Braunwalds Heart Disease A Textbook Of Cardiovascular Medicine 12ed (ie) (hb 2022)

Cover Braunwald’s Heart Disease: A Textbook of Cardiovascular Medicine Copyright Dedication Contributors Preface Preface to the First Edition Acknowledgments Contents Video Contents Part I: Foundations of Cardiovascular Medicine Chapter 1: Cardiovascular Disease: Past, Present, and Future The Birth Emergence of a Specialty Cardiac Imaging The Past The Present Invasive Procedures Cardiac Catheterization Percutaneous Coronary Intervention Cardiovascular Surgery Comments Hypertension The Past (null) Valvular Heart Disease The Past The Present Transcatheter Aortic Valve Replacement Arrhythmias The Past The Present Dyslipidemias The Past (null) Acute Myocardial Infarction Coronary Risk Factors Heart Failure The Past The Present Assisted Circulation The Past (null) Genomics and Genetics The Present (null) Primordial Prevention The Present The Future Inflammation The Past (null) Clonal Hematopoiesis Artificial Intelligence The Present The Future Conclusions References Chapter 2: Global Burden of Cardiovascular Disease Shifting Burden Epidemiologic Transitions Stage of Inactivity and Obesity: A Fifth Phase Different Patterns of Epidemiologic Transition Current Variations in the Global Burden High-Income Countries East Asia and Pacific Demographic and Social Indices Burden of Disease Central and Eastern Europe and Central Asia Demographic and Social Indices Burden of Disease Latin America and the Caribbean Demographic and Social Indices Burden of Disease North Africa and Middle East Demographic and Social Indices Burden of Disease South Asia Demographic and Social Indices Burden of Disease Sub-Saharan Africa Demographic and Social Indices Burden of Disease Risk Factors Tobacco Hypertension Lipids Diabetes Obesity Diet Physical Inactivity Aging Populations Genetic Fetal Influences Environmental Exposures Economic Burden Cost­Effective Solutions Established Cardiovascular Disease Management Risk Assessment Policy and Community Interventions Tobacco Use Salt, Dietary, and Lipid Reductions Summary and Conclusion References Chapter 3: Impact of the Environment on Cardiovascular Health Global Footprint and Impact of Pollutants on Human Health Air Pollution Composition and Sources of Air Pollution Particulate Air Pollutants Gaseous Pollutants Particulate Matter Sources, Composition, and Cardiovascular Risk Household Versus Ambient Air Pollution Assessment of Exposure Exposure-Response Function of Air Pollution, Mortality, and Cardiovascular Events Cardiovascular and Metabolic Effects of Air Pollution Ischemic Heart Disease and Cerebrovascular Events Blood Pressure and Hypertension Insulin Resistance and Diabetes Heart Failure Arrhythmia Venous Thromboembolism Chronic Kidney Disease Mechanistic Insights Into Air-Pollution and Cardiovascular Risk Windows of Exposure, Susceptibility, and Vulnerability Air Pollution Alerts and Approaches to Communicate Risk Societal and Personal Strategies to Mitigate Cardiovascular Effects of Air Pollution Climate Change Noise Pollution and Cardiovascular Disease Synthetic Chemicals and Cardiovascular Disease Metallic Pollutants and Cardiovascular Disease Challenges and Outlook For the Future References Chapter 4: Clinical Trials in Cardiovascular Medicine Clinical Trials Versus Other Types of Studies Components of Clinical Trials Rationale and Study Background Study Design Study Execution Randomization Blinding (Masking) Inclusion and Exclusion Criteria Endpoints or “Response Variables” Statistical Considerations in Trials Analysis of Primary and Secondary Endpoints Power and Sample Size Ethical Considerations and Informed Consent Equipoise in Clinical Trials Randomization to Placebo and Standard