Cardiovascular Manual for the Advanced Practice Provider: Mastering the Basics

Foreword
Letter from Editor
Contents
Part I: Introduction
1: Cardiac Anatomy, Physiology, and Exam
Embryologic Development
Excitation Contraction Coupling (ECC)
Conduction System
Electrocardiogram (EKG or ECG)
Cardiac Anatomy
Coronary Arteries
Physical Examination of the Cardiovascular System: Pearls and Techniques
Pulse Assessment
References
2: Basic Hemodynamics
Cardiac Cycle
Part II: Coronary Artery Disease
Introduction
3: Acute Coronary Syndrome (ACS) ST Segment Elevation Myocardial Infarction
Anatomy and Physiology
Definition of STEMI
Evaluation
Symptoms
Physical Exam
Diagnostics
Imaging/Management
Follow-Up
References
4: ACS Non-ST Elevation Myocardial Infarction (NSTEMI)
Introduction
Type I and Type II Myocardial Infarction
Assessment and Diagnosis
History
Physical Exam
Diagnostics
Troponin Trending
Management
Initial Medical Therapy and Stabilization
Invasive Verses Noninvasive Evaluation
Cardiac Catheterization (Fig. 4.4)
Percutaneous Coronary Intervention (PCI) Figs. 4.5 and 4.6
Medical Therapy at Discharge of Patients with ACS
Cardiac Rehabilitation
Patient Education Prior to Discharge
References
5: Outpatient Management of Coronary Artery Disease
Introduction
Assessment and Diagnosis
Diagnostics
Stress Testing in Intermediate-Risk Chest Pain
Structural Imaging
Physiologic Testing
Management
Antiplatelet Therapy
Cholesterol Lowering Agents
Antianginal Therapy
Behavior Modification
References
6: Surgical Management of Coronary Artery Disease
Indications for CABG
Preoperative Assessment and Calculating Risk
Conduit Selection
Internal Mammary Artery
Radial Artery
Greater and Lesser Saphenous Vein
Gastroepiploic Artery
References
Part III: Cardiac Electrophysiology
7: Antiarrhythmic and Anticoagulant Agents
Anticoagulation Therapy
References
8: Bradycardia
Sinus Node Dysfunction
Sinus Bradycardia
Sinus Pause
Chronotropic Incompetence
Atrioventricular Blocks
First Degree AV Block (See Figs. 8.1 and 8.2)
Second-Degree AV Block (See Figs. 8.3 and 8.4)
Advanced/High-Grade AV Block (Fig. 8.5)
Third Degree/Complete Heart Block (Fig. 8.6)
Conduction System Abnormalities
Right Bundle Branch Block (Fig. 8.7)
Left Bundle Branch Block (Fig. 8.8)
Left Anterior Fascicular Block (LAFB)
Evaluation and Management of Conduction Abnormalities
References
9: Atrial Arrhythmias
Introduction
Inappropriate Sinus Tachycardia
Anatomy and Physiology
Pathology/Description
Physical Exam Correlations
Diagnosis/Imaging
Management
Atrial Tachycardia
Anatomy/Physiology
Pathology
Imaging
Management
Focal Atrial Tachycardia
Acute Management [1]
Ongoing management [1]
Multifocal Atrial Tachycardia
Acute Management [1]
Ongoing Management [1]
AV Node Reentry Tachycardia (AVNRT)
Anatomy and Physiology
Pathology/Description
Typical AVNRT
Atypical AVNRT
Physical Exam Correlations
Imaging
Typical AVNRT
Atypical AVNRT
Management
Acute Management [1]
Ongoing Management [1]
AV Re-entry Tachycardia (AVRT)
Anatomy and Physiology
Pathology/Description
Management of Orthodromic AVRT (Narrow Complex AVRT)
Acute management [1]
Ongoing Management [1]
Wolff-Parkinson-White
WPW Pattern Vs WPW Syndrome
Imaging
Atrial Flutter
