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- troponin- 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 2. Stemi Complications 50 I.
Cardiogenic shock 50 II. Mechanical complications 53 III. Recurrent infarction and ischemia 55 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 III. Silent myocardial ischemia.
Is there a role for screening asymptomatic patients and post- PCI patients? 78 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 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 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 Appendix 1. Management of isolated or predominant RV failure 135 Questions and answers 138 5. Additional Heart Failure Topics 156 1.
Specific cardiomyopathies 156 I. Arrhythmia- induced cardiomyopathy 156 II. Viral myocarditis 157 2. Advanced heart failure: heart transplant and ventricular assist devices 163 I. Stages of HF 163 II. Cardiac transplantation 163 3. Pathophysiology of heart failure and hemodynamic aspects 166 I. LV diastolic pressure in normal conditions and in HF (whether systolic or diastolic) 166 II.
Definition of afterload 167 Questions and answers 173 Part 3. Valvular Disorders 181 6. Valvular Disorders 181 1. Mitral regurgitation 182 I. Mechanisms of mitral regurgitation 182 II. Specifics of various causes of mitral regurgitation 182 2. Mitral stenosis 192 I. Etiology and natural history 192 II.
Diagnosis 193 III. Treatment 197 3. Aortic insufficiency 199 I. Etiology 199 II. Pathophysiology and hemodynamics 200 III. Diagnosis 200 4. Aortic stenosis 203 I. Etiology 203 II.
Echo and catheterization diagnosis pitfalls and hemodynamics 204 5. Tricuspid regurgitation and stenosis 213 I. Etiology of tricuspid regurgitation 213 II. Natural history of TR 215 6. Pulmonic stenosis and regurgitation 216 I. Pulmonic stenosis 216 II. Pulmonic regurgitation 216 7. Mixed valvular disease; radiation heart disease 217 I.
Mixed single- valve disease 217 II. Multiple valvular involvement (combined stenosis or regurgitation of two different valves) 217 III. Radiation heart disease 217 8. Prosthetic valves 218 I. Bioprosthesis versus mechanical prosthesis 218 II. Determinants of valve degeneration and valve thrombosis; anticoagulation guidelines 218 III. Particular cases: women who wish to become pregnant and dialysis patients 220 IV. Echocardiographic follow- up of prosthetic valves 221 V.
Complications 221 9. Auscultation and summary ideas 223 I. Auscultation and other physical findings 223 II. General ideas and workup 226 Questions and answers 227 Part 4. Hypertrophic Cardiomyopathy 243 7. Hypertrophic Cardiomyopathy 243 I. Definition and features of HCM 243 II. Natural history and mortality 245 III.
Symptoms and ECG 246 Questions and answers 253 Part 5. Arrhythmias and Electrophysiology 257 8. Approach to Narrow and Wide QRS Complex Tachyarrhythmias 257 I. The unstable patient 257 II. Initial approach to any tachycardia 257 9. Ventricular Arrhythmias: Types and Management Sudden Cardiac Death 274 I. Premature ventricular complexes 274 II. Ventricular tachycardia 276 III.
Polymorphic ventricular tachycardia 278 Questions and answers 288 10. Atrial Fibrillation 294 I. Predisposing factors 294 II. Types of AF 295 III. General therapy of AF 295 X. AF burden as a correlate and a driver of HF progression 303 Appendix 1. Optimal heart rate and AF rate for optimal cardiac output 303 Appendix 2. Antiarrhythmic drug therapy 303 Appendix 3.
Catheter ablation of atrial fibrillation surgical ablation AV nodal ablation 305 Appendix 4. INR follow- up in patients receiving warfarin- Non- vitamin K oral anticoagulants 306 Appendix 5. Bridging anticoagulation in patients undergoing procedures 308 Appendix 6. Management of elevated INR values 309 Appendix 7. Left atrial appendage surgical and percutaneous closure 309 Appendix 8. A common situation: AF and symptomatic pauses or bradycardia 309 Appendix 9. DC cardioversion in patients with a slow ventricular response 310 Appendix 10. AF occurring post- cardiac surgery and AF related to acute transient triggers 310 Appendix 11.
Brief asymptomatic runs of AF on device interrogation and association with stroke. Role of rhythm monitoring after cryptogenic stroke 310 Questions and answers 311 11. Atrial Flutter and Atrial Tachycardia 319 I. Atrial flutter 319 II. Focal atrial tachycardia 322 III. Multifocal atrial tachycardia (MAT) (or chaotic atrial tachycardia) 325 Questions and answers 326 12. Atrioventricular Nodal Reentrant Tachycardia Atrioventricular Reciprocating Tachycardia Wolff-Parkinson- White Syndrome and Junctional Rhythms 329 I. Inappropriate sinus tachycardia (IST) and postural orthostatic tachycardia syndrome (POTS) 329 II.
Atrioventricular nodal reentrant tachycardia (AVNRT) 329 III. Atrioventricular reciprocating tachycardia (AVRT) and Wolff-Parkinson-White (WPW) syndrome 332 Questions and answers 342 13. Bradyarrhythmias 345 I. AV block 345 II. Sinus node dysfunction 354 Questions and answers 359 14. Permanent Pacemaker and Implantable Cardioverter Defibrillator 363 I. Indications for permanent pacemaker implantation 363 II. Types of cardiac rhythm devices 363 Appendix.
Cases of PM troubleshooting 381 Questions and answers 386 15. Basic Electrophysiologic Study 390 I. General concepts; intracardiac electrograms 390 II. AV conduction abnormalities 390 16. Action Potential Features and Propagation: Mechanisms of Arrhythmias Antiarrhythmic Drugs 403 I. Action potential 403 II.