of Care Potential for Harm in Clinical Trials Monitoring of Data and Data Safety Novel Approaches to Clinical Trial Design and Execution Pragmatic (Large Simple) Trials Use of Electronic Medical Records in Clinical Trials Adaptive Designs Interpretation of Clinical Trials Registration and Reporting of Clinical Trials Understanding the Primary Results Secondary Endpoints Interpretation of Subgroups Post-hoc Analyses Conclusion References Chapter 5: Clinical Decision-Making in Cardiology Diagnostic Decisions Therapeutic Decisions Deciding When to Change Clinical Practice Based on New Clinical Research Findings Shared Decision-Making Monitoring the Quality of Clinical Decisions System 1 and System 2 Thinking Teaching Clinical Reasoning Conclusion Classic References References Online-Supplemental References Chapter 6: Impact of Health Care Policy on Quality, Outcomes, and Equity in Cardiovascular Disease What is Health Policy Insurance Coverage and Access Policy Payment and Delivery System Policy to Improve Quality and Reduce Costs Public Reporting Value-Based Payment Programs: Hospitals Value-Based Purchasing: Outpatient Alternative Payment Models Inequities in Cardiovascular Disease Risk, Care, and Outcomes Racial and Ethnic Minorities Income Urban-Rural Geography Conclusions References Part II: Individualizing Approaches to Cardiovascular Disease Chapter 7: Applications of Genetics to Cardiovascular Medicine Key Principles of Human Genetics Central Dogma Heritability Genetic Architecture Genetic Variation Characterizing Human Genetic Variation Gene Discovery Family-Based Studies Hypercholesterolemia and Coronary Artery Disease Metabolic Syndrome and Coronary Artery Disease Case-Control and Population-Based Studies Genome-Wide Association Studies for Lipids Genome-Wide Association Studies for Coronary Artery Disease Population-Based Discovery of Rare Protein-Coding Variants Associated with Coronary Artery Disease Causal Inference of Epidemiologic Associations Mendelian Randomization Principles and Applications Causal Inference for Lipoproteins Causal Inference for Adiposity Mendelian Randomization Assumption Assessments Disease Risk Prediction Pathogenicity Assessments and Monogenic Risk Monogenic Coronary Artery Disease Polygenic Risk Scoring Polygenic Coronary Artery Disease Therapeutic Response Prediction Target Discovery and Clinical Trial Prediction On-Target Therapeutic Side Effect Prediction Precision Medicine CYP2C19 Familial Hypercholesterolemia Polygenic Coronary Artery Disease Next-Generation Technologies and Therapeutics Somatic Genomics Epigenetics Single-Cell Ribonucleic Acid Sequencing Therapeutically Targeting the Genome Future Perspectives References Chapter 8: Proteomics and Metabolomics in Cardiovascular Medicine Novel Technologies in the Identification of Biomarkers Introduction to Proteomics and Metabolomics Analytic Challenges for Proteomics and Metabolomics Overview of the Discovery Process Applications of Mass Spectrometry–Based Discovery to Cardiometabolic Disease Future Directions in Biomarker Discovery References Chapter 9: Principles of Drug Therapeutics, Pharmacogenomics, and Biologics Risk Versus Benefit of Drug Therapy Clinical Trials Can Define Unexpected Adverse Drug Reactions Classes of Adverse Drug Reactions Pharmacokinetics and Pharmacodynamics Molecular and Genetic Basis for Variable Drug Response High-Risk Pharmacokinetics Other Important Pharmacogenetic Effects Optimizing Drug Doses Plasma Concentration Monitoring Dose Adjustments in Disease Drug Interactions Incorporating Pharmacogenetic Information into Prescribing Future Perspectives References Chapter 10: Biomarkers and Use in Precision Medicine Overview of Biomarkers Clinical Applications of