Common Problems in Cardiology PDF
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Common Problems in Cardiology Common Problems in Cardiology Kanu Chatterjee Clinical Professor of Medicine The Carver College of Medicine University of Iowa, USA Emeritus Professor of Medicine University of California, San Francisco, USA Byron F Vandenberg Associate Professor of Medicine The Carver College of Medicine University of Iowa, USA The Health Sciences Publisher New Delhi | London | Philadelphia | Panama Jaypee Brothers Medical Publishers (P) Ltd Headquarters Jaypee Brothers Medical Publishers (P) Ltd 4838/24, Ansari Road, Daryaganj New Delhi 110 002, India Phone: +91-11-43574357 Fax: +91-11-43574314 Email: [email protected] Overseas Offices J.P. Medical Ltd Jaypee-Highlights Medical Publishers Inc 83 Victoria Street, London City of Knowledge, Bld. 237, Clayton SW1H 0HW (UK) Panama City, Panama Phone: +44 20 3170 8910 Phone: +1 507-301-0496 Fax: +44 (0)20 3008 6180 Fax: +1 507-301-0499 Email: [email protected] Email: [email protected] Jaypee Medical Inc. Jaypee Brothers Medical Publishers (P) Ltd The Bourse 17/1-B Babar Road, Block-B, Shaymali 111 South Independence Mall East Mohammadpur, Dhaka-1207 Suite 835, Philadelphia, PA 19106, USA Bangladesh Phone: +1 267-519-9789 Mobile: +08801912003485 Email: [email protected] Email: [email protected] Jaypee Brothers Medical Publishers (P) Ltd Bhotahity, Kathmandu Nepal Phone: +977-9741283608 Email: [email protected] Website: www.jaypeebrothers.com Website: www.jaypeedigital.com © 2016, Jaypee Brothers Medical Publishers The views and opinions expressed in this book are solely those of the original contributor(s)/author(s) and do not necessarily represent those of editor(s) of the book. All rights reserved. No part of this publication may be reproduced, stored or transmitted in any form or by any means, electronic, mechanical, photocopying, recording or otherwise, without the prior permission in writing of the publishers. 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Inquiries for bulk sales may be solicited at: [email protected] Common Problems in Cardiology First Edition: 2016 ISBN 978-93-5152-852-4 Printed at Contributors Alexander Mazur MD Dwayne N Campbell MD Associate Professor of Medicine The Carver College of Medicine The Carver College of Medicine University of Iowa, USA University of Iowa, USA Hardik Doshi MD Amandeep Dhaliwal MD Clinical Professor of Internal Medicine Physician The Carver College of Medicine The Carver College of Medicine University of Iowa, Iowa City, USA University of Iowa, Iowa, USA Andres Vargas-Estrada MD Hosam M Moustafa MD Physician Pediatric Radiologist The Carver College of Medicine 301 W Bastanchury Rd Ste 130 University of Iowa, Iowa City, USA Fullerton, CA, USA Ankur Vyas MD Jayasheel O Eshcol MD Physician Physician The Carver College of Medicine The Carver College of Medicine University of Iowa, Iowa, USA University of Iowa, Iowa City, USA Basil Abu-El-Haija MD Cardiac Specialist Jeffrey S Wilson MD 3901 Rainbow Blvd, Kansas City, Clinical Professor of Internal Medicine USA The Carver College of Medicine University of Iowa, Iowa City, USA Belal Al Khiami MD Physician Kanu Chatterjee MBBS The Carver College of Medicine Professor of Medicine University of Iowa, Iowa City, USA The Carver College of Medicine Byron F Vandenberg MD University of Iowa Associate Professor of Medicine Emeritus Professor of Medicine The Carver College of Medicine University of California University of Iowa, USA San Francisco, USA Denice Hodgson-Zingman MD Associate Professor of Internal Lee Joseph MD Assistant Attending Physician Medicine-Cardiovascular Medicine Associate Professor of Biomedical NewYork-Presbyterian Hospital/ Engineering Columbia University Medical Center, University of Iowa Hospitals and Clinics Department of Medicine Iowa City, USA USA vi Common Problems in Cardiology Manish Suneja MD Ravinder Kumar MD Clinical Professor of Internal Medicine - Consultant Cardiologist Nephrology West Patel Nagar University of Iowa Hospitals and Clinics New Delhi, India Iowa City, USA Rudhir Tandon MD Michael C Giudici MD Clinical Professor of Internal Medicine Clinical Professor of Internal Medicine University of Iowa Hospitals and Clinics University of Iowa Hospitals and Clinics Iowa City, USA Iowa City, USA Min Luo DO PhD Saket Girotra MBBS Cardiology Fellow Cardiology Division The Carver College of Medicine The Carver College of Medicine University of Iowa, Iowa City, USA University of Iowa, USA Nathan Funk MD Seth Maliske MD Consultant Cardilogist Clinical Professor of Internal Medicine 520 Medical Center University of Iowa Hospitals and Clinics Medford, Oregon, USA Iowa City, USA Olurotimi Mesubi MBBS Consultant Cardiologist Sif Hansdottir MD Johns Hopkins School of Medicine Pulmonologist Baltimore, Maryland, USA University of Iowa Hospitals and Clinics Iowa City, USA Omer Iqbal MD Clinical Professor of Internal Medicine Siva Krothapalli MBBS University of Iowa Hospitals and Clinics Cardiology Fellow Iowa City, USA University of Iowa Hospitals and Clinics Paul D Lindower MD Iowa City, USA Clinical Professor of Internal Medicine The Carver College of Medicine Tariq Hamid MD Specialist of General Family Medicine University of Iowa, USA Keene, New Hampshire, USA Prashant Bhave MD FHRS Clinical Professor of Internal