strati \201 cation, 125 post-MI, acute mitral regurgitation, 113 balloon valvotomy (PMBV), 182 physical exam \201 ndings, 180 Physical signs, 180 radiographic features recurrent, 109 \200\22310 right ventricular, 105 shock post-MI, 119 ST elevation myocardial infarction (STEMI), 91 \200\2232 algorithm to select the of, 181 testing, 181 treatment, 182 TTE/TEE for, 482 The mitral valve, 174 Mitral valve pro lapse, 186 \200\2237, optimal pacing mode, 400 checklist for pacing wire insertion, 68 complications, 401 \200\2232 epicardial wires, 67 indications for temporary STEMI additional measures, 104 complications, 109 \200\22310 diagnosis, 93 \200\2235 genera l measures, 96 \200\2237 poor prognosis, factors associated, C 2.B2 480 \200\2231 causes, 186 examination, 186 pathphysiology, 186 prognosis, 187 symptoms, 186 testing, 186 treatment, 187 pacing, 66 \200\2237 indications for temporary transvenous cardiac pacing, 67 predischarge risk insertion of a ventricular strati \201 cation, 107 \200\2238 reperfusion by primary pacing wire, 69 Pacemaker syndrome, 401 permanent pacemakers, PCI, 101 \200\2232 Multiple-gated (MUGA) reperfusion therapy (thrombolysis), 98 \200\223100 surgery for, 103 blood pool imaging, see Imaging, Equilibrium radionuclide angiography [ERNA] 398 international code, 398 PET scanning, 497 \200\2238 Temporary pacing: Ventricular septal defect post-MI, 111 \200\22312 Muscular dystrophies, 301 Mustard and Senning operations, 339 Myocardial diseases Classi \201 cation, 286 Myocardial infarction (MI), complications, 73 \200\2234 Temporary ventricular Ventricular pacing, 68 \200\22370 tachyarrhythmias post-MI, 483 Myocardial ischemia, 86 \200\2238, ventricular demand pacing (VVI), 66 Paget \200\231s disease, 244 Percutaneous Coronary Intervention (PCI) 89 \200\22390, 217 Myocarditis, 303 \200\2235 Causes of, 304 89 \200\22390 Localization of infarcts from ECG changes, 93 rescue, 102 Myxedematous effusion, Pericardial aspiration, 76 Pericardial effusion, 109 \200\22310 Pericardial effusion tam ponade, 309 \200\22310 Pericardial \202 uid analysis, 319 natural history of aortic regurgitation, 194 Myxomas, 491 Non-ST elevation myocardial infarction (NSTEMI)/unstable angina (UA), 122 \200\2233 clinical presentation, 1 22 integrated management N The National Cholesterol Education Program (NCEP), 277 \200\2239 NCEP Adult Treatment 326 Pericardiectomy, 314 Pericardiocentesis, 317, 75 \200\2237 plan, 122 \200\2233 complications of, 77 NSTEMI: Discharge and Panel III LDL goals: 2004 update, 275 Pericarditis secondary prevention, 132 acute, 48 \200\2239 causes, 48 management, 50 without effusion, 288 Autoimmune pericarditis , Neoplastic pericardial NSTEMI: invasive vs. disease, 318 Nesiritide, 235 Neuromuscular disorders, noninvasive strategies, 131 NSTEMI/UA: diagnosis, 302 323 124 The New York Heart calci \201 c without NSTEMI/UA: late risk strati \201 cation, 127 NSTEMI/UA: medical Association classi \201 cation (NYHA), 219 constriction, 312 constrictive, 311 constrictive vs. restrictive Niacin, 