Netter's Cardiology, 2nd Edition

667 Pages·2010·41.47 MB·English

by  Marschall S. Runge, George A. Stouffer, Cam Patterson

Netter’s
Cardiology
2nd edition
EditEd by
MARSCHALL S. RUNGE, Md, Phd
GEORGE A. StOUFFER, Md
CAM PAttERSON, Md, MbA
Illustrations by Frank H. Netter, MD
CONTRIBUTING ILLUSTRATORS
Carlos A. G. Machado, MD
John A. Craig, MD
David J. Mascaro, MS
Enid Hatton
Steven Moon, MA
Kip Carter, MS, CMI
Tiffany S. DaVanzo, MA, CMI
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N ETTER’ S CARDIOLOGY, SECOND EDITION I SBN: 978-1-4377-0637-6
I SBN (online): 978-1-4377-0638-3
C opyright © 2010 by Saunders, an imprint of Elsevier Inc.
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N otices
K nowledge and best practice in this fi eld are constantly changing. As new research and experience
broaden our understanding, changes in research methods, professional practices, or medical
treatment may become necessary.
P ractitioners and researchers must always rely on their own experience and knowledge in
evaluating and using any information, methods, compounds, or experiments described herein. In
using such information or methods they should be mindful of their own safety and the safety of
others, including parties for whom they have a professional responsibility.
W ith respect to any drug or pharmaceutical products identifi ed, readers are advised to check the
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P revious edition copyrighted 2004
L ibrary of Congress Cataloging-in-Publication Data
N etter’ s cardiology / edited by Marschall S. Runge, George A. Stouffer, Cam Patterson ; illustrations by
Frank H. Netter ; contributing illustrator, Carlos A. G. Machado.— 2 nd ed.
p . ; cm.
O ther title: Cardiology
I ncludes bibliographical references and index.
I SBN 978-1-4377-0637-6
1 . C ardiology. 2 . C ardiovascular system —D iseases. I . R unge, Marschall S.
II. S touffer, George A. I II. P atterson, Cam. I V. N etter, Frank H. (Frank Henry), 1906-1991.
V. T itle: Cardiology.
[ DNLM: 1 . C ardiovascular Diseases. 2 . D iagnostic Techniques, Cardiovascular. WG 120 N474 2011]
R C667.N47 2011
6 16.1′ 2 — d c22
2 010005892
N etter Director: Anne Lenehan
E ditor: Elyse O ’G rady
E ditorial Assistant : Julie Goolsby
P roject Manager: David Saltzberg
D esign Manager: Steven Stave
I llustrations Manager : Karen Giacomucci Working together to grow
M arketing Manager: Jason Oberacker
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L ast digit is the print number: 9 8 7 6 5 4 3 2 1
About the Editors
Marschall S. Runge, MD, PhD, was born in Austin, Texas, clinical and basic science research. His basic science research is
and was graduated from Vanderbilt University with a BA in in the areas of regulation of smooth muscle cell growth, the role
General Biology and a PhD in Molecular Biology. He received of the smooth muscle cytoskeleton in regulating signaling path-
his medical degree from the Johns Hopkins School of Medicine ways, thrombin generation, and renal artery stenosis.
and trained in internal medicine at Johns Hopkins Hospital. He Cam Patterson, MD, MBA, was born in Mobile, Alabama.
