Atlas Of Cardiovascular Emergencies

296 Pages·2015·38.29 MB·English

by  Cedric Lefebvre

Atlas of
Cardiovascular
Emergencies
FM.indd 1 12/5/2014 12:09:44 PM
NOTICE
Medicine is an ever-changing science. As new research and clinical experience broaden
our knowledge, changes in treatment and drug therapy are required. The authors and
the publisher of this work have checked with sources believed to be reliable in their
efforts to provide information that is complete and generally in accord with the standards
accepted at the time of publication. However, in view of the possibility of human error
or changes in medical sciences, neither the authors nor the publisher nor any other party
who has been involved in the preparation or publication of this work warrants that the
information contained herein is in every respect accurate or complete, and they disclaim
all responsibility for any errors or omissions or for the results obtained from use of the
information contained in this work. Readers are encouraged to confirm the information
contained herein with other sources. For example and in particular, readers are advised
to check the product information sheet included in the package of each drug they plan
to administer to be certain that the information contained in this work is accurate and
that changes have not been made in the recommended dose or in the contraindications
for administration. This recommendation is of particular importance in connection with
new or infrequently used drugs.
FM.indd 2 12/5/2014 12:09:44 PM
Atlas of
Cardiovascular
Emergencies
Editors
Cedric Lefebvre, MD
Assistant Professor
Department of Emergency Medicine
Wake Forest School of Medicine
Winston-Salem, North Carolina
James C. O’Neill, MD
Assistant Professor
Department of Emergency Medicine
Wake Forest School of Medicine
Winston-Salem, North Carolina
David M. Cline, MD
Professor
Department of Emergency Medicine
Wake Forest School of Medicine
Winston-Salem, North Carolina
New York Chicago San Francisco Athens London Madrid
Mexico City Milan Singapore Sydney Toronto
FM.indd 3 12/5/2014 12:09:46 PM
Copyright © 2015 by McGraw-Hill Education. All rights reserved. Except as permitted under the United States Copyright Act of 1976, no part of this publication may
be reproduced or distributed in any form or by any means, or stored in a database or retrieval system, without the prior written permission of the publisher, with the
exception that the program listings may be entered, stored, and executed in a computer system, but they may not be reproduced for publication.
ISBN: 978-0-07-179923-2
MHID: 0-07-179923-0
The material in this eBook also appears in the print version of this title: ISBN: 978-0-07-179394-0,
MHID: 0-07-179394-1.
eBook conversion by codeMantra
Version 1.0
All trademarks are trademarks of their respective owners. Rather than put a trademark symbol after every occurrence of a trademarked name, we use names in an
editorial fashion only, and to the benefit of the trademark owner, with no intention of infringement of the trademark. Where such designations appear in this book, they
have been printed with initial caps.
McGraw-Hill Education eBooks are available at special quantity discounts to use as premiums and sales promotions or for use in corporate training programs. To contact
a representative, please visit the Contact Us page at www.mhprofessional.com.
TERMS OF USE
This is a copyrighted work and McGraw-Hill Education and its licensors reserve all rights in and to the work. Use of this work is subject to these terms. Except as
permitted under the Copyright Act of 1976 and the right to store and retrieve one copy of the work, you may not decompile, disassemble, reverse engineer, reproduce,
modify, create derivative works based upon, transmit, distribute, disseminate, sell, publish or sublicense the work or any part of it without McGraw-Hill Education’s
prior consent. You may use the work for your own noncommercial and personal use; any other use of the work is strictly prohibited. Your right to use the work may be
terminated if you fail to comply with these terms.
THE WORK IS PROVIDED “AS IS.” McGRAW-HILL EDUCATION AND ITS LICENSORS MAKE NO GUARANTEES OR WARRANTIES AS TO THE
ACCURACY, ADEQUACY OR COMPLETENESS OF OR RESULTS TO BE OBTAINED FROM USING THE WORK, INCLUDING ANY INFORMATION
THAT CAN BE ACCESSED THROUGH THE WORK VIA HYPERLINK OR OTHERWISE, AND EXPRESSLY DISCLAIM ANY WARRANTY, EXPRESS
OR IMPLIED, INCLUDING BUT NOT LIMITED TO IMPLIED WARRANTIES OF MERCHANTABILITY OR FITNESS FOR A PARTICULAR PURPOSE.