273 Nitroprusside, 39 management, 128 \200\22330 myocardial, 325 Drug- or toxin-induced pericarditis, 321 Effusive-constrictive, 312 fungal, 323 granulomatous, 323 anti-ischemic therapy, 128 \200\2239 O Obesity, 259 visceral, 280 antiplatelet therapy, 129 antithrombotic therapy, 130 thrombolysis, 130 organ donation, 5 \200\2236 INDEX 664 Pseudoaneurysm and free Polymyositis and Nontuberculous bacterial wall rupture, 114 dermatomyositis, 442 Positive end-expiratory (purulent), 320 Postinfarction, 322 radiation, 321 TB constrictive, 314 TB effusive-constri ctive, Pulmonary angiography, 26 pulmonary artery catheter, pressure (PEEP), 63 \200\2234 Postcardiotomy syndrome, 5 \200\2236 Pulmonary artery 322 Pregnancy catheterization, 61 \200\2235 pulmonary capillary wedge pressure (PCWP), 407 Pulmonary Edem a, 9 \200\22310, 314 anticoagulation, 418 aortic Regurgitation, 416 aortic stenosis, 367 arrhythmias, 423 Cardia c Arrest, 424 Cardiac Disease, 406 Endocarditis prophylaxia, TB pericardial effusion, 315 \200\22316 traumatic, 323 tuberculous, 313 uremic, 317 viral, 313 119 assessment, 9 \200\22310 causes, 9 initial rapid assessment, 9 presentation, 9 urgent investigations for Peripheral Artery Disease 425 (PAD), 134, 135 general considerations, clinical presentation, 140 on Examination, 140 symptoms, 140 diagnosis and treatment of asy mptomatic, 145 diagnosis and treatment of critical limb ischemia, 148 all patients, 10 410 causes, 11 management, 12 \200\22314 speci \201 c conditions, 15 Pulmonary embolectomy, Hypertrophic obstructive cardiomyopathy (HOCM), 420 Ischemic heart disease, 419 28 Marfan \200\231s syndrome and pregnancy, 413 Pulmonary embolism, 24 diagnosis of acute limb assessment, 24 causes, 24 prognostic Features, 24 signs, 24 symptoms, 24 investigations, 25 \200\2236 mechanical heart valves, ischemia, 153 417 \200\22318 diagnosis of claudication and systemic risk treatment, 146 Limb ischemia, 81 \200\2232 Path ophysiology of PAD pathophysiology, 139 Prognosis in, 147 \200\22351 percutaneous translumi nal angioplasty and stents, 150 mitral regurgitation, 416 mitral stenosis, 415 normal cardiac \201 ndings, 409 general, 25 speci \201 c, 25 \200\2236 management, 27 \200\2238 symptoms, 24 thrombolytic therapy, 27 Physiological changes in, 407 pulmonary hypertension, 411 \200\22312 valvular heart disease Pulmonary stenosis, 347 Pulmonary Veins, in, 414 peripheral arterial surgery, Pressure half-time (PHT), 150 \200\2231 anomalous drainage, 348 482 treatment, 147 \200\22350 risk, 136 testing, 141 \200\2233 ankle brachial index (ABI), Prosthetic heart valves, 200 \200\2232 R Renal Artery Stenosis(RAS), assessment of prosthetic valve function, 200 \200\2232 141 \200\2232 computed tomographic 158 Common types of heart valve prostheses, 201 angiography (CTA), 143 contrast Angiography, 143 duplex ultrasound imaging, Renovascular disease, 157 \200\2239 diagnostic Testing, 157 indications for renal Complications, 203 endocarditis, 203 hemolysis, 203 systemic embolization, 203 valve thromb osis, 203 