Handbook of Inpatient Cardiology

Description

Designed specifically for cardiac care by hospitalists Easy to carry pocket-size reference Updated with newest guidelines and evidence from clinical trials Aids in the diagnosis and management of cardiovascular disease in the inpatient setting Discusses differential diagnoses of common cardiac chief complaints This book serves as a pocket-sized resource to aid with the diagnosis and management of cardiovascular disease in the inpatient setting. Containing up-to-date information from guidelines and clinical trials, this book is the only handbook-style reference on cardiac care designed specifically for the hospitalist. The first section of the book covers cardiac pathology with an emphasis on evidence-based and guideline-based approaches to patient care. Each chapter focuses on a specific cardiovascular disease state such as acute coronary syndrome, atrial fibrillation, pulmonary hypertension, and aortic disease. The second section examines the differential diagnoses and recommended workup for common cardiac chief complaints including chest pain, palpitations, syncope, and dyspnea. The third and final section discusses indications and interpretation of commonly used cardiac procedures and imaging modalities. This book provides a concise review over a broad range of cardiovascular disease states in an accessible handbook-style to aid with the care of these patients. The Handbook of Inpatient Cardiology is an essential resource for physician hospitalists caring for cardiac patients on the medical ward in addition to cardiology physicians and trainees, affiliate providers, and students. Contents......Page 6 Contributors......Page 10 Abbreviations......Page 16 Introduction......Page 25 Part I: Cardiac Pathology......Page 26 Chapter 1: Acute Coronary Syndrome......Page 27 Definitions (Table 1.1)......Page 28 Pathophysiology......Page 30 Classification......Page 31 Initial Management (Fig. 1.3)......Page 32 Risk Stratification......Page 36 Early Invasive Management Strategy......Page 37 Post-ACS Management......Page 38 References......Page 39 Chapter 2: Stable Ischemic Heart Disease......Page 42 Cardiovascular Risk in Patients Presenting with Chest Pain (Fig. 2.1)......Page 43 Preliminary Workup of Suspected SIHD......Page 45 Specific Testing in Suspected CAD: Who to Test......Page 46 Specific Testing in Suspected CAD: Stress Testing (See Table 2.2)......Page 47 Specific Testing in Already Known CAD......Page 51 Goals of Treatment......Page 52 Lipids......Page 54 Diabetes......Page 55 Medications that Treat Angina......Page 56 Revascularization in SIHD......Page 57 References......Page 59 Terminology......Page 63 Consequences of Atrial Fibrillation......Page 64 Evaluation of Patients with New Atrial Fibrillation......Page 65 Anticoagulation for Atrial Fibrillation......Page 66 Heart Rate Control in Atrial Fibrillation......Page 70 Rhythm Control in Atrial Fibrillation......Page 73 Antiarrhythmic Therapy......Page 74 Atrial Flutter......Page 77 When Should a Cardiology Consultation Be Considered......Page 78 References......Page 79 Chapter 4: Supraventricular Tachycardia......Page 81 Vagal Maneuvers......Page 82 Adenosine......Page 83 Response to Adenosine......Page 84 Typical AVNRT......Page 85 Pre-Excited Atrial Fibrillation......Page 87 Antidromic AVRT......Page 90 Focal Atrial Tachycardia......Page 91 Multifocal Atrial Tachycardia......Page 92 Junctional Tachycardia......Page 93 References......Page 94 Terminology and Definitions......Page 96 Epidemiology......Page 97 Mechanisms of Ventricular Ectopy and Tachycardia......Page 98 Diagnosis of Ventricular Tachycardia......Page 99 The Surface ECG......Page 100 Inpatient Management of Ventricular Tachycardia......Page 102 References......Page 105 Definition......Page 108 Causes......Page 109 Treatment......Page 110 Sinoatrial Exit Block......Page 111 Definition......Page 113 Diagnosis/ECG Features......Page 114 Causes......Page 115 Treatment......Page 116 Second-Degree AV Block......Page 117 Third-Degree AV Block......Page 121 Ventriculophasic Sinus Arrhythmia......Page 122 References......Page 123 Chapter 7: Pacemakers, Defibrillators, and Cardiac Resynchronization Therapy......Page 124 Identification......Page 125 Basic Concepts......Page 127 Pacemaker Codes......Page 128 Basic Troubleshooting......Page 130 Magnet Response......Page 132 Clinical Indications......Page 133 MRI Safety of CIED......Page 134 Implantation and Perioperative Considerations......Page 135 Indications for Device Interrogation and Consultation......Page 136 Conclusion......Page 138 Chapter 8: Acute Decompensated Heart Failure......Page 139 Diagnosis