McGraw-Hill Education and its licensors do not warrant or guarantee that the functions contained in the work will meet your requirements or that its operation will be
uninterrupted or error free. Neither McGraw-Hill Education nor its licensors shall be liable to you or anyone else for any inaccuracy, error or omission, regardless of
cause, in the work or for any damages resulting therefrom. McGraw-Hill Education has no responsibility for the content of any information accessed through the work.
Under no circumstances shall McGraw-Hill Education and/or its licensors be liable for any indirect, incidental, special, punitive, consequential or similar damages that
result from the use of or inability to use the work, even if any of them has been advised of the possibility of such damages. This limitation of liability shall apply to any
claim or cause whatsoever whether such claim or cause arises in contract, tort or otherwise.
To my wife, Jen, and my daughters, Ava and Alexis, for their love and encouragement; to my
parents and Isabella for their steadfast support; to my residents and faculty colleagues for their
collaboration on this project; and to Frank, Maggie, and José, for inspiring me to explore the
world of medical science.
Cedric Lefebvre
To my wife, Spence, my boys, Frank and Steven, my parents, Frank and Patricia, for all
their enduring support and love, and to the residents and fellows who have inspired and
challenged me.
James C. O’Neill
To my family for their continued support, to my fellow faculty who contributed to this project, to
the residents and students who inspired me to take on this project by asking questions I could not
answer without images to illustrate my point.
David M. Cline
FM.indd 5 12/5/2014 12:09:46 PM
This page intentionally left blank
contents
Contributors ix CT ANGIOGRAM FOR PULMONARY EMBOLISM 62
Preface xv VENTILATION/PERFUSION SCAN (V/Q SCAN) 64
Acknowledgments xvii
DOPPLER ULTRASOUND OF PERIPHERAL VENOUS SYSTEM 66
DOPPLER ULTRASOUND OF PERIPHERAL ARTERIAL SYSTEM 70
Chapter 1
ULTRASOUND GUIDED VASCULAR ACCESS 72
ANATOMY 1
Chapter 4
NORMAL CORONARY ARTERY ANATOMY 2
DEVICES 77
NORMAL CHAMBERS 4
NORMAL VALVES 6
TRANSCUTANEOUS PACEMAkER 78
PROSTHETIC VALVES 8
TRANSVENOUS PACEMAkER 81
ANOMALOUS LEFT CORONARY ARTERY 10
COMPLICATIONS OF IMPLANTED PACEMAkERS 84
DEXTROCARDIA 12
IMPLANTED CARDIOVERTER-DEFIBRILLATOR:
COMPLICATIONS 88
Chapter 2
LVAD: LEFT VENTRICULAR ASSIST DEVICE 90
ELECTROCARDIOGRAPHY: NORMAL
AUTOMATED CPR DEVICE 92
HEART, ACUTE ISCHEMIA, AND
EXTERNAL RHYTHM RECORDER: HOLTER MONITOR
CHRONIC DISEASE 13 AND kING OF HEARTS 94
EXTRACORPOREAL MEMBRANE OXYGENATION 96
Normal Heart 14
NORMAL CARDIAC CONDUCTION 14 Chapter 5
NORMAL RESTING ELECTROCARDIOGRAM (ECG) 16
ARRHYTHMIAS 99
Acute Ischemia and Chronic Disease 18
Sinus Arrhythmias 100
SUPPLEMENTAL ECG LEADS 18
ST-ELEVATION MYOCARDIAL INFARCTION (BY ANATOMIC SINUS BRADYCARDIA/TACHYCARDIA
