification and Progression of Atherosclerosis......Page 57
Classification......Page 58
Fibroatheromas......Page 59
Determinants of Stenosis Severity......Page 60
Plaques Causing Acute Coronary Syndromes......Page 61
Thrombus Formation......Page 62
Thin Fibrous Cap.......Page 63
Focal or Multifocal Plaque Vulnerability......Page 64
References......Page 65
Plaque Rupture......Page 68
Plaque Hemorrhage......Page 71
Regulation of Thrombosis......Page 72
Conclusions......Page 73
References......Page 74
Atheropromoting Immune Response......Page 76
Atheroprotective Immune Response......Page 77
Potential Role of Immunomodulation in Atherosclerosis Treatment......Page 78
References......Page 79
Autophagy......Page 81
Border Zone Apoptosis......Page 82
Inflammatory Cell Invasion......Page 83
Proinflammatory Cytokines......Page 84
Granulation Tissue Formation and Apoptosis......Page 85
Mitochondria......Page 86
Preconditioning......Page 88
Transplanted Progenitor Versus Endogenous Cell Survival......Page 89
Progenitor Cell Microenvironment......Page 90
References......Page 91
Pharmacogenomics......Page 96
Structure of the Human Genome......Page 97
Genetic Association Studies......Page 98
Candidate Gene Approach......Page 100
Genome-Wide Association Approach......Page 101
Drug Transporters......Page 102
Anticoagulants......Page 103
Nitrates......Page 104
Statins......Page 105
References......Page 106
Historical Perspective......Page 109
Clinical Setting......Page 110
Physical Examination......Page 111
Cardiac Examination......Page 112
Clinical Recognition of Acute Coronary Syndromes......Page 113
Acknowledgment......Page 114
References......Page 115
What is a Biomarker?......Page 116
Diagnostic Application of Biomarkers in the Universal Definition of Myocardial Infarction......Page 118
Effect of the New Troponin-Based Definition of Myocardial Infarction......Page 119
Case 1......Page 120
Case 3......Page 121
Using B-Type Natriuretic Peptide......Page 122
Potential Improvements In Biomarker Analyses in the Future......Page 123
References......Page 125
Chest Pain Evaluation in the Emergency Department......Page 128
Imaging Procedures......Page 129
Contrast-Enhanced Computed Tomography.......Page 131
Non–ST-Segment Elevation–Acute Coronary Syndrome Risk Scores......Page 132
Rationale for Noninvasive Testing Using a Selective Invasive Approach......Page 134
Exercise Testing......Page 137
Exercise Echocardiography.......Page 138
Advanced Imaging Techniques.......Page 139
Summary......Page 140
References......Page 141
Qualitative and Semiquantitative Evaluation of Regional and Global Systolic Function......Page 144
Quantitative Evaluation of Regional Left Ventricular Systolic Function and Assessment of Myocardial Ischemia......Page 146
Evaluation of Diastolic Function in Acute Coronary Syndromes......Page 147
Role of Echocardiography in the Emergency Department......Page 148
Relationship Between Abnormal Wall Motion and Electrocardiographic Infarct Location......Page 150
Ventricular Septal Defect......Page 151
Papillary Muscle Rupture......Page 152
Left Ventricular Thrombus......Page 153
Prognosis After Myocardial Infarction......Page 154
Dobutamine Stress Echocardiography......Page 155
Direct Visualization of Coronary Arteries......Page 157
Brachial Ultrasound......Page 158
References......Page 159
Predictive Value.......Page 163
Predictive Value.......Page 164
Exercise Nuclear Imaging......Page 165
Dobutamine Stress Perfusion Imaging.......Page 166
Early Post–Myocardial Infarction Risk Stratification......Page 167
Selective Versus Nonselective Invasive Approach After an Acute Myocardial Infarction (ST-Segment Elevation)......Page 168
Non–ST-Segment Elevation Myocardial Infarction.......Page 169
Selective Versus Nonselective Invasive Approach to Unstable Angina and Non–ST-Segment Elevation Myocardial Infarction......Page 170
Acute Transient Apical Ballooning (Takotsubo Cardiomyopathy) and Nuclear Cardiac Imaging......Page 171
Technetium-99m–Based Single-Photon Emission Computed Tomography Myocardial Perfusion Imaging......Page 172
Cost-Effectiveness......Page 174
References......Page 175
Computed Tomography Coronary Calcium Scoring......Page 178
Computed Tomography Coronary Imaging: Total Plaque Burden......Page 179
Multislice Computed Tomography Coronary Imaging......Page 181
