Braunwald's Heart Disease: A Textbook of Cardiovascular Medicine, 9th Edition (2-Volume Set)

Braunwald's Heart Disease remains your indispensable source for definitive, state-of-the-art answers on every aspect of contemporary cardiology. Edited by Drs. Robert O. Bonow, Douglas L. Mann, Douglas P. Zipes, and Peter Libby, this dynamic, multimedia reference helps you apply the most recent knowledge in molecular biology and genetics, imaging, pharmacology, interventional cardiology, electrophysiology, and much more. Weekly updates online, personally selected by Dr. Braunwald, continuously keep you current on the most important new developments affecting your practice. Enhanced premium online content includes new dynamic cardiac imaging videos, heart sound recordings, and podcasts. With sweeping updates throughout, and contributions from a "who's who" of global cardiology, Braunwald's is the cornerstone of effective practice. Continuously access the most important new developments affecting your practice with weekly updates personally selected by Dr. Braunwald, including focused reviews, "hot off the press" commentaries, and late-breaking clinical trials. Practice with confidence and overcome your toughest challenges with advice from the top minds in cardiology today, who synthesize the entire state of current knowledge and summarize all of the most recent ACC/AHA practice guidelines. Locate the answers you need fast thanks to a user-friendly, full-color design with more than 1,200 color illustrations. Search the complete contents online at www.expertconsult.com. Stay on top of the latest advances in molecular imaging, intravascular ultrasound, cardiovascular regeneration and tissue engineering, device therapy for advanced heart failure, atrial fibrillation management, structural heart disease, Chagasic heart disease, ethics in cardiovascular medicine, the design and conduct of clinical trials, and many other timely topics. Hone your clinical skills with new dynamic cardiac imaging videos, heart sound recordings, and podcasts at www.expertconsult.com. Braunwald's Heart Disease continues to provide THE BEST cardiology information with expanded premium multimedia features, extensively revised content, and new global experts. Epidemiologic Transitions......Page 16 Age of Receding Pandemics (1900-1930)......Page 18 Age of Delayed Degenerative Diseases (1965-2000)......Page 19 Current Worldwide Variations in the Global Burden of Cardiovascular Disease......Page 20 Low- and Middle-Income Countries......Page 21 Burden of Disease......Page 22 Demographic and Social Indices......Page 23 Burden of Disease......Page 24 Hypertension......Page 25 Tobacco......Page 26 Obesity......Page 27 East Asia Pacific.......Page 28 Middle East and North Africa.......Page 29 Economic Burden......Page 30 Established Cardiovascular Disease Management......Page 31 Tobacco.......Page 32 Epidemiologic Transitions......Page 33 Global Trends in Cardiovascular Disease......Page 34 Cost-Effective Solutions......Page 35 Distribution of Known Risk Factors for Heart Disease......Page 36 Disparities in Cardiovascular Care and Outcomes......Page 38 Therapy.......Page 39 Ischemic Heart Disease......Page 40 Heart Failure......Page 41 Construct of Race and Ethnicity in Medicine......Page 42 Hypertension......Page 43 Heart Failure......Page 44 Preventing and Avoiding Harm to Patients......Page 45 Addressing Refusals of and Requests for Withdrawal of Life-Sustaining Treatments......Page 46 Ensuring Appropriate Surrogate Decision Making......Page 47 Bedside Allocation of Health Care Resources......Page 48 References......Page 49 Sensitivity and Specificity (see Chaps. 14 and 17).......Page 50 Test Ordering.......Page 51 Expressions of Risk and Benefit.......Page 52 Efficacy and Effectiveness.......Page 53 Adoption of Innovation.......Page 54 Adoption of Innovation......Page 55 Decision-Making Support......Page 56 Guidelines and Quality Measures......Page 57 Retrospective Chart Review......Page 58 Prospective Data Collection......Page 59 Hospitals......Page 60 Improvement Strategies......Page 61 Guidelines and Performance Measures......Page 62 Improvement Strategies......Page 63 Constructing the Research Question......Page 64 Other Forms of Controlled Studies......Page 65 Selection of Endpoint of Clinical Trial......Page 66 During the Course of the Trial......Page 67 During the Analytic Phase of the Trial......Page 68 Future Perspectives......Page 69 Key Issues During the Trial and Measurement of the Treatment Effect......Page 70 Principles of Cell Biology and the Cell Cycle......Page 71 DNA......Page 73 From Genes to Proteins......Page 74 Principles and Techniques of Molecular Biology......Page 75 Blotting Techniques......Page 76 Genotype and the