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Percutaneous Coronary Intervention

Acknowledgments The authors acknowledge the late Donald Baim, MD, Fred Resnic, MD, Jeff Popma, MD, and Laura Mauri, MD, for their previous contributions to this chapter, and Thomas Lee, MD, for his previous contribution to the Guidelines section. Additional content is available online at Elsevier eBooks for Practicing Clinicians Background The first balloon angioplasty in humans was performed by Dr. Andreas Gruentzig in 1977 in Zurich,…

Stable Ischemic Heart Disease

Additional content is available online at Elsevier eBooks for Practicing Clinicians The spectrum of stable ischemic heart disease (SIHD) is broad and includes individuals with chronic stable angina, asymptomatic ischemia, prior myocardial infarction, and prior coronary revascularization, as well as individuals with nonobstructive coronary atherosclerosis, including microvascular disease. Because this spectrum of ischemic heart disease may unpredictably become unstable, some experts prefer the term chronic coronary…

Non–ST Elevation Acute Coronary Syndromes

Ischemic heart disease may manifest clinically as either chronic stable angina (see Chapter 40) or an acute coronary syndrome (ACS). The spectrum of ACS includes ST-segment elevation myocardial infarction (STEMI) (see Chapters 37 and 38) and the non–ST elevation acute coronary syndromes (NSTE-ACS). The latter consist of non–ST elevation myocardial infarction (NSTEMI) and unstable angina (UA) ( Fig. 39.1 ), which have indistinguishable clinical presentations at…

ST-Elevation Myocardial Infarction: Management

Additional content is available online at Elsevier eBooks for Practicing Clinicians The care of patients with ST-elevation myocardial infarction (STEMI) has transformed in conjunction with the shift in approach to reperfusion therapy from primarily pharmacologic to catheter-based strategies. With simultaneous advances in medical therapy, the case-fatality rate for patients with STEMI has continued to decline ( Fig. 38.1 ). , Nevertheless, optimal management of patients at…

ST-Elevation Myocardial Infarction: Pathophysiology and Clinical Evolution

Additional content is available online at Elsevier eBooks for Practicing Clinicians Myocardial infarction (MI) results from myocardial cell necrosis caused by an imbalance between oxygen supply and demand. Cardiac professional societies have jointly established criteria for the diagnosis of MI ( Table 37.1 ). The universal definition of myocardial infarction classifies MI into five types, depending on the circumstances in which the MI occurs ( Table…

Coronary Blood Flow and Myocardial Ischemia

Additional content is available online at Elsevier eBooks for Practicing Clinicians The coronary circulation is unique in that the heart is responsible for generating the arterial pressure that is required to perfuse the systemic circulation and yet, at the same time, has its own perfusion impeded during the systolic phase of the cardiac cycle. Because myocardial contraction is closely connected to coronary flow and oxygen delivery,…

Approach to the Patient with Chest Pain

Additional content is available online at Elsevier eBooks for Practicing Clinicians Acute chest pain remains one of the most common reasons for seeking care in the emergency department (ED), accounting for almost 10% of the approximately 100 million nontraumatic visits in the United States and representing the second most common complaint. Such pain suggests acute coronary syndrome (ACS), but after diagnostic evaluation, only 10% to 15%…

Integrative Approaches to the Management of Patients with Heart Disease

Additional content is available online at Elsevier eBooks for Practicing Clinicians Integrative Cardiology Integrative cardiology is a philosophy of care rather than a description of a discrete set of practices, with a particular focus on prevention of disease and an emphasis on patient well-being and personal agency. Completely inclusive of guideline-based medical therapy, integrative cardiology seeks to empower patients to the greatest degree possible with the…

Comprehensive Cardiac Rehabilitation

Additional content is available online at Elsevier eBooks for Practicing Clinicians For the past decades, a number of secondary preventive measures have been shown to help improve health and reduce recurrent cardiovascular events in individuals with known cardiovascular disease (CVD). Unfortunately, the delivery of these evidence-based therapies has been suboptimal in clinical practice. In a national study, only 50% of patients met goals for blood pressure…

Exercise and Sports Cardiology

Additional content is available online at Elsevier eBooks for Practicing Clinicians This chapter presents basic exercise physiology, describes cardiovascular (CV) adaptations to exercise training, and addresses common clinical issues among physically active individuals. The goal is to help clinicians evaluate symptoms produced by exercise, manage questions and clinical problems in athletes and physically active people, and assess the risks and benefits of exercise for individual patients.…