In Patients with Acute Chest Pain Presenting at the Emergency Department......Page 182
Triple Rule-Out Protocol in the Emergency Department......Page 184
References......Page 185
Emerging Diagnostic Procedures for the Vulnerable Plaque......Page 187
Intravascular Ultrasound–Virtual Histology......Page 188
Palpography......Page 189
Thermography......Page 190
Intravascular Magnetic Resonance Imaging......Page 191
Raman Spectroscopy......Page 192
Near-Infrared Diffuse Reflectance Spectroscopy......Page 193
References......Page 194
Age......Page 196
Peripheral Arterial Disease......Page 197
Electrocardiogram......Page 198
Detection of Necrosis......Page 199
Developing a Model......Page 200
Validation of the Model......Page 201
Growth Differentiation Factor-15......Page 202
Risk Stratification and Clinical Decision Making......Page 203
References......Page 206
Lifestyle Adjustment for the Prevention of Acute Coronary Syndromes......Page 209
Markers as Diagnostic Aids......Page 210
Multislice Computed Tomography......Page 211
High-Sensitivity Cardiac Troponin Assays......Page 212
Drug Therapy and Procedures......Page 213
References......Page 214
Platelet Populations and Subpopulations......Page 216
Translocation (Tethering)......Page 217
Adhesion......Page 218
Arterial Thrombosis Phenotype in Acute Coronary Syndrome......Page 219
Aspirin.......Page 220
Ticlopidine.......Page 221
Pharmacodynamics.......Page 222
Eptifibatide.......Page 223
Aspirin.......Page 224
Platelet-Directed Therapy Following Percutaneous Coronary Intervention.......Page 225
Triple Antithrombotic Therapy.......Page 226
Emerging Platelet-Directed Pharmacotherapy......Page 227
Correlating Measures of Platelet Performance with Clinical Outcomes......Page 230
Clopidogrel Response Variability......Page 232
Post-Treatment Platelet Response and Long-Term Ischemic Events......Page 233
References......Page 234
Nonresponsiveness to Antiplatelet Therapy......Page 237
Aspirin Nonresponsiveness and Clinical Outcomes......Page 238
Clopidogrel Nonresponsiveness and Clinical Outcomes......Page 239
References......Page 245
The Role of Thrombosis in Ischemic Heart Disease......Page 247
Mechanism of Action......Page 248
Acute Myocardial Infarction with Thrombolysis.......Page 249
Side Effects......Page 250
Myocardial Infarction with Thrombolysis.......Page 251
Percutaneous Coronary Angioplasty.......Page 252
ST-Segment Elevation Acute Myocardial Infarction.......Page 253
Direct Thrombin Inhibitors......Page 254
Side Effects......Page 255
Percutaneous Coronary Interventions.......Page 256
Dabigatran Etexilate......Page 257
New Factor Xa Inhibitors......Page 258
Rivaroxaban......Page 259
SR123781A......Page 260
Indications......Page 261
Conclusions and Future Directions......Page 262
References......Page 263
Pharmacologic Properties......Page 268
COMMIT Trial.......Page 269
Beta Blockers in Non–ST-Elevation Acute Coronary Syndromes......Page 271
Calcium Channel Blockers in Clinical Practice in Acute Coronary Syndromes......Page 272
Nitric Oxide Donors......Page 273
REFERENCES......Page 274
Evidence for Preconditioning in Human Myocardium......Page 276
Preinfarction Angina......Page 277
Cardiac Surgery......Page 278
Adenosine Triphosphate–Sensitive Potassium Channel Openers and Adenosine in Acute Coronary Syndromes......Page 279
Adenosine......Page 280
Remote Ischemic Preconditioning......Page 281
Postconditioning......Page 282
References......Page 283
The Adverse Contribution of Inflammation during the Reperfusion Injury......Page 286
The Immunoinflammatory Response to Ischemia and Reperfusion......Page 287
Corticosteroids......Page 291
Adenosine and its Agonists......Page 292
Anti-Leukocyte Therapies......Page 293
Complement Inhibitors......Page 294
ITF-1697......Page 295
FX06......Page 296
The Challenges of Clinical Investigations on Ischemia and Reperfusion......Page 297
Future Directions......Page 299
References......Page 300
Function of Vascular Smooth Muscle Cells......Page 304
Endothelium-Dependent Vasoconstriction.......Page 305
Reduction of Low-Density Lipoproteins (LDL)—Hydroxy-methylglutaryl Coenzyme A Reductase Inhibitors (Statins)......Page 306
Angiotensin Converting Enzyme (ACE) Inhibitors......Page 307
Immunomodulation for Plaque Stabilization......Page 308