Identification of Disease-Causing Genes......Page 77 Complex Trait Analysis.......Page 78 Oligonucleotide Arrays.......Page 79 Genetic Modification of Mice to Study Human Cardiovascular Disease......Page 80 Conditional Knockout Mice......Page 81 Adenovirus.......Page 82 Molecular Basis of Genetics......Page 83 Sarcomere Protein Gene Mutations.......Page 84 Thin-Filament Proteins......Page 85 Glycogen Storage Cardiomyopathy.......Page 86 Gene Mutations Causing Dilated Cardiomyopathy......Page 87 Mutations with Conduction System Disease.......Page 88 Gene Mutations Causing Arrhythmogenic Right Ventricular Dysplasia......Page 89 Atrial and Ventricular Septal Defects.......Page 90 Noonan Syndrome.......Page 92 References......Page 93 Genetic Basis for Long-QT Syndrome.......Page 95 Genotype-Phenotype Correlates.......Page 97 Clinical Description and Manifestations.......Page 98 Common Ion Channel Polymorphisms.......Page 99 Genetic Basis of Brugada Syndrome.......Page 100 Genetic Basis of Sick Sinus Syndrome.......Page 101 Ankyrin-B Syndrome......Page 102 References......Page 103 Variability in Drug Action......Page 105 Pharmacokinetics......Page 106 Metabolism and Excretion.......Page 107 Principles of Dosage Optimization......Page 108 Dose Adjustments......Page 110 Drug Interactions......Page 111 Genetics of Variable Drug Responses......Page 112 Cardiac Stem Cells......Page 113 Cardiac Stem Cells and Myocardial Aging......Page 115 Cardiac Stem Cells and Gender......Page 116 Cardiac Stem Cells and Myocardial Diseases......Page 117 Tissue Engineering......Page 119 Exogenous Stem Cells and Tissue Engineering......Page 120 4-u1.0-B978-1-4377-0398-6..00102-5..DOCPDF.pdf......Page 0 History......Page 121 Skin.......Page 122 Extremities.......Page 123 Jugular Venous Pressure and Waveform.......Page 124 Measuring the Blood Pressure.......Page 125 Assessing the Pulses.......Page 127 First Heart Sound (S1).......Page 128 Systolic Murmurs.......Page 129 Dynamic Auscultation.......Page 131 Physical Examination.......Page 132 Third and Fourth Heart Sounds.......Page 133 Other Findings.......Page 134 Valvular Heart Disease......Page 135 Mitral Regurgitation.......Page 136 Prosthetic Heart Valves (see Fig. 66-44).......Page 137 Assessment of Arterial Pulses and Blood Pressure......Page 138 Pericardial Tamponade......Page 139 The Cardiac Dipole.......Page 140 Role of Transmission Factors.......Page 141 Precordial Leads and the Wilson Central Terminal.......Page 142 Other Lead Systems.......Page 143 Lead Vectors and Heart Vectors.......Page 144 Electrocardiographic Processing and Display Systems......Page 145 Atrial Activation.......Page 146 Heart Rate Variability.......Page 147 Mid and Late QRS Patterns.......Page 148 Sequence of Ventricular Recovery.......Page 149 Normal Variants......Page 150 Left Atrial Abnormality.......Page 151 Diagnostic Accuracy.......Page 152 Left Ventricular Hypertrophy.......Page 153 Diagnostic Criteria......Page 154 Mechanisms for Electrocardiographic Abnormalities.......Page 155 Biventricular Hypertrophy.......Page 156 Fascicular Block.......Page 157 Left Anterior Fascicular Block.......Page 158 Mechanisms for the Electrocardiographic Abnormalities.......Page 159 Clinical Significance......Page 160 Multifascicular Blocks.......Page 161 Rate-Dependent Conduction Block (Aberration).......Page 162 Repolarization (ST-T Wave) Abnormalities.......Page 163 QRS Changes.......Page 164 Evolution of Electrocardiographic Changes.......Page 165 Other Ischemic ST-T Patterns.......Page 166 Ischemic U Wave Changes......Page 167 Electrocardiographic Diagnosis of Bundle Branch Blocks and Myocardial Infarction.......Page 168 Electrocardiographic Differential Diagnosis of Ischemia and Infarction.......Page 169 Noninfarction Q Waves.......Page 170 Fragmented QRS......Page 171 T Wave Inversion.......Page 172 Calcium.......Page 173 Magnesium.......Page 174 Alternans Patterns......Page 175 Technical Errors and Artifacts......Page 176 Future Perspectives......Page 177 Myocardial Ischemia and Infarction......Page 178 Patients without Known or Suspected Cardiovascular Disease......Page 179 References......Page 181 Cardiopulmonary Exercise Testing......Page 182 Anaerobic Threshold.......Page 183 Bicycle Ergometry.......Page 184 Walk Test.......Page 185 Measurement of ST-Segment Displacement.......Page 186 Computer-Assisted Analysis.......Page 189 Pathophysiology of the Myocardial Ischemic Response......Page 190 Maximal Work Capacity.......Page 191 Diagnostic Use of Exercise Testing......Page 192 Exercise Testing in Determining Prognosis......Page 193 Silent Myocardial Ischemia.......Page 194 Acute Coronary Syndromes.......Page 195 Congestive Heart Failure.......Page 196 Evaluation of Ventricular Arrhythmias.......Page 198 