Cardiovascular Biomarkers Novel Technologies in Biomarker Identification Clinical Measures of Biomarker Performance Sensitivity, Specificity, and Positive and Negative Predictive Value Discrimination, C-Statistics, and Receiver Operating Characteristic Curve Accuracy and Calibration Risk Reclassification External Validation and Impact Studies Practical Example: High-Sensitivity C-Reactive Protein, Lipids, and Reynolds Risk Score Conclusion References (null) Part III: Evaluation of the Patient Chapter 13: History and Physical Examination: An Evidence-Based Approach The History The General Physical Examination General Appearance Skin Head and Neck Extremities Chest and Abdomen The Cardiovascular Examination Jugular Venous Pressure and Waveform Measuring the Blood Pressure Assessing the Pulses Inspection and Palpation of the Heart Auscultation of the Heart Heart Sounds First Heart Sound (S1) Second Heart Sound (S2) Systolic Sounds Diastolic Sounds Cardiac Murmurs Systolic Murmurs Diastolic Murmurs Continuous Murmurs Dynamic Auscultation Integrated, Evidence-Based Approach to Specific Cardiac Disorders Heart Failure History Physical Examination Jugular Venous Pressure Third and Fourth Heart Sounds Rales and Edema Valsalva Maneuver Other Findings Patient with a Left Ventricular Assist Device Valvular Heart Disease Mitral Stenosis Mitral Regurgitation Aortic Stenosis Aortic Regurgitation Tricuspid Valve Disease Pulmonic Valve Disease Prosthetic Heart Valves Acute Coronary Syndromes Pericardial Disease Pericarditis Pericardial Tamponade Constrictive Pericarditis Future Directions Acknowledgments References Chapter 14: Electrocardiography The Normal Electrocardiogram Atrial Activation and the P Wave Atrial Activation and the Normal P Wave Atrial Repolarization Heart Rate Variability Atrioventricular Node Conduction and the PR Segment Ventricular Activation and the QRS Complex Normal QRS Complex The Normal ST-T Wave The QT Interval Other Repolarization Waves The U Wave The J Wave Normal Variants The Abnormal Electrocardiogram Chamber Enlargement and Hypertrophy Atrial Abnormalities Left Atrial Abnormality Diagnostic Criteria Right Atrial Abnormality Left Ventricular Hypertrophy Diagnostic Criteria Clinical Significance Right Ventricular Hypertrophy Diagnostic Criteria Clinical Significance Biventricular Hypertrophy Intraventricular Conduction Delays Fascicular Blocks Left Anterior Fascicular Block Left Posterior Fascicular Block Other Forms of Fascicular Block Left Bundle Branch Block Electrocardiogram Abnormalities Clinical Significance Right Bundle Branch Block Electrocardiogram Abnormalities Clinical Significance Multifascicular Blocks Myocardial Ischemia and Infarction Repolarization (ST-T Wave) Abnormalities QRS Changes Evolution of Electrocardiogram Changes Other Ischemic ST-T Patterns Electrocardiogram Localization of Myocardial Ischemia and Infarction Electrocardiogram Diagnosis of Myocardial Infarction with Bundle Branch Blocks Atrial Infarction Electrocardiogram Differential Diagnosis of Ischemia and Infarction Noninfarction Q Waves and Related Depolarization Changes ST-T Changes Simulating Ischemia and Infarction Drug Effects Electrolyte and Metabolic Abnormalities Calcium Potassium Clinical Issues in Electrocardiographic Interpretation Indications Reading Competency Technical Errors Computer Interpretation Future Perspectives References Guidelines: Electrocardiography Patients Without Known or Suspected Cardiovascular Disease Patients with Known or Suspected Cardiovascular Disease Special Populations Persons with Dangerous or Physically Demanding Occupations Preoperative Evaluation Screening of Athletes Cardioactive Drug Administration References Chapter 15: Exercise Physiology and Exercise