was a cardiology fellow and junior faculty member at Massachu- He was a Harold Sterling Vanderbilt Scholar and studied Psy-
setts General Hospital. Dr. Runge’s next position was at Emory chology and English at Vanderbilt University, graduating
University, where he directed the Cardiology Fellowship Train- summa cum laude. He participated in the Honors Research
ing Program. He then moved to the University of Texas Medical Program at Vanderbilt and conducted research in behavioral
Branch in Galveston, where he was Chief of Cardiology and pharmacology during that time. Dr. Patterson attended Emory
Director of the Sealy Center for Molecular Cardiology. He University School of Medicine, graduating with induction in the
came to the University of North Carolina (UNC) in 2000 as Alpha Omega Alpha Honor Society, and completed his resi-
Chair of the Department of Medicine. He is currently the dency in Internal Medicine at Emory University Hospitals. He
Charles Addison and Elizabeth Ann Sanders Distinguished Pro- became the youngest-ever Chief Resident at Grady Memorial
fessor of Medicine and Chair of the Department of Medicine. Hospital at Emory University in 1992, supervising over 200
In addition, in 2004, Dr. Runge was appointed President of house offcers in four hospitals. He completed 3 years of research
UNC Physicians and Vice Dean for Clinical Affairs. Dr. Runge fellowship under the guidance of Edgar Haber at the Harvard
is board-certifed in internal medicine and cardiovascular dis- School of Public Health, developing an independent research
eases and has spoken and published widely on topics in clinical program in vascular biology and angiogenesis that was sup-
cardiology and vascular medicine. He maintains an active clini- ported by a National Institutes of Health fellowship. In 1996,
cal practice in cardiovascular diseases and medicine in addition he accepted his frst faculty position at the University of Texas
to his teaching and administrative activities in the Department Medical Branch, and in 2000, Dr. Patterson was recruited to the
of Medicine and the UNC School of Medicine. University of North Carolina at Chapel Hill to become the
George A. Stouffer, MD, was born in Indiana, Pennsylva- founding director of the UNC McAllister Heart Institute. In
nia, and was graduated from Bucknell University and the Uni- 2005, he also became Chief of the Division of Cardiology at
versity of Maryland School of Medicine. He completed his UNC. Dr. Patterson is the Ernest and Hazel Craige Distin-
internal medicine residency, cardiology fellowship, and inter- guished Professor of Cardiovascular Medicine, and he has been
ventional cardiology fellowship at the University of Virginia. recognized at UNC with the Ruth and Phillip Hettleman Prize
During his cardiology fellowship, he completed a 2-year National for Artistic and Scholarly Achievement. He is an Established
Institutes of Health research fellowship in the laboratory of Gary Investigator of the American Heart Association and a Burroughs
Owens at the University of Virginia. He was on the faculty at the Wellcome Fund Clinical Scientist in Translational Research.
University of Texas Medical Branch from 1995 to 2000, where He is a member of several editorial boards, including Circulation
he became an associate professor and served as Co-Director of and Journal of Clinical Investigation, and is an elected member of
Clinical Trials in the Cardiology Division and as Associate the American Society of Clinical Investigation and the Associa-
Director of the Cardiac Catheterization Laboratory. He joined tion of University Cardiologists. Dr. Patterson maintains active
the faculty at the University of North Carolina in 2000 and cur- research programs in the areas of angiogenesis and vascular
rently serves as the Henry A. Foscue Distinguished Professor of development, cardiac hypertrophy, protein quality control, and
Medicine and Director of the Cardiac Catheterization Labora- translational genomics and metabolomics. He is also the direc-
tory. Dr. Stouffer’s main focus is clinical cardiology with an tor of the Cardiac Genetics Clinic. He received his MBA from
emphasis on interventional cardiology, but he is also involved in the UNC Kenan-Flagler School of Business in 2008.
Preface
The frst edition of Netter’s Cardiology was an effort to present lead to patient harm. We also added boxes and algorithms that
to clinicians the ever-increasing amount of medical information provide in an easy-to-read format quick overviews of critical
on cardiovascular diseases in a concise and highly visual format. diagnostic and therapeutic information covered in the text. (See
The challenge that clinicians face in “keeping up” with the the sample algorithm on the following page.) References are
medical literature has continued to grow in the 5 years since the annotated in the second edition of Netter’s Cardiology to guide the
frst edition of Netter’s Cardiology. This need to process the ever- reader to a more in-depth review, if considered necessary. As in
expanding medical information base and apply new fndings to the frst edition, the contributing authors have taken advantage
the optimal care of patients is acute in all areas of medicine, but of the genius of Frank Netter by carefully selecting the best of
perhaps it is most challenging in disciplines that require practi- his artwork to illustrate the most important clinical concepts
tioners to understand a broad spectrum of evidence-based medi- covered in each chapter. When Netter artwork was unavailable
cine, such as the feld of cardiovascular diseases. The explosion or diffcult to apply to illustrate modern clinical concepts, we
of medical knowledge is also a very real educational issue for again utilized the great artistic talents of Carlos A. G. Machado,
learners at all levels—students, residents, practicing physicians— MD, to create new artwork or to skillfully edit and update some
who must rapidly determine what is and is not important, orga- of Frank Netter’s drawings. The combination of Dr. Machado’s
nize the key information, and then apply these principles outstanding skills as a medical artist and his knowledge of the
effectively in clinical settings. medical concepts being illustrated was an invaluable asset.
