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E C SSENTIAL ARDIOLOGY Essential Cardiology P P RINCIPLES AND RACTICE SECOND EDITION Edited by C R , , , LIVE OSENDORFF MD PhD FRCP Professor of Medicine, Zena and Michael A. Wiener Cardiovascular Institute, Mount Sinai School of Medicine, New York, NY, and Veterans Affairs Medical Center, Bronx, NY © 2005 Humana Press Inc. 999 Riverview Drive, Suite 208 Totowa, New Jersey 07512 www.humanapress.com All rights reserved. No part of this book may be reproduced, stored in a retrieval system, or transmitted in any form or by any means, electronic, mechanical, photocopying, microfilming, recording, or otherwise without written permission from the Publisher. The content and opinions expressed in this book are the sole work of the authors and editors, who have warranted due diligence in the creation and issuance of their work. 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This is of utmost importance when the recommended drug herein is a new or infrequently used drug. It is the responsibility of the treating physician to determine dosages and treatment strategies for individual patients. Further it is the responsibility of the health care provider to ascertain the Food and Drug Administration status of each drug or device used in their clinical practice. The publisher, editors, and authors are not responsible for errors or omissions or for any consequences from the application of the information presented in this book and make no warranty, express or implied, with respect to the contents in this publication. Cover design by Patricia F. Cleary Cover illustration by Colin Richards. Used with permission of the artist. 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The fee code for users of the Transactional Reporting Service is: [1-58829-370-X/05 $30.00]. Printed in the United States of America. 10 9 8 7 6 5 4 3 2 1 eISBN 1-59259-918-4 Library of Congress Cataloging-in-Publication Data Essential cardiology : principles and practice / edited by Clive Rosendorff.-- 2nd ed. p. ; cm. Includes bibliographical references and index. ISBN 1-58829-370-X (alk. paper) 1. Heart--Diseases. 2. Cardiology. [DNLM: 1. Cardiovascular Diseases--Outlines. 2. Cardiovascular Physiology--Outlines. WG 18.2 E78 2005] I. Rosendorff, Clive. RC681.E85 2005 616.1'2--dc22 2005006266 P REFACE This second edition reflects the very rapid advances that have been made in our understanding and management of cardiovascular disease since the first edition was published in 2001. All of the chapters have been extensively reviewed and rewritten. There are now two chapters on acute coronary syndromes, reflecting the modern classification: one on unstable angina pectoris and non-ST-segment elevation myocardial infarction, and the other on ST-segment elevation myocardial infarction. Otherwise the format of the first edition has been retained, to include sections on epidemiology, cardiovascular function, examination and investigation of the patient, disorders of rhythm and conduction, heart failure, congenital heart disease, coronary artery disease, valvular heart disease, hypertension, and other conditions affecting the heart. I am also very happy to welcome Drs. Arnold M. Katz, Martin M. Goldman, David Benditt, Edward K. Kasper, and Roger J. Hajjar as new senior authors. I wish also to thank Pedro Perez for his superb contributions to the artwork, my assistants, Maria Anthony and Anitra Collins, and Paul Dolgert, John Morgan, Patricia Cleary, and Donna Niethe, and the editorial, production, and composition departments of Humana Press for their encouragement and hard work. Clive Rosendorff, MD, PhD, FRCP v P F E REFACE TO THE IRST DITION “A big book,” said Callimachus, the Alexandrian poet, “is a big evil!” Not always. There are some excellent, very big encyclopedias of cardiology, wonderful as works of reference. There are also many small books of cardiology, “handbooks” or “manuals,” which serve a different purpose, to summarize, list, or simplify. This book is designed to fill a large gap between these extremes, to provide a textbook that is both substantial and readable, compact and reasonably comprehensive, and to provide an intelligent blend of molecular, cellular, and physiologic concepts with current clinical practice. A word about the title. “Essential” is used here not in the sense of indispensable or absolutely required in all circumstances, for there is much more here than the generalist needs in order to practice good medicine, especially if there is easy access to a cardiology consultant. Rather, the word as used here denotes the essence or distillation or fundamentals of the mechanisms and practice of cardiology. The “Principles and Practice” subtitle affirms the idea that theory without a practical context may be academically satisfying but lacks usefulness, and practice without theory is plumbing. Good doctors understand the basic science foundation of what they do with patients, and great doctors are those who, as researchers or as teachers, see new connections between the basic sciences and clinical medicine. I have been very fortunate to be able to assemble a team of great doctors who are outstanding physicians and scientists, most of them internationally recognized for their leadership position in their areas of specialization. They represent a careful blend of brilliance and experience, and, most of all, they all write with the authority of undoubted experts in their fields. They have all been asked to write up-to-date reviews of their respective areas of expertise, at a level that will be intelligible to noncardiologists as well as cardiologists, to medical students, internal medicine residents, general internists, and cardiology fellows. I believe that they have succeeded brilliantly, and I know that they are all very proud to have participated as authors in this project, the first textbook of cardiology of the new millennium. I am deeply grateful to all of them for the care and enthusiasm with which they carried out this task. The organization of the book reflects pretty much the key issues that concern cardiologists and other internists at present; I have no doubt that the field will develop and change in time so that many of the modes of diagnosis and therapy described here will become much more prominent (such as gene therapy), while others may diminish or even disappear. This is what second or later editions of textbooks are for. Clive Rosendorff, MD, PhD, FRCP C ONTENTS Preface...................................................................................................................v Preface to First Edition........................................................................................vii