ESSENTIAL CARDIOLOGY

Essential Cardiology. PRINCIPLES AND PRACTICE. SECOND EDITION. Edited by. CLIVE ROSENDORFF, MD, PhD, FRCP. Professor of Medicine, Zena and Michael A. ...
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ESSENTIAL CARDIOLOGY

Essential Cardiology PRINCIPLES AND PRACTICE SECOND EDITION

Edited by

CLIVE ROSENDORFF, MD, PhD, FRCP Professor of Medicine, Zena and Michael A. Wiener Cardiovascular Institute, Mount Sinai School of Medicine, New York, NY, and Veterans Affairs Medical Center, Bronx, NY

© 2005 Humana Press Inc. 999 Riverview Drive, Suite 208 Totowa, New Jersey 07512 www.humanapress.com All rights reserved. No part of this book may be reproduced, stored in a retrieval system, or transmitted in any form or by any means, electronic, mechanical, photocopying, microfilming, recording, or otherwise without written permission from the Publisher. The content and opinions expressed in this book are the sole work of the authors and editors, who have warranted due diligence in the creation and issuance of their work. The publisher, editors, and authors are not responsible for errors or omissions or for any consequences arising from the information or opinions presented in this book and make no warranty, express or implied, with respect to its contents. Due diligence has been taken by the publishers, editors, and authors of this book to assure the accuracy of the information published and to describe generally accepted practices. The contributors herein have carefully checked to ensure that the drug selections and dosages set forth in this text are accurate and in accord with the standards accepted at the time of publication. Notwithstanding, as new research, changes in government regulations, and knowledge from clinical experience relating to drug therapy and drug reactions constantly occurs, the reader is advised to check the product information provided by the manufacturer of each drug for any change in dosages or for additional warnings and contraindications. This is of utmost importance when the recommended drug herein is a new or infrequently used drug. It is the responsibility of the treating physician to determine dosages and treatment strategies for individual patients. Further it is the responsibility of the health care provider to ascertain the Food and Drug Administration status of each drug or device used in their clinical practice. The publisher, editors, and authors are not responsible for errors or omissions or for any consequences from the application of the information presented in this book and make no warranty, express or implied, with respect to the contents in this publication.

Cover design by Patricia F. Cleary Cover illustration by Colin Richards. Used with permission of the artist. For additional copies, pricing for bulk purchases, and/or information about other Humana titles, contact Humana at the above address or at any of the following numbers: Tel.: 973-256-1699; Fax: 973-256-8341; E-mail: [email protected]; or visit our Website: www.humanapress.com This publication is printed on acid-free paper. ∞ ANSI Z39.48-1984 (American National Standards Institute) Permanence of Paper for Printed Library Materials. Photocopy Authorization Policy: Authorization to photocopy items for internal or personal use, or the internal or personal use of specific clients, is granted by Humana Press Inc., provided that the base fee of US $30.00 is paid directly to the Copyright Clearance Center at 222 Rosewood Drive, Danvers, MA 01923. For those organizations that have been granted a photocopy license from the CCC, a separate system of payment has been arranged and is acceptable to Humana Press Inc. The fee code for users of the Transactional Reporting Service is: [1-58829-370-X/05 $30.00]. Printed in the United States of America. 10 9 8 7 6 5 4 3 2 1 eISBN 1-59259-918-4 Library of Congress Cataloging-in-Publication Data Essential cardiology : principles and practice / edited by Clive Rosendorff.-- 2nd ed. p. ; cm. Includes bibliographical references and index. ISBN 1-58829-370-X (alk. paper) 1. Heart--Diseases. 2. Cardiology. [DNLM: 1. Cardiovascular Diseases--Outlines. 2. Cardiovascular Physiology--Outlines. WG 18.2 E78 2005] I. Rosendorff, Clive. RC681.E85 2005 616.1'2--dc22 2005006266