Medicine - Uzodinma C Emerenini MD Cardiovascular Medicine Cardiologist The Carver College of Medicine University of Iowa Hospitals and Clinics University of Iowa, Iowa City, USA Iowa City, USA Preface Approximately 600,000 people die from cardiac disease in the United States every year, according to the Centers for Disease and Control and Prevention (CDC) estimation. It is a leading cause of death in both men and women. Cardiac disease is often called a “silent killer”. Symptoms of cardiac disease vary depending on the specific condition, and physicians often find problems in diagnosing this specific condition. All types of cardiac diseases share some common traits with a few key differences. Common Problems in Cardiology deals with all the common topics in cardiology with a focus on main problem areas of general practitioners. All the chapters covered in the book present the signs and symptoms, etiological causes, diagnostic methods and management approaches of the various heart diseases. The main topics discussed are on chest pain, ischemic heart disease, coronary and pulmonary artery diseases, dyspnea, heart failure, hypertension and hypotension, shock, diseases of heart valve, infective endocarditis, pericardial diseases, syncope, palpitations, bradyarrhythmias, atrial fibrillation, tachyarrhythmia, claudication, aortic disease, stroke, dyslipidemias, etc. All the chapters are written by internationally and nationally recognized experts in their respective fields. We are very appreciative and grateful to the contributors for their sine qua non contributions. We sincerely thank Shri Jitendar P Vij (Group Chairman), Mr Ankit Vij (Group President), Mr Tarun Duneja (Director-Publishing), and the expert team of M/s Jaypee Brothers Medical Publishers (P) Ltd, New Delhi, India for their hard work and professional expertise, without which the book could not have been published. Kanu Chatterjee Byron F Vandenberg Contents 1. Chest Pain ......................................................................................................................1 Hosam Maustafa Acute Coronary Syndrome 2 Pulmonary Embolism 4 Acute Pericarditis 5 Musculoskeletal Chest Pain 6 Esophageal Diseases 6 2. Stable Ischemic Heart Disease ..............................................................................8 Amandeep Dhaliwal Testing 8 Treatment 11 3. Acute Coronary Syndromes .................................................................................20 Ankur Vyas, Saket Girotra Pathophysiology 20 Clinical Presentation 21 Diagnostic Evaluation 23 Risk Stratification 23 Management 25 Treatment Strategy in Nsteacs 29 Complications 31 Long-term Management 32 4. Dyspnea: Evaluation and Management .........................................................35 Ankur Vyas, Jeffrey S Wilson, Paul D Lindower Pathophysiology 35 Primary Etiologies of Dyspnea 36 History and Physical Examination 37 Laboratory Studies 39 Management 41 5. Heart Failure with Reduced Ejection Fraction .............................................43 Omer Iqbal Definition 43 Classifications and Staging 44 6. Heart Failure with Preserved Ejection Fraction ..........................................63 Ravinder Kumar Definition of Heart Failure 63 x Common Problems in Cardiology Epidemiology 64 Clinical Features (Demographic Features and Comorbid Conditions) 64 Stages of Heart Failure 65 Assessment of Diastolic Dysfunction 65 Pathophysiology 66 Management of HFPEF 68 7. Hypotension and Shock .........................................................................................73 Jayasheel O Eshcol Physiology 73 Classification 74 Cardiogenic Shock – Background, Physical Examination and Diagnostics 75 8. Hypertension...............................................................................................................84 Manish Suneja, Seth Maliske Hemodynamic Determinants of Blood Pressure and the Variables Affected in Systemic Hypertension 84 Determinants of Arterial Blood Pressure in the Younger as Well as Aged Circulatory System 85 Methods of Measuring BP 85 Measurement Protocol for Accurate Blood Pressure Recording Diagnosis and Classification of Hypertension 87 Physical Examination in a Patient with Hypertension 89 Clues for Previously Uncontrolled Hypertension 91 Lifestyle Factors in the Hypertensive Patient Contributing to Elevated Blood Pressure 92 Lifestyle Interventions to Lower the Risk of Developing Hypertension 92 Target Goals and Treatment Recommendations for Hypertension Based on Eight Joint National Committee (JNC 8) Guidelines 93 Mechanisms of Action for the Pharmacologic Treatment of Hypertension 95 Resistant Hypertension 96 Evaluation for Secondary Causes of Hypertension 98 What are Common Causes of Secondary Hypertension 99 How Does one Diagnose and Treat Primary Hyperaldosteronism? 99 9. Essentials of Pulmonary Hypertension .......................................................102 Rudhir Tandon, Sif Hansdottir Clinical Classification and Epidemiology 102 Hemodynamic Classification 104 Pathology and Pathogenesis 105 Genetics 105 Diagnosis 105 Treatment 110 10. Aortic and Mitral Valve Disease .......................................................................118 Byron F Vandenberg, Kanu Chatterjee Aortic Stenosis 118 Aortic Regurgitation 122
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