Anatomy and Physiology
Imaging
ECG
Management
Acute Management
Anticoagulation
Ongoing Management
Atrial Fibrillation
Anatomy and Physiology
Physical Exam Correlation
Imaging
Management
Left Atrial Appendage Occlusion
Cryptogenic Stroke
References
10: Ventricular Tachycardia
Introduction
Pathophysiology
Re-entry
Automaticity
Triggered Activity
Symptoms
Physical Exam
Diagnostics
Acute Management
Long-Term Treatment
Conclusion
References
11: Cardiac Channelopathies
Introduction
Long QT Syndrome
Short QT Syndrome
Brugada Syndrome
CPVT
Further Reading
12: Introduction to Cardiac Ablation
References
Further Reading
13: Introduction to Electrophysiology Devices
Basics of Pacemakers
Temporary Pacemakers
Indications for Pacemakers
Interpreting Device Interrogations
Implantable Cardioverter Defibrillators (ICDs)
Basic Principles of Defibrillators
Temporary Defibrillators
Permanent Defibrillators
Indications for Defibrillators
Interpreting Device Interrogations
Common Problems and Troubleshooting Pacemakers and ICDs
References
14: Cardioversion
Electrical Cardioversion
Pharmacologic Cardioversion
Recommendation for Prevention of Thromboembolism [3]
References
15: Cardiac Syncope
Introduction and Pathophysiology
Symptoms
Physical Exam
Diagnostics
Management
Further Reading
Part IV: Structural/Valvular Heart Disease
Introduction
General Information About Valve Disease
16: Aortic Valve Disease
Bicuspid Aortic Valve (BAV)
Aortic Stenosis (AS)
Etiology/Pathophysiology of Aortic Stenosis
Symptoms
Physical Exam/Cardiac Studies
Evaluation/Management
Intervention
Aortic Valve Pre-Intervention Testing
Transcatheter Aortic Valve Replacement (TAVR)
TAVR Procedural Conduction Management
Post TAVR Valve Implant Management
Surgical Management of Aortic Stenosis
Valve Selection in SAVR
Aortic Bioprosthetic or Mechanical Valve Dysfunction
Aortic Insufficiency (AI) or Aortic Regurgitation (AR)
Acute Aortic Insufficiency
Etiology
Physical Exam
Intervention/Management of Acute AI
Chronic Aortic Insufficiency
Etiology
Physical Exam
Evaluation/Management
Preoperative Assessment and Calculating Risk
Valve Selection
References
17: Mitral Valve Disease
Mitral Insufficiency/Mitral Regurgitation (MR)
Acute Mitral Insufficiency
Surgical Intervention for Acute MR
Chronic Mitral Insufficiency
Etiology and Pathophysiology
Symptoms
Physical Exam/Cardiac Studies
Imaging Modalities
EKG
Echocardiography
Management of Primary MR
Management Secondary MR
Transcatheter Edge-to-Edge Mitral Valve Repair (mTEER)
Surgical Management of Mitral Regurgitation
Surgical Intervention for Chronic Primary MR
Surgical Intervention for Chronic Secondary MR
Preoperative Assessment and Calculating Risk
Surgical Approach and Valve Selection
Mitral Stenosis
Symptoms
Physical Exam/Cardiac Studies
Mitral Stenosis Management
Degenerative, Nonrheumatic Calcific MS
Rheumatic Mitral Stenosis Intervention
Mitral Valve Selection
References
18: Tricuspid Valve Disease
Tricuspid Insufficiency/Regurgitation (TI/TR)
Etiology
Symptoms
Evaluation
Management
Surgical Management of Tricuspid Regurgitation
Preoperative Assessment and Surgical Risk
Valve Selection
Tricuspid Stenosis
Symptoms
Evaluation
Management/Intervention
