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Coronary Angiography and Intravascular Imaging

Acknowledgments The authors thank Dr. Sabato Sorrentino for editorial assistance. Additional content is available online at Elsevier eBooks for Practicing Clinicians Coronary angiography consists of the visualization of the coronary anatomy under fluoroscopy, facilitated by direct injection of contrast media into the epicardial coronary arteries through a catheter advanced from a peripheral artery to the aortic root and into the coronary ostia. The history of coronary…

Cardiac Computed Tomography

Additional content is available online at Elsevier eBooks for Practicing Clinicians Over the last 15 years, cardiac computed tomography (CT) has evolved considerably and is now an essential noninvasive tool for evaluating various forms of heart disease. The technical advances that have permitted this evolution include the development of scanner systems with improved spatial and temporal resolution, thereby allowing the acquisition of high-resolution images with virtually…

Cardiovascular Magnetic Resonance Imaging

Additional content is available online at Elsevier eBooks for Practicing Clinicians The multicomponent capability of cardiovascular magnetic resonance (CMR) provides morphologic, structural, and physiologic information relevant to a broad array of cardiovascular diseases. CMR offers technical advantages of unrestricted tomographic imaging in arbitrary scan planes, various types of tissue characterization, and a lack of need for ionizing radiation. In this chapter, we will review the current…

Nuclear Cardiology

Additional content is available online at Elsevier eBooks for Practicing Clinicians Nuclear cardiology encompasses multiple quantitative imaging techniques with established clinical applications in ischemic heart disease, heart failure, cardiac and vascular inflammation and infection, with emerging applications in valvular heart disease and peripheral arterial disease (PAD). Extensive literature over the last 50 years supports a role for nuclear cardiology imaging to diagnose cardiovascular disease, stratify risk,…

Chest Radiography in Cardiovascular Disease

Additional content is available online at Elsevier eBooks for Practicing Clinicians The chest radiograph (CXR) has endured, despite all advances in technology, due to its instantaneous capture of patient health as a snapshot in time. Like photographic snapshots, CXRs can also be collected over time to tell the story of disease in a particular patient and provide valuable information at the bedside when a patient is…

Echocardiography

Additional content is available online at Elsevier eBooks for Practicing Clinicians Echocardiography remains the most commonly used comprehensive cardiac imaging modality and is often the first test of choice for assessing cardiac structure and function. When compared with other imaging methods, echocardiography can be performed quickly at bedside, with minimal patient inconvenience or risk, and provides immediate clinically relevant information at relatively low cost. Echocardiography provides…

Exercise Physiology and Exercise Electrocardiographic Testing

Acknowledgment The authors wish to acknowledge the previous contributions of Dr. Anthony Morise, which have laid the foundation for this chapter. Additional content is available online at Elsevier eBooks for Practicing Clinicians Exercise electrocardiographic testing is among the most fundamental and widely used tests for the evaluation of patients with cardiovascular disease (CVD). It is easy to administer, perform, and interpret; it is flexible and adaptable;…

Electrocardiography

Additional content is available online at Elsevier eBooks for Practicing Clinicians The technology and the clinical value of the electrocardiogram (ECG or, as sometimes referred to, EKG) have continuously evolved since the invention of the string galvanometer by Einthoven in 1901. The ECG soon became the most commonly used cardiac diagnostic test, and it remains the fundamental method to assess the heart’s electrical activity. This chapter…

History and Physical Examination: An Evidence-Based Approach

Acknowledgments The authors wish to acknowledge the previous contributions of Drs. Eugene Braunwald, Joseph Perloff, Robert O’Rourke, and James A. Shaver, which laid the foundation for this chapter. Additional content is available online at Elsevier eBooks for Practicing Clinicians Evaluation of the patient with known or suspected cardiovascular disease begins with a directed history and targeted physical examination, the scope and duration of which depend on…

Wearable Devices in Cardiovascular Medicine

Additional content is available online at Elsevier eBooks for Practicing Clinicians Definitions and Overview Wearable technology, commonly referred to as “wearables,” represents a broad category of electronic, hands-free devices that are used for the measurement of physiologic signals, diagnosis of physiologic states or medical conditions, and treatment of disease. Eyeglasses, developed in 13th century, are considered to be the first wearable device. The contemporary definition refers…