Electrocardiographic Testing Exercise Physiology Total-Body Oxygen Uptake Myocardial Oxygen Demand and Supply Relationships During Exercise Technical Components of Exercise Testing Patient Preparation Patient Assessment Symptom Rating Scales Electrocardiographic Lead Systems Exercise Test Modality and Protocols Exercise Test Supervision Risks of Exercise Testing Exercise Testing in Coronary Artery Disease Exercise-Induced Symptoms Functional Capacity ST-Segment Changes ST Depression Upsloping ST Depression Lead aVR ST Elevation ST Adjustments ST Elevation Pharmacologic Influences on Interpretation Digitalis Glycosides Beta Adrenoreceptor Blockers Diagnostic Value Sensitivity and Specificity Positive and Negative Predictive Values Pre-Test and Post-Test Probability of Disease Assessment of Anatomic and Functional Extent of Disease Testing in Women Prognostic Value Predictive Variables Post–Myocardial Infarction Evaluation Preoperative Evaluation in Noncardiac Surgery Assessment of Therapy Exercise Testing in Nonatherosclerotic Heart Disease Valvular Heart Disease Aortic Stenosis Severe Acquired Aortic Valve Stenosis Moderate to Severe Congenital Valvular Aortic Stenosis Mitral Regurgitation Hypertrophic Cardiomyopathy Adult Congenital Heart Disease Additional Uses for Exercise Testing Chest Pain Units Physical Activity and Exercise Prescription Evaluation of Peripheral Artery Disease Patients with Diabetes Summary Acknowledgment Classic References References Chapter 16: Echocardiography Principles of Ultrasound and Instrumentation Principles of Image Generation Physical Principles of Ultrasound Doppler Echocardiography in Practice Assessment of Flow and Continuity Equation The Standard Adult Transthoracic Echocardiographic Examination M-Mode Echocardiography Assessment of Cardiac Structure and Function Left Ventricular Structure: Size and Mass Left Ventricular Systolic Function Left Ventricular Diastolic Function Mitral Inflow Patterns Doppler Tissue Imaging Pulmonary Venous Doppler Flow Patterns Color M-Mode and Flow Propagation Assessing Diastolic Function in Clinical Practice Right Ventricular Structure and Function Left and Right Atria Transesophageal Echocardiography The Standard Transesophageal Echocardiographic Examination Three-Dimensional Echocardiography Ultrasound Enhancing Agents Myocardial Infarction Practical Considerations in Assessment of Regional Wall Motion Echocardiographic Prognostic Indicators After Myocardial Infarction Cardiomyopathies Dilated Cardiomyopathy Hypertrophic Cardiomyopathy Other Cardiomyopathies With Regional or Global Variations in Myocardial Composition Left Ventricular Noncompaction Arrhythmogenic Cardiomyopathy Restrictive Cardiomyopathies Heart Failure Assessment of Ventricular Synchrony Assessment After Orthotopic Heart Transplantation Lung Ultrasound in Heart Failure The Athlete’s Heart Stress Echocardiography Limitations of Stress Echocardiography Risk Stratification with Stress Echocardiography Assessment of Myocardial Viability Coronary Flow Reserve and Perfusion Stress Echocardiography in Valvular Heart Disease Valvular Heart Disease Mitral Valve Mitral Stenosis Echocardiographic Features Quantification of Severity Patient Selection for Balloon Valvuloplasty Mitral Regurgitation Primary (Degenerative) Mitral Regurgitation Secondary (Functional) Mitral Regurgitation Quantitation of Mitral Regurgitation Aortic Valve Aortic Stenosis Quantitation of Severity Low-Gradient Severe Aortic Stenosis Aortic Regurgitation Tricuspid Valve Acquired Disorders of the Tricuspid Valve Quantitation of Tricuspid Regurgitation Pulmonic Valve Quantitation of Valve Dysfunction Prosthetic Valves Pericardial Disease Pericardial Effusion Pericardial Hematoma Constrictive