For the second edition of Netter’s Cardiology, our goal was As in the frst edition, we chose to use authors from the
to produce an improved text that keeps these issues in clear University of North Carolina School of Medicine at Chapel
focus and also addresses important clinical areas that were Hill or those with close ties to the university. This allowed us
not well covered in the frst edition or in many other cardiol- to select authors who are clinical authorities, many of whom
ogy texts. To accomplish this expansion while maintaining a are also well known for their national and international contri-
concise text that could be used as a ready reference, we again butions. All have active clinical practices that require daily use
avoided exhaustive treatment of topics. We also have made of the information covered in their chapters, and all are well
every effort to present the essential information in a reader- aware of the approach to patient management utilized by their
friendly format that increases the reader’s ability to learn the peers at other institutions and in other practice settings. Many
key facts without getting lost in details that can obfuscate the of the contributing authors of the frst edition have continued
learning process. on as second-edition authors and have provided updates. Each
After a careful review of reader comments about the frst author, whether a previous contributor or not, was given
edition, we made some substantial changes to achieve our clearly defned guidelines that emphasized the need to distill
educational goals. Chapters were added and topics expanded to the large amount of complex information in his or her feld and
address reader concerns about the lack of coverage of a number to present it concisely in a carefully prescribed format main-
of important topics commonly encountered in clinical practice. tained across all chapters. The result is a text that is truly clini-
Examples include these new chapters: Chest Radiography, cally useful and less of a compendium than is commonly the
Echocardiography, Stress Testing and Nuclear Imaging, Car- case in many medical texts.
diac Computed Tomography and Magnetic Resonance Imaging, We believe that the changes we have made in the second
Left and Right Heart Catheterization, Identifying the Patient at edition substantially improve Netter’s Cardiology and ensure that
High Risk for Acute Coronary Syndrome: Plaque Rupture and it will continue to be a highly useful resource for all physicians,
“Immediate Risk,” Cardiogenic Shock after Myocardial Infarc- both generalists and subspecialists, who need to remain current
tion, Stress-Induced Cardiomyopathy, Supraventricular Tachy- in cardiology—from trainees to experienced practitioners.
cardia, Sleep Disorders and the Cardiovascular System, Whether we have succeeded will obviously be determined by
Cardiovascular Toxicity of Noncardiac Medications, and Sudden our readers. Based on our experience with the revision of
Cardiac Death in Athletes. The chapter subheadings of “Opti- the frst edition, we welcome the comments, suggestions, and
mum Treatment” and “Avoiding Treatment Errors” are new criticisms of readers that will help us improve future editions of
additions that address concerns about therapeutic errors that can this work.
vi  Preface
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 ⫽ test
angiography, or computed
tomographic angiography)
Renal artery stenosis present Renal artery stenosis absent Blue ⫽ 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 ⫽ treatment options
Treat risk factors
Consider revascularization
Marschall S. Runge, MD, PhD Cam Patterson, MD, MBA
Charles Addison and Elizabeth Ann Sanders Ernest and Hazel Craige Distinguished Professor of Medicine
Distinguished Professor of Medicine Professor of Medicine, Pharmacology, and Cell
Professor and Chair, Department of Medicine and Developmental Biology
The University of North Carolina School of Medicine Chief, Division of Cardiology
Chapel Hill, North Carolina Director, UNC McAllister Heart Institute
Associate Chair for Research, Department of Medicine
George A. Stouffer, MD
The University of North Carolina School of Medicine
Henry A. Foscue Distinguished Professor of Medicine
Chapel Hill, North Carolina
Chief of Clinical Cardiology
Director, C.V. Richardson Cardiac
Catheterization Laboratory
Director, Interventional Cardiology
Division of Cardiology
The University of North Carolina School of Medicine
Chapel Hill, North Carolina
About the Artists
Frank H. Netter, MD of choice among medical and health professions students the
Frank H. Netter was born in 1906 in New York City. He world over.