PREFACE This second edition reflects the very rapid advances that have been made in our understanding and management of cardiovascular disease since the first edition was published in 2001. All of the chapters have been extensively reviewed and rewritten. There are now two chapters on acute coronary syndromes, reflecting the modern classification: one on unstable angina pectoris and non-ST-segment elevation myocardial infarction, and the other on ST-segment elevation myocardial infarction. Otherwise the format of the first edition has been retained, to include sections on epidemiology, cardiovascular function, examination and investigation of the patient, disorders of rhythm and conduction, heart failure, congenital heart disease, coronary artery disease, valvular heart disease, hypertension, and other conditions affecting the heart. I am also very happy to welcome Drs. Arnold M. Katz, Martin M. Goldman, David Benditt, Edward K. Kasper, and Roger J. Hajjar as new senior authors. I wish also to thank Pedro Perez for his superb contributions to the artwork, my assistants, Maria Anthony and Anitra Collins, and Paul Dolgert, John Morgan, Patricia Cleary, and Donna Niethe, and the editorial, production, and composition departments of Humana Press for their encouragement and hard work. Clive Rosendorff, MD, PhD, FRCP

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PREFACE TO THE FIRST EDITION “A big book,” said Callimachus, the Alexandrian poet, “is a big evil!” Not always. There are some excellent, very big encyclopedias of cardiology, wonderful as works of reference. There are also many small books of cardiology, “handbooks” or “manuals,” which serve a different purpose, to summarize, list, or simplify. This book is designed to fill a large gap between these extremes, to provide a textbook that is both substantial and readable, compact and reasonably comprehensive, and to provide an intelligent blend of molecular, cellular, and physiologic concepts with current clinical practice. A word about the title. “Essential” is used here not in the sense of indispensable or absolutely required in all circumstances, for there is much more here than the generalist needs in order to practice good medicine, especially if there is easy access to a cardiology consultant. Rather, the word as used here denotes the essence or distillation or fundamentals of the mechanisms and practice of cardiology. The “Principles and Practice” subtitle affirms the idea that theory without a practical context may be academically satisfying but lacks usefulness, and practice without theory is plumbing. Good doctors understand the basic science foundation of what they do with patients, and great doctors are those who, as researchers or as teachers, see new connections between the basic sciences and clinical medicine. I have been very fortunate to be able to assemble a team of great doctors who are outstanding physicians and scientists, most of them internationally recognized for their leadership position in their areas of specialization. They represent a careful blend of brilliance and experience, and, most of all, they all write with the authority of undoubted experts in their fields. They have all been asked to write up-to-date reviews of their respective areas of expertise, at a level that will be intelligible to noncardiologists as well as cardiologists, to medical students, internal medicine residents, general internists, and cardiology fellows. I believe that they have succeeded brilliantly, and I know that they are all very proud to have participated as authors in this project, the first textbook of cardiology of the new millennium. I am deeply grateful to all of them for the care and enthusiasm with which they carried out this task. The organization of the book reflects pretty much the key issues that concern cardiologists and other internists at present; I have no doubt that the field will develop and change in time so that many of the modes of diagnosis and therapy described here will become much more prominent (such as gene therapy), while others may diminish or even disappear. This is what second or later editions of textbooks are for. Clive Rosendorff, MD, PhD, FRCP

CONTENTS Preface ................................................................................................................... v Preface to First Edition ........................................................................................ vii Contributors ....................................................................................................... xiii Color Plates ......................................................................................................... xix

Part I. EPIDEMIOLOGY 1

Multivariable Evaluation of Candidates for Cardiovascular Disease William B. Kannel ....................................................................................... 3

Part II. CIRCULATORY FUNCTION 2

Molecular and Cellular Basis of Myocardial Contractility Arnold M. Katz .......................................................................................... 21

3

Ventricular Function Lionel H. Opie ........................................................................................... 37

4

Vascular Function Clive Rosendorff ........................................................................................ 55

5

Thrombosis Yale Nemerson and Mark B. Taubman ................................................... 77