Pericarditis Diseases of the Aorta Focal Aortopathies Aortic Emergencies Pulmonary Hypertension Infective Endocarditis Role of Echocardiography in Surgery for Endocarditis Cardiac Masses Secondary Tumors Alternative Diagnoses Pseudoneoplasms Intracardiac Thrombus Adult Congenital Heart Disease Atrial Septal Defect Secundum Atrial Septal Defect Primum Atrial Septal Defect Sinus Venosus Atrial Septal Defect Coronary Sinus Atrial Septal Defect Ventricular Septal Defect Membranous (Paramembranous) and Outlet Ventricular Septal Defects Inlet Ventricular Septal Defects Muscular Ventricular Septal Defects Transcatheter Interventions Future Directions Multimodality and Fusion Imaging Handheld Echocardiography (Point of Care Ultrasound) Recent Echocardiography Techniques Artificial Intelligence References Appropriate Use Criteria: Echocardiography References Chapter 17: Chest Radiography in Cardiovascular Disease Overview PA and Lateral CXR Approach to CXR Evaluation Radiographic Densities CXR Anatomy PA Radiograph Lateral Radiograph Common Anatomic Variants Azygous Lobe Variant Aortic Arch Variants Localization Within Cardiac Silhouette Fat Calcifications Pulmonary Vasculature Support Lines and Devices Specific Cardiovascular Conditions Congenital Heart Disease Acquired Heart Disease Valvular Heart Disease Coronary Artery Disease Heart Failure Advanced Imaging in ICU References Chapter 18: Nuclear Cardiology Principles of Imaging Single Photon Emission Computed Tomography Conventional SPECT Novel Image Reconstruction Software Novel SPECT Scanners Positron Emission Tomography Hybrid SPECT/CT, PET/CT, and PET/MR SPECT and PET Image Acquisition Radiotracers and Protocols Physiologic Basis for Stress Testing Stress Testing Protocols Exercise Stress Pharmacologic Stress Imaging Protocols General Principles SPECT Protocols Myocardial Perfusion Imaging Transthyretin Cardiac Amyloidosis Imaging PET Protocols Myocardial Perfusion Imaging 18F-FDG Metabolic Imaging Protocols Reducing Radiation Dose Patient-Centered Clinical Applications Ischemic Heart Disease Principles of Perfusion Imaging Suspected Stable Coronary Artery Disease Patients with New-Onset Chest Pain Risk Stratification with Radionuclide Myocardial Perfusion Imaging Symptomatic Patients Without Angiographic Obstructive Coronary Artery Disease Evaluation Before Organ Transplantation Suspected Acute Coronary Syndrome Patients with Nondiagnostic Electrocardiogram and Troponin Elevation Patients with Known Stable Coronary Artery Disease Patients with Prior PCI and Recurrent Symptoms Patients with Recent Myocardial Infarction Evaluated for Potential Staged PCI Patients with Prior Myocardial Infarction and Ventricular Arrhythmias Patients with Chronic Total Coronary Artery Occlusion Heart Failure and Cardiomyopathies Patients with Newly Diagnosed Left Ventricular Systolic Dysfunction Patients with Ischemic Cardiomyopathy and Heart Failure Pathophysiology of Ischemic Left Ventricular Dysfunction Radionuclide Imaging Approaches to Assess Myocardial Ischemia and Viability Myocardial Viability Imaging to Guide Revascularization in Patients with Ischemic Heart Failure Infiltrative Cardiomyopathy: Amyloidosis Inflammatory Cardiomyopathy: Sarcoidosis Infective Endocarditis Cardio-Oncology Assessment of Ventricular Function Evaluation of Coronary Artery Disease Evaluation of Primary or Metastatic Cardiac Neoplasms Machine Learning and Artificial Intelligence Translational Molecular Imaging Aortic Valve Disease References Chapter 19: Cardiovascular Magnetic Resonance Imaging Principles of Magnetic Resonance Imaging Basic Physics of Magnetic Resonance Imaging Clinical Applications of CMR Coronary Artery Disease Assessing Stable Chest Pain Syndromes CMR Assessment