9780412112812

Foreword

xix

(2)

Preface

xxi

Chapter 1 The Cardiovascular Examination

(20)

History

(2)

Organic Cardiac Symptoms

(1)

Functional Cardiac Symptoms

(1)

Method of Physical Examination

(1)

Inspection and Palpation

(1)

Auscultation

(1)

Percussion

(1)

Electrocardiography and Vectorcardiography

(1)

Cardiac Radiography

(1)

Phonocardiography and Other Graphic Methods

(2)

Phonocardiography

(1)

Carotid Pulse

(1)

Jugular Venous Pulse

(1)

Apex Cardiogram

(1)

Echocardiography

(3)

Doppler Echocardiography

(1)

Intravascular Ultrasonography

(1)

Radionuclide Studies

(1)

Other Cardiac Imaging Studies

(1)

Heart Catheterization and Selective Angiocardiography

(1)

Swan-Ganz Catheterization

(2)

Classification of Cardiac Problems

(1)

Points to Remember and the Cost-Effective Approach

(3)

Chapter 2 Diagnostic Clues in Cardiovascular Disease

(18)

Skin

(1)

Head

(1)

Neck

(3)

Chest

(8)

Inspection and Palpation Clues

(2)

Auscultatory Clues

(6)

Heart Sounds

(2)

Heart Murmurs

(4)

Innocent Murmurs

(1)

The Innocent Systolic Ejection Murmur

(1)

Cardiorespiratory Murmur

(1)

Venous Hum

(1)

The Mammary Souffle

(1)

Carotid and Supraclavicular Bruit

(1)

Common Organic Murmurs

(1)

Points to Remember about Murmurs

(1)

Abdomen

(1)

Extremities

(2)

Points to Remember and the Cost-Effective Approach

(3)

Chapter 3 Clinical Electrocardiography

(36)

Basic Principles

(4)

Myocardial Infarction

(8)

Ventricular Hypertrophy

(2)

Atrial Enlargement

(1)

Bundle-Branch Block

(2)

The ST Segment and the T Wave

(1)

How to Understand Electrocardiographic Interpretations

(9)

Common Arrhythmia Interpretations

(5)

Points to Remember and the Cost-Effective Approach

(4)

Chapter 4 Coronary Heart Disease

(156)

Angina Pectoris

(7)

Coronoary Atherosclerosis

(2)

Angina with Normal Coronary Arteriograms

(5)

Syndrome X

(2)

Coronary Artery Spasm

(1)

Mitral Valve Prolapse

(1)

Myocardial Bridges

(1)

Hypertrophic Cardiomyopathy

(1)

Aortic Valve Disease

(1)

Systemic Hypertension

(1)

Pulmonary Hypertension

(1)

Unusual Causes of Angina

(1)

The Diagnosis of Angina Pectoris

(18)

History

(3)

Physical Examination

(1)

Stress Electrocardiogram

(2)

Interpretation of the Stress Electrocardiogram

(5)

Blood Pressure Responses to Stress

(1)

Radionuclide Studies in Angina

(4)

Coronary Arteriography

(1)

Coronary Velocity Reserve

(1)

Differential Diagnosis

(1)

Medical Treatment of Angina Pectoris

100

(1)

Stable Angina

101

(8)

Activity

101

(1)

Drugs

102

(7)

Nitrates

102

(2)

XXX-Blockers

104

(2)

Calcium-Entry Blockers

106

(3)

Associated Aggravating Conditions

109

(1)

Unstable Angina

109

(3)

Percutaneous Transluminal Coronary Angioplasty

112

(6)

Atherectomy

115

(1)

Laser Angioplasty

116

(1)

Stents

116

(1)

Restenosis

117

(1)

Surgical Treatment of Coronary Artery Disease

118

(2)

Silent Myocardial Ischemia

120

(2)

Points to Remember and the Cost-Effective Approach to Angina

122

(1)

Acute Myocardial Infarction

123

(1)

Diagnosis of Acute Myocardial Infarction

124

(7)

Symptoms

124

(2)

Prodromal Symptoms

124

(1)

The Acute Attack

125

(1)

Physical Examination

126

(1)

