Cardiovascular Therapeutics: A Companion to Braunwalds Heart Disease

Inside cover
Copyright page
Dedication
Contributors
Foreword
Preface
Acknowledgments
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Part I: Decision Making and Therapeutic Strategies in Cardiovascular Medicine
Chapter 1: Tools for Assessment of Cardiovascular Tests and Therapies
Interpretation of Diagnostic Tests
Clinical Trials
Need for Clinical Trials
Clinical Trial Design
Randomized Controlled Trials
Nonrandomized Concurrent Control Studies
Historic Controls
Crossover Design
Withdrawal Studies
Factorial Design
Trials that Test Equivalence of Therapies
Selection of Endpoint
Sample Size Estimations and Sequential Stopping Boundaries
False-Positive and False-Negative Error Rates and Power of Clinical Trials
How to Read and Interpret a Clinical Trial
Missing Data
Measures of Treatment Effect
Detection of Treatment Effects in Clinical Trials
Meta-Analysis
Principles of Pooling Studies
Cumulative Meta-Analysis
Meta-Regression
Future Trends in Meta-Analysis
How to Read and Interpret a Meta-Analysis
Comparative Effectiveness Research
Methods for Comparative Effectiveness Research
Balancing Risks and Benefits
Cost-Effectiveness Analysis
Types of Economic Evaluation
Methods for Performing a Cost-Effectiveness Analysis
Trial-Based Analyses
Modeling Approaches
Hybrid Approaches
Other Methodologic Considerations
Sensitivity Analysis
Perspective
Discounting
Time Horizon
Defining When a Therapy Is Cost Effective
How to Read an Economic Evaluation
References
Chapter 2: New Drug Development
Overview of the Drug Development Process
Phase I to IV Paradigm
Cycle of New Therapeutic Development
Regulation of New Drugs: Prototypical Interface with the Food and Drug Administration
Before the Investigational New Drug Application
Types of Investigational New Drug Application
Advisory Panels
Labeling
Postmarketing Surveillance
Exemptions from Investigational New Drug Application and Practice of Medicine
Investigator-Initiated Investigational New Drug Application
CDER Versus CBER: Key Differences for Biologics
International Drug Development Overview
Ethics of Drug Development in Developing Countries
Anatomy of a Clinical Trial: Operations
Protocol Development
Site Management
Data Management
Statistics
Safety Surveillance
Clinical Events Adjudication
Economics of New Drug Development
Prescription Drug User Fee Act
National Institutes of Health Roadmap Program
Patent Considerations
Summary
References
Chapter 3: Device Development for Cardiovascular Therapeutics:
Overview
Medical Device Development and Differences from Drugs
Development and Implementation of Cardiovascular Medical Devices: An Overview
Differences Between Devices and Drugs and Associated Regulatory Implications
Regulatory Fundamentals
History of Device Regulation and the Medical Device Classification System
Pathways for Regulatory Review of Cardiovascular Devices
510k Premarket Notification
Premarket Approval Application
Investigational Device Exemption
Humanitarian Device Exemption
Contemporary Regulatory Issues
Randomized Versus Nonrandomized Studies in Medical Device Evaluation
Endpoints and Surrogate Endpoints in Cardiovascular Device Trials
Study Blinding in Cardiovascular Device Trials
Use of Foreign Data for U.S. Product Approval
Independent Oversight of Cardiovascular Device Trials
Labeling and Off-Label Use of Cardiovascular Devices
Risk, Benefit, and the Product Life Cycle
Total Product Life Cycle Approach
Device Safety and Failure Concepts
Ensuring the Safety of Marketed Devices
Postmarket Safety Assessment Tools
Cardiologists’ Role in Ensuring Device Safety and Performance
Product Recall and Center for Devices and Radiological Health
Other Key Regulatory Topics
Combination Products
Role of the Advisory Panel
CDRH Interactions with External Stakeholders and Government Partners
References
Chapter 4: Pharmacogenetics
Clopidogrel
Drug, Indications, Mechanism of Action, and Pharmacology
Drug Interactions
Pharmacogenetics of Clopidogrel Therapy
CYP2C19
ABCB1
PON1
Therapeutic Implications
Pharmacogenetic Testing in Clopidogrel Therapy
Therapeutic modifications
Cost Effectiveness of Clopidogrel Pharmacogenetics Testing
Future Directions
Warfarin
Drug, Indications, Mechanism of Action, and Pharmacology
Drug Interactions
Pharmacogenetics of Warfarin Therapy
VKORC1
CYP2C9
CYP4F2
Therapeutic Implications
Pharmacogenetic Testing in Warfarin Therapy
Cost Effectiveness of Warfarin Pharmacogenetics Testing
Therapeutic Modifications
Future Directions
Statins
Drug, Indications, Mechanism of Action, and Pharmacology
Drug Interactions
Pharmacogenetics of Statin Therapy
Key Genetic Variants Affecting Statin Efficacy
APOE
PCSK9
HMGCR
CETP
LDLR
KIF6
Genome-Wide Association Studies of Statin Response
Key Genetic Variants Affecting Statin Adverse Effects
SLCO1B1
Therapeutic Implications
Future Directions
References
Chapter 5: Systems of Health Care
Systems Theory
Why Systems of Care Are Needed
Experience to Date with Cardiovascular Systems of Care
ST-Segment Elevation Myocardial Infarction
Prehospital Diagnosis, Catheterization Laboratory Activation, and Transport to Primary Percutaneous Coronary Intervention Centers
Regional Transfer Protocols
State Systems for ST-Segment Elevation Myocardial Infarction CARE
Mission: Lifeline Program to Improve ST-Segment Elevation Myocardial Infarction CARE
Heart Failure
Cardiac Arrest
Quality Improvement Theory
Experience to Date with Cardiovascular Quality Improvement
ST-Segment Elevation Myocardial Infarction
American College of Cardiology Door-to-Balloon Alliance
CRUSADE Initiative
Get with the Guidelines?Coronary Artery Disease Program
Acute Coronary Treatment and Intervention Outcomes Network
Heart Failure
Out-of-Hospital Cardiac Arrest
Lessons Learned
References
Chapter 6: Global Cardiovascular Therapy
Introduction to Global Challenges in Cardiovascular Disease Therapy
Burden of Cardiovascular Disease
Current Trends and Challenges
Acute Management and Secondary Prevention
Acute Coronary Syndrome
Secondary Prevention
Challenges to Therapeutic Usage
Current State of cardiovascular disease Drug Availability and Affordability in Low- and Middle-Income Countries
Role of the World Health Organization Essential Drug List
Human Resources Shortages
Primary Prevention
Polypill
Population Strategies
Risk Factors for Cardiovascular Disease
Tobacco
Blood Pressure
Lipids
Obesity
Summary
References
Part II: Ischemic Heart Disease
Chapter 7: Pharmacologic Options for Treatment of Ischemic Disease
Organic Nitrates
Overview
Mechanisms of Action
Pharmacokinetics
Pharmacodynamic Effects
Side Effects of Organic Nitrates