Surgical Management of Tricuspid Stenosis
References
19: Infective Endocarditis
Symptoms
Physical Exam
Risk Factors
Pathology/Description
Microbiology
Imaging
EKG
Diagnostic Criteria
Management
Antimicrobial Therapy
Surgical Management
Outpatient Management and Follow-Up Evaluation (Table 19.8)
References
Part V: Cardiomyopathies/Congestive Heart Failure
20: Heart Failure with Reduced Ejection Fraction (HFrEF)
Introduction
Anatomy and Physiology
Physical Exam
Volume Status
Perfusion Status
Review of Systems
Clinical Classifications
Imaging
Echocardiography
Cardiac Magnetic Resonance Imaging
Pathology/Description
Ischemic Heart Failure
Nonischemic Cardiomyopathy (NICM)
Hypertrophic Cardiomyopathy (HCM)
Restrictive Cardiomyopathy (RCM)
Amyloidosis
Cardiac Sarcoidosis
Dilated Cardiomyopathy (DCM)
Myocarditis
Peripartum Cardiomyopathy
Arrhythmogenic Right Ventricular Cardiomyopathy (ARVC)
Unclassified
Takotsubo Cardiomyopathy
Management
Guideline-Directed Medical Therapy (GDMT)
Beta Blockers
RAAS Inhibition
ACE Inhibitors (ACEIs)
Angiotension Receptor Blockers: ARBs
Angiotensin Receptor-Neprilysin Inhibitor: ARNIs
Mineralocorticoid Receptor Antagonists
Sodium-Glucose Cotransporter 2 Inhibition (SGLT2i)
Diuretics
Device Therapy
Implantable Cardiac Defibrillators (ICDs)
Cardiac Resynchronization Therapy (CRT)
Advanced Heart Failure Therapies
Management of Comorbidities
Mitral Regurgitation
Hypertension
Sleep-Disordered Breathing (SDB)
Iron Deficiency
References
Additional References
21: Heart Failure with Preserved Ejection Fraction (HFpEF)
Anatomy and Physiology
Physical Exam (See Chap. 20)
Classification (See Chap. 20)
Imaging (See Chap. 20)
Diagnosis
Management
Medical Therapy
Nonmedical Management
References
22: Pulmonary Vascular Disease
Introduction
Classifications
Presentation/Physical Exam Findings
Diagnostic Modalities/Imaging
Echocardiography
Computerized Tomographic Angiography (CTA) of the Chest
CT of the Chest
Ventilation Perfusion Scan
PFTs: Pulmonary Function Studies
Cardiac MRI
Right Heart Catheterization
Chest X-ray
12 Lead ECG
OSA Evaluation
Vasoreactivity Study
6-min Walk
Pulmonary Artery (PA) Angiogram
Initial Routine Lab Work
Treatment
Prostacyclin Pathway
Endothelin Receptor Antagonists
ERA Clinical Points
Nitric Oxide Pathway
PDE-5 Inhibitors (Phosphodiesterase-5 Inhibitors)
PDE-5 Inhibitors (Phosphodiesterase-5 Inhibitors) Clinical Pearls
Soluble Guanylate Cyclase Stimulator
Pulmonary Embolism
Introduction
Physiology
Classification and Risk Stratification
History and Presentation
Physical Findings
Imaging
Treatment and Management
Pharmacologic Therapies
Advanced Therapies
Conclusion and Future Considerations
Cor Pulmonale
Physical Exam
Evaluation
Treatment
Sleep Apnea and Cardiovascular Disorders
Presentation
Physical Exam
Physiology
Diagnosis
Sleep Study
Management
References
23: Pericardial Disease
Pericardial Disease
Pericarditis
Physical Exam
Diagnostic Testing
Management of Acute Pericarditis
Myocarditis
Constrictive Pericarditis
Physiological Characteristics
Physical Exam
Noninvasive Testing
Treatment
Pericardial Effusion
Physical Examination
Diagnosis
Treatment
Cardiac Tamponade
Clinical Signs
Diagnosis
Treatment
References