Preexcitation Syndrome.......Page 199 Hypertension.......Page 200 Older Patients.......Page 201 Cardiac Transplantation and Left Ventricular Assist Devices.......Page 202 Safety and Risks of Exercise Testing......Page 203 Nonelectrocardiographic Observations......Page 204 Specific Clinical Applications......Page 205 Exercise Test Performance and Training......Page 206 Diagnosis of Obstructive Coronary Artery Disease......Page 207 Special Populations......Page 208 References......Page 212 M-Mode, Two-Dimensional, and Three-Dimensional Transthoracic Echocardiography......Page 214 Transesophageal Echocardiography......Page 217 Views of the Aorta, Pulmonary Artery, and Pulmonary Veins......Page 221 Color Flow Imaging or Color Doppler......Page 222 Tissue Doppler and Strain Imaging......Page 224 Left Ventricular Endocardial Border Enhancement and Assessment of Myocardial Perfusion......Page 226 Left Ventricular Dimensions......Page 229 Right Ventricular Dimensions......Page 231 Left Ventricular Volume......Page 232 Left Ventricular Ejection Fraction.......Page 233 Assessment of Diastolic Function......Page 234 Normal Diastolic Filling Pattern......Page 235 Grade 2 Diastolic Dysfunction or Moderate Diastolic Dysfunction......Page 236 Clinical Applications of Diastolic Function Assessment......Page 237 Coronary Artery Disease......Page 238 New Systolic Murmur: Ventricular Septal Rupture, Papillary Muscle Rupture, and Acute Outflow Obstruction.......Page 239 Evaluation of Left Ventricular Remodeling and Ischemic Mitral Regurgitation (see Chap. 57).......Page 240 Stress Echocardiography......Page 241 Diagnostic Accuracy.......Page 242 Assessment of Myocardial Viability......Page 243 Stroke Volume and Cardiac Output......Page 244 Continuity Equation (see Chap. 66)......Page 245 PISA Method......Page 246 Aortic Stenosis......Page 248 Severe Aortic Stenosis with Low Aortic Pressure Gradient.......Page 249 Mitral Stenosis......Page 250 Aortic Regurgitation......Page 251 Mitral Regurgitation......Page 252 Pulmonary Stenosis and Regurgitation......Page 253 Prosthetic Valve Evaluation (see Chap. 66)......Page 254 Infective Endocarditis......Page 258 Dilated Cardiomyopathy (see Chap. 68)......Page 259 Hypertrophic Cardiomyopathy (see Chap. 69)......Page 261 Athlete’s Heart Versus Hypertrophic Cardiomyopathy.......Page 262 Restrictive Cardiomyopathy (see Chap. 68)......Page 263 Arrhythmogenic Right Ventricular Dysplasia/Cardiomyopathy (see Chap. 68)......Page 264 Pericardial Cyst......Page 265 Pericardial Effusion and Tamponade......Page 266 Constrictive Pericarditis......Page 268 Transient Constrictive Pericarditis......Page 269 Carcinoid Disease (see Chaps. 66 and 68)......Page 270 Aortic Aneurysm......Page 271 Aortic Dissection, Intramural Hematoma, and Aortic Ulcer (see Chap. 69)......Page 272 Papillary Fibroelastoma......Page 274 Echocardiography in Atrial Fibrillation (see Chap. 40)......Page 275 Atrial Septal Defect......Page 277 Ventricular Septal Defect......Page 279 Patent Ductus Arteriosus......Page 280 Contrast Echocardiography......Page 281 Valvular Heart Disease and Endocarditis......Page 282 Atrial Fibrillation......Page 283 Echocardiography......Page 284 References......Page 290 Technical Considerations......Page 291 Image Recording and Radiation Exposure......Page 292 Cardiac Chambers and Aorta.......Page 293 Lungs and Pulmonary Vasculature.......Page 295 Normal Variations.......Page 296 Evaluating the Chest Radiograph in Heart Disease......Page 297 Lungs and Pulmonary Vasculature......Page 300 Left Atrium.......Page 301 Pulmonary Arteries.......Page 302 Aorta.......Page 303 Conclusion......Page 304 Evaluating the Chest Radiograph in Heart Disease......Page 306 Basics of Quality Control.......Page 307 SPECT Image Interpretation and Reporting......Page 308 General Principles of Interpretation and Reporting.......Page 310 Incorporating Bayesian Principles into Image Interpretation......Page 311 Lung Uptake......Page 314 Attenuation Correction Methods.......Page 316 Combined PET-CT and SPECT-CT Scanners......Page 317 CT Attenuation Correction for PET and SPECT.......Page 318 Electrocardiographically Gated Radionuclide Techniques to Assess the Physiology of Ventricular Function......Page 319 Planar Myocardial Perfusion Imaging......Page 320 Image Acquisition.......Page 321 Image Acquisition.......Page 322 PET Perfusion Tracers: Research Directions......Page 323 Assessment of Infarct Size......Page 324 Effect of a Coronary Stenosis on Coronary Blood Flow Reserve (see Chap. 52)......Page 325 Exercise Stress to Induce Coronary Hyperemia.......Page 326 Mechanism of Coronary Arteriolar Vasodilator Pharmacologic Stress......Page 327 Reversal of the Effects of Vasodilator Pharmacologic Stress.......Page 328 