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Approach to the Patient with Cardiac Arrhythmias

Additional content is available online at Elsevier eBooks for Practicing Clinicians The evaluation of patients with suspected cardiac arrhythmias is highly individualized and must include a comprehensive assessment of the patient. Evaluation of the patient begins with a careful history and physical examination and should usually progress from the simplest to the most complex diagnostic test, from the least invasive and safest to the most invasive…

Cardiac Transplantation

AcknowledgmentS The author gratefully acknowledges Drs. Mariell Jessup, Pavan Alturi, and Michael A. Acker, whose chapter on this topic in the prior edition of Braunwald’s Heart Disease: A Textbook of Cardiovascular Medicine served as the partial basis for the current chapter. This chapter is dedicated in memory of the late David O. Taylor, MD, and the advanced heart failure and cardiac transplant medicine fellows that have…

Mechanical Circulatory Support

Additional content is available online at Elsevier eBooks for Practicing Clinicians Mechanical circulatory support (MCS) devices are mechanical pumps designed to assist or replace the function of the left and/or right ventricle(s) of the heart. Important features that characterize MCS devices include: (1) location of the pumping chamber; (2) ventricle(s) supported by the pump; (3) pumping mechanism; and (4) intended use and duration of support (…

Devices for Monitoring and Managing Heart Failure

Additional content is available online at Elsevier eBooks for Practicing Clinicians While implantable cardioverter defibrillators (ICDs) were first approved by the U.S. Food and Drug Administration (FDA) for the secondary prevention of sudden cardiac death (SCD) in 1985, the advent of device-based therapy for the management of heart failure (HF) did not begin until 2001 when the FDA approved cardiac resynchronization therapy (CRT) to reduce the…

Cardio-Oncology: Approach to the Patient

Additional content is available online at Elsevier eBooks for Practicing Clinicians Never in history have there been more cancer survivors than presently, and thus, never have the chances been greater for a cardiologist to treat a patient with a cancer diagnosis. The latter conclusion holds true even more so in view of the general aging of the population and the fact that aging is a risk…

Cardio-Oncology: Managing Cardiotoxic Effects of Cancer Therapies

Additional content is available online at Elsevier eBooks for Practicing Clinicians Cardiovascular (CV) disease and cancer are highly prevalent and two major causes of mortality worldwide, resulting in a substantial public health burden. Global estimates suggest 422 million prevalent cases of CV disease. Each year, there are an estimated 17 million incident cases of cancer. CV disease accounts for an estimated 17.9 million deaths and cancer…

Myocarditis

Additional content is available online at Elsevier eBooks for Practicing Clinicians Overview and Definition In its broadest sense, myocarditis refers to any inflammation of the myocardium. Inflammation can be found after any form of injury to the heart, including ischemic damage, mechanical trauma, and genetic cardiomyopathies. More specifically, however, classic myocarditis refers to inflammation of the heart muscle occurring as a result of exposure to either…

Hypertrophic Cardiomyopathy

Additional content is available online at Elsevier eBooks for Practicing Clinicians Hypertrophic cardiomyopathy (HCM) is a primary disorder of the myocardium. It is defined by the presence of unexplained left ventricular hypertrophy (LVH), occurring in the absence of identifiable factors that may account for increased left ventricular wall thickness, including pressure overload and infiltrative or storage disorders. Classically, myocyte hypertrophy, disarray, and myocardial fibrosis are present…

Cardiac Amyloidosis

Additional content is available online at Elsevier eBooks for Practicing Clinicians The systemic amyloidoses are a group of diseases characterized by the extracellular deposition of insoluble, misfolded fibrillar proteins in the form of β-pleated sheets, resulting in organ dysfunction. First applied to human disease by Rudolph Virchow in 1854, amyloid derives its name from the Latin amylum or starch, because amyloid was initially and erroneously thought…

The Dilated, Restrictive, and Infiltrative Cardiomyopathies

Additional content is available online at Elsevier eBooks for Practicing Clinicians There remains no satisfying universal definition of cardiomyopathy. Even though it is now agreed that myocardial disease secondary to atherosclerotic coronary artery disease (CAD), valvular disease, congenital heart disease, and systemic hypertension should not be classified as a cardiomyopathy, opinion differs as to whether the condition should be defined on the basis of morphology and…