Uncomplicated Cases

126

(1)

Complicated Cases

126

(1)

Laboratory Tests

127

(2)

Electrocardiographic Findings

129

(1)

Vectorcardiographic Findings

129

(1)

Chest Radiography

129

(1)

Echocardiography

130

(1)

Radionuclide Studies

130

(1)

Cardiac Catheterization and Angiocardiography

130

(1)

Differential Diagnosis

131

(2)

Acute Pericarditis

131

(1)

Pulmonary Embolism

132

(1)

Dissecting Aortic Aneurysm

132

(1)

Spontaneous Pneumothorax and Mediastinal Emphysema

132

(1)

Gastrointestinal Lesions

132

(1)

Anxiety State

132

(1)

Treatment of Acute Myocardial Infarction

133

(1)

Prehospital and General Management

133

(2)

Initial Management

135

(14)

Oxygen, Nitroglycerin, XXX-Blockers, Aspirin

135

(2)

Thrombolytic Therapy, Heparin

137

(5)

Indications for Thrombolytic Therapy

137

(1)

Contraindications for Thrombolytic Therapy

138

(1)

Choice of Thrombolytic Agent

139

(3)

Other Adjunctive Therapy

142

(2)

Opiates

142

(1)

Calcium Channel Blockers

143

(1)

Magnesium

143

(1)

ACE Inhibitors

143

(1)

Lidocaine

144

(1)

Primary Angioplasty or as an Adjunct to Thrombolytic Therapy

144

(2)

Long-Term Anticoagulation

146

(1)

Non-Q-Wave Myocardial Infarction

147

(1)

Bed Rest and Activity

147

(1)

Diet

148

(1)

Bowel Function

148

(1)

Bladder Function

148

(1)

Complications of Myocardial Infarction

149

(1)

Arrhythmia

149

(1)

Tachyarrhythmias

150

(6)

Supraventricular Arrhythmias

150

(1)

Sinus Tachycardia

150

(1)

Atrial and Junctional Arrhythmias

151

(1)

Ventricular Arrhythmias

151

(5)

Premature Ventricular Beats

151

(1)

Ventricular Tachycardia

152

(2)

Accelerated Idioventricular Rhythm

154

(1)

Ventricular Fibrillation

155

(1)

Bradyarrhythmias

156

(4)

Sinus Bradycardia

156

(1)

Atrioventricular Conduction Disturbances

157

(3)

Ventricular Asystole

160

(1)

Hemodynamic and Mechanical Complications

160

(1)

Heart Failure

160

(3)

Pulmonary Edema

162

(1)

Cardiogenic Shock

163

(2)

Embolism

165

(1)

Heart Murmurs

165

(4)

Papillary Muscle Dysfunction

165

(1)

Papillary Muscle Rupture

166

(1)

Ventricular Septal Rupture

167

(2)

Free Wall Rupture

169

(1)

Ventricular Aneurysm

169

(2)

Postmyocardial Infarction Syndrome

171

(1)

Right Ventricular Infarction

171

(1)

Atrial Infarction

172

(1)

Postinfarction Management

172

(1)

Drugs to Prevent Morbidity and Mortality

173

(5)

XXX-Blockers

173

(2)

Antiplatelet Agents

175

(1)

Antiarrhythmic Agents

176

(1)

Postinfarction Drug Therapy

177

(1)

Cardiac Rehabilitation and Prevention

178

(5)

Phase I

178

(1)

Phase II

178

(4)

Phase III

182

(1)

Coronary Artery Disease Risk Factors

183

(18)

Blood Lipids

184

(3)

Dietary Treatment

187

(5)

Drug Treatment

192

(5)

Hypertension

197

(1)

Smoking

197

(1)

Exercise

198

(2)

Genetic Factors

200

(1)

Personality Types

200

(1)

Other Factors

201

(1)

Prevention of Plaque Rupture

201

(1)

Age, Gender, and Race Considerations

202

(6)

Elderly

202

(2)

Gender Differences

204

(2)

Race

206

(2)

Points to Remember and Cost-Effectiveness about Myocardial Infarction

208

(23)

