Netter's Cardiology

597 Pages·2019·197.39 MB·english

by  George A. Stouffer

NETTER’S
CARDIOLOGY
EDITED BY ILLUSTRATIONS BY
George A. Stouffer, MD Frank H. Netter, MD
Ernest and Hazel Craige Distinguished Professor of Medicine
Chief, Division of Cardiology
Physician in Chief, UNC Heart and Vascular Service Line CONTRIBUTING ILLUSTRATORS
University of North Carolina at Chapel Hill
Chapel Hill, North Carolina Carlos A.G. Machado, MD
Marschall S. Runge, MD, Ph@ John A. Craig, MD
Professor of Internal Medicine
Dean, University of Michigan Medical Schoo\ David J. Mascaro, MS
Executive Vice President for Medical Affairs
Enid Hatton
Chief Executive Officer, Michigan Medicine
Ann Arbor, Michigan
Steven Moon, MA
Cam Patterson, MD, MBA
Chancellor Kip Carter, MS, CMI
University of Arkansas for Medical Sciences
Little Rock, Arkansas Tiffany S. Davanzo, MA, CMI
Joseph S. Rossi, MD
Associate Professor of Medicine
Director, Cardiac Catheterization Laboratory
University of North Carolina at Chapel Hill
Chapel Hill, North Carolina
ELSEVIER
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NETTER’S CARDIOLOGY, THIRD EDITION ISBN: 978-0-323-54726-0
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Notices
Knowledge and best practice in this field are constantly changing. As new research and experience broaden
our understanding, changes in research methods, professional practices, or medical treatment may become
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Previous editions copyrighted 2010 and 2004.
Library of Congress Cataloging-in-Publication Data
Names: Stouffer, George A., editor. | Runge, Marschall Stevens, 1954- editor. | Patterson, Cam, editor. |
Rossi, Joseph S., editor. | Netter, Frank H. (Frank Henry), 1906-1991, illustrator.
Title: Netter’s cardiology / edited by George A. Stouffer, Marschall S. Runge, Cam Patterson, Joseph S. Rossi ;
illustrations by Frank H. Netter ; contributing illustrations, Carlos A. G. Machado [and 6 others].
Other titles: Cardiology
Description: 3rd edition. | Philadelphia, PA : Elsevier, [2019] | Includes bibliographical references and index.
Identifiers: LCCN 2018013552 | ISBN 9780323547260 (hardcover : alk. paper)
Subjects: | MESH: Cardiovascular Diseases | Diagnostic Techniques, Cardiovascular
Classification: LCC RC667 | NLM WG 120 | DDC 616.1/2—dc23 LC record available at https://lccn.loc.
gov/2018013552
Content Strategist: Marybeth Thiel
Publishing Services Manager: Catherine Albright Jackson
Senior Project Manager: Claire Kramer
Design Direction: Patrick Ferguson
Printed in China
Last digit is the print number: 9 8 7 6 5 4 3 2 1
ABOUT THE EDITORS
George A. Stouffer, MD, was born in Indiana, Pennsylvania, and Cam Patterson, MD, MBA, was born in Mobile, Alabama. He
was graduated from Bucknell University and the University of was a Harold Sterling Vanderbilt Scholar and studied psychology
Maryland, School of Medicine. He completed his internal medicine and English at Vanderbilt University, graduating summa cum laude.
residency, cardiology fellowship, and interventional cardiology fel- Dr. Patterson attended Emory University School of Medicine,
lowship at the University of Virginia. During his cardiology fel- graduating with induction in the Alpha Omega Alpha Honor Society,
lowship, he completed a 2-year National Institutes of Health research and completed a residency in Internal Medicine at Emory University
fellowship in the laboratory of Gary Owens at the University of Hospitals and Chief Residency at Grady Memorial Hospital. He
Virginia. He was on the faculty at the University of Texas Medical completed 3 years of research fellowship under the guidance of
Branch from 1995 to 2000, where he became an associate professor Edgar Haber at the Harvard School of Public Health, developing
and served as Co-Director of Clinical Trials in the Cardiology an independent research program in vascular biology and angio-
Division and as Associate Director of the Cardiac Catheterization genesis that was supported by a National Institutes of Health fel-
Laboratory. He joined the faculty at the University of North Caro- lowship. He did a cardiology fellowship and was on the faculty at
lina in 2000 and currently serves as the Henry A. Foscue Distin- the University of Texas Medical Branch from 1996 to 2000. Dr.