Heart Failure with Preserved and Mildly Reduced Ejection Fraction

Additional content is available online at Elsevier eBooks for Practicing Clinicians The pathophysiologic definition of heart failure (HF)—the “inability of the heart to pump blood to the body at a rate commensurate with its needs, or to do so only at the cost of high filling pressures” —is based on the presence of hemodynamic congestion that results in a clinical syndrome characterized by breathlessness, fatigue, and…

Management of Heart Failure Patients with Reduced Ejection Fraction

Additional content is available online at Elsevier eBooks for Practicing Clinicians The epidemiology and clinical assessment of patients with heart failure (HF) is reviewed in Chapter 48 , whereas the following chapter will focus on the management of patients with a reduced ejection fraction, which is referred to as HFrEF . The diagnosis and management of patients with acute HF is discussed in Chapter 49 ,…

Diagnosis and Management of Acute Heart Failure

Additional content is available online at Elsevier eBooks for Practicing Clinicians Acute heart failure (AHF) is among the most common causes for hospitalization in patients older than 65 years in the developed world. Increasingly, the spectrum of worsening HF is recognized to encompass not just patients requiring acute hospitalization, but also worsening of HF in outpatient settings and in patients already hospitalized. The prevalence of HF…

Approach to the Patient with Heart Failure

Additional content is available online at Elsevier eBooks for Practicing Clinicians Heart Failure Definition and Epidemiology Heart failure (HF) is a complex clinical syndrome resulting from structural and functional impairment of ventricular filling or ejection of blood. While the clinical syndrome of HF may arise due to abnormalities or disorders involving all aspects of cardiac structure and function, most patients have impairment of myocardial function, ranging…

Pathophysiology of Heart Failure

Additional content is available online at Elsevier eBooks for Practicing Clinicians This chapter focuses on the molecular and cellular changes that underlie heart failure with a reduced ejection fraction (HFrEF), with an emphasis on the role of neurohormonal activation and left ventricular (LV) remodeling as the primary determinants for disease progression in HF. The hemodynamic, contractile, and wall motion disorders in HF are discussed in the…

Mechanisms of Cardiac Contraction and Relaxation

Acknowledgment We honor the memory of Dr. Lionel H. Opie who contributed to previous versions of this chapter over the years. Additional content is available online at Elsevier eBooks for Practicing Clinicians Microanatomy of Contractile Cells and Proteins Ultrastructure of Contractile Cells The major function of cardiac muscle cells ( cardiomyocytes or myocytes ) is to execute cardiac excitation-contraction-relaxation that depends on the electrical calcium ion…

Prevention and Management of Ischemic Stroke

Additional content is available online at Elsevier eBooks for Practicing Clinicians Each year, almost 800,000 Americans have a stroke, and between 200,000 and 500,000 have a transient ischemic attack (TIA). Data from 2020 show that about 610,000 of these strokes are new and 185,000 are recurrent. Overall the incidence of stroke has declined in adults from the 1980s to 2010, although this was somewhat uneven in…

Treatment of Noncoronary Obstructive Vascular Disease

Additional content is available online at Elsevier eBooks for Practicing Clinicians Peripheral vascular disease is a general term that includes pathologic processes affecting arteries, veins, and lymphatics (see Chapter 43 ). This chapter focuses on catheter-based endovascular treatment of large- and medium-sized arteries predominantly affected by atherosclerosis, as well as large-vein obstruction secondary to chronic disease. Although peripheral artery disease (PAD) refers to lower limb arterial…

Peripheral Artery Diseases

Acknowledgment The authors thank Dr. Peter Libby, co-author of this chapter in editions 6 to 10, for his contributions and mentorship. Additional content is available online at Elsevier eBooks for Practicing Clinicians Peripheral artery disease (PAD) generally refers to acute or chronic obstruction of the arteries supplying the lower or upper extremities that, when severe, results in downstream ischemia and potentially tissue loss. , Most often…

Diseases of the Aorta

Additional content is available online at Elsevier eBooks for Practicing Clinicians The Normal Aorta Anatomy and Physiology The aorta, the largest artery in the body, has thoracic and abdominal components ( Fig. 42.1 ). The thoracic aorta is divided into the ascending, arch, and descending segments, and the abdominal aorta into the suprarenal and infrarenal segments. The ascending aorta has two distinct portions. The aortic root…