Management of Complex Cardiovascular Problems (eBook)

Thach N. Nguyen, Dayi Hu, Shao Liang Chen, Moo-Hyun Kim, Cindy L. Grines (Herausgeber)

eBook Download: PDF

2016 | 4. Auflage
John Wiley & Sons (Verlag)
978-1-118-96504-7 (ISBN)

Infos

Patients with complex cardiovascular problems pose a special management challenge for both the specialist and the non-specialist. This book helps you approach difficult cases with the confidence to strategically map care, understand the risk profile of your patient, and make effective treatment decisions.

• Dependable and succinct content provides  high yield information for the busy cardiologist
• Take home call outs, and critical thinking boxes provide candid advice on incorporating guidelines and evidence based medicine into your practice
• New convenient pocket-sized format
• New chapter addressing cardiovascular problems in women
• Discussion of high risk factors for and strategic care mapping encourage clinical focus
• Clinical pearls offer expert advice on topical issues
• Includes emerging trends and clinical trials keeping you up to date

Thach Nguyen, MD, FACC FSCAI, Director of Cardiology, Community Health System, St Mary Medical Center, Hobart, USA

Dayi Hu, MD FACC FHRS FESC, Director, Heart Center of People's Hospital of Peking University, President, Chinese College of Cardiovascular Physician (CCCP), President, Chinese Society of Cardiology (CSC), China

Shao Liang Chen MD, Chief of Cardiology, Nanjing First Hospital, Nanjing China

Moo-Hyun Kim, MD, FACC, Associate Professor of medicine, Director, Cardiology Department, Dong A University, Busan, Korea

