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Rheumatic Fever

Additional content is available online at Elsevier eBooks for Practicing Clinicians Rheumatic fever (RF) is a leading cause of acquired heart disease in children and young adults worldwide. It is an illness preceded by a pharyngeal infection with group A beta-hemolytic streptococci (GAS), occurring most often between 5 and 15 years. The inflammatory process causes damage to collagen fibrils and connective tissue ground substance, resulting typically…

Infectious Endocarditis and Infections of Indwelling Devices

Additional content is available online at Elsevier eBooks for Practicing Clinicians Infections involving the heart valves (infectious endocarditis [IE]) and those that involve cardiovascular devices, including permanent pacemakers, implantable cardioverter-defibrillators (ICDs), coronary stents, and ventricular assist devices, are associated with substantial morbidity and mortality. As indications for devices continue to expand, infectious complications, including those that may require device removal, are becoming more commonplace. Because IE…

Prosthetic Heart Valves

Additional content is available online at Elsevier eBooks for Practicing Clinicians The past six decades have witnessed extraordinary advancements in patient survival and functional outcomes following heart valve replacement surgery. Continued refinements in prosthetic valve design and performance, surgical and percutaneous techniques, myocardial preservation, systemic perfusion, cerebral protection, and anesthetic management have enabled the application of surgical and transcatheter valve therapy to an increasingly wider spectrum…

Transcatheter Therapies for Mitral and Tricuspid Valvular Heart Disease

Additional content is available online at Elsevier eBooks for Practicing Clinicians The impetus for the development of transcatheter therapies for valvular heart disease (VHD) arises from two major factors. First, a transcatheter therapy can avoid the risks associated with more invasive surgical approaches, particularly those associated with cardiopulmonary bypass and median sternotomy, while preserving or enhancing outcomes. Second, the patient wants to avoid the invasiveness and…

Tricuspid, Pulmonic, and Multivalvular Disease

Additional content is available online at Elsevier eBooks for Practicing Clinicians Tricuspid Stenosis Causes and Pathology Tricuspid stenosis (TS) is almost always rheumatic in origin, although rheumatic valve disease more commonly affects left-sided valves. Other causes of obstruction to right atrial emptying are unusual and include congenital tricuspid atresia (see Chapter 82 ); right atrial tumors, which may produce a clinical picture suggesting rapidly progressive TS;…

Mitral Regurgitation

Additional content is available online at Elsevier eBooks for Practicing Clinicians The prevalence of valvular heart disease increases with age, and population studies have shown mitral regurgitation (MR) of either primary or secondary cause is the most prevalent valvular disorder, occurring in 9% to 10% of elderly patients in United States (see Nkomo et al., Classic References). Prognosis and treatment, however, are distinctly different based on the…

Mitral Stenosis

Additional content is available online at Elsevier eBooks for Practicing Clinicians Mitral stenosis (MS), known in the literature since at least the 1669 description by John Mayow and a major manifestation of rheumatic heart disease (RHD), remains an important problem worldwide. While the developed world has all but eliminated RHD, it continues to be a major cause of heart disease, morbidity, and mortality in the low…

Transcatheter Aortic Valve Replacement

Additional content is available online at Elsevier eBooks for Practicing Clinicians Epidemiology, Natural History, and Treatment Alternatives for Valvular Aortic Stenosis See the online chapter for discussion on epidemiology, natural history, and treatment alternatives for valvular aortic stenosis (AS) (see also Chapter 72 ). The dire prognosis of untreated severe symptomatic aortic stenosis (AS) was prospectively validated in the first randomized Placement of Aortic Transcatheter Valves…

Aortic Regurgitation

Additional content is available online at Elsevier eBooks for Practicing Clinicians Causes and Pathology Aortic regurgitation (AR) can result from primary disease of the aortic valve leaflets and/or dilation of the aortic root and ascending aorta ( Table 73.1 ). Among patients with isolated AR who undergo aortic valve replacement (AVR), the percentage with primary disease of the aorta has been increasing steadily during the past…

Aortic Valve Stenosis

Additional content is available online at Elsevier eBooks for Practicing Clinicians Epidemiology In population-based echocardiographic studies, 1% to 2% of persons aged 65 or older and 12% of persons 75 or older had calcific aortic stenosis (AS) (see Chapter 90 ). Among those older than 75, 3.4% (95% confidence interval [CI] 1.1% to 5.7%) have severe AS. The prevalence of aortic valve sclerosis without stenosis, defined…