Artificial Intelligence in Cardiovascular Medicine

Additional content is available online at Elsevier eBooks for Practicing Clinicians Artificial intelligence (AI) is ubiquitous. It autocompletes the sentences we type, populates web searches before we complete our thoughts, enables our phones to understand verbal commands, permits cars to drive themselves to destinations we speak, and increasingly supports medical diagnostic tests. In medicine it has identified retinal pathology with a skill that exceeds that of…

Biomarkers and Use in Precision Medicine

Additional content is available online at Elsevier eBooks for Practicing Clinicians Clinicians use biomarkers daily in the practice of cardiovascular medicine. Moreover, the use of biomarkers can continue to improve physicians’ ability to provide clinically effective and cost-effective cardiovascular medicine in the years ahead. Appropriate risk stratification and targeting of therapies should not only help improve patient outcomes but also assist in responding to the urgent…

Principles of Drug Therapeutics, Pharmacogenomics, and Biologics

Additional content is available online at Elsevier eBooks for Practicing Clinicians In 2018 the total cost of health care in the United States was approximately $3.6 trillion, 17.7% of the Gross Domestic Product, and more than 10% was spent on prescription drugs. Cardiovascular disease makes up the largest subcategory in this spending: in 2020 the American Heart Association estimated that the cost of care for cardiovascular…

Proteomics and Metabolomics in Cardiovascular Medicine

Additional content is available online at Elsevier eBooks for Practicing Clinicians Novel Technologies in the Identification of Biomarkers The limitations of currently available biomarkers for screening or prognostic use underscore the importance of identifying “uncorrelated” or “orthogonal” biomarkers associated with novel disease pathways. Most current cardiovascular biomarkers have derived from extensions of targeted physiologic studies investigating known pathways such as tissue injury, inflammation, or hemostasis. By…

Applications of Genetics to Cardiovascular Medicine

Additional content is available online at Elsevier eBooks for Practicing Clinicians Naturally occurring human genetic variation has served for decades to elucidate the root causes of disease, including cardiovascular disease. Exponential technologic advances in computation, data science, and assay development have recently enabled population-based analyses, broad clinical profiling, and direct-to-consumer genetic testing in millions of people. Because germline genetic variation is established at conception and persists…

Impact of Health Care Policy on Quality, Outcomes, and Equity in Cardiovascular Disease

Additional content is available online at Elsevier eBooks for Practicing Clinicians What is Health Policy? Health policy is the collection of federal, state, and local statutes and regulations that determine the “rules of the game” in health care. Many of the major issues in health policy are driven by statute, also known as law. For example, in 1965, President Lyndon B. Johnson signed into law the…

Clinical Decision-Making in Cardiology

Additional content is available online at Elsevier eBooks for Practicing Clinicians Medicine is an information science. Information is being produced at an unprecedented rate and is readily accessible using electronic searches and hand-held devices, making skills to parse and use the appropriate information ever more important. Memorization of medical facts is less a necessity, while processing knowledge and critical thinking remain essential for high-value medical care.…

Clinical Trials in Cardiovascular Medicine

Additional content is available online at Elsevier eBooks for Practicing Clinicians Modern cardiovascular medicine prides itself on being evidence based. Virtually all the therapeutic advances that have informed the treatment of patients with cardiovascular disease have resulted from the findings of randomized clinical trials. Randomized trials are generally considered to provide the highest level of evidence, and this principle is reflected in the approach that all…

Impact of the Environment on Cardiovascular Health

Additional content is available online at Elsevier eBooks for Practicing Clinicians The Lancet Commission on pollution and health defines pollution as unwanted, often dangerous, chemical material introduced into the environment as the result of human activity, that threatens health and harms ecosystems. Given the diversity of environmental exposures that an individual may encounter, the term “pollutome” is a useful encompassing term that refers to the aggregate…

Global Burden of Cardiovascular Disease

Additional content is available online at Elsevier eBooks for Practicing Clinicians Shifting Burden Between 1990 and 2017, deaths from cardiovascular disease (CVD) increased from 26% to 32% of all deaths globally, a reflection of the rapid epidemiologic transition, particularly in low- and middle-income countries (LMICs). Although the net percentage of deaths caused by CVD overall has increased, this reflects a rise in LMICs and a decline…