Contributors.......................................................................................................xiii Color Plates.........................................................................................................xix Part I. EPIDEMIOLOGY 1 Multivariable Evaluation of Candidates for Cardiovascular Disease William B. Kannel.......................................................................................3 Part II. CIRCULATORY FUNCTION 2 Molecular and Cellular Basis of Myocardial Contractility Arnold M. Katz..........................................................................................21 3 Ventricular Function Lionel H. Opie...........................................................................................37 4 Vascular Function Clive Rosendorff........................................................................................55 5 Thrombosis Yale Nemerson and Mark B. Taubman...................................................77 Part III. EXAMINATION AND INVESTIGATION OF THE PATIENT 6 The Medical History and Symptoms of Heart Disease H. J. C. Swan.............................................................................................87 7 Physical Examination of the Heart and Circulation Jonathan Abrams......................................................................................99 8 Electrocardiography Tara L. DiMino, Alexander Ivanov, James F. Burke, and Peter R. Kowey............................................................................117 9 Echocardiography Daniel G. Blanchard and Anthony N. DeMaria...................................139 10 Exercise Testing Gregory Engel and Victor Froelicher ...................................................169 11 Radiology of the Heart Gautham P. Reddy and Robert M. Steiner............................................185 12 Cardiac Catheterization and Coronary Angiography Mark J. Ricciardi, Nirat Beohar, and Charles J. Davidson................197 ix x Contents 13 Nuclear Imaging in Cardiovascular Medicine Diwakar Jain and Barry L. Zaret..........................................................221 14 Cardiovascular Magnetic Resonance and X-Ray Computed Tomography Gerald M. Pohost, Radha J. Sarma, Patrick M. Colletti, Mark Doyle, and Robert W. W. Biederman ....................................245 15 Choosing Appropriate Imaging Techniques Jonathan E. E. Fisher and Martin E. Goldman...................................269 Part IV. DISORDERS OF RHYTHM AND CONDUCTION 16 Electrophysiology of Cardiac Arrhythmias Sei Iwai, Steven M. Markowitz, Suneet Mittal, Kenneth M. Stein, and Bruce B. Lerman.........................................285 17 Treatment of Cardiac Arrhythmias Davendra Mehta......................................................................................305 18 Syncope Fei Lü, Scott Sakaguchi, and David G. Benditt ...................................329 Part V. HEART FAILURE 19 Pathophysiology of Heart Failure Mark Scoote, Ian F. Purcell, and Philip A. Poole-Wilson ..................347 20 Treatment of Congestive Heart Failure Stephen S. Gottlieb..................................................................................371 Part VI. CONGENITAL HEART DISEASE 21 Congenital Heart Disease Julien I. E. Hoffman...............................................................................393 Part VII. CORONARY ARTERY DISEASE 22 Pathogenesis of Atherosclerosis Prediman K. Shah...................................................................................409 23 Risk Factors and Prevention, Including Hyperlipidemias Antonio M. Gotto, Jr. and John Farmer...............................................419 24 Coronary Blood Flow and Myocardial Ischemia Robert J. Henning and Ray A. Olsson ..................................................439 25 Stable Angina Satya Reddy Atmakuri, Michael H. Gollob, and Neal S. Kleiman ..........................................................................451 26 Unstable Angina and Non-ST Segment Elevation Myocardial Infarction (Acute Coronary Syndromes) Satya Reddy Atmakuri and Neal S. Kleiman........................................471 Contents xi 27 ST Segment Elevation Myocardial Infarction Rajat Deo, Christopher P. Cannon, and James A. de Lemos..............489 28 Cardiopulmonary Resuscitation Joseph P. Ornato.....................................................................................521 29 Rehabilitation After Acute MI Fredric J. Pashkow.................................................................................531 Part VIII. VALVULAR HEART DISEASE 30 Rheumatic Fever and Valvular Heart Disease Edmund A. W. Brice and Patrick J. Commerford................................545 31 Infective Endocarditis Adolf W. Karchmer.................................................................................565 Part IX. HYPERTENSION 32 Hypertension: Mechanisms and Diagnosis Clive Rosendorff......................................................................................595 33 Hypertension Therapy Norman M. Kaplan.................................................................................615 Part X. OTHER CONDITIONS AFFECTING THE HEART 34 Cardiomyopathies and Myocarditis Edward K. Kasper ...................................................................................641 35 Pericardial Disease David H. Spodick ....................................................................................653 36 Pulmonary Vascular Disease Dermot O’Callaghan and Sean P. Gaine..............................................661 37 Diseases of the Aorta Eric M. Isselbacher.................................................................................681 Part XI. ADDITIONAL TOPICS 38 Pregnancy and Cardiovascular Disease Samuel C. B. Siu and Jack M. Colman.................................................693 39 Heart Disease in the Elderly Michael W. Rich......................................................................................705 40 Cardiovascular Complications in Patients With Renal Disease Richard A. Preston, Simon Chakko, and Murray Epstein ..................729 41 Assessment of Patients With Heart Disease for Fitness for Noncardiac Surgery Joseph Savino and Lee A. Fleisher.......................................................747 xii Contents 42 Cardiovascular Gene and Cell Therapy Eddy Kizana, Federica del Monte, Sian E. Harding, and Roger J. Hajjar ...........................................................................763 43 Preventive Cardiology Michael Miller.........................................................................................789 44 Peripheral Arterial Disease James J. Jang and Jonathan L. Halperin.............................................807 Index ..................................................................................................................829