Clinical Efficacy of Organic Nitrates
Sublingual Nitrates
Long-Acting Nitrates
Congestive Heart Failure
Other Nitrate Indications
Nitrate Tolerance
Biotransformation Hypothesis
Neurohormonal Hypothesis
Free Radical Hypothesis
Nonhemodynamic Effects of Organic Nitrates
Current Perspectives on Therapy with Organic Nitrates
Calcium Channel Blockers
Fundamental Mechanisms of Calcium Channel Blockers
Calcium Channel as Site of Action
Molecular Structure
Drug Binding Sites
Calcium Channels: L and T Types
Pharmacologic Properties of Calcium Channel Blockers
Pharmacodynamic Effects
Major Cardiovascular Actions of Calcium Channel Blockers
Classification of Calcium Channel Blockers
Vascular Selectivity
Noncardiovascular Effects
Pharmacokinetics
Major Indications for Calcium Channel Blockers
Systemic Hypertension
Angina Pectoris
Supraventricular Tachycardia
Postinfarct Protection
Specific Calcium Channel Blockers
Verapamil
Pharmacokinetics
Dose
Oral Preparations
Intravenous Use
Side Effects
Contraindications
Pregnancy
Diltiazem
Pharmacokinetics
Dose
Side Effects
Contraindications
Pregnancy
Dihydropyridines
First-Generation Dihydropyridines
Contraindications and Cautions
Side Effects
Pregnancy
Second-Generation Calcium Channel Blockers
Drug Interactions of Calcium Channel Blockers
β-Blockers
Digoxin
Diltiazem
Dihydropyridines
Calcium Channel Blockers: The “Safety? Controversy
β-Adrenergic Blockers
β-Adrenergic Receptors
Effects in Angina Pectoris
Comparison with Other Antianginal Therapies
Angina at Rest and Vasospastic Angina
Combined Use of β-Blockers with Other Antianginal Therapies in Angina Pectoris
Nitrates
Calcium Channel Blockers
Ranolazine
Conditions Associated with Angina Pectoris
Arrhythmias
Hypertension
Survivors of Acute Myocardial Infarction
“Silent? Myocardial Ischemia
Other Cardiovascular Conditions Associated with Angina Pectoris
Hypertrophic Cardiomyopathy
Congestive Cardiomyopathy
Mitral Valve Prolapse
Dissecting Aneurysms
Ehlers-Danlos Syndrome
Syndrome X
Perioperative Therapy in High-Risk Patients with Ischemic Heart Disease
Pharmacologic Differences Among β-Adrenergic Receptor–Blocking Drugs
Potency
β1 Selectivity
Intrinsic Sympathomimetic Activity Partial Agonist Activity
α-Adrenergic Activity
Nitric Oxide Potentiating Effect
Pharmacokinetics
Adverse Effects of β-Adrenergic Receptor Blockers
Contraindications to β-Adrenergic Receptor Blockers
Overdosage
β-Adrenergic Receptor Blocker Withdrawal
Drug-Drug Interactions
Newer Options for Treatment of Chronic Angina
Nicorandil
Ivabradine
Ranolazine
Mechanism of Action
Other Potential Uses of Ranolazine
Trimetazidine
Thrombosis and Ischemic Cardiovascular Heart Disease
Antiplatelet Therapy
Aspirin
Mechanisms of Action
Indication
Dosages
Side Effects and Contraindications
P2Y12 Receptor Antagonists
Mechanisms of Action
Indication
Dosages
Side Effects and Contraindications
Glycoprotein IIb/IIIa Receptor Antagonists
Mechanisms of Action
Indications
Dosages
Side Effects and Contraindications
Novel Antiplatelet Agents
Anticoagulant Therapy
Unfractionated Heparin
Mechanisms of Action
Indications
Dosages
Side Effects and Contraindications
Low-Molecular-Weight Heparin
Mechanisms of Action
Indications
Dosages
Side Effects and Contraindications
Direct Thrombin Inhibitors
Hirudin Lepirudin
Mechanisms of Action
Indications and Dosages
Side Effects and Contraindications
Argatroban
Mechanisms of Action
Indications
Dosages
Side Effects and Contraindications
Bivalirudin Hirulog
Mechanisms of Action
Indications and Dosage
Factor Xa Inhibitors
Fondaparinux
Mechanisms of Action
Indications and Dosages
Oral Anticoagulants
Warfarin
Mechanisms of Action
Indications
Dosages
Side Effects and Contraindications
Novel Anticoagulant Agents
Fibrinolytics
Mechanisms of Action
Indications
Dosages
Side Effects and Contraindications
References
Chapter 8: Stable Ischemic Heart Disease/Chronic Stable Angina
Epidemiology
Natural History
Assessment and Investigation
Clinical Assessment
Risk Stratification
Clinical Indicators
Noninvasive Evaluation
Electrocardiogram
Echocardiography
Cardiac Magnetic Resonance Imaging
Myocardial Perfusion Scintigraphy
Computed Tomography
Coronary Calcium Score
Computed Tomography Coronary Angiography
Selection and Frequency of Noninvasive Stress Testing
Invasive Evaluation
Overall Assessment of Risk
Therapeutic Interventions
Lifestyle and Risk Factor Modifications
Smoking
Dietary Intervention
Obesity
Diabetes Mellitus
Symptomatic Therapy
Cardiac Rehabilitation
Pharmacologic Therapy
β-Blockers
Calcium Channel Blockers
Nitrates
Acute Relief of Angina
Prevention of Anginal Episodes
Potassium Channel Agonists
Miscellaneous Medical Therapies
Coronary Revascularization
Percutaneous Coronary Intervention
Indications: Percutaneous Coronary Intervention Versus Medical Treatment
Percutanous Coronary Intervention Versus Coronary Artery Bypass Grafting
Culprit Lesion Percutaneous Coronary Intervention
Percutaneous Coronary Intervention After Coronary Artery Bypass Grafting
Stents
Antiplatelet Therapy
Complications
Coronary Artery Bypass Graft Surgery
Indications: Coronary Artery Bypass Grafting Versus Medical Treatment
Complications
Arterial Conduits
Prevention of Coronary Events
Cardiac Rehabilitation
Antiplatelet Therapy
Lipid-Lowering Therapy
β-Blockers
Angiotensin-Converting Enzyme Inhibition
Coronary Revascularization
Coronary Artery Bypass Graft Surgery
Potential Future Therapies
Cholesteryl Ester Transfer Protein Inhibitors
Novel Antiplatelet Therapies
References
Chapter 9: Non–ST-Segment Elevation Acute Coronary Syndromes
Antiischemic Medications
Nitrates
β-Adrenergic Receptor Blockers
Calcium Channel Antagonists
Ranolazine
Antiplatelet Agents
Aspirin
P2Y12 Antagonists
Clopidogrel
Prasugrel
Ticagrelor
Duration of Therapy
Platelet Function Testing and Genetics
Intravenous Platelet Inhibitors
Conclusions
Anticoagulants
Unfractionated Heparin and Low-Molecular-Weight Heparin
Direct Thrombin Inhibitors
Factor Xa Inhibitors
Other Anticoagulants
Summary on Anticoagulant Selection
Invasive Versus Conservative Strategy for Cardiac Catheterization
Hospital Discharge and Postdischarge Care
Antiplatelet Therapy, Anticoagulation, Angiotensin-Converting Enzyme Inhibitors, and Angiotensin Receptor Blockade
β-Blockade and Blood Pressure Control
Cholesterol Treatment and Cigarette Smoking Cessation
Diabetes Management and Diet
Exercise
Influenza Vaccine
Cardiac Syndrome X
Cocaine and Methamphetamines
Diabetes Mellitus
The Elderly
Women
Chronic Kidney Disease
References
Chapter 10: ST-Segment Elevation Myocardial Infarction
Overview
Pre?ST-Segment Elevation Myocardial Infarction Management
Prehospital Management