Hypotension and Syncope

Additional content is available online at Elsevier eBooks for Practicing Clinicians Definition Syncope is a symptom that presents with abrupt, transient, complete loss of consciousness (LOC) associated with the inability to maintain postural tone, with rapid and spontaneous recovery. The presumed mechanism of syncope is cerebral hypoperfusion. , The metabolism of the brain, in contrast to that of many other organs, is exquisitely dependent on perfusion.…

Cardiac Arrest and Sudden Cardiac Death

Additional content is available online at Elsevier eBooks for Practicing Clinicians Perspective Sudden cardiac arrest (SCA), and its common consequence sudden cardiac death (SCD), is the common cardiac pathway for death. There are a diverse array of cardiac and noncardiac causes and mechanisms underlying the development of SCA and SCD. While SCA and SCD are most likely deterministic processes rather than true stochastic processes, the inability…

Pacemakers and Implantable Cardioverter-Defibrillators

Additional content is available online at Elsevier eBooks for Practicing Clinicians Cardiac implantable electrical devices (CIEDs) refer to implanted devices that deliver therapeutic electrical stimuli and include permanent pacemakers and implantable cardioverter-defibrillators (ICDs). Types of Devices Electrical therapy for cardiac arrhythmias includes low-voltage (typically 1 to 5 V) pacing stimuli (pulses) and high-voltage (typically 500 to 1400 V) stimuli (shocks). Pacemakers deliver pacing pulses to treat…

Bradyarrhythmias and Atrioventricular Block

Additional content is available online at Elsevier eBooks for Practicing Clinicians Bradyarrhythmias Based on large population studies of healthy individuals, the lower limit of normal resting heart rate is defined as 50 beats , Frequently, bradyarrhythmias are physiologic, as in well-conditioned athletes with low resting heart rates or in type I atrioventricular (AV) block during sleep. In other cases, bradyarrhythmias can be pathologic. Similar to tachyarrhythmias,…

Ventricular Arrhythmias

Additional content is available online at Elsevier eBooks for Practicing Clinicians Ventricular arrhythmias originate in the ventricular myocardium or His-Purkinje system. These include premature ventricular complexes (PVCs), nonsustained and sustained ventricular tachycardias (VT), and ventricular fibrillation (VF). They can occur in all forms of structural heart disease that involve the ventricles and can be the initial presentation of disease. Sustained arrhythmias are an important cause of…

Atrial Fibrillation: Clinical Features, Mechanisms, and Management

Additional content is available online at Elsevier eBooks for Practicing Clinicians Electrocardiographic Features Atrial fibrillation (AF) is a supraventricular arrhythmia characterized electrocardiographically by low-amplitude baseline oscillations (fibrillatory or f waves from the fibrillating atria) and an irregularly irregular ventricular rhythm. The f waves, 300 to 600 beats/min, are variable in amplitude, shape, and timing. Atrial flutter waves have a rate of 250 to 350 beats/min and…

Supraventricular Tachycardias

Additional content is available online at Elsevier eBooks for Practicing Clinicians Definitions The 2015 American College of Cardiology/American Heart Association/Heart Rhythm Society (ACC/AHA/HRS) guidelines defined supraventricular tachycardia (SVT) as: An umbrella term used to describe tachycardias (atrial and/or ventricular rates in excess of 100 bpm at rest), the mechanism of which involves tissue from the His bundle or above. These SVTs include inappropriate sinus tachycardia, atrial…

Therapy for Cardiac Arrhythmias

Additional content is available online at Elsevier eBooks for Practicing Clinicians It is estimated that almost a third of people will have a problematic tachyarrhythmia, most often atrial fibrillation (AF), at some point during a normal life span. Thus, most clinicians will need to manage their patients’ rhythm problems, or those treatments may impact or may be impacted by treatment of the patient’s other disorders. Treatment…

Genetics of Cardiac Arrhythmias

Additional content is available online at Elsevier eBooks for Practicing Clinicians Cardiac arrhythmias encompass a large and heterogenous group of electrical abnormalities of the heart with or without underlying structural heart disease. Cardiac arrhythmias can be innocuous, can predispose to the development of potentially lethal stroke or embolus, or can present emergently with a life-threatening condition that may result in sudden cardiac death (SCD), one of…

Mechanisms of Cardiac Arrhythmias

Additional content is available online at Elsevier eBooks for Practicing Clinicians Foundations of Cardiac Electrophysiology The Functions of the Cardiac Electrical System While this might come as a surprise to some electrophysiologists, the role of the electrical system of the heart is not to generate nice-looking action potentials (APs) and conduction patterns. Its role is to subserve and control the mechanical function of the heart appropriately.…