studied art at the Art Student’s League and the National The Netter illustrations are appreciated not only for their
Academy of Design before entering medical school at New York aesthetic qualities but, more importantly, for their intellectual
University, where he received his MD degree in 1931. During content. As Dr. Netter wrote in 1949, “clarifcation of a subject
his student years, Dr. Netter’s notebook sketches attracted the is the aim and goal of illustration. No matter how beautifully
attention of the medical faculty and other physicians, allowing painted, how delicately and subtly rendered a subject may be, it
him to augment his income by illustrating articles and text- is of little value as a medical illustration if it does not serve to
books. He continued illustrating as a sideline after establishing make clear some medical point.” Dr. Netter’s planning, concep-
a surgical practice in 1933, but he ultimately opted to give up tion, point of view, and approach are what inform his paintings
his practice in favor of a full-time commitment to art. After and what makes them so intellectually valuable.
service in the United States Army during World War II, Dr. Frank H. Netter, MD, physician and artist, died in 1991.
Netter began his long collaboration with the CIBA Pharmaceu- Learn more about the physician–artist whose work has
tical Company (now Novartis Pharmaceuticals). This 45-year inspired the Netter Reference Collection: www.netterimages.
partnership resulted in the production of the extraordinary col- com/artist/netter.htm.
lection of medical art so familiar to physicians and other medical
professionals worldwide. Carlos A. G. Machado, MD
In 2005, Elsevier Inc. purchased the Netter Collection Carlos A. G. Machado was chosen by Novartis to be Dr. Net-
and all publications from Icon Learning Systems. Now ter’s successor. He continues to be the main artist who contrib-
over 50 publications featuring the art of Dr. Netter are avail- utes to the Netter Collection of Medical Illustrations.
able through Elsevier Inc. (in the United States: www. Self-taught in medical illustration, cardiologist Carlos A. G.
us.elsevierhealth.com/Netter; outside the United States: www. Machado has contributed meticulous updates to some of Dr.
elsevierhealth.com). Netter’s original plates and has created many paintings of his
Dr. Netter’s works are among the fnest examples of the use own in the style of Netter as an extension of the Netter Collec-
of illustration in the teaching of medical concepts. The 13-book tion. Dr. Machado’s photorealistic expertise and his keen insight
Netter Collection of Medical Illustrations, which includes the into the physician–patient relationship inform his vivid and
greater part of the more than 20,000 paintings created by Dr. unforgettable visual style. His dedication to researching each
Netter, has become one of the most famous medical works ever topic and subject he paints places him among the premier
published. The Netter Atlas of Human Anatomy, frst published medical illustrators at work today.
in 1989, presents the anatomic paintings from the Netter Col- Learn more about his background and see more of his art at:
lection. Now translated into 16 languages, it is the anatomy atlas www.netterimages.com/artist/machado.htm.
Acknowledgments
This second edition of Netter’s Cardiology benefted enormously Julie Goolsby at Elsevier were instrumental in helping us make
from the hard work and talent of many dedicated individuals. a very good frst edition more comprehensive and more focused
First, we thank the contributing authors. All are current or in its second edition.
former faculty members at the University of North Carolina We are also indebted to Ms. Angela Clotfelter-Rego, whose
School of Medicine, Chapel Hill, or have close ties to the insti- superb organizational skills helped make this text a reality.
tution. Without their intellect, dedication, and drive for excel- Special thanks go to Carolyn Kruse for excellent editing and Dr.
lence, Netter’s Cardiology, 2nd edition, could not have been Deborah Montague for invaluable reviewing and updating of
published. We had a solid foundation on which to build the the pharmacologic information.
second edition, thanks to the hard work of the frst-edition We would especially like to acknowledge our families: our
contributing authors, many of whom we were fortunate to have wives—Susan Runge, Meg Stouffer, and Kristine Patterson—
continue on to this edition. We are also grateful for the invalu- whose constant support, encouragement, and understanding
able editorial contribution that Dr. E. Magnus Ohman made to made completion of this text possible; our children—Thomas,
the frst edition. Elizabeth, William, John, and Mason Runge; Mark, Jeanie,
Special recognition goes to John A. Craig, MD, and Carlos Joy, and Anna Stouffer; and Celia, Anna Alyse, and Graham
A. G. Machado, MD. They are uniquely talented physician– Patterson—who inspire us and remind us that there is life
artists who, through their work, brought to life important con- beyond the computer; and, fnally, our parents—whose persis-
cepts in medicine in the new and updated fgures included in tence, commitment, and work ethic got us started on this road
this text. Anne Lenehan, Elyse O’Grady, Marybeth Thiel, and many, many years ago.