Symptom Recognition
Out-of-Hospital Arrest
Emergency Medical Services and Systems of Care
Prehospital Fibrinolysis
Prehospital Destination Protocols
Emergency Department Management
Patient Triage
Patient Evaluation
Early Risk Assessment
Medications Used in the Acute Phase
Oxygen
Nitroglycerin
Analgesia
Antiplatelet Agents
Aspirin
Clopidogrel
Prasugrel
Ticagrelor
Glycoprotein IIb/IIIa Inhibitors
Anticoagulant Agents
Antithrombins
Direct Thrombin Inhibitors
Fondaparinux
β-Blockers
Reperfusion Therapy
General Concepts
Time from Symptom Onset
Risk Stratification in ST-Segment Elevation Myocardial Infarction
Risk of Bleeding
Predicted Transfer and Door-to-Balloon Time
Fibrinolytic Therapy
Indications and Contraindications
Mortality Benefit
Effect on Left Ventricular Function
Complications
Comparison of Fibrinolytic Agents
Percutaneous Coronary Intervention
Primary
Use of Stents
Thrombus Aspiration
Pharmacoinvasive Management
Hospitals Without on-Site Cardiac Surgery
Hospital Management
Location
Routine Measures
Medications
Nitroglycerin
Antithrombotic Agents
β-Blockers
Inhibition of the Renin-Angiotensin-Aldosterone System
Glycemic Control
Calcium Channel Blockers
Hemodynamic Disturbances
Hemodynamic Assessment
Hypotension
Low-Output State
Pulmonary Congestion
Cardiogenic Shock
Right Ventricular Infarction
Mechanical Complications
Mitral Regurgitation
Ventricular Septal Rupture
Left Ventricular Free Wall Rupture
Left Ventricular Aneurysm and Left Ventricular Thrombus
Mechanical Support Devices
Arrhythmias
Bradyarrhythmias
Supraventricular Arrhythmia
Ventricular Arrhythmias
Recurrent Chest Pain
Recurrent Ischemia or Infarction
Pericarditis
Other Complications
Ischemic Stroke
Deep Venous Thrombosis and Pulmonary Embolism
Hemorrhagic Complications
Coronary Artery Bypass Surgery
Risk Stratification
Exercise Testing
Echocardiography
Myocardial Perfusion Imaging
Left Ventricular Function
Myocardial Viability
Invasive Evaluation
Assessment of Electrical Substrate
Long-Term Management
Risk Factor Control
Weight Management
Smoking Cessation
Lipid Management
Blood Pressure Control
Diabetes Management
Medications
Antiplatelet Agents
β-Blockers
Statins
Inhibition of the Renin-Angiotensin-Aldosterone System
Warfarin
Hormone Replacement Therapy
Functional Status
Physical Activity
Cardiac Rehabilitation
Psychosocial Impact
Follow-Up Visit
Return to Work and Disability
References
Chapter 11: Advances in Coronary Revascularization
Overview
Advances in Coronary Stenting
Pre-Stent Era
Bare-Metal Stents
Drug-Eluting Stents
Development of Drug-Eluting Stents
Drug-Eluting Stents Currently Available in the United States
Sirolimus-Eluting Stents
Paclitaxel-Eluting Stents
Zotarolimus-Eluting Stents and Everolimus-Eluting Stents
Efficacy and Safety of Drug-Eluting Stents
Efficacy of Drug-Eluting Stents
Safety of Drug-Eluting Stents
When to Use Drug-Eluting Stents
New Drug-Eluting Stents Available Outside the United States or Undergoing Investigation
Products Involving Changes to the Stent Platform
Traditional Stent Platforms
Biodegradable Stents
Products Involving Changes to Drug Coatings
Products Involving Changes to the Polymer Structure
Stents with Durable Polymers
Stents with Biodegradable Polymers
Biolimus A9?based Stents.
Myolimus-Based Stents.
Paclitaxel-Based Stents.
Everolimus-Based Stents.
Sirolimus-Based Stents.
Polymer-Free Stents
Drug-Coated Balloons
Advances in Revascularization in Specific Conditions
Saphenous Vein Graft Interventions
Chronic Total Occlusion Intervention
Bifurcation Lesion Treatment
Advances in Catheterization Techniques
Transradial Access
Mechanical Support for High-Risk Percutaneous Coronary Intervention
Intravascular Assessment of Lesion Severity
Advances in Surgical Coronary Revascularization
Minimally Invasive Surgical Coronary Revascularization
Off-Pump Coronary Artery Bypass Grafting
Small-Access Coronary Revascularization
Minimally Invasive Direct Coronary Artery Bypass
Thoracoscopic Minimally Invasive Direct Coronary Bypass
Multivessel Minimally Invasive Procedures
Robotically Assisted Revascularization
Non?Left Internal Mammary Arterial Conduits in Surgical Revascularization
Background and Introduction
Right Internal Mammary Artery for Use in Bilateral Mammary Artery Grafting
Radial Artery Grafts
Gastroepiploic Artery Grafts
Hybrid Coronary Revascularization
Introduction and Definition
Rationale and Background
Technical and Timing Issues of Hybrid Interventions
Percutaneous Intervention Before Surgical Intervention
Surgical Intervention Before Percutaneous Intervention
Simultaneous Procedures
Current State of Hybrid Revascularization and Recent Information
Future Directions
References
Part III: Heart Failure
Chapter 12: Pharmacologic Management of Heart Failure in the Ambulatory Setting
Pathophysiology and Staging System: Targets of Therapy
Diuretics and Sodium Restriction
Pathophysiologic Mechanisms
Sodium Restriction
Diuretics
Mechanisms of Action
Adverse Effects
Practical Considerations
Renin-Angiotensin System Inhibitors
Pathophysiologic Mechanisms
Clinical Efficacy
Angiotensin-Converting Enzyme Inhibitors
Cooperative North Scandinavian Enalapril Survival Study CONSENSUS
Vasodilator Heart Failure Trial V-HeFT II
Studies of Left Ventricular Dysfunction SOLVD
Assessment of Treatment with Lisinopril and Survival ATLAS
Angiotensin Receptor Blockers
Practical Considerations
Angiotensin-Converting Enzyme Inhibitors
Angiotensin Receptor Blockers
β-Blockers
Pathophysiologic Rationale
Pharmacology
Clinical Efficacy
Cardiac Insufficiency Bisoprolol Studies CIBIS I and II
U.S. Carvedilol Heart Failure Trials
Metoprolol CR/XL Randomised Intervention Trial in Congestive Heart Failure MERIT-HF
β-Blocker Evaluation and Survival Trial
Carvedilol Prospective Randomized Cumulative Survival Trial COPERNICUS
Carvedilol and Metoprolol European Trial COMET
Carvedilol Post-Infarct Survival Control in Left Ventricular Dysfunction CAPRICORN
Study of the Effects of Nebivolol Intervention on Outcomes and Rehospitalization in Seniors with Heart Failure SENIORS
Practical Considerations
Choice of β-Blocker
Aldosterone Antagonists
Pathophysiology
Clinical Efficacy
Practical Considerations
Options for Patients who Remain Symptomatic Despite Standard Therapy
Hydralazine and Isosorbide Dinitrate
Practical Considerations
Digoxin
Pharmacologic and Clinical Effects
Practical Considerations
Calcium Channel Blockers
Positive Inotropic Agents
Oral Positive Inotropes
Intravenous Positive Inotropes
Bridge to Transplantation
Bridge to End of Life
Antithrombotic Therapy
Antiarrhythmic Therapy
Special Considerations
Heart Failure Patients with Preserved Ejection Fraction