of Myocardial Viability and Benefit from Coronary Revascularization Cardiomyopathies Overall Approach to Undiagnosed Cardiomyopathy Hypertrophic Cardiomyopathy Arrhythmogenic Cardiomyopathy Myocarditis Cardiac Sarcoidosis Cardiac Amyloidosis Idiopathic Dilated Cardiomyopathy Other Cardiomyopathies Valvular Heart Disease Aortic Stenosis Aortic Regurgitation Mitral Regurgitation Tricuspid Regurgitation Pericardial Disease Novel CMR Imaging Techniques and Future Perspectives References Chapter 20: Cardiac Computed Tomography Basics of Cardiac Computed Tomography Different Types of Cardiac Computed Tomography Exams Coronary Artery Calcium Testing Test Performance and Acquisition Clinical Data Special Populations Clinical Indications and Management Recommendations Clinical Indications Management Recommendations Limitations of Coronary Artery Calcium Testing Coronary Computed Tomography Angiography Diagnostic Accuracy Prognostic Implications Plaque Burden and Prognosis Coronary Computed Tomography Angiography in Acute Chest Pain Coronary Computed Tomography Angiography in Non–ST Elevation Myocardial Infarction Coronary Computed Tomography Angiographyin Stable Chest Pain Selecting Appropriate Candidates for Coronary Computed Tomography Angiography Pretest Probability of Obstructive Coronary Artery Disease Patient Outcomes Following Coronary Computed Tomography Angiography Hard Clinical Outcomes Use of Invasive Angiography Following Coronary Computed Tomography Angiography Coronary Computed Tomography Angiography Plaque Characteristics High-Risk Plaque Characteristics Low-Attenuation Plaque Positive Remodeling Napkin-Ring Sign Spotty Calcifications Plaque Characteristics and Incident Risk Perivascular Fat Attenuation Physiologic Evaluation of Coronary Artery Disease Computed Tomography Fractional Flow Reserve Diagnostic Accuracy Clinical Effectiveness Coronary Tomography Perfusion Stress Computed Tomography Perfusion Comparing and Integrating Different Techniques Implications of the ISCHEMIA Trial for Coronary Computed Tomography Angiography Patient Management Considerations Patient Management Recommendations Special Populations Guidelines Assessment of Cardiovascular Structure and Function Pericardial and Myocardial Disease Valvular Heart Disease Shunts Use of Cardiac Computed Tomography for Structural Heart Disease Interventions Pre-Transcatheter Aortic Valve Replacement Post-Transcatheter Aortic Valve Replacement Evaluation Pre-Transcatheter Mitral Valve Replacement Evaluation of Left Atrial Appendage (for Thrombus, Pre-Left Atrial Appendage Occlusion Devices) Evaluation of Cardiac Masses Future Directions References Chapter 21: Coronary Angiography and Intravascular Imaging Indications for Coronary Angiography Appropriate Use Criteria Coronary Arteriography Technique Patient Preparation Access Sites Basic Technique Catheters for Diagnostic Procedures Ventriculography Left Ventriculography Aortography Right Ventriculography Selection of Contrast Media Automatic and Manual Injection of Contrast Media Angiographic Projections Coronary Anatomy Coronary Artery Anomalies Pitfalls of Coronary Angiography Myocardial Bridging Coronary Artery Spasm Angiogram Evaluation Syntax Score Quantification of the Stenosis Evaluation of Microvascular Blood Flow Special Lesion Considerations Chronic Total Occlusion Calcific Lesions Thrombotic Lesions Bifurcation Lesions Coronary Dissections Coronary Intravascular Imaging Intravascular Ultrasound Procedure Interpretation Clinical Data Plaque Lipid Core Detection Optical Coherence Tomography Clinical Applications Normal Vessel Wall Stable Coronary Artery Disease Plaque Morphology Acute Coronary Syndrome Procedure Planning and Lesion Preparation Assessment After Percutaneous