Practical cardiovascular medicine

990 Pages·2022·320.319 MB·English

by  Elias B. Hanna

PRACTICAL H A N N A
SE C OND E DI T ION
E L I A S B . H A N N A
CARDIOVASCULAR MEDICINE
C P
A R
Providing a complete but succinct overview of the information cardiologists and cardiology trainees
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need to have at their fingertips, Practical Cardiovascular Medicine, Second Edition is an everyday S E C O N D E D I T I O N
primary guide to the specialty. D C
• P rovides cardiologists with a thorough and up-to-date review of cardiology, from I T PRACTICAL
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pathophysiology to practical, evidence-based management I
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• A bly synthesizes pathophysiology fundamentals and evidence-based approaches to V
CARDIOVASCULAR
prepare a physician for a subspecialty career in cardiology A
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• C linical chapters cover coronary artery disease, heart failure, arrhythmias, valvular disorders,
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pericardial disorders, congenital heart disease, and peripheral arterial disease
MEDICINE
• P ractical chapters address ECG, coronary angiography, catheterization techniques, C
echocardiography, hemodynamics, and electrophysiological testing U
• I ncludes over 730 figures, key notes boxes, references for further study, and coverage
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of clinical trials
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• R eview questions help clarify topics and can be used for Board preparation — over 650
questions in all! R
The second edition has been comprehensively updated with the newest data and with both the
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American and European guidelines. More specifically, 20 clinical chapters have been rewritten
and extensively revised. Procedural chapters have been enhanced with additional concepts and
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illustrations, particularly the hemodynamic and catheterization chapters. Clinical questions have
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been revamped, new questions have been added, including a new, 259-question section at the end
of the book.
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Practical Cardiovascular Medicine, Second Edition is an ideal reference for the resident, fellow,
cardiologist, and any professional treating patients with cardiovascular disease. I
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Elias B. Hanna, MD, FACC, is Associate Professor of Medicine (Cardiovascular Medicine E
and Interventional Cardiology) at the University of Iowa, Iowa, USA. He has authored multiple
cardiology books and has extensive fellowship teaching experience.
SE COND
EDIT ION
www.wiley.com/go/hanna/practicalcardiovascularmedicine
Cover Design: Wiley
Cover Image: © Science Photo Library - PIXOLOGICSTUDIO/Getty Images,
Courtesy of Elias Hanna
www.wiley.com/wiley-blackwell
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Practical Cardiovascular
Medicine
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Practical Cardiovascular
Medicine
Second Edition
Elias B. Hanna, MD, FACC
Associate Professor of Medicine
Division of Cardiovascular Medicine
Division of Interventional Cardiology
University of Iowa School of Medicine
Iowa City, Iowa, USA
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This edition first published 2022
© 2022 John Wiley & Sons Ltd
Edition History
John Wiley & Sons Ltd (1e, 2017)
All rights reserved. No part of this publication may be reproduced, stored in a retrieval system, or transmitted, in any form or by any means, electronic,
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The right of Elias B. Hanna to be identified as the author of this work has been asserted in accordance with law.
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Library of Congress Cataloging-in-Publication Data
Names: Hanna, Elias B., author.
Title: Practical cardiovascular medicine / Elias B. Hanna.
Description: Second edition. | Hoboken : Wiley, 2022. | Includes index.
Identifiers: LCCN 2021028069 (print) | LCCN 2021028070 (ebook) | ISBN
9781119832706 (paperback) | ISBN 9781119832713 (adobe pdf) | ISBN
9781119832720 (epub)
Subjects: MESH: Cardiovascular Diseases
Classification: LCC RC667 (print) | LCC RC667 (ebook) | NLM WG 120 | DDC
616.1–dc23
LC record available at https://lccn.loc.gov/2021028069
LC ebook record available at https://lccn.loc.gov/2021028070
Cover Design: Wiley
Cover Image: © Science Photo Library - PIXOLOGICSTUDIO/Getty Images, Courtesy of Elias Hanna
Set in 8.5/10.5pt FrutigerLTStd-Light by straive, Pondicherry, India
10 9 8 7 6 5 4 3 2 1
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To my mother Marie, my sister Eliana, and my beautiful
nephew Marc‐Elias and nieces Clara and Elya,
the joys of my life
To my mentors and my fellows, and to all who
share my passion for cardiology
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Contents
Preface, xx
Abbreviations, xxi
About the Companion Website, xxiv
PART 1. Coronary Artery Disease, 1
1. Non- ST- Segment Elevation Acute Coronary Syndrome, 1
I. Definition, types of myocardial infarction, and pitfalls, 1
II. Clinical features, ECG, cardiac biomarkers, and echocardiography in ACS, 6
III. Initial approach to acute chest pain presentations and the use of conventional and high- sensitivity troponins, 8