REGION, INCLUDES SGARBOSSA CRITERIA) 23 INCLUDING RESPIRATORY VARIABLITY 100
T-WAVE INVERSION 28 Atrial Arrhythmias 103
HYPERACUTE T-WAVES 29
PREMATURE ATRIAL CONTRACTIONS (PAC) 103
ST SEGMENT DEPRESSION 30
WANDERING ATRIAL PACEMAkER 105
Q WAVES 32
CLASSIFICATION AND MECHANISMS
WELLENS’ SYNDROME 33
OF SUPRAVENTRICULAR TACHYCARDIA 107
Chapter 3 Atrioventricular Tachycardias 111
PRINCIPLES OF CARDIOVASCULAR AV NODAL REENTRY TACHYCARDIA SLOW-FAST
CONDUCTION, FAST-SLOW CONDUCTION 111
IMAGING 35
AV RECIPROCATING TACHYCARDIA, ORTHODROMIC
CHEST RADIOGRAPHS 36 AVRT, ANTIDROMIC AVRT 113
BEDSIDE ULTRASOUND/ECHOCARDIOGRAPHY 39 WOLFF–PARkINSON–WHITE SYNDROME
TRANSTHORACIC ECHOCARDIOGRAPHY 43 AND PRE-EXCITATION SYNDROMES 116
TRANSESOPHAGEAL ECHOCARDIOGRAPHY 46 LOWN–GANONG–LEVINE SYNDROME 119
BEDSIDE ULTRASOUND: EVALUATION Atrial Tachycardias 120
FOR DEEP VEIN THROMBOSIS 51
MULTIFOCAL ATRIAL TACHYCARDIA 120
CARDIAC COMPUTED TOMOGRAPHY 56
ECTOPIC (UNIFOCAL) ATRIAL TACHYCARDIA 122
CARDIAC MAGNETIC RESONANCE IMAGING 59
ATRIAL FLUTTER 124
vii
FM.indd 7 12/5/2014 12:09:46 PM
viii CONTENTS
■
ATRIAL FIBRILLATION WITH/WITHOUT Chapter 7
RVR, WITH ABERRANCY 126 CARDIOMYOPATHIES 187
Aberrant Atrial Conduction 128
DILATED CARDIOMYOPATHY 188
ASHMAN PHENOMENA, ATRIAL FIBRILLATION WITH
RESTRICTIVE CARDIOMYOPATHIES 190
PREMATURE SUPRAVENTRICULAR
HYPERTROPHIC CARDIOMYOPATHY 193
ABERRANT BEATS 128
AORTIC STENOSIS 196
Junctional Rhythms 129 MITRAL STENOSIS 199
JUNCTIONAL ESCAPE RHYTHM 129 ACUTE AORTIC INSUFFICIENCY 201
JUNCTIONAL TACHYCARDIA 131 MITRAL REGURGITATION AND ACUTE MITRAL INSUFFICIENCY 203
Ventricular Arrhythmias 133
Chapter 8
PREMATURE VENTRICULAR CONTRACTIONS 133
PEDIATRIC CARDIOLOGY 207
ACCELERATED IDIOVENTRICULAR RHYTHM 135
VENTRICULAR TACHYCARDIA INCLUDING Pediatric Electrocardiogram Norms 208
POLYMORPHIC, MONOMORPHIC 137
NORMAL ECG AT AGE INTERVALS (NEWBORN,
TORSADES DE POINTES 139
1MO, 3MO, 12MO, 3Y, 5Y, 8Y, 13Y) 208
VENTRICULAR FIBRILLATION 141
Congenital Heart Disease 214
BRUGADA SYNDROME 144
NEONATAL CONGENITAL HEART DISEASE 214
Conduction Disorders 146
INFANTILE CONGENITAL HEART DISEASE 217
FIRST-DEGREE ATRIOVENTRICULAR BLOCk 146
PEDIATRIC CONGENITAL HEART DISEASE 221
SECOND-DEGREE-ATRIOVENTRICULAR BLOCk,
Inflamatory and Infectious Disorders 225
MOBITZ TYPE I 149
MYOCARDITIS AND PERICARDITIS 225
SECOND-DEGREE-ATRIOVENTRICULAR BLOCk,
kAWASAkI DISEASE 230
MOBITZ TYPE II 151
RHEUMATIC HEART DISEASE 232
THIRD-DEGREE ATRIOVENTRICULAR BLOCk 153
BIFASCICULAR BLOCk 155 Obstructive Shock 234
LEFT ANTERIOR FASCICULAR BLOCk 157
CARDIAC TAMPONADE 234
RIGHT BUNDLE BRANCH BLOCk 159
Cardiac Rhythm Disorders 237
LEFT BUNDLE BRANCH BLOCk 161
SUPRAVENTRICULAR TACHYCARDIA IN CHILDREN 237
LONG QT SYNDROME 162
HEART BLOCk IN CHILDREN 241
Pacemaker Rhythms 164
WOLFF–PARkINSON–WHITE IN CHILDREN 245
ECG INTERPRETATION OF PACED RHYTHM 164 LONG QT SYNDROME IN CHILDREN 248
Chapter 6 Chapter 9
VASCULAR DISEASE 169 PROCEDURES 251