guished Professor of Medicine and Chief of Cardiology. Dr. Stouffer’s Patterson was at the University of North Carolina at Chapel Hill
main focus is clinical cardiology with an emphasis on interventional from 2000 to 2014 where he served as founding director of the
cardiology, but he is also involved in clinical and basic science UNC McAllister Heart Institute, Chief of Cardiology, and the
research. His basic science research is in the areas of regulation of Ernest and Hazel Craige Distinguished Professor of Cardiovascular
smooth muscle cell growth, the role of the smooth muscle cyto- Medicine. He received his MBA from the UNC Kenan-Flagler
skeleton in regulating signaling pathways, thrombin generation, School of Business in 2008. He is an elected member of the American
and renal artery stenosis. Society of Clinical Investigation and the Association of University
Cardiologists. Until recently he was Senior Vice President and
Marschall S. Runge, MD, PhD, was born in Austin, Texas, and Chief Operating Officer at New York Presbyterian–Weill Cornell
was graduated from Vanderbilt University with a BA in general Medical Center and currently serves as Chancellor of the University
biology and a PhD in molecular biology. He received his medical of Arkansas for Medical Sciences.
degree from the Johns Hopkins School of Medicine and trained in
internal medicine at Johns Hopkins Hospital. He was a cardiology Joseph S. Rossi, MD, was born in Hopedale, Illinois. He completed
fellow and junior faculty member at Massachusetts General Hospital. his undergraduate studies at the University of Illinois and then
Dr. Runge’s next position was at Emory University, where he directed completed his medical education at the University of Illinois–Chicago,
the Cardiology Fellowship Training Program. He then moved to graduating with induction into the Alpha Omega Alpha Honor
the University of Texas Medical Branch in Galveston, where he Society. He completed residency and fellowships in internal medi-
was Chief of Cardiology and Director of the Sealy Center for cine, cardiovascular disease, and interventional cardiology at North-
Molecular Cardiology. He was at the University of North Carolina western University, where he also obtained a master’s degree in
from 2000 to 2015, where he served as Charles Addison and Eliza- clinical investigation. Dr. Rossi is currently the Director of the
beth Ann Sanders Distinguished Professor of Medicine, Chair of Cardiac Catheterization Lab at the University of North Carolina.
the Department of Medicine, President of UNC Physicians, and He is actively involved in multiple clinical trials and has received
Vice Dean for Clinical Affairs. He is currently Dean of the Medical research grants to support his interest in the pharmacogenomics
School at the University of Michigan, Executive Vice President for of dual antiplatelet therapy and complex coronary artery revascu-
Medical Affairs, and Chief Executive Officer of Michigan Medicine. larization among Medicare beneficiaries. Dr. Rossi is particularly
Dr. Runge is board-certified in internal medicine and cardiovascular interested in pairing clinical and administrative data to enhance
diseases and has spoken and published widely on topics in clinical our knowledge of trends and resource utilization for patients with
cardiology and vascular medicine. advanced vascular disease.
v
PREFACE
Our goal for the third edition of Netter’s Cardiology was to provide chapters. The result is a text that is truly clinically useful and less
a concise and practical overview of cardiovascular medicine that has of a compendium than is commonly the case in many medical texts.
been updated to include new information and important clinical We believe that the changes we have made in the third edition
areas that were not well covered in the previous editions or in other substantially improve Netter’s Cardiology and ensure that it will con-
cardiology texts. To accomplish this expansion while maintaining a tinue to be a highly useful resource for all physicians, both generalists
focused text that could be used as a ready reference, we again avoided and subspecialists, who need to remain current in cardiology—from
exhaustive treatment of topics. We also have made every effort to trainees to experienced practitioners. Whether we have succeeded
present the essential information in a reader-friendly format that will obviously be determined by our readers. We welcome the com-
increases the reader’s ability to learn the key facts without getting ments, suggestions, and criticisms of readers that will help us improve
lost in details that can obfuscate the learning process. future editions of this work.