Coronary Intervention Co-registration of Intravascular Imaging and X-Ray Angiography for Patients Undergoing Percutaneous Coronary Intervention Acknowledgments Classic References References Chapter 22: Invasive Hemodynamic Diagnosis of Cardiac Disease Introduction to Invasive Hemodynamic Diagnosis of Cardiac Disease Indications for Cardiac Catheterization and Hemodynamic Assessment Complications and Risks Vascular Access Arterial Access Percutaneous Radial Artery Technique Percutaneous Femoral Artery Technique Venous Access Percutaneous Femoral Vein Access Percutaneous Brachial Vein Access Percutaneous Internal Jugular Vein Access Transseptal Catheterization Left-Heart Catheterization Right-Heart Catheterization Technical Aspects and Artifacts of Pressure Measurements Fluid-Filled Pressure Systems Micromanometer Catheters and Pressure Sensor Guidewires Computations for Hemodynamic Measurements Cardiac Output Measurements Thermodilution Method Fick Method Normal Right and Left Heart Waveforms and Valvular Hemodynamics Including HOCM (LVOT Gradients) The Cardiac Cycle and Generation of Pressure Waves Normal Pressure Waveforms Atrial Pressures Pulmonary Capillary Wedge Pressure Aortic and Pulmonary Artery Pressure Waveforms Ventricular Pressure Waveforms Evaluation of Valvular Heart Disease Calculation of Stenotic Valve Orifice Areas Aortic Valve Stenosis Low-Flow, Low-Gradient Aortic Stenosis Hypertrophic Obstructive Cardiomyopathy Mitral Valve Stenosis Pulmonary and Tricuspid Valve Stenosis Aortic Regurgitation Mitral Regurgitation Pulmonary and Tricuspid Valve Regurgitation Septal Defects and Left-to-Right/Right-to-Left Shunts Pericardial Disease and Restrictive Cardiomyopathy Normal Pericardial Function and Pathophysiology of Constriction Cardiac Tamponade Physiologic and Pharmacologic Maneuvers and PV Loops Exercise Provocation Dynamic Exercise Static Exercise Pacing Tachycardia Physiologic Maneuvers and Volume Challenge Pharmacologic Challenges Dobutamine Isoproterenol Pulmonary Vasodilators Nitric Oxide Nitroprusside Pressure-Volume (PV) Relationships Acknowledgment References Chapter 23: Anesthesia and Noncardiac Surgery in Patients with Heart Disease Assessment of Risk Ischemic Heart Disease Hypertension Heart Failure Hypertrophic Cardiomyopathy The Decision to Undergo Diagnostic Testing Risk Calculators Tests to Improve Identification and Definition of Cardiovascular Disease Overview of Anesthesia for Cardiac Patients Undergoing Noncardiac Surgery Regional Anesthesia Monitored Anesthesia Care Intraoperative Hemodynamics and Myocardial Ischemia Postoperative Management Postoperative Response to Surgery Surveillance and Implications of Perioperative Cardiac Complications Strategies to Reduce the Risk Associated with Noncardiac Surgery Coronary Artery Revascularization Percutaneous Coronary Intervention and Noncardiac Surgery Pharmacologic Interventions Beta-Adrenergic Blocking Agents Statin Therapy Other Therapies Conclusion Classic References References Part IV: Preventive Cardiology Chapter 24: The Vascular Biology of Atherosclerosis Overview and Background Structure of the Normal Artery Cell Types Composing the Normal Artery Endothelial Cells Arterial Smooth Muscle Cells Layers of the Normal Artery Intima Tunica Media Adventitia Atherosclerosis Initiation Extracellular Lipid Accumulation Leukocyte Recruitment and Retention Focality of Lesion Formation Intracellular Lipid Accumulation: Foam Cell Formation Evolution of Atheroma Innate and Adaptive Immunity: Mechanisms of Inflammation in Atherogenesis Smooth Muscle Cell Migration and Proliferation Smooth Muscle Cell Death During Atherogenesis Arterial Extracellular Matrix Angiogenesis in Plaques Plaque Mineralization Complication