Chapter 5 Systemic Hypertension and Hypertensive Heart Disease

231

(26)

Causes of Hypertension

232

(1)

Mechanisms of Essential Hypertension

233

(2)

Secondary Causes of Hypertension

235

(6)

Renal Disease

236

(1)

Renovascular Hypertension

236

(2)

Pheochromocytomas

238

(1)

Primary Aldosteronism (Conn's Syndrome)

239

(1)

Cushing's Syndrome

240

(1)

Coarctation of the Aorta

240

(1)

Oral Contraceptives

241

(1)

Systolic Hypertension

241

(1)

Treatment of Hypertension

241

(8)

Nonpharmacologic Therapy

242

(1)

Pharmacologic Therapy

242

(7)

Special Therapeutic Considerations

249

(2)

Hypertension in the Elderly

251

(1)

J-shaped Curve Phenomenon

251

(1)

Hypertensive Crises

251

(2)

Points to Remember and the Cost-Effective Approach

253

(4)

Chapter 6 Rheumatic Fever and Valvular Heart Disease

257

(56)

Acute Rheumatic Fever

257

(1)

Major Manifestations

258

(1)

Arthritis

258

(1)

Carditis

258

(1)

Chorea

259

(1)

Subcutaneous Nodules

259

(1)

Erythema Marginatum

259

(1)

Minor Manifestations Plus Evidence of Streptococcal Infection

259

(1)

Differential Diagnosis

260

(1)

Treatment

261

(2)

Chemoprophylaxis

261

(1)

Treatment of Acute Rheumatic Fever

262

(1)

Mitral Valve Disease

263

(23)

Mitral Insufficiency

263

(12)

Etiology

263

(1)

Rheumatic Mitral Insufficiency

263

(5)

Mitral Valve Prolapse

268

(6)

Coronary Artery Disease

274

(1)

Calcified Mitral Annulus

274

(1)

Connective Tissue Diseases

275

(1)

Congenital Mitral Insufficiency

275

(1)

Left Ventricular Enlargement

275

(1)

Treatment of Chronic Mitral Insufficiency

275

(2)

Acute Mitral Insufficiency

277

(2)

Mitral Stenosis

279

(7)

Aortic Valve Disease

286

(17)

Aortic Insufficiency

286

(17)

Acute Aortic Insufficiency

293

(1)

Aortic Stenosis

294

(8)

Aortic Stenosis in the Elderly

302

(1)

Tricuspid Valve Disease

303

(2)

Tricuspid Insufficiency

303

(1)

Tricuspid Stenosis

304

(1)

Pulmonary Valve Disease

305

(2)

Multivalvular Disease

307

(1)

Points to Remember and the Cost-Effective Approach

308

(5)

Chapter 7 Congenital Heart Disease

313

(40)

Left-to-Right Shunts

313

(11)

Ventricular Septal Defect

313

(2)

Atrial Septal Defect

315

(7)

Patent Ductus Arteriosus

322

(2)

Right-to-Left Shunts

324

(1)

Lesions with Decreased Pulmonary Blood Flow

324

(5)

Tetralogy of Fallot

324

(3)

Tricuspid Atresia

327

(2)

Lesions with Increased Pulmonary Blood Flow

329

(1)

Cardiac Malpositions

329

(4)

Complete Transposition of the Great Vessels

330

(1)

Double Outlet Right Ventricle

331

(1)

Corrected Transposition

332

(1)

Truncus Arteriosus

333

(1)

Pulmonary Hypertension

334

(3)

The Eisenmenger Complex

334

(1)

Eisenmenger's Syndrome

334

(1)

Primary Pulmonary Hypertension

335

(2)

Obstructive Defects

337

(6)

Pulmonary Stenosis

337

(2)

Aortic Stenosis (Valvular, Subvalvular, Supravalvular)

339

(2)

Coarctation of the Aorta

341

(2)

Hypoplastic Left Heart Syndrome

343

(1)

Lesions that Produce Continuous Murmurs

343

(2)

Rupture of a Sinus of Valsalva Aneurysm

343

(1)

Coronary Arteriovenous Communication

344

(1)

Anomalous Origin of Coronary Arteries

344

(1)