Dobutamine Stress to Induce Coronary Hyperemia.......Page 329 2-[18F]Fluoro-2-Deoxyglucose.......Page 330 [11C]Acetate.......Page 332 Evaluation of Diastolic Function with Radionuclide Techniques......Page 333 The Relation Between the Extent of Perfusion Defect and Natural History Outcomes......Page 334 Dynamic Assessment of Prognosis by Serial Scintigraphic Studies: A New Paradigm?......Page 335 Detecting the Presence and Extent of Coronary Artery Disease.......Page 336 Angiography as the Gold Standard.......Page 337 Sensitivity and Specificity of Myocardial Perfusion Imaging.......Page 338 Pharmacologic Stress Testing for Detection of Coronary Artery Disease.......Page 339 Imaging After Coronary Artery Bypass Surgery......Page 340 Application of Radionuclide Imaging: Answering the Clinical Questions.......Page 341 Assessment of Inducible Ischemia after Acute Myocardial Infarction......Page 342 Imaging of Ischemic Memory......Page 343 Is coronary Artery Disease the Cause of Heart Failure?......Page 344 Comparison of Imaging Techniques for Viability Assessment.......Page 345 Myocarditis (see Chap. 70).......Page 346 Imaging of the Tissue Angiotensin-Converting Enzyme Receptor System......Page 347 Assessment of the Physiology and Pathophysiology of Myocardial Blood Flow, Myocardial Metabolism, and Ventricular Function......Page 348 Disease Detection, Risk Stratification, and Clinical Decision Making......Page 349 Nuclear Cardiology......Page 350 References......Page 353 Generation of Magnetic Resonance Signal, Signal Contrast, and Image Formation......Page 354 Technical Aspects of Cardiac Magnetic Resonance Pulse Sequences......Page 355 Contrast-Enhanced Imaging......Page 356 Imaging Of Myocardial Infarction.......Page 357 Myocardial Perfusion Imaging......Page 359 Assessment of Cardiomyopathies......Page 360 Hypertrophic Cardiomyopathy.......Page 361 Arrhythmogenic Right Ventricular Cardiomyopathy.......Page 362 Cardiac Sarcoidosis.......Page 363 Iron Overload Cardiomyopathy.......Page 364 Pericardial Disease......Page 365 Anomalous Pulmonary Venous Connection.......Page 366 Cardiac Thrombi and Masses......Page 368 Magnetic Resonance Spectroscopy......Page 369 Cardiac Magnetic Resonance at 3 T......Page 370 Coronary Artery Disease......Page 371 Other Clinical Applications......Page 372 Cardiovascular Magnetic Resonance......Page 373 Reference......Page 375 Radiation Exposure......Page 376 Preparation of the Patient and Scanning Sequence......Page 377 Cardiac Computed Tomography Anatomy......Page 378 Coronary Artery Calcium Scanning......Page 379 Detection of Noncalcified Plaque......Page 382 Ventricular and Valvular Morphology and Function......Page 383 Emerging Applications......Page 387 Training and Certification......Page 388 Coronary CT Angiography......Page 392 Cardiac Computed Tomography......Page 393 References......Page 396 Indications for Diagnostic Cardiac Catheterization......Page 397 Radiation Safety.......Page 398 Catheters and Associated Equipment.......Page 399 Balloon Flotation Catheters.......Page 400 The Judkins Technique.......Page 401 Postprocedure Care.......Page 402 Transseptal Catheterization.......Page 403 Endomyocardial Biopsy.......Page 404 Percutaneous Intra-aortic Balloon Pump Insertion.......Page 405 Atrial Pressure......Page 407 Great Vessel Pressures......Page 408 Abnormal Pressure Characteristics.......Page 409 Fick Method.......Page 410 Determination of Vascular Resistance.......Page 411 Mitral Stenosis......Page 412 Calculation of Stenotic Valve Orifice Areas.......Page 413 Oximetric Method.......Page 414 Dynamic Exercise......Page 415 Pharmacologic Maneuvers......Page 416 Intracardiac Echocardiography......Page 417 Acknowledgment......Page 418 Complications Associated with Cardiac Catheterization......Page 419 Indications for Coronary Arteriography (see Guidelines for Coronary Arteriography)......Page 420 Contraindications.......Page 421 Preparation of the Patient.......Page 422 Other Catheters.......Page 423 Anticoagulants.......Page 424 Side Effects.......Page 425 Arterial Nomenclature and Extent of Disease.......Page 426 Cannulation......Page 427 Left Anterior Descending Artery.......Page 428 Right Coronary Artery.......Page 429 Saphenous Vein Grafts.......Page 431 Gastroepiploic Artery.......Page 432 Anomalous Pulmonary Origin of the Coronary Arteries (APOCA).......Page 433 Anomalous Coronary Artery from the Opposite Sinus (ACAOS).......Page 434 Coronary Artery Fistulas.......Page 435 Coronary Artery Spasm......Page 436 Lesion Complexity......Page 437 Ostial Location.......Page 439 Lesion Calcification.......Page 440 Thrombus.......Page 441 Coronary Collateral Circulation......Page 442 Quantitative Angiography......Page 443 Complications of Coronary Arteriography......Page 