IV. Management of NSTEMI, 10
V. General procedural management after coronary angiography: PCI, CABG, or medical therapy only, 14
VI. Discharge medications in NSTEMI, 14
VII. Prognosis, 17
Appendix 1. Complex angiographic disease- Moderate disease progression, 17
Appendix 2. Women and ACS, elderly patients and ACS, CKD, 18
Appendix 3. Bleeding, transfusion, patients on chronic warfarin or NOAC, gastrointestinal bleed, 19
Appendix 4. Antiplatelet and anticoagulant therapy, 20
Appendix 5. Difference between plaque rupture and plaque erosion, 23
Appendix 6. Spontaneous coronary artery dissection, 23
Appendix 7. Harmful effects of NSAIDs and cyclooxygenase- 2 inhibitors in CAD, 25
Appendix 8. Additional ideas on the physiology of hs-t roponin- Role of hs- troponin in primary prevention, 25
Questions and answers, 25
2. ST- Segment Elevation Myocardial Infarction, 38
1. Definition, reperfusion, and general management, 39
I. Definition, 39
II. Timing of reperfusion, 39
III. ECG phases of STEMI, 40
IV. STEMI diagnostic tips and clinical vignettes, 40
V. Specific case of new or presumably new LBBB, 41
VI. Reperfusion strategies: fibrinolytics, primary PCI, and combined fibrinolytics–PCI, 42
VII. Coronary angiography and PCI later than 24 hours after presentation-role of stress testing, 45
VIII. Angiographic findings, PCI, and cellular reperfusion; multivessel disease in STEMI, 46
IX. Antithrombotic therapies in STEMI, 47
X. Other acute therapies, 48
XI. Risk stratification, 49
XII. LV remodeling and infarct expansion after MI, 49
XIII. Discharge, EF improvement, ICD, 49
2. Stemi Complications, 50
I. Cardiogenic shock, 50
II. Mechanical complications, 53
III. Recurrent infarction and ischemia, 55
IV. Tachyarrhythmias, 55
V. Bradyarrhythmias, bundle branch blocks, fascicular blocks, 57
VI. LV aneurysm and LV pseudoaneurysm, 58
VII. Pericardial complications, 59
VIII. LV thrombus and thromboembolic complications, 59
IX. Early and late mortality after STEMI, 60
Appendix 1. Out- of- hospital cardiac arrest: role of early coronary angiography and therapeutic hypothermia, 60
Questions and answers, 62
3. Stable Ischemic Heart Disease and Approach to Chronic Chest Pain, 74
I. Causes of angina and pathophysiology of coronary flow, 74
II. Diagnostic approach, 75
vii
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viii Contents Contents ix
III. Silent myocardial ischemia. Is there a role for screening asymptomatic patients and post- PCI patients?, 78
IV. Medical therapy: antiplatelet therapy, 79
V. Medical therapy: antianginal therapy and risk factor control, 79
VI. Indications for revascularization, 81
VII. CABG and CABG vs. medical therapy, 82
VIII. PCI and PCI vs medical therapy, 82
IX. PCI vs. CABG in multivessel and left main disease, 83
X. High- surgical- risk patients, 85
XI. Role of complete functional revascularization, 85
XII. Hybrid CABG–PCI, 85
XIII. Enhanced external counterpulsation, 86
XIV. Mortality in CAD, 86
Appendix 1. Notes on various surgical grafts, 86
Appendix 2. Coronary vasospasm (variant angina, Prinzmetal angina), 88
Appendix 3. Microvascular endothelial dysfunction, 90
Appendix 4. Women with chest pain and normal coronary arteries, 90
Appendix 5. Diagnostic strategy for ischemia with non- obstructed coronary arteries (INOCA), 91
Appendix 6. Myocardial bridging, 91
Appendix 7. Coronary collaterals, chronic total occlusion, 92
Appendix 8. Hibernation, stunning, ischemic preconditioning, 92
Questions and answers, 93
PART 2. Heart Failure (Chronic and Acute Heart Failure, Specific Cardiomyopathies,
and Pathophysiology), 103
4. Heart Failure, 103
Definition, Types, Causes, and Diagnosis of Heart Failure, 104
1. Definition and types of heart failure, 104
I. Heart failure is diagnosed clinically, not by echocardiography, 104
II. After HF is defined clinically, echocardiography is used to differentiate the three major types of HF, 105
III. Two additional types of HF, 107
2. Causes of heart failure, 107
I. Systolic HF or HF with reduced EF (HFrEF), 107
II. HF with preserved EF (HFpEF), 108
III. Right HF, 110
3. Diagnostic tests, 110
I. Echocardiography, 110
II. BNP, 111
III. ECG, 112
IV. Coronary angiography and other ischemic tests, 112
V. Diastolic stress testing, 112
VI. Endomyocardial biopsy, 112
VII. Cardiac MRI, 113
Chronic Treatment of Heart Failure, 113
1. Treatment of systolic heart failure, 113
I. Treat the underlying etiology: target BP and CAD, 113
II. Value of revascularization in ischemic cardiomyopathy: STICH trial, 113
III. Role of viability testing and ischemic testing, 113
IV. Drugs that affect survival in EF<40%, 115
V. Specifics of drugs that affect survival, 116
VI. Drugs that improve symptoms and morbidity, 120
VII. Devices, 122
VIII. Other therapeutic measures, 123
IX. Prognosis, 124
2. Treatment of HFpEF, 124
Acute Heart Failure and Acutely Decompensated Heart Failure, 126
I. Triggers of acute decompensation, 126
II. Profiles of acute HF: congestion without low cardiac output, congestion with low cardiac output, 127
III. Treatment of acute HF: diagnosis and treatment of triggers, 127
IV. Treatment of acute HF: diuretics, cardiorenal syndrome, aggressive decongestion, ultrafiltration, 128
V. Treatment of acute HF: vasodilators, 132
VI. Treatment of acute HF: IV inotropic agents, 132
VII. In-hospital and pre-discharge use of ACE-I/ ARB, angiotensin-neprilysin inhibition, and β-blockers, 133
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