of Acute Decompensated Heart Failure......Page 140 Key Historical Clinical Features in the Diagnosis of Acute Decompensated Heart Failure......Page 142 Key Physical Exam Findings in the Diagnosis of Acute Decompensated Heart Failure......Page 143 Key Tests in the Diagnosis of Acute Decompensated Heart Failure......Page 145 Classification of Acute Decompensated Heart Failure......Page 146 Treatment of Acute Heart Failure with Reduced Ejection Fraction......Page 147 Treatment of Acute Heart Failure with Preserved Ejection Fraction (HFpEF)......Page 152 Discharge Considerations......Page 153 References......Page 154 Chapter 9: Chronic Heart Failure......Page 157 Definition and Pathophysiology of Chronic Heart Failure (CHF)......Page 158 Treatment of Heart Failure with Reduced Ejection Fraction......Page 159 ACE Inhibitors (ACEi)/Angiotensin Receptor Blockers (ARBs)......Page 161 Isosorbide Dinitrate (Isordil)/Hydralazine (Hydral)......Page 164 Digoxin......Page 165 Indications for Cardiac Resynchronization Therapy (CRT)......Page 166 Patient Selection for Advanced Therapies......Page 167 Heart Failure with Recovered Ejection Fraction (HFrecEF)......Page 168 Diabetes and Heart Failure......Page 169 CardioMEMs Device......Page 170 References......Page 171 Chapter 10: Management of Pulmonary Hypertension in the Hospital Setting......Page 175 Etiology of Pulmonary Hypertension......Page 176 Clinical Consequences of Pulmonary Hypertension......Page 178 Workup of Pulmonary Hypertension......Page 182 Therapy for Pulmonary Hypertension......Page 184 References......Page 188 Chapter 11: Acquired Cardiomyopathies......Page 191 Ischemic Cardiomyopathy......Page 193 Treatment......Page 194 Arrhythmia-Induced CMP (AICM)......Page 195 Giant Cell Myocarditis (GCM)......Page 196 Autoimmune Cardiomyopathy......Page 197 Scleroderma......Page 198 HIV......Page 199 Amyloid......Page 200 Sarcoidosis......Page 204 Chemotherapeutic Agents [15, 39]......Page 205 Iron-Overload CM [41]......Page 206 References......Page 207 Introduction......Page 211 Hemodynamics......Page 212 Etiologies......Page 213 Evaluation......Page 214 Management......Page 215 References......Page 222 Chapter 13: Native Valve Disease......Page 224 Background......Page 225 Evaluation and Management......Page 227 Background......Page 230 Evaluation and Management......Page 231 Background......Page 232 Background......Page 233 Presentation and Management......Page 234 Pulmonary and Tricuspid Valves......Page 236 References......Page 238 Chapter 14: Prosthetic Valve Disease......Page 241 Valve Types......Page 242 Choice of Valve Prosthesis......Page 243 Mechanical Valves......Page 244 Bioprosthetic Valves......Page 245 Prosthetic Valve Complications......Page 246 Bleeding and Supratherapeutic INR......Page 248 Thromboembolism......Page 249 Patient-Prosthesis Mismatch......Page 250 Prosthetic Valve Regurgitation......Page 251 Infective Endocarditis of the Prosthetic Valve......Page 252 References......Page 254 Introduction......Page 256 Clinical Presentation/Initial Workup......Page 257 General......Page 262 Directed......Page 263 Surgery......Page 265 Embolization......Page 266 Anticoagulation......Page 267 References......Page 268 Chapter 16: Peripheral Artery Disease, Carotid Artery Disease, and Renal Artery Disease......Page 271 Clinical Manifestations of PAD......Page 272 Diagnosis......Page 274 Treatment......Page 275 Introduction and Risk Factors......Page 276 Diagnosis......Page 277 Treatment......Page 278 Introduction......Page 280 Diagnosis......Page 281 Treatment......Page 282 References......Page 284 Chapter 17: Aortic Disease......Page 286 Risk Factors......Page 287 Clinical Presentation......Page 288 Diagnosis......Page 289 Management......Page 290 Definition......Page 291 Management......Page 292 Loeys-Dietz Syndrome......Page 293 Turner Syndrome......Page 294 Takayasu Arteritis......Page 295 Giant Cell Arteritis......Page 296 References......Page 298 Chapter 18: Pericardial Disease, Myocarditis, and Cardiac Tamponade......Page 299 Etiology......Page 300 Clinical Features......Page 301 Diagnostics......Page 302 Management......Page 304 Definition......Page 306 Clinical Features......Page 307 Diagnostics......Page 308 Management......Page 309 Etiology......Page 310 Clinical Features......Page 311 Diagnostics......Page 312 Treatment......Page 313 References......Page 314 Chapter 19: Pulmonary Embolism and DVT......Page 315 Pulmonary Embolism......Page 316 Deep Vein Thrombosis......Page 323 References......Page 326 Chapter 20: Hypertension......Page 328 Definition and Classification......Page 329 Secondary Hypertension......Page 330 Resistant Hypertension......Page 