Part VI: Shock
24: Cardiogenic Shock
Introduction
Differentiating Shock
Pathophysiology
Clinical Presentation
History and Physical
Diagnostic Studies
Management
Long-Term Care
References
25: Introduction to Mechanical Support
Intro to Support Devices
Reference
Part VII: Peripheral Vascular Disease
Introduction
26: Carotid Artery Stenosis (CAS)
Anatomy and Physiology
Pathology/Pathophysiology of Carotid Artery Stenosis
Presentation of CAS
Physical Examination
Imaging/Diagnostic Testing
Management of Carotid Artery Stenosis
Surveillance
References
27: Peripheral Arterial Disease (PAD)
Anatomy
Physical Examination
Pathology/Pathophysiology
Imaging/Diagnostic Testing
Ankle Brachial Index
Arterial Duplex Ultrasound
Computed Tomography Angiography (CTA)
Management
Surveillance
Deep Vein Thrombosis
Anatomy and Physiology
Physical Exam
Pathology/Description
Imaging and Diagnosis
Management
References
28: Diseases of the Aorta
Aneurysm
Anatomy and Physiology
Pathology/Description
Classification
Risk Factors
Signs and Symptoms
Physical Exam
Imaging
Management
Aortic Dissection
Anatomy and Physiology
Pathology/Description
Risk Factors for Dissection
Physical Exam
Imaging
Management
Surveillance
References
Part VIII: Adult Congenital Heart Disease (ACHD)
1.1 Introduction
29: ACHD
Simple Defects
Anatomy and Physiology
Types of ASD
Physical Exam Correlations
Pathology/Description
Management
Ventricular Septal Defect (VSD)
Bicuspid Aortic Valve (BAV)
Valvar Pulmonary Stenosis (PS)
Tetralogy of Fallot (TOF)
Coarctation of the Aorta
L-TGA
D-TGA
Ebstein’s Anomaly
Single Ventricle/Fontan Physiology
Infective Endocarditis Prophylaxis
References
Part IX: Ambulatory/Preventative Cardiology
30: Prevention of Cardiometabolic Disease
Introduction
Assessment of Risk
Risk-Enhancing Factors
Risk-Enhancing Factors
Calcium Scoring
Modification of Risk
Social Determinants of Health
Nutrition and Diet
Physical Activity and Obesity
Type 2 Diabetes Mellitus
Management of Blood Cholesterol
Blood Pressure
Tobacco Use
Aspirin Use
Conclusion
References
Part X: Emergency Department Evaluation of Chest Pain
31: Acute Evaluation of Chest Pain
Introduction
Etiologies of Chest Pain
Myocardial Ischemia
Pericardial Disease
Vascular Causes
Pulmonary Causes
Gastrointestinal
History
Physical Examination
Diagnostic Testing During the Acute Presentation
Electrocardiogram
Chest Radiography
Ultrasonography
Cardiac Biomarkers
Troponin
D-Dimer
BNP
Clinical Decision Pathways
Management
References
Part XI: Cardiovascular Disease in Pregnancy
32: Cardiovascular Disease in Pregnancy
Introduction
Physiological Changes During Pregnancy
Chest Pain in Pregnancy
Spontaneous Coronary Artery Dissection (SCAD)
Pulmonary Embolism in Pregnancy
Clinical Presentation
Diagnosis
Treatment
Musculoskeletal Chest Pain
GERD
Aortic Diseases
Marfan Syndrome
Management
Hypertension in Pregnancy
Pre-eclampsia
Eclampsia
Pre-existing Hypertension
Pre-existing Hypertension with Overlapping Gestational Hypertension
Treatment
Arrhythmias
Fetal Arrhythmias
Syncope
Edema
Peripartum Cardiomyopathy
Treatment
Delivery
Counseling for Future Pregnancy
Pulmonary Edema Post-Delivery with Normal LV Function
Amniotic Fluid Embolism (AFE)
References
Index