Systemic Arteriovenous Fistula

344

(1)

Pulmonary Arteriovenous Fistula

345

(1)

Less Common Defects

345

(2)

Ebstein's Anomaly

345

(1)

Total Anomalous Pulmonary Venous Drainage

346

(1)

Dextrocardia and Other Cardiac Malpositions

346

(1)

Congenital Heart Defects in the Adult (With or Without Reparative Surgery)

347

(3)

Points to Remember and the Cost-Effective Approach

350

(3)

Chapter 8 Pulmonary Heart Disease

353

(24)

Chronic Cor Pulmonale

353

(1)

Pathogenesis and Pathology

353

(2)

Alveolar Hypoventilation

353

(1)

Reduction in Pulmonary Vascular Bed

354

(1)

Intrapulmonary Vascular Shunts

354

(1)

Myocardial Factors

355

(1)

Functional Classification

355

(2)

Diagnosis

357

(6)

Clinical Features of Pulmonary Disease

357

(1)

Pulmonary Function Tests

358

(1)

Clinical Features of Cor Pulmonale

359

(2)

Radiographic Studies

361

(1)

Electrocardiographic Findings

361

(1)

Echocardiographic and Radionuclide Studies

362

(1)

Treatment

363

(2)

Pulmonary Hypertension

363

(1)

Smoking

363

(1)

Oxygen

363

(1)

Brochodilators

364

(1)

Antibiotics

364

(1)

Sedation

364

(1)

Steroids

364

(1)

Acid-Base Regulation

365

(1)

Surgery

365

(1)

Cardiac Failure

365

(2)

Digitalis

365

(1)

Diuretics

366

(1)

Phlebotomy

366

(1)

Vasodilators

366

(1)

Pulmonary Embolism

367

(6)

Acute Cor Pumonale

367

(1)

Clinical Findings

367

(2)

Laboratory Studies

369

(1)

Treatment

369

(4)

Points to Remember and the Cost-Effective Approach

373

(4)

Chapter 9 Diseases of the Aorta

377

(16)

Cardiovascular Syphilis

377

(1)

Thoracic Aortic Disease

378

(5)

Aneurysms

378

(1)

Marfan's Syndrome

379

(1)

Annuloaortic Ectasia

380

(1)

Aortic Arch Syndrome

381

(2)

Abdominal Aortic Disease

383

(3)

Aneurysms

383

(2)

Leriche's Syndrome

385

(1)

Saddle Embolus

385

(1)

Atheromatous Emboli

385

(1)

Trauma to the Aorta

386

(1)

Congenital Anomalies of the Aorta

386

(1)

Aortic Dissection

387

(3)

Points to Remember and the Cost-Effective Approach

390

(3)

Chapter 10 Infective Endocarditis

393

(14)

Etiology

394

(1)

Diagnosis

395

(4)

Clinical Findings

395

(2)

Echocardiography

397

(1)

Gallium Scanning

398

(1)

Laboratory Findings

398

(1)

Blood Culture

399

(1)

Differential Diagnosis

399

(1)

Treatment

400

(3)

Medical Therapy

400

(2)

Surgical Therapy

402

(1)

Prognosis

403

(1)

Prophylaxis

403

(1)

Points to Remember and the Cost-Effective Approach

404

(3)

Chapter 11 Myocardial Disease

407

(24)

Cardiomyopathies

407

(11)

Dilated Cardiomyopathy

407

(4)

Alcoholic Cardiomyopathy

409

(2)

Peripartum Heart Disease

411

(1)

Hypertrophic Cardiomyopathy

411

(6)

Restrictive Cardiomyopathy

417

(1)

Amyloidosis

418

(1)

Endomyocardial Fibrosis

418

(1)

Endocardial Fibroeleastosis

418

(1)

Myocardial Involvement in Systemic Diseases

418

(6)

Sarcoidosis

418

(1)

Connective Tissue Diseases

419

(1)

Infiltrative Diseases

420

(1)

Neuromuscular Diseases

421

(1)

Metabolic Diseases

421

(1)

Nutritional Diseases

422

(1)

Physical Agents

422

(1)