The first two editions of Netter’s Cardiology were an effort to
present in a concise and highly visual format the ever-increasing George A. Stouffer, MD
amount of medical information on cardiovascular disease. The Ernest and Hazel Craige Distinguished Professor of Medicine
challenge that clinicians face in “keeping up” with the medical Chief, Division of Cardiology
literature has continued to grow in the 14 years since the first Physician in Chief, UNC Heart and Vascular Service Line
edition of Netter’s Cardiology. This need to process the ever-expanding University of North Carolina at Chapel Hill
medical information base and apply new findings to the optimal Chapel Hill, North Carolina
care of patients is acute in all areas of medicine, but perhaps it
is most challenging in disciplines that require practitioners to Marschall S. Runge, MD, PhD
understand a broad spectrum of evidence-based medicine, such Professor of Internal Medicine
as the field of cardiovascular diseases. The explosion of medical Dean, University of Michigan Medical School
knowledge is also a real educational challenge for learners at all Executive Vice President for Medical Affairs
levels—students, residents, and practicing physicians—who must Chief Executive Officer, Michigan Medicine
rapidly determine what is and is not important, organize the key Ann Arbor, Michigan
information, and then apply these principles effectively in clinical
settings. Cam Patterson, MD, MBA
The third edition includes substantial changes. All the chapters Chancellor
have been updated, there is a new section on Structural Heart University of Arkansas for Medical Sciences
Disease, and new chapters have been added on Basic Anatomy and Little Rock, Arkansas
Embryology of the Heart, Stem Cell Therapies for Cardiovascular
Disease, Diabetes and Cardiovascular Events, Coronary Hemody- Joseph S. Rossi, MD
namics and Fractional Flow Reserve, Epidemiology of Heart Failure: Associate Professor of Medicine
Heart Failure with Preserved Ejection Fraction and Heart Failure Director, Cardiac Catheterization Laboratory
with Reduced Ejection Fraction, Management of Acute Heart Failure, University of North Carolina at Chapel Hill
Cardiac Transplantation and Mechanical Circulatory Support Chapel Hill, North Carolina
Devices, Cardiovascular Manifestations of Rheumatic Fever, Clinical
Presentation of Adults with Congenital Heart Disease, Transcatheter
Aortic Valve Replacement, Transcatheter Mitral Valve Repair, Tri-
cuspid and Pulmonic Valve Disease, Deep Vein Thrombosis and
Pulmonary Embolism, Cardiac Tumors and Cardio-oncology, and
Cardiovascular Disease in the Elderly.
As in the first two editions, the contributing authors have taken
advantage of the genius of Frank Netter by carefully selecting the
best of his artwork to illustrate the most important clinical concepts
covered in each chapter. When Netter artwork was unavailable or
difficult to apply to illustrate modern clinical concepts, we again
used the great artistic talents of Carlos A. G. Machado, MD, to
create new artwork or to skillfully edit and update some of Frank
Netter’s drawings. The combination of Dr. Machado’s outstanding
skills as a medical artist and his knowledge of the medical concepts
being illustrated was an invaluable asset.
As in the first two editions, we chose to use authors from the
University of North Carolina School of Medicine at Chapel Hill
or those with close ties to the university. This allowed us to select
authors who are clinical authorities, many of whom are also well
known for their national and international contributions. All have
active clinical practices that require daily use of the information
covered in their chapters, and all are well aware of the approach
to patient management used by their peers at other institutions and
in other practice settings. Many of the contributing authors for this
edition also contributed to prior editions of this textbook. Each
author, whether a previous contributor or not, was given clearly
defined guidelines that emphasized the need to distill the large
amount of complex information in his or her field and to present
it concisely in a carefully prescribed format maintained across all
vi
Preface vii
Algorithms have been color coded for quick reference.