Clinical Efficacy
Practical Considerations
Patients with Ischemic Heart Disease
Patients with Valvular Heart Disease
Patients with Diabetes
Gender, Race, and Ethnic Considerations
Patients with Myocarditis
Future Directions in Pharmacologic Therapy
Pharmacotherapy
Comorbidities
References
Chapter 13: Implantable Devices for the Management of Heart Failure
Implantable Cardioverter-Defibrillators in the Management of Heart Failure
MADIT II
DEFINITE
SCD-HeFT
Implantable Cardioverter-Defibrillators Early After Myocardial Infarction
DINAMIT
IRIS
Indications for Prophylactic Cardioverter-Defibrillator Implantation in Heart Failure Patients
Practical Considerations in Implantable Cardioverter-Defibrillator Therapy
Conduction Abnormalities in Heart Failure
Landmark Cardiac Resynchronization Therapy Clinical Trials
MUSTIC
MIRACLE
MIRACLE ICD
CONTAK CD
COMPANION
CARE-HF
Cardiac Resynchronization Therapy in Mild Heart Failure
REVERSE
MADIT-CRT
RAFT
Cardiac Resynchronization Therapy
Cardiac Resynchronization Therapy in Long-Term Right Ventricle Pacing
Cardiac Resynchronization Therapy in Atrial Fibrillation
Indications for Cardiac Resynchronization Therapy in Heart Failure Patients
Future Directions of Cardiac Resynchronization Therapy
Monitoring Heart Failure Through Implantable Devices
Future Directions in Implantable Devices for the Management of Heart Failure
Summary
References
Chapter 14: Strategies for Management of Acute Decompensated Heart Failure
Terminology
Epidemiology
Pathophysiology
Heart Failure with Reduced Versus Preserved Ejection Fraction
Acute Compensatory Mechanisms
Myocardial Injury
Common Precipitating Factors of Heart Failure
General Management
Initial Patient Evaluation
Risk Stratification
Clinical Assessment of Intracardiac Filling Pressures
Clinical Assessment of Systemic Perfusion
Laboratory Assessment
B-Type Natriuretic Peptide
Noninvasive Versus Invasive Management
Hemodynamic Profiles
Hemodynamic Goals of Therapy
Fluid Management
Parenteral Diuretic Therapy
Ultrafiltration
Vasoactive Therapy
Nitroglycerin
Nesiritide
Nitroprusside
Dobutamine
Milrinone
Dopamine
Epinephrine and Norepinephrine
Digoxin
Adjustment of Oral Medications
Renin-Angiotensin-Aldosterone System Inhibitors
Nitrates and Hydralazine
β-Blockers
Oral Diuretics
Other Management Issues
Sodium and Fluid Restriction
Oxygen Supplementation
Ventricular Arrhythmias
Anticoagulation
Comorbidities
Discharge Planning and Immediate Postdischarge Care
Special Considerations
Mechanical Circulatory Support
Acute Pulmonary Edema
Heart Failure with Preserved Ejection Fraction
Unfulfilled Promises and Future Directions
References
Chapter 15: Cardiac Transplantation and Circulatory Support Devices
Overview
Patient Selection for Advanced Heart Failure Therapies
Cardiac Transplantation
Patient Selection
Assessment of Cardiac Disease Severity
Assessment of the Pulmonary Vasculature
Other Cardiac Transplantation Candidacy Issues
Age
Comorbidities
Immunologic Sensitization
Listing for Cardiac Transplantation
Pretransplantation Patient Management
Cardiac Transplantation Surgical Technique
Management of the Patient After Cardiac Transplantation
Prevention and Treatment of Cardiac Rejection
Drug Interactions
Prevention and Treatment of Posttransplant Complications
Infections
Hypertension
Diabetes
Dyslipidemia
Cardiac Allograft Vasculopathy
Renal Insufficiency
Malignancy
Future Directions
Mechanical Circulatory Support
Benefits of Mechanical Circulatory Support
Hemodynamic
Biologic
Configuration of Mechanical Circulatory Support
Pulsatile Flow
Continuous Flow
Cannulation
Indications for Mechanical Circulatory Support
Univentricular Versus Biventricular Support
Timing of Support
Considerations Prior to Long-Term Mechanical Circulatory Support
Cardiac Considerations
Right Ventricular Function
Valvular Disease
Arrhythmias
Other Cardiac Abnormalities
Noncardiac Considerations
Surgical Considerations
Other Considerations
Adverse Events
References
Chapter 16: Regenerative Therapy for Heart Failure
Circulating Progenitor Cells and Myocardial Regeneration
Hematopoietic Stem Cell Transdifferentiation
Bone Marrow Cells and Clinical Studies
Endogenous Cardiac Progenitors
Age, Cardiac Disease, and Human Cardiac Stem Cell Function
References
Chapter 17: Hypertrophic, Restrictive, and Infiltrative Cardiomyopathies
Hypertrophic Cardiomyopathy
Management of Left Ventricular Outflow Tract Obstruction
Therapies for Nonobstructive Hypertrophic Cardiomyopathy
Prevention of Sudden Cardiac Death in Hypertrophic Cardiomyopathy
Management of Atrial Fibrillation in Hypertrophic Cardiomyopathy
Screening at-Risk Family Members for Hypertrophic Cardiomyopathy
Restrictive and Infiltrative Cardiomyopathies
Idiopathic Restrictive Cardiomyopathy
Cardiac Amyloidosis
Cardiac Sarcoidosis
Treatment
Cardiac Hemochromatosis
Treatment
Storage Diseases of the Myocardium
Fabry Disease
Cardiomyopathy Associated with Mutations in LAMP2 Danon Disease, PRKAG2, or Mitochondrial Genes
Endomyocardial Disorders
Endomyocardial Fibrosis
Löffler Hypereosinophilic Syndrome
References
Part IV: Arrhythmias and Conduction Disturbances
Chapter 18: Clinical Pharmacology of Antiarrhythmic Drugs
Classification of Antiarrhythmic Drugs
Drugs
Lidocaine
Clinical Applications
Mechanism of Action
Clinical Pharmacology
Dosage and Administration
Modification of Dosage in Disease States
Adverse Reactions
Drug Interactions
Mexiletine
Clinical Applications
Mechanism of Action
Clinical Pharmacology
Dosage and Administration
Modification of Dosage in Disease States
Adverse Reactions
Drug Interactions
Procainamide
Clinical Applications
Mechanism of Action
Clinical Pharmacology
Dosage and Administration
Modification of Dosage in Disease States
Adverse Reactions
Drug Interactions
Disopyramide
Clinical Applications
Mechanisms of Action
Clinical Pharmacology
Dosage and Administration
Modification of Dosage in Disease States
Adverse Reactions
Drug Interactions
Quinidine
Clinical Applications
Mechanism of Action
Clinical Pharmacology
Dosage and Administration
Modification of Dosage in Disease States
Adverse Reactions
Drug Interactions
Propafenone
Clinical Applications
Clinical Pharmacology
Dosage and Administration
Modification of Dosage in Disease States
Drug Interactions
Flecainide
Clinical Applications
Mechanism of Action
Clinical Pharmacology
Dosage and Administration
Modification of Dosage in Disease States
Adverse Reactions
Drug Interactions
Sotalol
Clinical Applications
Mechanism of Action
Clinical Pharmacology
Dosage and Administration
Modification of Dosage in Disease States
Adverse Reactions
Drug Interactions
Amiodarone
Clinical Applications
Mechanism of Action