echocardiographic 142 revascularization, 160 magnetic resonance revascularization, 159 angiography (MRA), 142 Restrictive Cardiomyopathy Causes of, 296 treadmill exercise testing, Rheumatic Fever, 176 \200\2238, assessment of, 488 mechanical Valves, 200 TEE for a cardiac source of embolism, 474 TEE for aortic valve prosthesis, 487 142 322 treatment of Acute Limb clinical features, 176 \200\2237 Diagnostic criteria (Jones Ischemia, 154 treatment of claudication, criteria), 178 epidemiology, 176 pathology, 176 prognosis, 178 treatment, 177 147 Ultrasonography, 143 TEE for prosthetic valve dysfunction, 483 The Physician \200\231s Health Study (PHS), 283 tissue Valves, 200 types, 200 valve hemodynamics, 200 Polyarteritis nodosa Rheumatoid disease, 443 Right heart valve lesions, and other systemic vasculitides, 438 \200\2239 197 \200\2239 INDEX 665 Transplantation, Cardiac, pulmonary regurgitation, Systemic lupus 238 199 erythematosus (SLE), 301, 323 Transposition of the great pulmonic stenosis, 198 \200\2239 tricuspid regurgitation arteries, 348 treatment algorithm, 268 Trendelenberg position, (TR), 197 \200\2238 T Takayasu arteritis, 436 \200\2237 Takotsubo cardiomyopathy tricuspid stenosis (TS), 197 59 \200\22360 right interior jugular (RIJ) approach, 68 \200\22370 Right ventricular out \202 ow Trifascicular block, 362 Troponins, 95 tumor necrosis factor ( \200\234broken heart syndrome \200\235), 300 tract (RVOT) tachycardia, 385 (TNF), 212 Diagnostic criteria, 300 risk factors for Tamponade cardiovascular disease, 136 Cardiac, 51 \200\2232, 73, 309 management, 53 \200\2235 investigations, 53 management, 53 s pecial Cases, 54 \200\2235 U Ultrasound physics, 449 Risk strati \201 cation, 123 Ross procedure, 338 \200\2239 V vagal maneuvers, 375 Valvular endothelium, 204 Valvular heart disease presentation, 51 \200\2232 S The SAPPHIRE trial, 155 Sick sinus syndrome, 359 Sinoatrial node, 354 Smoking cessation, 88 Syncope causes, 51 important Physical signs, 51 presentation, 51 raised JVP, causes of hypotension, 19 TEE assessment of mitral v alve prosthesis, 484 \200\2235 anatomy, 204 concomitant, 244 development, 204 effort syncope, 351 \200\2232 Staphylococcus aureus, Valvuloplasty Balloon aortic 320, 476 valvuloplasty, 192 Ventricular septal defect, Tetralogy of Fallot, 337, Statins, 88 Stroke 349 346 Thiamine, 301 Thiazide diuretics, 265 Thrombocytopenia, 81 \200\2232 Thrombolytic Therapy, 22 Thyrotoxicosis, 244 Torsades de pointes (TdP), see Long QT syndrome Transcatheter techni ques, causes of, 156 Verapamil, 115 \200\22316 VF/VT, see Universal Subarrachnoid hemorrhage (SAH), 37 \200\2238 treatment algorithm, Ventricular \201 brillation/ pulseless ventricular tachycardia The subclavian vein and surrounding structures, 60 Subclavian vein cannulation, 59 \200\22360 W Wegener \200\231s granulomatosis, 192 Swan-Ganz catheter, see pulmonary artery catheter Transient ischemic attacks, 155 438 This page intentionally left blank Normal hemodynamics Right atrial pressure 0 \200\2238 mmHg Right ventricle systolic 