Algorithm for Evaluating Patients in Whom
Renal Artery Stenosis Is Suspected
Clinical findings associated with renal artery stenosis
Present Absent
Noninvasive evaluation Follow clinically
(duplex ultrasonography of renal Treat risk factors
arteries, magnetic resonance
Orange (cid:31) test
angiography, or computed
tomographic angiography)
Renal artery stenosis present Renal artery stenosis absent Blue (cid:31) all other
Nuclear imaging Follow clinically
to estimate fractional Treat risk factors
flow to each kidney
Unilateral renal artery Unilateral renal artery Bilateral renal artery
stenosis and asymmetric stenosis and symmetric stenosis present
perfusion present perfusion present
Follow clinically Green (cid:31) treatment options
Treat risk factors
Consider revascularization
ABOUT THE ARTISTS
Frank H. Netter, MD Carlos A. G. Machado, MD
Frank H. Netter was born in 1906 in New York City. He studied Carlos Machado was chosen by Novartis to be Dr. Netter’s suc-
art at the Art Student’s League and the National Academy of Design cessor. He continues to be the main artist who contributes to the
before entering medical school at New York University, where he Netter collection of medical illustrations.
received his medical degree in 1931. During his student years, Dr. Self-taught in medical illustration, cardiologist Carlos Machado
Netter’s notebook sketches attracted the attention of the medical has contributed meticulous updates to some of Dr. Netter’s original
faculty and other physicians, allowing him to augment his income plates and has created many paintings of his own in the style of
by illustrating articles and textbooks. He continued illustrating as Netter as an extension of the Netter collection. Dr. Machado’s
a sideline after establishing a surgical practice in 1933, but he ulti- photorealistic expertise and his keen insight into the physician/
mately opted to give up his practice in favor of a full-time com- patient relationship inform his vivid and unforgettable visual style.
mitment to art. After service in the United States Army during His dedication to researching each topic and subject he paints places
World War II, Dr. Netter began his long collaboration with the him among the premier medical illustrators at work today.
CIBA Pharmaceutical Company (now Novartis Pharmaceuticals). Learn more about his background and see more of his art at
This 45-year partnership resulted in the production of the extraor- https://www.netterimages.com/artist-carlos-a-g-machado.html.
dinary collection of medical art so familiar to physicians and other
medical professionals worldwide.
In 2005, Elsevier, Inc., purchased the Netter Collection and all
publications from Icon Learning Systems. There are now more
than 50 publications featuring the art of Dr. Netter available through
Elsevier, Inc. (www.elsevierhealth.com).
Dr. Netter’s works are among the finest examples of the use of
illustration in the teaching of medical concepts. The 13-book Netter
Collection of Medical Illustrations, which includes the greater part of
the more than 20,000 paintings created by Dr. Netter, became and
remains one of the most famous medical works ever published. The
Netter Atlas of Human Anatomy, first published in 1989, presents
the anatomic paintings from the Netter Collection. Now translated
into 16 languages, it is the anatomy atlas of choice among medical
and health professions students the world over.
The Netter illustrations are appreciated not only for their aes-
thetic qualities, but also, more important, for their intellectual
content. As Dr. Netter wrote in 1949, “. . . clarification of a subject
is the aim and goal of illustration. No matter how beautifully painted,
how delicately and subtly rendered a subject may be, it is of little
value as a medical illustration if it does not serve to make clear some
medical point.” Dr. Netter’s planning, conception, point of view,
and approach are what inform his paintings and what makes them
so intellectually valuable.
Frank H. Netter, MD, physician and artist, died in 1991.
Learn more about the physician-artist whose work has inspired
the Netter Reference collection at https://www.netterimages.com/
artist-frank-h-netter.html.
viii
ACKNOWLEDGMENTS
This third edition of Netter’s Cardiology benefited enormously from
the hard work and talent of many dedicated individuals.
First, we thank the contributing authors. All are current or former
faculty members at the University of North Carolina School of
Medicine, Chapel Hill, or have close ties to the institution. Without
their intellect, dedication, and drive for excellence, Netter’s Cardiol-
ogy, third edition, could not have been published. We had a solid
foundation on which to build the third edition, thanks to the hard
work of the contributing authors of the second edition, many of
whom we were fortunate to have continue on to this edition. We
are also grateful for the invaluable editorial contribution that Dr.
E. Magnus Ohman made to the first edition.
Special recognition goes to John A. Craig, MD, and Carlos A.