Clinical Pharmacology
Dosage and Administration
Modification of Dosage in Disease States
Adverse Reactions
Drug Interactions
Ibutilide
Clinical Applications
Mechanism of Action
Clinical Pharmacology
Dosage and Administration
Modification of Dosage in Disease States
Adverse Reactions
Drug Interactions
Dofetilide
Clinical Applications
Mechanism of Action
Clinical Pharmacology
Dosage and Administration
Modification of Dosage in Disease States
Adverse Drug Reactions
Drug Interactions
Adenosine
Clinical Applications
Mechanism of Action
Clinical Pharmacology
Dosage and Administration
Modification of Dosage in Disease States
Adverse Reactions
Drug Interactions
Dronedarone
Clinical Applications
Mechanism of Action
Clinical Pharmacology
Individualization of Dosage
Modification of Dosage in Disease States
Adverse Reactions
Drug Interactions
Appendix
References
Chapter 19: Pharmacologic Management of Supraventricular Tachycardias
Pharmacology of Supraventricular Tachycardias
Evaluation of Therapy
Paroxysmal Supraventricular Tachycardia
Mechanisms of Paroxysmal Supraventricular Tachycardia
Management of Acute Episodes of Paroxysmal Supraventricular Tachycardia
Long-Term Therapy of Premature Supraventricular Tachycardia
Long-Term Pharmacologic Therapy
Atrial Flutter
Short-Term Management of Atrial Flutter
Long-Term Management of Atrial Flutter
Multifocal Atrial Tachycardia
Inappropriate Sinus Tachycardia
Junctional Ectopic Tachycardia
References
Chapter 20: Atrial Fibrillation
Classification
Decision for Rhythm or Rate Control
Rate Control
Pharmacologic Rate Control in Atrial Fibrillation: Optimal Ventricular Rate
Nonpharmacologic Approach to Rate Control
Rhythm Control
Pharmacologic Cardioversion
Electrical Cardioversion
Maintenance of Sinus Rhythm
Pharmacologic Approaches
Choice of Drug
Initiation and Monitoring of Antiarrhythmic Drugs
Adjunctive Therapy for the Maintenance of Sinus Rhythm
Nonpharmacologic Approaches to the Maintenance of Sinus Rhythm
Pacing for the Maintenance of Sinus Rhythm
Thromboembolic Prophylaxis
Pericardioversion Anticoagulation
Atrial Fibrillation Following Cardiac Surgery
Conclusions
References
Chapter 21: Nonpharmacologic Treatment of Tachyarrhythmias
Catheter Ablation for the Treatment of Tachyarrhythmias
Practical Considerations
Catheter Ablation by Specific Arrhythmia Syndrome
Catheter Ablation for Supraventricular Tachyarrhythmias
Accessory Pathway?mediated Tachycardias
Atrioventricular Node Reentry
Atrial Tachycardia
Atrial Flutter
Isthmus-Dependent Atrial Flutter
Other Atrial Flutters
Atrial Fibrillation
Atrioventricular Junction Ablation for Ventricular Rate Control
Catheter Ablation for Ventricular Tachyarrhythmias
Idiopathic Ventricular Tachycardia
Ventricular Tachycardia in Patients with Structural Heart Disease
Ventricular Fibrillation and Polymorphic Ventricular Tachycardia
Summary
References
Chapter 22: Role of Implantable Cardioverter-Defibrillators in Primary and Secondary Prevention of Sudden Cardiac Death
Sudden Cardiac Death
Implantable Cardioverter-Defibrillator Systems and Technology
Implantable Cardioverter-Defibrillators for Secondary Prevention of Sudden Death
Implantable Cardioverter-Defibrillators for Primary Prevention of Sudden Cardiac Death
Clinical Trials
Risk Stratification for Sudden Cardiac Death
Ejection Fraction
Electrophysiologic Studies
Nonsustained Ventricular Arrhythmias
Signal-Averaged Electrocardiogram
T-Wave Alternans
Autonomic Function
Left Ventricular Scar Burden
Genetic Testing
Comorbidities and Implantable Cardioverter-Defibrillator Benefit
Age
Kidney Disease
Heart Failure
Effects of Multiple Comorbid Conditions
Cardiac Resynchronization Implantable Cardioverter-Defibrillators
Guidelines for Cardioverter-Defibrillator Implantation
Class I Indications
Class II Indications
Class III Indications
Special Patient Groups
After Coronary Artery Bypass Graft/Revascularization
Immediately after Myocardial Infarction
Long QT Syndrome
Hypertrophic Cardiomyopathy
Arrhythmogenic Right Ventricular Dysplasia
Brugada Syndrome
CARdioverter-defibrillator therapy
Clinical Issues
Follow-Up
Implantable Cardioverter-Defibrillator Shocks
Electrical Storm
Electromagnetic Interference and Perioperative Care
Driving
References
Chapter 23: Treatment of Ventricular Tachycardia and Cardiac Arrest
Ventricular Tachycardia: Acute Management
Sustained Monomorphic Ventricular Tachycardia with a Pulse
Lidocaine
Procainamide
Sotalol
Amiodarone
Magnesium
Overdrive Ventricular Pacing
Cardioversion
Evaluation to Exclude Potentially Reversible Causes of Ventricular Tachycardia
Polymorphic Ventricular Tachycardia
Management of Cardiac Arrest
Epidemiology and General Principles
Cardiopulmonary Resuscitation and Advanced Cardiac Life Support
Chest Compressions
Defibrillation
Rescue Breathing
Advanced Cardiac Life Support
Post?Cardiac Arrest Care
General Approach
Critical Care Support
Therapeutic Hypothermia
Neurologic Prognostication
References
Part V: Dyslipoproteinemias and Atherosclerosis
Chapter 24: Drugs for Elevated Low-Density Lipoprotein Cholesterol
Effects on Lipids and Lipoproteins
Pharmacokinetic Properties
Drug Interactions
Efficacy
Angiographic Trials
Large-Scale Clinical Trials
Mechanism of Benefit of Statins
Safety
Liver
Muscle
Bile Acid Sequestrants
Effects on Lipids and Lipoproteins
Efficacy
Safety/Compliance Issues
Ezetimibe and Cholesterol Absorption Inhibitors
Effect on Lipids/Lipoproteins
Efficacy
Safety
Plant Stanol Esters
Effect on Lipids/Lipoproteins
Efficacy Against Coronary Heart Disease
Safety
References
Chapter 25: Therapy to Manage Low High-Density Lipoprotein Cholesterol and Elevated Triglycerides
Rationale for Combination Therapy
Lack of Achievement of Non?High-Density Lipoprotein Goals
Residual Risk for Statin Therapy
Combined Dyslipidemia
Non?High-Density Lipoprotein Cholesterol Reduction
Therapy to Modify High-Density Lipoprotein
Statin-Fibrate Combination
Statin-Niacin Combination
Statin?Omega-3 Fatty Acids Combination
Cholesteryl Ester Transfer Protein Inhibition
Conclusion
References
Chapter 26: Cardiovascular Disease and Lifestyle Modification
Dietary Fats and Blood Lipids
High-Carbohydrate, Low-Fat Diets to Reduce Low-Density Lipoprotein Cholesterol and Blood Pressure
The DASH Diet
Low-Fat Diets, Low Saturated Fat, and Cardiovascular Disease: Clinical Trials and Epidemiology
Moderate Unsaturated Fat Diets
Reduced-Carbohydrate, Higher Unsaturated Fat, and Protein Diets: A New Twist to the DASH Dietary Approach
Type of Carbohydrate
Fish Oil to Prevent Coronary Heart Disease
Obesity
Clinical Assessment of Obesity
Goals for Weight Loss and Management
Determination of Calorie Levels for Weight Loss