ABDOMINAL AORTIC ANEURYSM 170 RADIOFREQUENCY ABLATION 252
AORTIC DISSECTION 172 ANkLE BRACHIAL INDEX 254
ACUTE ARTERIAL OCCLUSION 174 CARDIAC CATHETERIZATION 256
DVT: UPPER/LOWER, PHLEGMASIA ALBA DOLENS, PERICARDIOCENTESIS 261
PHLEGMASIA CERULEA DOLENS 176 PERICARDIAL WINDOW 263
PULMONARY EMBOLISM 178 CARDIOVERSION/EXTERNAL DEFIBRILLATION 265
SYSTEMIC AND PULMONARY HYPERTENSION 181
LEFT VENTRICULAR ANEUYRSM 185 INDEX 267
FM.indd 8 12/5/2014 12:09:47 PM
contRIBUtoRs
William Alley, MD, RDMS Joseph Hayes Calvert, DO
Assistant Professor Clinical Instructor
Department of Emergency Medicine Department of Emergency Medicine
Wake Forest School of Medicine Wake Forest School of Medicine
Winston-Salem, North Carolina Winston-Salem, North Carolina
Chapter 3 Chapter 5
Kim Askew, MD Cheryl Cammock, MD
Assistant Professor Assistant Professor
Department of Emergency Medicine Department of Pediatrics
Wake Forest School of Medicine Section of Cardiology
Winston-Salem, North Carolina Wake Forest School of Medicine
Chapter 5 Winston-Salem, North Carolina
Chapter 8
Shad Baab, MD, FAAP
Assistant Professor Alan T. Chiem, MD, MPH
Department of Emergency Medicine
Assistant Clinical Professor
Wake Forest School of Medicine
Department of Emergency Medicine
Winston-Salem, North Carolina
Olive View-UCLA Medical Center
Chapter 8
Geffen School of Medicine at UCLA
P. Matthew Belford, MD, FACC Los Angeles, California
Chapters 2 and 8
Assistant Professor
Department of Medicine Jason W. Christie, MD
Section on Cardiology
Fellow in Vascular Surgery
Wake Forest School of Medicine
Department of Vascular and Endovascular Surgery
Winston-Salem, North Carolina
Wake Forest School of Medicine
Chapter 9
Winston-Salem, North Carolina
Erin Boyd, DO Chapter 3
Clinical Instructor
David M. Cline, MD
Department of Emergency Medicine
Wake Forest School of Medicine Professor
Winston-Salem, North Carolina Department of Emergency Medicine
Chapter 5 Wake Forest School of Medicine
Winston-Salem, North Carolina
Glenn M. Brammer, MD Chapters 5 and 6
Assistant Professor
Kristi Colbenson, MD
Department of Medicine
Section on Cardiology Fellow in Sports Medicine
Wake Forest School of Medicine Department of Orthopedics
Winston-Salem, North Carolina Vanderbilt University
Chapters 4 and 5 Nashville, Tennessee
Chapter 7
Joshua S. Broder, MD
Sean Collins, MD, MSc
Associate Professor
Department of Surgery, Associate Professor
Division of Emergency Medicine Department of Emergency Medicine
Duke University School of Medicine Vanderbilt University
Durham, North Carolina Nashville, Tennessee
Chapters 1 and 6 Chapter 7
Ron Buchheit, MD Thomas D. Conlee, MD
Instructor Fellow in Vascular Surgery
Department of Emergency Medicine Department of Vascular and Endovascular Surgery
University of Tennessee College of Medicine Chattanooga Wake Forest School of Medicine
Chattanooga, Tennessee Winston-Salem, North Carolina
Chapter 5 Chapter 3
ix
FM.indd 9 12/5/2014 12:09:47 PM