333 Non-pharmacological Management......Page 334 Pharmacological Management......Page 335 Special Populations......Page 336 Hypertensive Crisis and Management......Page 338 References......Page 345 Chapter 21: Commonly Encountered Congenital Heart Disease......Page 347 Ostium Secundum ASD......Page 348 Sinus Venosus ASD......Page 350 Patent Foramen Ovale (PFO)......Page 351 Ventricular Septal Defect (VSD)......Page 352 Introduction......Page 354 Natural History (Un-Operated)......Page 355 TOF Repair......Page 356 Pulmonary Regurgitation After TOF Repair......Page 357 Introduction......Page 358 General Principles for Inpatients with Cyanotic Heart Disease......Page 359 Common Inpatient Emergencies in Cyanotic Heart Disease......Page 360 References......Page 361 Chapter 22: Pregnancy and Heart Disease......Page 362 Evaluation and Diagnosis of Cardiac Disease in Pregnancy......Page 363 Clinical Presentation and Diagnosis......Page 365 Acute Coronary Syndrome (ACS)......Page 366 Management......Page 367 Management......Page 368 Management......Page 369 Clinical Presentation and Diagnosis......Page 370 Valvular Heart Disease......Page 371 Arrhythmias......Page 372 Management......Page 373 Venous Thromboembolism......Page 374 Cardiovascular Medications During Pregnancy......Page 375 References......Page 377 Introduction......Page 383 Heart Failure......Page 384 Coronary Artery Disease/Therapy-Related Ischemia......Page 387 Arrhythmia......Page 388 Thromboembolic Disease......Page 389 Pulmonary Hypertension......Page 390 References......Page 391 Part II: Clinical Approach to the Patient Chief Complaint......Page 396 Introduction......Page 397 Initial Evaluation......Page 398 Angina and Acute Coronary Syndromes......Page 400 Pericarditis and Myopericarditis......Page 402 Aortic Dissection......Page 403 Pulmonary Embolism......Page 404 Gastrointestinal Diseases......Page 405 Miscellaneous Causes......Page 406 References......Page 410 Background......Page 413 Electrical Cardiac Disease......Page 414 Structural Heart Disease......Page 415 Psychosomatic Disorders......Page 416 Evaluation......Page 417 Management......Page 420 References......Page 421 Chapter 26: Syncope......Page 423 Epidemiology......Page 424 Mechanisms and Causes of Syncope......Page 425 History......Page 429 Physical Exam......Page 432 Electrocardiogram......Page 435 Laboratory Studies......Page 436 Continuous Electrocardiographic monitoring (Fig. 26.4)......Page 437 Tilt Table Testing......Page 440 Risk Stratification and Patient Triage......Page 441 Treatment......Page 442 References......Page 444 Chapter 27: Dyspnea......Page 448 Pathophysiology......Page 449 History......Page 450 Diagnostic Approach......Page 453 References......Page 461 Chapter 28: Perioperative Cardiac Risk Assessment......Page 464 Selected Clinical Predictors of Risk [3]......Page 465 Management Algorithm [3]......Page 467 Indications for Pre-Operative Diagnostics......Page 468 Pre-Operative Medications......Page 469 Relevant Studies......Page 470 Sources......Page 472 Part III: Cardiac Diagnostic Imaging and Procedures......Page 474 Chapter 29: Approach to ECG Interpretation......Page 475 Rate......Page 476 Axis......Page 478 Hypertrophy......Page 485 ST Segment and T Wave Changes......Page 487 Conduction Abnormalities: (See Fig. 29.5)......Page 488 Drugs......Page 490 References......Page 491 Systolic Assessment......Page 493 Assessment of Right Ventricular (RV) Function......Page 494 McConnell’s Sign......Page 495 Aortic Stenosis (AS)......Page 496 Aortic Regurgitation (AR)......Page 497 Mitral Stenosis (MS)......Page 499 Mitral Regurgitation (MR)......Page 500 Pulmonic Regurgitation (PR)......Page 501 Aortic Dissection......Page 502 Inferior Vena Cava (IVC)......Page 503 Tamponade Assessment......Page 504 References......Page 506 Chapter 31: Stress Testing, Nuclear Imaging, CT Angiography, and Cardiac MRI......Page 508 Pharmacologic Stress Test......Page 509 Indications/Contraindications: See Table 31.1......Page 510 Assessment of Coronary Arterial Disease......Page 511 Assessment of Peripheral Arterial Disease (PAD)......Page 512 Stress Echocardiography SE......Page 513 Nuclear Cardiology......Page 514 Indications/Contraindications/Safety: See Table 31.2......Page 515 Cardiac MRI CMR......Page 516 References......Page 519 General Principles......Page 526 LHC and Coronary Angiography......Page 527 Preparation of the Patient......Page 529 Post-procedure Care......Page 531 Pharmacotherapy During Cardiac Catheterization......Page 532 Right Heart Catheterization......Page 533 Complications of Cardiac Catheterization......Page 535 References......Page 537 Index......Page 538