445 Lesion Complexity......Page 446 Coronary Arteriography in Patients with Congenital Heart Disease......Page 447 Other Uses of Coronary Arteriography......Page 448 References......Page 454 Evaluation of Atheroma Burden and Vascular Remodeling......Page 455 Clinical Indications for Intravascular Ultrasound Imaging......Page 456 Intravascular Ultrasound Assessment of Novel Antiatherosclerotic Treatments......Page 458 Future Perspectives......Page 459 Clinical Indications for Intravascular Ultrasound Imaging......Page 460 Future Perspectives......Page 461 Imaging Strategies......Page 462 Cell Trafficking: Leukocytes and Stem Cells......Page 463 Phagocytosis......Page 466 Angiogenesis......Page 467 Glucose Metabolism......Page 469 Uses for Molecular Imaging......Page 470 Biologic Processes Amenable to Molecular Targeting for Imaging......Page 471 Ultrastructure of Contractile Cells......Page 473 Titin and Length Sensing.......Page 474 Actin and Troponin Complex.......Page 475 Myosin and Molecular Basis of Muscle Contraction.......Page 476 Cross-Bridge Cycling Differs from Cardiac Contraction-Relaxation Cycle.......Page 477 Ryanodine Receptors.......Page 479 Calcium Uptake by SERCA into the Sarcoplasmic Reticulum......Page 481 Sodium-Calcium Exchanger.......Page 482 The Stimulatory G Protein Gs.......Page 483 Coupling of ALPHA1 Receptor by G Proteins.......Page 484 Cyclic Adenosine Monophosphate–Dependent Pro­tein Kinases.......Page 485 Physiologic Switch-Off and Beta-Arrestin Signaling......Page 486 Compartmentalization of cGMP.......Page 487 Other Inhibitory Signal Systems.......Page 488 Left Ventricular Contraction.......Page 489 Frank and Isovolumic Contraction.......Page 491 Wall Stress......Page 492 Force-Frequency Relationship and Optimal Heart Rate.......Page 493 Kinetic Work.......Page 494 Defects in the Contractile Function Concept.......Page 495 Ventricular Suction during Early Diastole.......Page 496 Wall Stress and Compensated Left Ventricular Hypertrophy.......Page 497 Future Perspectives......Page 498 Contractile Performance of the Heart......Page 499 Activation of the Sympathetic Nervous System.......Page 501 Activation of the Renin-Angiotensin System.......Page 503 Neurohormonal Alterations of Renal Function.......Page 504 Natriuretic Peptides.......Page 505 Endothelin.......Page 506 Adrenomedullin.......Page 507 Inflammatory Mediators.......Page 508 Cardiac Myocyte Hypertrophy......Page 509 Sarcoplasmic Reticulum in the Failing Heart.......Page 510 Beta-Adrenergic Desensitization......Page 511 Autophagy.......Page 512 Cardiac Fibroblasts and Mast Cells......Page 514 Matrix Metalloproteinases.......Page 515 Alterations in the Left Ventricular Structure in Heart Failure.......Page 516 Neurohormonal Mechanisms......Page 517 Left Ventricular Remodeling......Page 518 Heart Failure Symptoms......Page 519 Other Historical Information......Page 520 Physical Examination......Page 521 Measurement of Blood Chemistry and Hematologic Variables......Page 522 Biomarkers......Page 523 Detection of Comorbidities......Page 524 Use of Imaging Modalities in the Diagnosis and Management of Patients with Heart Failure (see Chaps. 15, 17-19)......Page 525 Cardiac Imaging to Differentiate Between Ischemic and Nonischemic Causes of Heart Failure......Page 526 Summary and Future Perspectives......Page 528 Laboratory Testing, Right-Heart Catheterization, Endomyocardial Biopsy, and Exercise Testing......Page 529 Use of Imaging Modalities in Diagnosis and Management of Heart Failure......Page 530 Classification......Page 531 Congestion in Acute Heart Failure Syndromes......Page 534 Myocardial Function in Acute Heart Failure Syndromes (see Chaps. 24, 26, 28, and 30)......Page 535 Abnormalities of the Natriuretic Peptide System.......Page 536 Predictive Models of In-Hospital Mortality......Page 537 Hyponatremia.......Page 538 Blood Pressure in Response to Provocative Testing.......Page 539 Renal Function Tests......Page 540 Management of Acute Heart Failure Syndromes......Page 541 Noninvasive Ventilation.......Page 542 Diuretics (Table 27-9; see Table 28-7).......Page 543 Vasodilators (see Table 27-9).......Page 544 Nesiritide......Page 545 Inotropes with Vasodilatory Properties (Table 27-10).......Page 546 Dobutamine......Page 547 Digoxin......Page 548 Cardiogenic Pulmonary Edema.......Page 549 Treatment of Clinical and Hemodynamic Congestion.......Page 550 Phase III: Management After Discharge and During the Vulnerable Phase......Page 551 Cardiac Myosin Activators.......Page 552 Pathophysiology......Page 553 Assessment of Acute Heart Failure Syndromes......Page 554 Potential New Therapies and Future Perspectives......Page 555 Causative Factors......Page 557 Prognosis......Page 558 Biomarkers and Prognosis......Page 