Toxic Agents

423

(1)

Hematologic Diseases

424

(1)

Myocarditis

424

(1)

Endomyocardial Biopsy

425

(1)

Approach to Undiagnosed Cardiomegaly

426

(1)

Points to Remember and the Cost-Effective Approach

426

(5)

Chapter 12 Pericardial Diseases

431

(20)

Acute Pericarditis

431

(3)

Pericarditis with Effusion

434

(5)

Cardiac Tamponade

436

(1)

Pericardiocentesis

437

(2)

Constructive Pericarditis

439

(3)

Occult Constrictive Pericarditis

442

(1)

Effusive-Constrictive Pericarditis

442

(1)

Specific Types of Pericarditis

442

(5)

Acute Idiopathic or Nonspecific

442

(1)

Bacterial

443

(1)

Tuberculous

443

(1)

Fungal

444

(1)

Rheumatic Pericarditis

445

(1)

Rheumatoid Arthritis

445

(1)

Systemic Lupus Erythematosus

445

(1)

Scleroderma

445

(1)

Uremia

445

(1)

Myxedema

446

(1)

Acute Myocardial Infarction, Postinfarction Syndrome, and Postpericardiotomy Syndrome

446

(1)

Dissecting Aneurysm

446

(1)

Neoplastic

446

(1)

Trauma

446

(1)

Radiation

446

(1)

Drugs

446

(1)

Unusual Pericardial Effusions

446

(1)

Congenital Defects

447

(1)

Points to Remember and the Cost-Effective Approach

448

(3)

Chapter 13 Miscellaneous Cardiac Problems

451

(18)

Pregnancy and the Heart

451

(6)

Rheumatic Heart Disease

453

(1)

Congenital Heart Disease

454

(1)

Infective Endocarditis

455

(1)

Hypertension

455

(1)

Coronary Artery Disease

456

(1)

Mitral Valve Prolapse

456

(1)

Idiopathic Hypertrophic Subaortic Stenosis

456

(1)

Marfan's Syndrome

456

(1)

Cardiac Arrhythmias

457

(1)

Thyroid and the Heart

457

(4)

Hyperthyroidism

457

(2)

Myxedema

459

(2)

Obesity and the Heart

461

(1)

Tumors of the Heart

461

(3)

Trauma and the Heart

464

(1)

Athlete's Heart

465

(1)

Points to Remember and the Cost-Effective Approach

466

(3)

Chapter 14 Arrhythmias

469

(78)

Antiarrhythmic Drugs

471

(7)

Pharmacodynamic and Pharmacokinetic Effects of Antiarrhythmic Drugs

473

(5)

Supraventricular Arrhythmias

478

(1)

Premature Atrial Beats

478

(1)

Regular Narrow QRS Complex Complex Tachycardias

479

(1)

Short RP Tachycardias

480

(3)

Atrioventricular Nodal Re-entrant Tachycardia

480

(2)

Atrioventricular Re-entrant Tachycardia

482

(1)

Long RP Tachycardias

483

(3)

Sinus Tachycardias

483

(1)

Sinus Nodal Re-entrant Tachycardia

483

(1)

Atrial Tachycardia

484

(1)

Multifocal Atrial Tachycardia

485

(1)

Permanent Junctional Reciprocating Tachycardia

486

(1)

Nonparoxysmal Junctional Tachycardia

486

(1)

Atrial Flutter

486

(2)

Atrial Fibrillation

488

(6)

AV Junctional Rhythm and Arrhymias

494

(1)

Ventricular Arrhythmias

495

(8)

Premature Ventricular Beats

495

(2)

Ventricular Tachycardia

497

(6)

Monomorphic Ventricular Tachycardia

497

(3)

Polymorphic Ventricular Tachycardia

500

(2)

Accelerated Idioventricular Rhythm

502

(1)

Ventricular Flutter and Fibrillation

503

(1)

Pre-Excitation Syndrome (Wolff-Parkinson-White)

503

(3)

Regular Tachycardias

506

(1)

Sinus Nodal Disorders

506

(7)

Sinus Bradycardia

506

(1)

Sinoatrial Pause and Sinoatrial Exit Block

506

(1)