2010 Dietary Guidelines
Healthy Eating Patterns
The Mediterranean Diet
Physical Activity
Overall Effect of Diet and Lifestyle
References
Chapter 27: Steps Beyond Diet and Drug Therapy for Severe Hypercholesterolemia
Definition of the Target Population
Description of the Patient Population
Homozygous Familial Hypercholesterolemia
Patients with Low-Density Lipoprotein Cholesterol Concentrations of More than 200 mg/dL and Coronary Artery Disease
Patients with Low-Density Lipoprotein Cholesterol Concentrations of More than 300 mg/dL Without Coronary Artery Disease
Extracorporeal Therapies for the Treatment of Severe Hypercholesterolemia
Technical Aspects
Low-Density Lipoprotein Apheresis Using Dextran Sulfate Cellulose Columns
Low-Density Lipoprotein Apheresis Using Immunoadsorption Columns
Low-Density Lipoprotein Apheresis Using Heparin-Induced Extracorporeal Low-Density Lipoprotein Precipitation
Low-Density Lipoprotein Apheresis Using Whole Blood?compatible Systems
Risks of Low-Density Lipoprotein Apheresis
Benefits of Low-Density Lipoprotein Apheresis
Benefits of Low-Density Lipoprotein Apheresis Beyond Reducing Low-Density Lipoprotein Concentrations
Low-Density Lipoprotein Apheresis: Failure to Treat Individuals Who May Benefit
Surgical Procedures
Portacaval Shunt
Technique
Cholesterol Lowering
Risks and Benefits
Treatment Guidelines
Liver Transplantation
Cholesterol Lowering
Risks and Benefits
Treatment Guidelines
Partial Ileal Bypass
Technique
Cholesterol Lowering
Risks and Benefits
Gene Therapy
Conclusions and Recommendations for Therapy
References
Part VI: Hypertension
Chapter 28: Initial Evaluation and Approach to the Patient with Hypertension
Overview and Definitions
Evaluation of the Patient
History
Present Illness
Family History
Past Medical History
Review of Systems
Personal History
Physical Examination
Blood Pressure Measurement
Laboratory Evaluation
Overview of Treatment of the Hypertensive Patient
Resistant Hypertension
Adherence to Antihypertensive Medications
Lifestyle Modifications: Overview
Practical Approaches to Encouraging Lifestyle Modifications
Barriers to Lifestyle Modifications
Approaches to Increasing the Adoption of Lifestyle Modifications
Readiness for Change
Tips for Success in Adopting Healthier Dietary Practices
Tips for Success in Increasing Physical Activity
General Tips for Adopting Healthier Lifestyles
Conclusion
References
Chapter 29: Pharmacologic Management of Hypertension
Overview
Principles of Treatment
Evidence-Based Treatment
Blood Pressure Goals
Selecting Drug Therapy
Uncomplicated Hypertension
Patients with Compelling Indications
Diabetes
Chronic Kidney Disease
Coronary Artery Disease
Left Ventricular Dysfunction
Previous Ischemic Stroke
Overview of Drug Classes
Angiotensin-Converting Enzyme Inhibitors
Angiotensin Receptor Blockers
Calcium Channel Blockers
Diuretics: Thiazides
β-Blockers
Aldosterone Antagonists
Other Agents
α-Blockers
Arterial Vasodilators
Central α-Agonists
Direct Renin Inhibitor
Rauwolfia Alkaloids
Implementing Drug Therapy
Need for 24-Hour Coverage
Monotherapy Versus Combination Therapy
Monotherapy
Combination Therapy
Effects of Patient Characteristics on Blood Pressure Lowering
Monitoring
Adherence
Step-Down Therapy
Special Populations
Elderly Patients
Isolated Systolic Hypertension
Blood Pressure Goals
Orthostatic Hypotension
Selecting Drug Therapy
African-American Patients
References
Chapter 30: Endocrine Causes of Hypertension
Pheochromocytoma
Presentation
Syndromic Pheochromocytoma
Diagnosis
Principles of Treatment
Preoperative Management
α-Adrenergic Blockade
β-Adrenergic Blockade
Catecholamine Synthesis Inhibitor
Calcium Channel Blockers
Acute Hypertensive Crises
Anesthesia and Surgery
Long-Term Postoperative Follow-Up
Malignant Pheochromocytoma
Pheochromocytoma in Pregnancy
Primary Aldosteronism
Diagnosis
Case Detection
Confirming the Diagnosis
Subtype Evaluation
Principles of Treatment
Surgical Treatment of Aldosterone-Producing Adenoma and Unilateral Hyperplasia
Pharmacologic Treatment
Pharmacologic Treatment of Glucocorticoid-Remediable Aldosteronism
Other Forms of Mineralocorticoid Excess
Hyperdeoxycorticosteronism
Congenital Adrenal Hyperplasia
11-β-Hydroxylase Deficiency
17-α-Hydroxylase Deficiency
Deoxycorticosterone-Producing Tumor
Primary Cortisol Resistance
Apparent Mineralocorticoid Excess Syndromes
Cushing Syndrome
Presentation
Diagnosis
Principles of Treatment
Thyroid and Parathyroid Disease
Thyroid Dysfunction
Presentation and Diagnosis
Principles of Treatment
Primary Hyperparathyroidism
Presentation and Diagnosis
Principles of Treatment
Acromegaly
Presentation and Diagnosis
Principles of Treatment
References
Chapter 31: Resistant Hypertension
Pseudoresistance
Diagnosis
Ambulatory Blood Pressure Monitoring
Cardiovascular Risk
Secondary Causes of Hypertension
Obstructive Sleep Apnea and Resistant Hypertension
Primary Aldosteronism and Resistant Hypertension
Interfering Substances
Dietary Sodium
Pharmacologic Treatment
Diuretics
Mineralocorticoid Receptor Antagonists
Other Antihypertensive Agents
Other Treatment Modalities
Renal Sympathetic Denervation
Baroreflex Activation Therapy
Role of the Hypertension Specialist
References
Chapter 32: Hypertensive Crisis
Overview
Definitions
Hypertensive Urgency
Hypertensive Emergency
Hypertensive Crisis
Malignant and Accelerated Hypertension
Epidemiology and Etiology
Pathophysiology
Patient Evaluation
History, Physical Examination, and Ancillary Testing
Management of Hypertensive Emergency
Cardiovascular Presentations
Acute Coronary Syndromes
Left Ventricular Failure and Acute Pulmonary Edema
Aortic Dissection
Neurologic Presentations
Ischemic Cerebrovascular Syndromes
Hemorrhagic Cerebrovascular Syndromes
Intracerebral Hemorrhage
Subarachnoid Hemorrhage
Hypertensive Encephalopathy
Renal Presentations
Catecholaminergic Presentations
Acute Withdrawal of Antihypertensive Therapy
Pheochromocytoma
Sympathomimetic Drugs
Autonomic Dysfunction
Pediatric Hypertensive Emergencies
Obstetric Presentations: Preeclampsia and Eclampsia
Hemorrhage and Post?Vascular Surgery Presentations
Follow-up and Prognosis
Caveats to Therapy in Hypertensive Emergency Care
References
Chapter 33: Hypertension in Pregnancy
Overview
Epidemiology and Risk Factors
Pathophysiology
Preeclampsia
Chronic Hypertension
Gestational Hypertension
Diagnosis
Treatment
Prevention
Treatment of Hypertension in Pregnancy
Acute Management of Severe Hypertension in Pregnancy
Prevention and Management of Eclampsia
Implications for Later Cardiovascular Disease
Conclusions
References
Chapter 34: Management of Hypertension in Children and Adolescents
Overview