G. Machado, MD. They are uniquely talented physician-artists
who, through their work, brought to life important concepts in
medicine in the new and updated figures included in this text.
Marybeth Thiel at Elsevier was invaluable in bringing the third
edition to fruition.
We would especially like to acknowledge our families: our wives—
Susan Runge, Meg Stouffer, Emma Rossi, and Kristine Patterson—
whose constant support, encouragement, and understanding made
completion of this text possible; our children—Thomas, Elizabeth,
William, John, and Mason Runge; Mark, Jeanie, Joy, and Anna
Stouffer; Paul, Samuel, and James Rossi; and Celia, Anna Alyse,
and Graham Patterson—who inspire us and remind us that there
is life beyond the computer; and, finally, our parents—whose per-
sistence, commitment, and work ethic got us started on this road
many, many years ago.
ix
CONTRIBUTORS
EDITORS Sharon Ben-Or, MD
Assistant Professor
Cam Patterson, MD, MBA Department of Surgery
Chancellor University of South Carolina at Greenville
University of Arkansas for Medical Sciences Greenville, South Carolina
Little Rock, Arkansas
Hannah Bensimhon, MD
Joseph S. Rossi, MD Cardiology Fellow
Associate Professor of Medicine Department of Medicine
Director, Cardiac Catheterization Laboratory University of North Carolina at Chapel Hill
University of North Carolina at Chapel Hill School of Medicine
Chapel Hill, North Carolina Chapel Hill, North Carolina
Marschall S. Runge, MD, PhD Christoph Bode, MD, PhD
Professor of Internal Medicine Chairman of Internal Medicine
Dean, University of Michigan Medical School Medical Director, Department of Cardiology and Angiology
Executive Vice President for Medical Affairs Albert-Ludwigs-Universität Freiburg
Chief Executive Officer, Michigan Medicine Freiburg, Germany
Ann Arbor, Michigan
Michael Bode, MD
George A. Stouffer, MD Cardiovascular Disease Fellow
Ernest and Hazel Craige Distinguished Professor of Medicine Department of Medicine
Chief, Division of Cardiology Division of Cardiology
Physician in Chief, UNC Heart and Vascular Service Line University of North Carolina at Chapel Hill
University of North Carolina at Chapel Hill Chapel Hill, North Carolina
Chapel Hill, North Carolina
Weeranun D. Bode, MD
Assistant Professor
AUTHORS Department of Medicine
Division of Cardiology
Basil Abu-el-Haija, MD University of North Carolina at Chapel Hill
Clinical Cardiac Electrophysiology Chapel Hill, North Carolina
Staff Physician, Kaweah Delta Hospital
Visalia, California Mark E. Boulware, MD
Interventional Cardiologist
Tiffanie Aiken, BS University of Colorado Health Heart and Vascular Center
MD Candidate 2019 Colorado Springs, Colorado
University of South Carolina School of Medicine Greenville
Greenville, South Carolina Michael E. Bowdish, MD
Director, Mechanical Circulatory Support
Sameer Arora, MD Assistant Professor of Surgery
Cardiovascular Disease Fellow Keck School of Medicine of University of Southern California
University of North Carolina at Chapel Hill Los Angeles, California
Chapel Hill, North Carolina
Timothy Brand, MD
Matthew S. Baker, MD Cardiothoraic Surgery Resident
Assistant Professor of Medicine University of North Carolina Hospitals
Division of Cardiology Chapel Hill, North Carolina
University of North Carolina School of Medicine
Chapel Hill, North Carolina Bruce R. Brodie, MD, FACC
Past President, LeBauer Cardiovascular Research Foundation
Charles Baggett, MD Cone Health Heart and Vascular Center
Cardiologist Greensboro, North Carolina
The Harbin Clinic
Rome, Georgia Adam W. Caldwell, MD
Cardiovascular Disease Fellow
Thomas M. Bashore, MD Division of Cardiology
Professor of Medicine University of North Carolina School of Medicine
Senior Vice Chief, Division of Cardiology Chapel Hill, North Carolina
Duke University Medical Center
Durham, North Carolina Eric P. Cantey, MD
Department of Medicine
Feinberg School of Medicine at Northwestern University
Chicago, Illinois
x