of Atherosclerosis Arterial Stenoses and Clinical Implications Thrombosis and Atheroma Complication Plaque Rupture and Thrombosis Thrombosis Caused by Superficial Erosion of Plaques Thrombosis and Healing in Progression of Atheroma Diffuse and Systemic Nature of Plaque Susceptibility to Rupture and Inflammation in Atherogenesis Special Cases of Arteriosclerosis Restenosis After Arterial Intervention Accelerated Arteriosclerosis After Transplantation Aneurysmal Disease Infection, the Microbiome, and Atherosclerosis References Chapter 25: Primary Prevention of Cardiovascular Disease Overview Trends in Cardiovascular Disease and Risk Factors Global Trends Trends in the United States Types of Prevention: Primordial, Primary, and Secondary Cardiovascular Disease Risk Assessment Cardiovascular Health and Life’s Simple 7 Global Risk Lifetime Risk Vascular Imaging in Preventive Practice: Coronary Artery Calcium and Coronary Computed Tomographic Angiography Society Guidelines for Cardiovascular Risk Assessment and Statin Therapy Risk Factors for Cardiovascular Disease Traditional Risk Factors Smoking and e-Cigarettes Hypertension Guideline Recommendations Interventions to Reduce Blood Pressure Drug Therapy Metabolic Syndrome, Insulin Resistance, and Diabetes Interventions to Reduce Cardiovascular Risk among Patients with Diabetes Obesity Family History Risk-Enhancing Factors Social Determinants of Health Psychosocial Factors Ankle-Brachial Index Biomarkers Lipids/Lipoproteins Standard Lipid Testing Fasting versus nonfasting LDL Cholesterol HDL Cholesterol Triglycerides Alternative Lipid Measures Lipoprotein(a) Homocysteine High-Sensitivity C-Reactive Protein and Other Biomarkers of Inflammation Cardiovascular Prevention in Women Premature Menopause and Pregnancy-Associated Conditions Menopause and Postmenopausal Hormone Therapy Lifestyle Factors and Interventions Nutrition and Diet Low-Risk Populations High-Risk Populations and Randomized Trials of the Mediterranean Diet Alcohol Consumption Physical Activity Sedentary Behavior Interventions to Increase Physical Activity Pharmacologic Therapies Shared Decision-Making Statins Monitoring of Therapy Aspirin N-3 Fatty Acids Primary Prevention High-Risk Primary Prevention Updated Meta-Analyses and Summary Novel Approaches to Preventive Cardiology The Polypill in Current Practice Precision Medicine Versus Preventive Care Community Interventions Mobile Health, Remote Monitoring, and Wearables Gaps in the Evidence and Future Perspectives Regional and International Perspectives References Chapter 26: Systemic Hypertension: Mechanisms, Diagnosis, and Treatment Definitions of Hypertension Epidemiology Pathophysiology Pressure Natriuresis and Salt Sensitivity Renin-Angiotensin-Aldosterone System Sympathetic Nervous System Natriuretic Peptides Endothelium Arterial Stiffness in Hypertension Immune System in Hypertension Factors Involved in Predisposition to Hypertension Genetics Obesity A Diagnostic Approach to Primary Hypertension History and Physical Examination Blood Pressure Measurement Office Blood Pressure Measurement Office Versus Home Blood Pressure Clinical Use of Ambulatory and Home Blood Pressure Monitoring Integrating Home Blood Pressure Into Clinical Practice Laboratory and Other Complementary Tests Echocardiography Evaluation of Sodium and Potassium Intake Renin Profiling Diagnostic approach for Secondary Hypertension Endocrine Causes Primary Hyperaldosteronism Apparent Mineralocorticoid Excess States Hyperaldosteronism Associated with Sleep-Disordered Breathing Pheochromocytoma Hypercortisolism (Cushing disease) Thyroid Dysfunction Acromegaly Nonendocrine Causes Lifestyle Factors Drug-Induced Hypertension Sleep Deprivation and Sleep-Disordered Breathin