Diabetes and the Cardiovascular System

Additional content is available online at Elsevier eBooks for Practicing Clinicians Scope of the Problem Diabetes Mellitus Diabetes mellitus (DM) involves insufficient production of insulin and/or failure to respond appropriately to insulin, resulting in hyperglycemia. Table 31.1 summarizes the current diagnostic criteria. Type 2 DM is characterized by insulin resistance and relative insulin deficiency (>90% of all DM cases), whereas type 1 is defined by absolute…

Obesity: Medical and Surgical Management

Additional content is available online at Elsevier eBooks for Practicing Clinicians A medical perspective defines obesity as excess body fat associated with comorbid conditions and increasing mortality risk. This chapter discusses basic concepts on the cause of obesity as it relates to cardiovascular outcomes, including (1) fat accumulation in selective adipose depots and nonadipose tissues as related to various health outcomes, (2) the tools to assess…

Nutrition and Cardiovascular and Metabolic Diseases

Additional content is available online at Elsevier eBooks for Practicing Clinicians Together with physical activity, smoking cessation, sleep, and stress reduction, a healthy diet forms the foundation for prevention and treatment of cardiometabolic diseases, including coronary heart disease (CHD), stroke, type 2 diabetes mellitus (DM), obesity, and related conditions. Dietary factors represent 8 of the top 25 causes of global deaths, largely owing to effects on…

Cardiovascular Disease Risk of Nicotine and Tobacco Products

Additional content is available online at Elsevier eBooks for Practicing Clinicians Wild plants belonging to the Nicotiana genus were first domesticated and cultivated in the Americas. They were used by Amer-Indians for many centuries in religious and healing practices. Early European settlers in the Americas learned to use tobacco from Amerindians and exported tobacco products to Europe in the 16th century, where their use spread quickly.…

Lipoprotein Disorders and Cardiovascular Disease

Additional content is available online at Elsevier eBooks for Practicing Clinicians Atherosclerotic cardiovascular diseases (ASCVDs) represent a major burden to society and on national health care systems. Despite public health measures aimed at decreasing saturated fat consumption and cigarette smoking and targeted pharmacologic therapies that can modify cardiovascular risk, an aging population with increased comorbidities, such as obesity, diabetes, and high blood pressure, continues to pose…

Systemic Hypertension: Mechanisms, Diagnosis, and Treatment

Additional content is available online at Elsevier eBooks for Practicing Clinicians Primary hypertension is a key contributor to premature morbidity and mortality in the United States and consistently ranks among the top two risk factors worldwide for global disease burden in 2015. After tobacco use and diabetes, uncontrolled primary hypertension is the most important risk factor for peripheral vascular disease (the second leading cause of loss…

Primary Prevention of Cardiovascular Disease

Additional content is available online at Elsevier eBooks for Practicing Clinicians Overview Trends in Cardiovascular Disease and Risk Factors Global Trends Cardiovascular disease remains the leading cause of death worldwide, accounting for approximately 18 million deaths in 2017, with most deaths (approximately 70%) now occurring in low- and middle-income countries ( eFig. 25.1 ) (see Chapter 2 ). During the past decade, total cardiovascular disease deaths…

The Vascular Biology of Atherosclerosis

Additional content is available online at Elsevier eBooks for Practicing Clinicians Overview and Background The 20th century witnessed a remarkable evolution in concepts concerning the pathogenesis of atherosclerosis. This disease has a venerable history, having left traces in the arteries of mummies. , Atherosclerosis became epidemic as populations increasingly survived early mortality associated with communicable diseases and malnutrition. Economic development and urbanization promoted poor diet (e.g.,…

Anesthesia and Noncardiac Surgery in Patients with Heart Disease

Additional content is available online at Elsevier eBooks for Practicing Clinicians Cardiovascular morbidity and mortality represent a special concern in patients with known (or with risk factors for) cardiovascular disease who undergo noncardiac surgery. The cost of perioperative myocardial injury adds substantially to the total health care expenditure, with an average increased length of stay (LOS) of 6.8 days for patients with perioperative myocardial ischemic injury.…

Invasive Hemodynamic Diagnosis of Cardiac Disease

Acknowledgment This section extends the corresponding chapter of prior editions of Braunwald’s Heart Disease , which was authored by Drs. Charles J. Davidson and Robert O. Bonow. Additional content is available online at Elsevier eBooks for Practicing Clinicians Introduction to Invasive Hemodynamic Diagnosis of Cardiac Disease The cardiac catheterization laboratory serves multiples roles, which include not only angiography and vascular interventions but also, structural interventions. The…