Cindy Grines MD, Chief of Cardiology, Detroit Medical Center, Detroit MI, USA

Inhalt

Management of Complex Cardiovascular Problems 3
Contents 7
List of Contributors 9
Foreword to the Third Edition 19
Preface 21
Practicing cardiology is like car racing at the Indy 500 21
Acknowledgements 23
1 Hyperlipidemia 25
Background 27
Challenges 27
Strategic mapping 28
High-risk markers 28
Additional high-risk markers 29
High-risk predictors 30
Investigations 31
Symptoms to look for 31
Signs to look for 31
Smart testing 31
Looking forward: A new biomarker – HDL-C efflux capacity in the Dallas Heart Study 32
Management 33
Strategic mapping for therapy 33
Statin therapy 35
Combination therapy 36
Patients intolerant of statins 38
Adverse effects of statins 39
Management of patients not on the recommendation list of the ACC/AHA guidelines 42
Patients with CKDs 42
Patients with diabetes 45
Patients with heart failure 45
Patients younger than 40 years 45
Pregnant women 46
Patients with an ASCVD risk of less than 7.5% 46
Race/Ethnicity 46
Hypertryglyceridemia 46
Rationale for the treatment of high TG levels 46
Management 46
References 51
2 Hypertension 54
Background 55
Challenges 55
Strategic planning 56
High-risk markers 56
High-risk predictors 56
Investigations 56
Symptoms to look for 57
Signs to look for 57
Blood pressure readings 57
Self-measurement of BP 58
Routine ambulatory BP 58
Smart testing 58
Management 59
Lifestyle modifications 59
Pharmacologic treatment 59
Non-African Americans 61
African Americans 61
Beta-blockers 62
Aldosterone blockers 63
Influence of comorbid conditions 63
Diabetes mellitus 63
Chronic kidney disease 64
Hypertensive urgency 65
Compliance with antihypertensive medications 65
Secondary causes of hypertension 66
Medications 66
Obstructive sleep apnea 67
References 68
3 Stable Coronary Artery Disease 74
Background 75
Challenges 76
Strategic mapping 77
Risk profiling 77
High-risk predictors 78
Investigations 79
Symptoms to look for 79
Signs to look for 79
Smart testing 80
Functional assessment of ischemic risk 81
Strategic mapping for sequential multi-modalities imaging 81
Appropriate use criteria for stress echocardiography 83
Appropriate use criteria for myocardial perfusion imaging 84
Anatomical assessment of ischemic risk 85
Coronary angiography 85
Appropriate use criteria for coronary angiography 86
Appropriate use criteria for coronary CT angiography 88
Diagnosis 88
Management 89
Optimal medical therapy 89
Event prevention 93
Polypharmacy 95
Revascularization 95
References 103
4 Acute Coronary Syndrome 110
Background 111
Challenges 112
Strategic mapping 112
High-risk profiling 114
High-risk predictors 115
Investigations 116
Symptoms to look for 116
Signs to look for 116
Smart testing 117
Biomarkers 117
Management 117
Antiplatelet agents 118
Anticoagulants 122
Lipid lowering agents 123
Symptom relief and reduction of myocardial ischemia 124
Invasive versus conservative strategy 125
Management of patients with major co-morbidities 126
Special situations 127
References 131
5 ST Segment Elevation Myocardial Infarction 137
Background 138
Challenges 139
Strategic mapping 139
High-risk markers 139
High-risk predictors 139
Investigations 141
Symptoms to look for 141
Signs to look for 142
Smart testing 142
Management 142
Upstream management 142
Thrombolytic therapy 144
Anticoagulants following thrombolytic therapy 145
Primary percutaneous coronary intervention 145
Anticoagulants during primary PCI 146
Indicators of excellence 148
Thrombectomy 148
Adjunctive medical management 148
Glycoprotein 2b3a inhibitor 150
Looking forward: Anticoagulants after primary PCI 150
Lipid lowering drugs 152
Comprehensive management 152
Indicators of excellence 153
Preferential management 153
PCI after thrombolytic therapy 153
References 160
6 Heart Failure (Stages A, B and C) 165
Stage A: Asymptomatic heart failure risk factors 167
Background 167
Challenges 167
Strategic mapping 167
High-risk markers 169
High-risk predictors 169
Investigations 169
Symptoms to look for 169
Signs to look for 169
Smart testing 169
Management 170
Indicators of excellence 170
Stage B: Asymptomatic left ventricular remodeling 171
Background 171
Challenges 171
Strategic mapping 171
High-risk markers 171
High-risk predictors 172
Management 172
Lifestyle change and education 172
Pharmacologic therapy 173
Prevention and treatment of precipitating factors 174
Prevention of heart failure 175
Is the goal of preventing heart failure achievable? 176
Prevention of heart failure and sudden death 178
Indicators of excellence 178
Stage C: Heart failure 179
Background 179
Challenges 179
Strategic mapping 179
High-risk markers 180
High-risk predictors 180
Investigations 180
Symptoms to look for 180
Signs to look for 181
Smart testing 181
Management 182
Angiotensin converting enzyme inhibitor 182
New standard of care: Neprilysin inhibition and ARB 184
Beta-blockers 185
Aldosterone antagonists 185
Vasodilators (hydralazine and nitrates) 186
Digoxin for atrial fibrillation 186
Long-acting nitrates 187
Device therapy 187
Revascularization for heart failure patients 188
Iron for anemia 188
References 189
7 Acute Decompensated and Chronic Stage D Heart Failure 193
New understandings 194
Strategic mapping 195
High-risk markers 195
Respiratory difficulty and distress 195
Hypotension 195
High-risk predictors 196
Investigations 196
Symptoms to look for 196
Signs to look for 197
Signs and symptoms requiring immediate action 198
Smart testing 199
Diagnoses 201
Management 202
Strategic mapping 202
System-based practice: Discharge 208
Strategic mapping 208
System-based practice: Early and recurrent readmission 210
Scope of the problem 210
Conventional transitional care interventions 210
The key components 211
Problems with telemonitoring 211
Implantable hemodynamic monitors 212
Personalized and hi-tech medicine 213
Advanced (stage D) heart failure 213
Management 213
Inotrope therapy 214
Ultrafiltration 214
Mechanical circulatory support 215
Heart transplantation 217
End of life care and palliative therapy 217
References 219
8 Atrial Fibrillation 222
Background 224
Challenges 224
Strategic mapping 225
Stroke prevention 227
High-risk markers 227
High-risk predictors 228
Investigations 228
Symptoms to look for 228
Signs to look for 228
Smart testing 228
Acute management 230
Strategic mapping 230
Chronic management 241
Strategic mapping 241
Invasive management 245
Management of complex problems or high-risk patient subsets 248
References 252
9 Ventricular Tachycardia 257
Background 258
Challenges 258
Strategic mapping 259
High-risk profiling 259
High-risk predictors 259
Symptoms to look for 260
Signs to look for 260
Smart testing 261
Diagnoses 265
Electrocardiographic artifact 265
Supraventricular tachycardia with wide QRS complexes 266
Re-entrant monomorphic ventricular tachycardia 266
Bundle branch re-entry ventricular tachycardia 266
Verapamil-sensitive fascicular tachycardia 267
Outflow tract ventricular tachycardia 267
Papillary muscle and mitral annulus ventricular tachycardia 268
Polymorphic ventricular tachycardia 268
Management 271
Strategic mapping 271
Acute management 272
Treatment of coexisting precipitating factors 273
Anti-arrhythmic drugs 274
Treatment of specific genetic syndromes 276
References 283
10 Syncope 290
Background 292
Challenges 292
Strategic mapping 292
High-risk markers 293
High-risk predictors 293
Investigations 294
Age 296
Presence of cardiac disease 297
Pertinent medical history 298
Family history 299
Medications 299
Event characteristics 300
Event history 302
Physical examination 302
Working diagnoses 305
Smart testing 306
Strategic mapping 306
Observational tests 307
Provocative tests 309
Management 311
Strategic mapping 311
Neurally mediated reflex syncope 312
Invasive management 316
References 317
11 Aortic Stenosis 323
Background 324
Challenges 324
High-risk markers 325
High-risk predictors 325
Investigations 326
Symptoms to look for 326
Signs to look for 327
Smart testing 328
Management 331
Medical treatment 331
Balloon aortic valvuloplasty 331
Multidisciplinary aortic valve replacement approach 332
Indications for surgical aortic valve replacement 332
Trans-catheter aortic valve replacement 335
New valves 338
Pitfalls in TAVR 339
Unmet needs 345
References 347
12 Mitral Regurgitation 353
Background 354
Challenges 354
Strategic mapping 355
High-risk markers 356
High-risk predictors 356
Investigations 356
Symptoms to look for 356
Signs to look for 357
Smart testing 357
Primary mitral regurgitation 365
Management 365
Secondary mitral regurgitation 372
Challenges 373
Medical therapy 373
Surgery in functional mitral regurgitation 375
Acute mitral regurgitation 375
Background 375
Challenges 376
Strategic mapping 376
Smart testing 378
Management 379
References 380
13 Cardiovascular Problems in Elderly Patients 388
Background 389
Challenges 389
Strategic mapping 390
Prioritize the goals of treatment 390
Holistic approach 391
Tiered management 391
High-risk markers 391
High-risk predictors 391
Investigations 392
Symptoms to look for 392
Signs to look for 392
Frailty index 392
Smart testing 393
Biomarkers 393
Exercise stress testing 393
Pharmacological stress test 394
Management 394
Polypharmacy 395
Specific disease management 395
General points regarding aging and management decisions 399
References 400
14 Cardiovascular Problems in Women 403
Background 404
Challenges 404
High-risk markers 405
Strategic mapping 405
Investigations 406
Symptoms to look for 406
Signs to look for 406
Pretest probability calculations 406
Differential diagnoses 408
Smart testing 410
Electrocardiogram (EKG) 410
Biomarkers 411
Exercise stress test 411
ST-T segment changes 412
Myocardial perfusion imaging 414
Stress echocardiography 414
SPECT myocardial perfusion imaging (MPI) 415
Radiation 415
Cardiac computed tomography angiography (CCTA) 416
Invasive testing 417
Coronary angiography 417
Management 417
Primary prevention 417
Secondary prevention 418
Acute coronary syndrome (ACS) 418
Invasive treatment 419
Drug-eluting stents (DES) 420
Complications of percutaneous coronary interventions (PCI) 420
ST segment elevation myocardial infarction (STEMI) 421
Coronary artery bypass graft surgery (CABG) 421
Acute coronary syndrome (ACS) in pregnancy 421
References 425
Index 430
Supplemental Images 450
EULA 452