Definitions of High Blood Pressure in Children
Confirmation of Elevated Blood Pressure
Primary Versus Secondary Hypertension in Childhood
Approach to Therapy
Nonpharmacologic Approaches
Use of Antihypertensive Medications
Summary
References
Part VII: Other Vascular Conditions
Chapter 35: Peripheral Artery Disease
Overview
Medical Therapy of Peripheral Artery Disease
Cardiovascular Risk Reduction
Antiplatelet Therapy
Anticoagulant Therapy
Lipid-Lowering Drugs
HMG-CoA Reductase Inhibitor Statin Therapy
Nonstatin Lipid-Lowering Therapy
Antihypertensive Therapy
Angiotensin-Converting Enzyme Inhibitor Therapy
β-Blocker Therapy
Smoking Cessation Therapy
Diabetes
Intermittent Claudication
Pentoxifylline
Cilostazol
Perioperative Medical Therapy for Noncardiac Vascular Surgery
β-Blockers
Statin Therapy
Antiplatelet Therapy
Interventional Management of Peripheral Artery Disease
Indications for Revascularization
Procedural Considerations
Aortoiliac Disease
Femoral-Popliteal Disease
Infrapopliteal Disease
Therapeutic Angiogenesis
Conclusions
References
Chapter 36: Cerebrovascular Disease
Atherosclerotic Carotid Artery Disease and Stroke
Risk of Stroke
Prevalence of Carotid Artery Disease
Medical Therapy of Atherosclerotic Carotid Artery Disease
Smoking Cessation
Antihypertensive Therapy
Lipid-Lowering Therapy
Antiplatelet Therapy
Revascularization for Carotid Artery Disease
Surgical Revascularization
Carotid Endarterectomy for Symptomatic Carotid Artery Stenosis
Carotid Endarterectomy for Asymptomatic Carotid Artery Stenosis
Endovascular Therapy for Carotid Artery Stenosis
Carotid Artery Stenting in Symptomatic and Asymptomatic Patients at HIGH Surgical Risk: Data From Large Registries
Carotid Artery Stenting in Patients at HIGH Surgical Risk: Data From Randomized Trials
Carotid Artery Stenting in Normal-Risk Symptomatic Patients
Carotid Artery Stenting in Normal-Risk Symptomatic and Asymptomatic Patients: CREST
Should Asymptomatic Carotid Artery Stenosis Be Revascularized?
Carotid Artery Disease and Coronary Artery Bypass Graft Surgery
References
Chapter 37: Renal Artery Stenosis
Overview
Clinical Manifestations
Natural History of Renal Artery Stenosis
Diagnosis of Renal Artery Stenosis
Treatment of Atherosclerotic Renal Artery Stenosis
Medical Therapy
Which Patients Should Be Revascularized?
Catheter-Based Intervention
Surveillance of Renovascular Disease
Catheter-Based Renal Artery Sympathetic Denervation
Conclusion
References
Chapter 38: Pulmonary Embolism and Deep Vein Thrombosis
Epidemiology and Risk Factors
Pathophysiology and Natural History
Diagnosis
Deep Vein Thrombosis
Clinical Presentation
Clinical Likelihood Assessment
Laboratory Testing
Imaging
Overall Diagnostic Algorithm
Pulmonary Embolism
Clinical Presentation
Laboratory Testing
Electrocardiogram
Chest Radiography
Chest Computed Tomography for Diagnosis and Risk Stratification
Echocardiography for Diagnosis and Risk Stratification
Lung Scanning
Magnetic Resonance Imaging
Overall Diagnostic Algorithm
Overall Risk Stratification of Pulmonary Embolism
Management
Spectrum of Disease: Superficial Venous Thrombosis, Deep Vein Thrombosis, and Pulmonary Embolism
Anticoagulation
Unfractionated Heparin
Heparin-Induced Thrombocytopenia
Low-Molecular-Weight Heparin
Fondaparinux
Warfarin
Direct Factor XA and Factor IIA Inhibitors
Basic Versus Advanced Therapy for Venous Thromboembolism
Deep Vein Thrombosis
Advanced Therapy for Pulmonary Embolism
Duration of Anticoagulation
Inferior Vena Cava Filters
Prevention
Prevention of Venous Thromboembolism in Patients with Cancer
Implementation of in-Hospital Prophylaxis
Hip Replacement, Knee Replacement, and Hip Fracture
Mechanical Prophylaxis
Unconventional Prophylaxis
Vitamin E
Statins
Duration of Prophylaxis and Extension of Prophylaxis after Hospital Discharge
Conclusions
References
Chapter 39: Treatment of Pulmonary Arterial Hypertension
Current State of Diagnosis
Epidemiologic Associations
Current Pathobiologic Paradigm of Pulmonary Arterial Hypertension
Diagnosis and Risk Stratification
Current State of Therapy
Prostanoids
Endothelin Receptor Antagonism
Phosphodiesterase Inhibition
Atrial Septostomy
Transplantation for Idiopathic Pulmonary Arterial Hypertension
Medical Therapy Algorithms
New Pathobiologic and Care Paradigms
Pregnancy and Contraception
References
Chapter 40: Aortic Disease
Abdominal Aortic Aneurysms
Surgical Management
Medical Management
Thoracic Aortic Aneurysms
Surgical Management
Medical Management
Aortic Dissection
Definitive Therapy
Long-Term Therapy and Late Follow-up
Intramural Hematoma
Penetrating Atherosclerotic Ulcer
Thoracic Aortic Atheroembolism
References
Part VIII: Other Cardiovascular Conditions
Chapter 41: Pharmacologic Options for Treating Cardiovascular Disease During Pregnancy
Hypertension
Edema
Valvular Heart Disease
Thromboembolic Disease During Pregnancy
Fibrinolysis
Ischemic Heart Disease
Lipid Disorders
Heart Failure
Cardiac Arrhythmias
Marfan Syndrome
Pulmonary Hypertension
Antibiotic Prophylaxis
References
Chapter 42: Care for Adults with Congenital Heart Disease
Issues for the Care Provider
Endocarditis
Left-to-Right Shunting: General Principles
Cyanosis
Major Cyanotic Organ Complications
Musculoskeletal Changes
Hematologic Changes
Renal Changes
Cardiopulmonary Exercise
Neurologic Effects
Recommendations for Management of the Cyanotic Patient
Pregnancy
Recommendations
Noncardiac Surgery
Recommendations
Arrhythmia Management
Exercise and Athletic Participation
Transplantation
Guidelines for Management of Patients with Specific Congenital Cardiac Lesions
Atrial Septal Defects
Recommendations
Patent Foramen Ovale
Patent Foramen Ovale and Hypoxemia
Patent Foramen Ovale and Migraine
Recommendations
Bicuspid Aortic Valve
Recommendations
Pulmonary Stenosis
Recommendations
Aortic Coarctation
Recommendations
Tetralogy of Fallot
Recommendations
Patent Ductus Arteriosus
Recommendations
Ventricular Septal Defects
Post?Myocardial Infarction Ventricular Septal Rupture
Perimembranous Ventral Septal Defect Closure
Recommendations
Postoperative Residual Defects, Collaterals, and Fenestrations
References
Chapter 43: Prevention and Treatment of Infective Endocarditis
Overview
Diagnosis
Echocardiography in the Diagnosis and Management of Endocarditis
Antibiotic Therapy
Identifying Patients at Risk of Poor Clinical Outcomes
Surgical Therapy and Complicated Infective Endocarditis
Heart Failure
Abscess
Embolic Events
Prosthetic Valve Infections
Cardiac Device Infections
Long-Term Outcomes and Management
Prevention
Future Directions
Conclusions
References
Chapter 44: Treatment of Pericardial Disease
Acute Pericarditis
Recurrent Pericarditis