Sick Sinus Syndrome

507

(6)

Atrioventricular Heart Block

513

(7)

Indications for Permanent Pacemakers

515

(5)

Summary of Indications for Pacemakers

520

(1)

Types and Modes of Pacing

521

(3)

Pacemaker Malfunction

524

(2)

ECG Clues for Detection of Complex Arrhythmias

526

(2)

Syncope

528

(2)

Sudden Cardiac Death

530

(3)

Management of Cardiac Arrest

533

(6)

Points to Remember and the Cost-Effective Approach

539

(8)

Chapter 15 Cardiac Failure in Adults

547

(52)

Systolic Dysfunction

548

(3)

Symptoms

551

(1)

Left-Sided Heart Failure

551

(1)

Right-Sided Heart Failure

552

(1)

Physical Findings

552

(3)

Cardiovascular Findings

553

(1)

Congestive Phenomena

554

(1)

Radiographic Examination and Other Tests

555

(1)

Diastolic Dysfunction

556

(1)

Diagnostic Problems

557

(1)

Treatment of Heart Failure due Primarily to Systolic Dysfunction

557

(3)

Digitalis Therapy

560

(8)

Action

561

(1)

Determining Optimal Dose

562

(3)

Precautions

565

(3)

Digitalis Toxicity

568

(3)

Therapy for Digitalis Toxicity

570

(1)

Diuretics

571

(7)

Vasodilator Therapy

578

(2)

Other Agents Being Evaluated

580

(2)

Arrhythmias in Congestive Heart Failure

582

(1)

Management of Refractory Heart Failure

582

(5)

Treatment of Heart Failure due Primarily to Diastolic Dysfunction

587

(1)

Acute Pulmonary Edema

588

(3)

Cardiac Transplantation

591

(1)

Circulatory Support with Mechanical Devices

592

(1)

Points to Remember and the Cost-Effective Approach

592

(7)

Chapter 16 Noncardiac Surgery in Cardiac Patients

599

(26)

Preoperative Evaluation

599

(6)

Preoperative Drug Evaluation

600

(1)

Corticosteroids

600

(1)

Antihypertensive Agents

600

(1)

Antidepressants

601

(1)

Hypoglycemic Agents

601

(1)

Anticoagulants and Antiplatelet Drugs

602

(1)

Cardiovascular Drugs

602

(3)

Preoperative Management of Specific Cardiovascular Conditions and Problems

605

(9)

Coronary Atherosclerotic Heart Disease

605

(3)

Hypertensive Cardiovascular Disease

608

(1)

Valvular Heart Disease

608

(3)

Congenital Heart Disease

611

(1)

Pulmonary Heart Disease

611

(1)

Hypertrophic Obstructive Cardiomyopathy

611

(1)

Preoperative Arrhythmias

611

(1)

Congestive Heart Failure

612

(1)

Abnormal Electrocardiogram

613

(1)

Contraindications to Elective Surgery

614

(1)

Operative Period

614

(2)

Postoperative Management

616

(5)

Electrolyte Disturbances

617

(1)

Hypovolemia and Hypervolemia

618

(1)

Hypotension

618

(1)

Oliguria

619

(1)

Respiratory Depression

620

(1)

Arrhythmias and Congestive Heart Failure

620

(1)

Fever

620

(1)

Thrombophlebitis and Pulmonary Embolism

620

(1)

Points to Remember and the Cost-Effective Approach

621

(4)

Chapter 17 Initial Care in the Office or Emergency Department--Cost-Effectiveness

625

(8)

Chest Pain

625

(3)

Myocardial Ischemic Pain

625

(1)

Atypical Pain Suggestive of Myocardial Ischemia

626

(1)

Nonmyocardial Ischemic Pain

627

(1)

Other Causes of Ischemic-like Pain

627

(1)

Dyspnea

628

(1)

Arrhythmias

628

(1)

Cardiac Tamponade

629

(1)

Hypertensive Crisis

630

(1)

Points to Remember and the Cost-Effective Approach

630

(3)

Index

633

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Clinical Cardiology A Cost-Effective Approach

0412112817

Summary

Table of Contents

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