560 Patients at High Risk for Developing Heart Failure (Stage A).......Page 561 Defining the Appropriate Strategy......Page 563 General Measures......Page 564 Management of Fluid Status......Page 565 Loop Diuretics.......Page 566 Mechanisms of Action.......Page 567 Carbonic Anhydrase Inhibitors.......Page 568 Diuretic Treatment of Heart Failure.......Page 569 Diuretic Resistance and Management.......Page 570 Angiotensin-Converting Enzyme Inhibitors.......Page 572 Angiotensin Receptor Blockers.......Page 573 Beta-Adrenergic Receptor Blockers.......Page 574 Side Effects of Aldosterone Antagonists......Page 577 Complications of Digoxin Use......Page 578 Cancer Patients.......Page 579 Sleep-Disordered Breathing......Page 580 Disease Management......Page 581 Management of Heart Failure......Page 582 Initial Patient Evaluation......Page 583 Treatment of Patients at High Risk of Developing Heart Failure (Stage A)......Page 584 Treatment of Patients with Left Ventricular Dysfunction Who Have Not Developed Symptoms (Stage B)......Page 585 Treatment of Patients with Left Ventricular Dysfunction and Current or Prior Symptoms (Stage C)......Page 586 Treatment of Patients with Refractory End-Stage Heart Failure (Stage D)......Page 587 The Hospitalized Patient......Page 588 Special Populations and Concomitant Disorders......Page 589 End-of-Life Care......Page 590 References......Page 591 Multisite Stimulation in Cardiomyopathy Trials.......Page 592 CONTAK CD.......Page 593 Indications for Cardiac Resynchronization Therapy in Heart Failure Patients......Page 594 Multicenter Automatic Defibrillator Implantation Trial with Cardiac Resynchronization Therapy.......Page 595 Sudden Cardiac Death–Heart Failure Trial.......Page 596 Implantable Devices to Monitor Heart Failure......Page 597 Ventricular Dyssynchrony......Page 598 Implantable Devices to Monitor Heart Failure......Page 599 Clinical Features......Page 600 Obesity.......Page 601 Rarer Causes of Heart Failure with a Normal Ejection Fraction.......Page 603 The Elderly Patient with Exertional Dyspnea, Normal Ejection Fraction, and Pulmonary Hypertension.......Page 604 Doppler Echocardiographic Assessment of Diastolic Function and Filling Pressures.......Page 605 Invasive and Noninvasive Assessment of Left Ventricular Relaxation......Page 606 Evidence for Impaired Relaxation......Page 608 Invasive and Noninvasive Assessment of Left Ventricular Diastolic Stiffness.......Page 609 Vascular Dysfunction.......Page 610 Randomized Controlled Clinical Trials......Page 611 Pathophysiology......Page 613 Therapy......Page 614 Risks of Coronary Artery Bypass Grafting......Page 615 Survival Benefit.......Page 616 Mitral Valve......Page 617 Left Ventricular Reconstruction......Page 620 Passive Cardiac Support Devices......Page 621 Evaluation of the Potential Recipient......Page 622 Surgical Considerations......Page 624 Rejection......Page 625 Infection......Page 626 Renal Insufficiency.......Page 627 Functional Outcomes.......Page 628 Left Ventricular Reconstruction......Page 629 Cardiac Transplantation......Page 630 Classification and Description of Devices......Page 631 Clinical Cardiac Recovery......Page 632 Clinical Outcomes with Chronic Mechanical Assistance......Page 633 Patient Factors Influencing Outcome......Page 634 Pulmonary Function.......Page 635 Surgical Considerations......Page 636 Right Ventricular Failure......Page 637 Percutaneous Mechanical Support......Page 638 The Emerging Future of Mechanical Circulatory Support......Page 639 Long-term Management, the Total Artificial Heart, and Percutaneous Mechanical Support......Page 640 Stem and Progenitor Cells (see Chap. 11).......Page 641 Clinically Used Cell Types......Page 643 Cell Therapy in Acute Myocardial Infarction.......Page 645 Cell Therapy and Cell Mobilization Strategies in Patients with Chronic Heart Failure.......Page 647 Future Perspectives in Myocardial Repair and Regeneration.......Page 648 Gene Therapy......Page 649 Pharmacogenetics......Page 651 Metabolic Modulation......Page 653 Myocardial Regeneration......Page 655 Pharmacogenetics......Page 656 Metabolic Modulation......Page 657 Palliative Care......Page 658 Continuous Goal Assessment......Page 659 Types of Documents.......Page 660 Physical and Psychological Symptoms and Their Management......Page 661 Withdrawing and Withholding Life-Sustaining Treatment......Page 662 Care During the Last Hours......Page 663 Outcome Measures......Page 664 Assessment, Goals, and Care Planning......Page 665 Function.......Page 666 Innervation.......Page 667 Atrioventricular Node.......Page 669 Terminal Purkinje Fibers.......Page 670 Pathways of Innervation.......Page 671 Arrhythmias and the Autonomic Nervous System......Page 672 Physiology of Ion Channels......Page 