Pericardial Effusion and Tamponade
Constrictive Pericarditis
Treatment of Specific Causes of Pericarditis
Purulent Pericarditis
Mycobacterial and Fungal Pericarditis
Human Immunodeficiency Virus?Associated Pericarditis
Neoplastic Pericarditis
Pericarditis Complicating Myocardial Infarction and the Postpericardial Injury Syndrome
Radiation-Induced Pericardial Disease
Traumatic Pericardial Disease
Chylopericardium
Pericardial Disease in Patients with Renal Failure
Myxedema Pericardial Disease
Connective Tissue Disease?Related Pericardial Disease
Pericardial Disease and Pregnancy
Drug-Induced and Iatrogenic Pericardial Disease
Anticoagulation in Pericarditis
Acknowledgment
References
Chapter 45: Optimal Timing of Surgical and Mechanical Intervention in Native Valvular Heart Disease
Overview
Aortic Stenosis
Assessment of Severity
Timing of Surgical Intervention
Symptomatic Patients
Low-Gradient Aortic Stenosis
Elderly Patients
Asymptomatic Patients
Overall Approach
Role of Percutaneous Intervention
Mitral Stenosis
Assessment of Severity
Overall Approach
Percutaneous Mitral Balloon Valvuloplasty
Aortic Insufficiency
Assessment of Severity
Timing of Surgical Intervention
Symptomatic Patients with Normal Left Ventricular Function
Symptomatic Patients with Left Ventricular Dysfunction
Asymptomatic Patients
Overall Approach
Mitral Insufficiency
Assessment of Severity
Timing of Intervention
Symptomatic Patients
Asymptomatic Patients
Overall Approach
Functional Ischemic Mitral Regurgitation
Right-Sided Valve Disease
Tricuspid Valve Disease
Pulmonary Valve Disease
Future Directions
References
Chapter 46: Surgery for Valvular Heart Disease
Overview
General Considerations
Epidemiology
Indications
Preoperative Evaluation and Optimization
History and Physical examination
Echocardiography
Cardiac Catheterization
Other Preoperative Testing
Medical Therapy
Surgical Approaches
Median Sternotomy
Minimally Invasive Approaches
Prostheses
Mechanical Valves
Stented Xenografts
Stentless Xenografts
Homografts
Postoperative Care
Aortic Valve Surgery
Overview
Indications
Aortic Stenosis/Mixed Aortic Valve Disease
Aortic Regurgitation
Aortic Valve Replacement
Surgical Technique
Choice of Prosthesis
Patient-Prosthesis Mismatch
Aortic Valve Repair
Results
Early
Late
Mitral Valve Surgery
Overview
Anatomy
Carpentier’s Functional Classification
Preoperative Evaluation
Indications
Mitral Regurgitation
Mitral Stenosis
Mitral Valve Repair
Principles
Annuloplasty
Leaflet Prolapse Repair Techniques Type II
Restricted Leaflet Techniques Type III
Other Techniques
Mitral Valve Replacement
Chordal-Sparing Mitral Valve Replacement
Choice of Prosthesis
Results
Early
Late
Tricuspid Valve Surgery
Overview
Indications
Surgical Techniques
Approach
Valve Repair
Valve Replacement
Results
Special Considerations
Multiple Valves
Mitral and Tricuspid Disease
Aortic and Mitral Disease
Reoperation
Endocarditis
Ischemic Heart Disease
Incidental Coronary Disease in Valve Surgery Patients
Incidental Valve Disease in Coronary Surgery Patients
Aortic Stenosis in Coronary Artery Bypass Grafting Patients
Mitral Regurgitation in Coronary Artery Bypass Grafting Patients
Atrial Fibrillation
References
Chapter 47: Percutaneous Treatment for Valvular Heart Disease
Overview
Percutaneous Aortic Valve Implantation
Current Percutaneous Aortic Valves
Edwards Sapien Valve
Medtronic CoreValve Revalving System
Patient Evaluation and Imaging Prior to Transcatheter Aortic Valve Implantation
Access Site Evaluation
Measurement of Aortic Valve Annulus
Transcatheter Aortic Valve Implantation Procedure
Patient Outcomes
New Access Approaches
New Applications
Potential Complications
Next-Generation Aortic Valve Therapy
Transapical Valves
Percutaneous Mitral Valve Therapy
Approach to Leaflet Repair
Chamber Remodeling
Direct Annuloplasty
Ventricular Remodeling
Chordal Implantation
Mitral Valve Replacement
Summary
References
Chapter 48: Manifestations, Mechanisms, and Treatment of HIV-Associated Cardiovascular Disease
Overview
Antiretroviral Therapy
Protease Inhibitors
Nucleoside/Nucleotide Reverse Transcriptase Inhibitors
Nonnucleoside Reverse Transcriptase Inhibitors
Fusion Inhibitors
Integrase Inhibitors
Combination Medications
Metabolic Effects of HIV Infection and Antiretroviral Therapy
Hypertension
Lipodystrophy and the Metabolic Syndrome
Screening for Cardiovascular Disease in HIV-Positive Patients
HIV Infection and Myocardial Infarction
Clinical Features of Coronary Disease in HIV Patients
Pathogenesis of Coronary Heart Disease in HIV Infection
Treatment of Coronary Risk Factors in HIV Patients
Myocardial Involvement in HIV
Pericardial Disease in Patients with HIV Infection
HIV-Related Pulmonary Hypertension
Cerebrovascular Disease
Endocarditis and Other Cardiac Disease
Summary
References
Chapter 49: Rehabilitation of the Patient with Cardiovascular Disease
Physiologic Effects of Immobility
Physical Training
Newer Concepts Regarding Physiologic Benefits of Exercise Training
Cardiac Rehabilitation After Myocardial Infarction
Disability from Myocardial Infarction
In-Hospital Exercise After a Coronary Event
Patient Education
Exercise Testing Before Hospital Discharge
Outpatient Cardiac Rehabilitation
Other Components of Outpatient Rehabilitation
Safety of Cardiac Rehabilitation
Monitoring in Outpatient Rehabilitation
Maintenance Program
Exercise Prescription for Outpatient Rehabilitation
Principles of Exercise Prescription
Resistance Exercise
Contraindications to Exercise Training
Rehabilitation in Patients with Chronic Heart Failure
Meta-Analyses of Survival After Cardiac Rehabilitation
Evolving Landscape for Cardiac Rehabilitation
Summary
References
Part IX: Appendix
Cardiovascular Devices
Pulmonary Artery Catheters
Indications
Design
Technical Aspects of Placement
Interpretation of Waveforms
Troubleshooting and Complications
Intraaortic Balloon Pump Counterpulsation
Indications
Design
Technical Aspects of Placement
Timing and Waveforms
Complications
Pericardiocentesis
Indications
Technical Aspects
Electrical Cardioversion and Defibrillation
Equipment
Setup and Patient Preparation
Technical Considerations
Permanent Pacemakers
Leads
Basic Pacing Concepts
Pacemaker Programming Considerations
Mode
Rate-Responsive Pacing
Pseudo Pacemaker Malfunction
Temporary Pacemakers
Indications
Placement
Complications and Troubleshooting
Implantable Cardioverter-Defibrillators
Programmed Therapies for Ventricular Arrhythmias
Magnet Operation
Inappropriate Shocks
Routine Follow-up
References
Index
A
B
C
D
E
F
G
H
I
J
K
L
M
N
O
P
Q
R
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U
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W
X
Y
Z