Estrogens......Page 309
References......Page 310
Evidence for the Benefit of an Early Invasive Strategy......Page 314
Cost Effectiveness......Page 317
Risk Stratification in Relation to the Effects of Invasive Treatment......Page 320
Stress Tests for Risk Stratification......Page 321
When?......Page 322
How?......Page 323
References......Page 324
Thienopyridines......Page 328
Unfractionated Heparin......Page 331
Direct Thrombin Inhibitors......Page 332
Antiplatelet Therapy......Page 333
Conclusion......Page 334
References......Page 335
Influence of Definition and Treatment Strategies......Page 337
Mechanisms of Bleeding and Increased Mortality......Page 339
Prevention......Page 340
References......Page 342
Bepridil......Page 345
Unfractionated and Low-Molecular-Weight Heparin, Antiplatelet Agents, and Thrombolytic Agents......Page 346
Clinical Studies with Enhanced External Counterpulsation......Page 347
Procedure and Mechanism of Action.......Page 349
Clinical Studies......Page 350
Clinical Studies......Page 352
Angiogenic Gene Therapy......Page 353
Percutaneous Coronary Intervention (Stents) for Total Occlusions......Page 354
References......Page 355
The Mediterranean Diet: Rationale and Evidence for Its Benefit......Page 359
Fish, n-3 Fatty Acids, and Sudden Cardiac Death......Page 361
Saturated Fatty Acids, Oleic Acid, Trans Fatty Acids, and n-6 Fatty Acids......Page 362
Deficiency in Specific Micronutrients......Page 363
Inflammation and Atherosclerosis: Many Questions......Page 364
Inflammation, Atherosclerosis, and Essential Fatty Acids......Page 365
Omega-3 Polyunsaturated Fatty Acids and Inflammation......Page 367
Blood Pressure......Page 369
Endothelial Dysfunction......Page 370
References......Page 371
Underutilization of Exercise-Based Cardiac Rehabilitation......Page 376
Atherosclerosis Progression/Regression......Page 378
Weight Loss......Page 379
Exercise Prescription......Page 380
Risk Stratification and Level of Supervision......Page 381
References......Page 382
Diagnosis and Treatment of Non–ST-Segment Elevation Acute Coronary Syndromes:......Page 384
Pathophysiology......Page 385
Exercise or Other Stress Testing.......Page 386
Risk Scores......Page 387
Anticoagulants......Page 388
Anticoagulants During Percutaneous Coronary Intervention Procedures in Non–ST-Segment Elevation Acute Coronary Sydrome......Page 389
Glycoprotein IIb/IIIa Receptor Inhibitors in a Conservative Strategy......Page 390
Recommendations for Resistance to Antiplatelet Treatment or Drug Interactions......Page 391
Recommendations for Invasive Evaluation and Revascularization......Page 392
Bleeding Complications......Page 393
The Elderly......Page 394
Recommendations for Patients With Chronic Kidney Disease......Page 395
Risk Assessment......Page 396
Urgent Invasive Strategy......Page 397
References......Page 398
Overview of Changes......Page 400
Cardiac Biomarkers of Necrosis.......Page 401
Selected Recommendations for Initial Evaluation and Management......Page 403
Selected Recommendations: Anti-Ischemic and Analgesic Therapy......Page 404
Choice of Strategy: Initial Conservative Versus Early Invasive......Page 405
Platelet Glycoprotein (GP) IIb/IIIa Antagonists......Page 407
Selected Recommendations: Early Antiplatelet Therapy......Page 408
Factor Xa Inhibitors......Page 409
Selected Recommendations: Coronary Revascularization......Page 411
General Principles and Care Objectives......Page 413
Lifestyle and Secondary Preventive Measures......Page 414
Selected Recommendations: Late Hospital Care, Hospital Discharge, and Posthospital Discharge Care......Page 415
Women......Page 416
Selected Recommendations: Special Groups......Page 417
References......Page 418
From Coronary Care Unit to Contemporary Cardiac Care Unit......Page 420
Prehospital Care......Page 421
The Emergency Department......Page 423
The Contemporary Cardiac Care Unit......Page 424
Ventilator-Associated Pneumonia......Page 425
Nursing......Page 426
Assessment of Quality......Page 427
The Cardiac Care Unit as a Research Platform......Page 428
References......Page 429
A......Page 432
B......Page 434
C......Page 435
D......Page 437
E......Page 438
F......Page 439
I......Page 440
L......Page 441
M......Page 442
O......Page 443
P......Page 444
R......Page 445
T......Page 447
U......Page 448
Z......Page 449