673 Ion Flux Through Voltage-Gated Channels.......Page 674 Voltage-Gated Ca2+ Channels.......Page 675 Intercalated Discs......Page 676 General Considerations......Page 677 Mechanism of Phase 0.......Page 678 Upstroke of the Action Potential.......Page 679 Phase 2: Plateau......Page 681 Normal Automaticity......Page 682 Passive Membrane Electrical Properties.......Page 683 Effects of Reduced Resting Potential.......Page 684 Disorders of Impulse Formation......Page 685 Major Role of Intracellular Ca2+ Handling Abnormalities in DAD Generation.......Page 686 Long-QT Syndrome.......Page 688 Anatomic Reentry.......Page 689 Conditions for Reentry......Page 690 Spatiotemporal Organization and Focal Discharge (see Chap. 40)......Page 691 Primary Ion Channel Abnormalities in Atrial Fibrillation.......Page 692 Preexcitation Syndrome (see Chap. 39).......Page 693 Ventricular Fibrillation: Initiation and Maintenance (see Chap. 39).......Page 695 Anatomy of the Cardiac Conduction System......Page 697 Mechanisms of Arrhythmogenesis......Page 698 Physical Examination......Page 700 The Ladder Diagram......Page 702 Exercise Testing (see Chap. 14)......Page 703 Ambulatory Electrocardiographic (Holter) Recording......Page 704 Implantable Loop Recorder......Page 705 T Wave Alternans......Page 706 Upright Tilt-Table Testing......Page 708 Intraventricular Conduction Disturbance......Page 709 Sinoatrial Conduction Time.......Page 710 Tachycardia (see Chap. 39)......Page 711 Direct Cardiac Mapping: Recording Potentials Directly from the Heart......Page 712 References......Page 714 Assessment of Risk......Page 715 Clinical Competence......Page 716 Narrow- and Wide-Complex QRS Tachycardia......Page 717 Unexplained Palpitations......Page 719 Clinical Competence......Page 720 References......Page 722 Class IV......Page 723 Mechanisms of Arrhythmia Suppression (see Table 37-2).......Page 724 Pharmacogenetics (see Chap. 10).......Page 725 Proarrhythmia......Page 726 Pharmacokinetics (see Table 37-4).......Page 728 Indications.......Page 729 Indications.......Page 730 Pharmacokinetics (see Table 37-4).......Page 731 Indications.......Page 732 Beta Adrenoceptor Blocking Agents......Page 733 Pharmacokinetics (see Table 37-4).......Page 734 Hemodynamic Effects.......Page 735 Adverse Effects.......Page 736 Indications.......Page 737 Electrophysiologic Actions (see Tables 37-1, 37-2, 37-3, and 37-5).......Page 738 Indications.......Page 739 Digoxin......Page 740 Technique.......Page 741 Indications.......Page 742 Ablation Therapy for Cardiac Arrhythmias......Page 743 Location of Pathways.......Page 744 Ablation Site.......Page 745 Slow Pathway Ablation.......Page 746 Radiofrequency Catheter Ablation of Arrhythmias Related to the Sinus Node.......Page 747 Reentrant Atrial Tachycardia.......Page 748 Radiofrequency Catheter Ablation of Atrial Flutter (see Chap. 39).......Page 749 Radiofrequency Catheter Ablation of Ventricular Tachycardia.......Page 751 Location and Ablation.......Page 752 Indications......Page 753 Chemical Ablation.......Page 754 Surgical Techniques.......Page 755 Pharmacologic Therapy......Page 756 Electrotherapy......Page 757 Strength-Duration Relationship.......Page 758 Rationale for Cardiac Resynchronization Therapy.......Page 759 Intracardiac Electrogram......Page 761 Blanking and Refractory Periods.......Page 762 Sensing Thresholds.......Page 763 VT/VF Detection......Page 764 Confirmation, Redetection, and Episode Termination.......Page 765 Atrial Inhibited Pacing We Are Pleased To Present The Ninth Edition Of Braunwald's Heart Disease: A Textbook Of Cardiovascular Medicine As The Hub Of An Ongoing, Advanced Learning System Designed To Provide Practitioners, Physicians-in-training, And Students At All Levels With The Tools Needed To Keep Abreast Of Rapidly Changing Scientific Foundations, Clinical Research Results, And Evidence-based Medical Practice. In Keeping With The Tradition Established By The Previous Editions Of Braunwald's Heart Disease, The Ninth Edition Covers The Breadth Of Cardiovascular Practice, Highlighting New Advances And Their Potential To Transform The Established Paradigms Of Prevention, Diagnosis, And Treatment. We Have Thoroughly Revised This Edition To Keep The Content Vibrant, Stimulating, And Up-to-date. Twenty-four Of The 94 Chapters Are Entirely New, Including Nine Chapters That Cover Topics Not Addressed In Earlier Editions. We Have Added 46 New Authors, All Highly Accomplished And Recognized In Their Respective Disciplines. All Chapters Carried Over From The Eighth Edition Have Been Thoroughly Updated And Extensively Revised. This Edition Includes Nearly 2500 Figures, Most Of Which Are In Full Color, And 600 Tables. We Have Continued To Provide Updated Sections On Current Guidelines Recommendations That Complement Each Of The Appropriate Individual Chapters.