Produkt-Details

• Erscheint lt. Verlag: 5.4.2016
• Mitarbeit: Stellvertretende Herausgeber: Faisal Latif
• Sprache: englisch
• Themenwelt: Medizin / Pharmazie ► Allgemeines / Lexika
• Themenwelt: Medizinische Fachgebiete ► Innere Medizin ► Kardiologie / Angiologie
• Schlagworte: Acute Coronary Syndrome • Aortic stenosis • Atrial Fibrillation • B and C) • Cardiology • Cardiovascular Disease • cardiovascular problems in women • Cardiovascular surgery • Cindy Grines • Complex Cardiovascular Problems • Dayi Hu • decompensated heart failure (ADHF and Stage D) • heart failure (stage A • Herz- u. Gefäßchirurgie • Herz- u. Gefäßchirurgie • high risk factors • Hyperlipidemia • Hypertension • Interventional cardiology • Invasive Kardiologie • Kardiovaskuläre Erkrankung • Kardiovaskuläre Erkrankungen • Kardiovaskuläre Erkrankung • Kardiovaskuläre Erkrankungen • Medical Science • Medizin • Mitral regurgitation • Moo-Hyun Kim • Shao Liang Chen • stable coronary artery disease • strategic care mapping • ST segment elevation myocardial infarction • Syncope • Thach Nguyen • the older patient • ventricular Tachycardia
• ISBN-10: 1-118-96504-3 / 1118965043
• ISBN-13: 978-1-118-96504-7 / 9781118965047