15 \200\22330 mmHg 0 \200\2238 mmHg end diastolic Pulmonary artery systolic/diastolic 15 \200\22330/4 \200\22312 mmHg 9 \200\22316 mmHg mean PCWP LVEDP 2 \200\22310 mmHg 8 \200\22312 mmHg Cardiac output 5 \200\2239 L/min 2.8 \200\2234.2 L/min/m2 Cardiac index 770 \200\2231500 dyne.s/cm5 Systemic vascular resistance 100 \200\223250 dyne.s/cm5 Pulmonary vascular resistance Left ventricular Ejection Fraction 55 \200\22375% ATP III classi \201 cation of LDL, total, and HDL cholesterol LDL cholesterol, mg/dL (mmol/L) <100 (2.58) 100 \200\223129 (2.58 \200\2233.33) 130 \200\223159 (3.36 \200\2234.11) 160 \200\223189 (4.13 \200\2234.88) (cid:1)190 (4.91) Optimal Near or above optimal Borderline high High Very high Total cholesterol, mg/dL (mmol/L) <200 (5.17 Desirable 200 \200\223239 (5.17 \200\2236.18) Borderline high (cid:1)240 (6.20) High HDL cholesterol, mg/dL (mmol/L) <40 (1.03) (cid:1)60 (1.55) Low High ATP III criteria for diagnosis of the metabolic syndrome (cid:1)3 out of 5 criteria must be satis \201 ed for diagnosis Variable Threshold Waist circumference >40 \200\235 Men >35 \200\235 Women Fasting glucose >100 mg/dL Blood pressure >130/>85 mmHg HDL cholesterol < 40 mg/dL in men < 50 mg/dL in women Triglycerides >150 mg/dL TIMI Risk Score for UA/NSTEMI Risk Score = Total Points (0 \200\2237) Factor Points 14-Day risk of cardiac events Age (cid:1) 65 1 SCORE RISK (%) (cid:1) 3 CAD Risk factors 1 0/1 5 Known coronary stenosis (cid:1) 50% 1 2 8 ASA use in prior 7 days 1 3 13 Recent severe angina ((cid:2)24 h) 1 4 20 Elevated cardiac biomarkers 1 5 26 ST deviation (cid:1) 0.5 mm 1 6/7 41 Antman et al. JAMA, 264: 835 \200\223842 CHADS 2 Score = sum of individual risk factors (0 \200\2236) Score Adjusted stroke rate (%/year) Risk Factor Points 0 1.9 Congestive Heart Failure 1 1 2.8 Hypertension 1 2 4 Age > 75 y 1 3 5.9 Diabetes mellitus 1 4 8.5 Prior stroke or TIA 2 5 12.5 6 18.2 Gage et al. JAMA. 2001; 285:2854 \200\2232870 Duke Criteria for Infective Endocarditis De \201 nite endocarditis requires 2 major, 1 maj or and 3 minor, or 5 minor criteria Major criteria Positive blood culture Positive echocardiogram or new valve regurgitation Minor criteria Predisposing condition or IV drug use Fever >38o C Vascular phenomena: arterial emboli, septic pulmonary infarcts, mycotic aneurysm, intracran ial and conjunctival hemorrhage, Janeway lesions Immunologic phenomena: glomerulonephritis, Osler \200\231s nodes, Roth spots, rheumatoid fa ctor Positive blood cultures not meeting major criteria Durack DT, Lukes AS, Bright DK. Am J Med. 96:200 \200\223209, 1994. Framingham risk scoring system for men Age Diabetes Coronary heart disease risk Years Points Points 30 \200\22334 \200\2231 No 0 Total points 10 yr risk (%) 35 \200\22339 0 Yes 2 < \200\2233 1 40 \200\22344 1 Smoker \200\2232 2 45 \200\22349 2 Points \200\2231 2 50 \200\22354 3 No 0 0 3 55 \200\22359 4 Yes 2 1 4 60 \200\22364 5 2 5 65 \200\22369 6 3 6 70 \200\22374 7 4 7 LDL-C (mg/dL) HDL-C (mg/dL) 5 9 Points Points 6 11 <100 \200\2233 <35 2 7 14 100 \200\223129 0 35 \200\22344 1 8 18 130 \200\223159 0 45 \200\22349 0 9 22 160 \200\223190 1 50 \200\22354 0 10 27 >190 2 >60 \200\2231 11 33 SBP (mmHg) DBP (mmHg) 12 40 < 80 80 \200\22384 85 \200\22389 90 \200\22399 (cid:116)100 13 47 14 56 <120 0 0 1 2 3 120 \200\223129 0 0 1 2 3 130 \200\223139 1 1 1 2 3 140 \200\223159 2 2 2 2 3 (cid:116)160 3 3 3 3 3 Framingham risk scoring system for women Age Diabetes Coronary heart disease risk Years Points Points 30 \200\22334 \200\2239 No 0 Total points 10 yr risk (%) 35 \200\22339 \200\2234 Yes 4 < \200\2232 1 40 \200\22344 0 Smoker \200\2232 2 45 \200\22349 3 Points 0 2 50 \200\22354 6 No 0 1 2 55 \200\22359 7 Yes 2 2 3 60 \200\22364 8 3 3 65 \200\22369 8 4 4 70 \200\22374 8 5 5 LDL-C (mg/dL) HDL-C (mg/dL) 6 6 Points Points 7 7 <100 \200\2233 <35 5 8 8 100 \200\223129 0 35 \200\22344 2 9 9 130 \200\223159 0 45 \200\22349 1 10 11 160 \200\223190 1 50 \200\22354 0 11 13 >190 2 >60 \200\2232 12 15 SBP (mmHg) DBP (mmHg) 13 17 < 80 80 \200\22384 85 \200\22389 90 \200\22399 (cid:116)100 14 10 15 24 <120 \200\2233 0 0 2 3 16 27 120 \200\223129 0 0 0 2 3 17 32 130 \200\223139 0 0 0 2 3 140 \200\223159 2 2 2 2 3 (cid:116)160 3 3 3 3 3 Reprinted with permission from Wilson, PW, et al. Prediction of coronary heart disease usin g risk factor categories. Circulation 1998; 97:1837 \200\2231847. Common Exercise Stress Protocols Stage Duration Bruce Modi \201 ed Bruce (min) Grade (%) Speed (mph) METS Grade (%) Speed (mph) METS 1 3 10 1.7 5 0 1.7 1.7 2 3 12 2.5 7 5 1.7 2.8 3 3 14 3.4 10 10 1.7 5.4 4 3 16 4.2 13 12 2.5 7 5 3 18 5.0 16 14 3.4 10 6 3 20 5.5 19 16 4.2 13 7 3 22 6.0 22 18 5.0 17 ECG Localization of myocardial infarction Anterior ST elevation and/or Q waves in V1 \200\223V4/V5. Anteroseptal ST elevation and/or Q waves in V1 \200\223V3. Anterolateral ST elevation and/or Q waves in V1 \200\223V6 and I and aVL. Lateral ST elevation and/or Q waves in V5 \200\223V6 and T wave inversion/ST elevation/Q waves in I and aVL. Inferolateral ST elevation and/or Q waves in II, III, aVF and V5 \200\223V6 (sometimes I and aVL). Inferior ST elevation and/or Q waves in II, III and aVF. Inferoseptal ST elevation and/or Q waves in II, III, aVF, V1 \200\223V3. True posterior Tall R waves in V1 \200\223V2 with ST depression in V1 \200\223V3. T waves remain upright i n V1 \200\223V2. This can be con \201 rmed with an esophageal lead if available (method si milar to an NG tube). Usually occurs in conjunction with an inferior or lateral infarct. RV infarction ST segment elevation in the right precordial leads (V3R \200\223 V4R). Usually found in con junction with inferior infarction. This may only be present in the early hours of infarctio n. JNC 7 Blood pressure classi \201 cation Category SBP (mmHg) DBP (mmHg) Normal BP <120 AND <80 Pre-hypertension 120 \200\223139 OR 80 \200\22389 Stage 1 Hypertension 140 \200\223159 OR 90 \200\22399 Stage 2 Hypertension (cid:116)160 OR (cid:116)100 Reprinted with pe rmission from Chobanian AV, et al. Hypertension 2003; 42(6): 1206 \200 \2231252.