--pref. Fundamentals Of Cardiovascular Disease -- Global Burden Of Cardiovascular Disease -- Heart Disease In Varied Populations -- Ethics In Cardiovascular Medicine -- Clinical Decision Making In Cardiology -- Measurement And Improvement Of Quality Of Cardiovascular Care -- Design And Conduct Of Clinical Trials -- Molecular Biology And Genetics -- Principles Of Cardiovascular Molecular Biology And Genetics -- Inherited Causes Of Cardiovascular Disease -- Genetics Of Cardiac Arrhythmias -- Principles Of Drug Therapy -- Cardiovascular Regeneration And Tissue Engineering -- Evaluation Of The Patient -- The History And Physical Examination: An Evidence-based Approach -- Electrocardiography -- Exercise Stress Testing -- Echocardiography -- The Chest Radiograph In Cardiovascular Disease -- Nuclear Cardiology -- Cardiovascular Magnetic Resonance Imaging -- Cardiac Computed Tomography -- Cardiac Catheterization -- Coronary Arteriography -- Intravascular Ultrasound Imaging --^ Molecular Imaging In Cardiovascular Disease -- Heart Failure -- Mechanisms Of Cardiac Contraction And Relaxation -- Pathophysiology Of Heart Failure -- Clinical Assessment Of Heart Failure -- Diagnosis And Management Of Acute Heart Failure Syndromes -- Management Of Heart Failure Patients With Reduced Ejection Fraction -- Devices For Monitoring And Managing Heart Failure -- Heart Failure With Normal Ejection Fraction -- Surgical Management Of Heart Failure -- Assisted Circulation In The Treatment Of Heart Failure -- Emerging Therapies And Strategies In The Treatment Of Heart Failure -- Care Of Patients With End-stage Heart Disease -- Arrhythmias, Sudden Death, And Syncope -- Genesis Of Cardiac Arrhythmias: Electrophysiologic Considerations -- Diagnosis Of Cardiac Arrhythmias -- Therapy For Cardiac Arrhythmias -- Pacemakers And Implantable Cardioverter-defibrillators -- Specific Arrhythmias: Diagnosis And Treatment --^ Atrial Fibrillation: Clinical Features, Mechanisms, And Management -- Cardiac Arrest And Sudden Cardiac Death -- Hypotension And Syncope -- Preventive Cardiology -- The Vascular Biology Of Atherosclerosis -- Risk Markers For Atherothrombotic Disease -- Systemic Hypertension: Mechanisms And Diagnosis -- Systemic Hypertension: Therapy -- Lipoprotein Disorders And Cardiovascular Disease -- Nutrition And Cardiovascular Disease -- Primary And Secondary Prevention Of Coronary Heart Disease -- Exercise-based, Comprehensive Cardiac Rehabilitation -- Complementary And Alternative Approaches To Management Of Patients With Heart Disease. Atherosclerotic Cardiovascular Diasease -- Coronary Blood Flow And Myocardial Ischemia -- Approach To The Patient With Chest Pain -- St-segment Elevation Myocardial Infarction: Pathology, Pathophysiology, And Clinical Features -- St-segment Elevation Myocardial Infarction: Management -- Unstable Angina And Non-st Elevation Myocardial Infarction -- Stable Ischemic Heart Disease -- Percutaneous Coronary Intervention -- Percutaneous Therapies For Structural Heart Disease In Adults -- Diseases Of The Aorta -- Peripheral Artery Diseases -- Prevention And Management Of Stroke -- Endovascular Treatment Of Noncoronary Obstructive Vascular Disease -- Diabetes And The Cardiovascular System -- Diseases Of The Heart, Pericardium, And Pulmonary Vasculature Bed -- Congenital Heart Disease -- Valvular Heart Disease -- Infective Endocarditis -- The Dilated, Restrictive, And Infiltrative Cardiomyopathies -- Hypertrophic Cardiomyopathy -- Myocarditis -- Chagas' Disease --^ Cardiovascular Abnormalities In Hiv-infected Individuals -- Toxins And The Heart -- Primary Tumors Of The Heart -- Pericardial Diseases -- Traumatic Heart Disease -- Pulmonary Embolism -- Pulmonary Hypertension -- Sleep Apnea And Cardiovascular Disease -- Cardiovascular Disease In Special Populations -- Cardiovascular Disease In The Elderly -- Cardiovascular Disease In Women -- Pregnancy And Heart Disease -- Exercise And Sports Cardiology -- Medical Management Of The Patient Undergoing Cardiac Surgery -- Anesthesia And Noncardiac Surgery In Patients With Heart Disease -- Cardiovascular Disease And Disorders Of Other Organs -- Endocrine Disorders And Cardiovascular Disease -- Hemostasis, Thrombosis, Fibrinolysis, And Cardiovascular Disease -- Rheumatic Fever -- Rheumatic Diseases And The Cardiovascular System -- The Cancer Patient And Cardiovascular Disease -- Psychiatric And Behavioral Aspects Of Cardiovascular Disease -- Neurologic Disorders And Cardiovascular Disease --^ Interface Between Renal Disease And Cardiovascular Illness -- Cardiovascular Manifestations Of Autonomic Disorders. Edited By Robert O. Bonow ... [et Al.]. Includes Bibliographical References And Index.