Part III. EXAMINATION AND INVESTIGATION OF THE PATIENT 6

The Medical History and Symptoms of Heart Disease H. J. C. Swan ............................................................................................. 87

7

Physical Examination of the Heart and Circulation Jonathan Abrams ...................................................................................... 99

8

Electrocardiography Tara L. DiMino, Alexander Ivanov, James F. Burke, and Peter R. Kowey ............................................................................ 117

9

Echocardiography Daniel G. Blanchard and Anthony N. DeMaria ................................... 139

10

Exercise Testing Gregory Engel and Victor Froelicher ................................................... 169

11

Radiology of the Heart Gautham P. Reddy and Robert M. Steiner ............................................ 185

12

Cardiac Catheterization and Coronary Angiography Mark J. Ricciardi, Nirat Beohar, and Charles J. Davidson ................ 197 ix

x

Contents 13

Nuclear Imaging in Cardiovascular Medicine Diwakar Jain and Barry L. Zaret .......................................................... 221

14

Cardiovascular Magnetic Resonance and X-Ray Computed Tomography Gerald M. Pohost, Radha J. Sarma, Patrick M. Colletti, Mark Doyle, and Robert W. W. Biederman .................................... 245

15

Choosing Appropriate Imaging Techniques Jonathan E. E. Fisher and Martin E. Goldman ................................... 269

Part IV. DISORDERS OF RHYTHM AND CONDUCTION 16

Electrophysiology of Cardiac Arrhythmias Sei Iwai, Steven M. Markowitz, Suneet Mittal, Kenneth M. Stein, and Bruce B. Lerman ......................................... 285

17

Treatment of Cardiac Arrhythmias Davendra Mehta ...................................................................................... 305

18

Syncope Fei Lü, Scott Sakaguchi, and David G. Benditt ................................... 329

Part V. HEART FAILURE 19

Pathophysiology of Heart Failure Mark Scoote, Ian F. Purcell, and Philip A. Poole-Wilson .................. 347

20

Treatment of Congestive Heart Failure Stephen S. Gottlieb .................................................................................. 371

Part VI. CONGENITAL HEART DISEASE 21

Congenital Heart Disease Julien I. E. Hoffman ............................................................................... 393

Part VII. CORONARY ARTERY DISEASE 22

Pathogenesis of Atherosclerosis Prediman K. Shah ................................................................................... 409

23

Risk Factors and Prevention, Including Hyperlipidemias Antonio M. Gotto, Jr. and John Farmer ............................................... 419

24

Coronary Blood Flow and Myocardial Ischemia Robert J. Henning and Ray A. Olsson .................................................. 439

25

Stable Angina Satya Reddy Atmakuri, Michael H. Gollob, and Neal S. Kleiman .......................................................................... 451

26

Unstable Angina and Non-ST Segment Elevation Myocardial Infarction (Acute Coronary Syndromes) Satya Reddy Atmakuri and Neal S. Kleiman ........................................ 471

Contents

xi 27

ST Segment Elevation Myocardial Infarction Rajat Deo, Christopher P. Cannon, and James A. de Lemos .............. 489

28

Cardiopulmonary Resuscitation Joseph P. Ornato ..................................................................................... 521

29

Rehabilitation After Acute MI Fredric J. Pashkow ................................................................................. 531

Part VIII. VALVULAR HEART DISEASE 30

Rheumatic Fever and Valvular Heart Disease Edmund A. W. Brice and Patrick J. Commerford ................................ 545

31

Infective Endocarditis Adolf W. Karchmer ................................................................................. 565

Part IX. HYPERTENSION 32

Hypertension: Mechanisms and Diagnosis Clive Rosendorff ...................................................................................... 595

33

Hypertension Therapy Norman M. Kaplan ................................................................................. 615

Part X. OTHER CONDITIONS AFFECTING THE HEART 34

Cardiomyopathies and Myocarditis Edward K. Kasper ................................................................................... 641

35

Pericardial Disease David H. Spodick .................................................................................... 653

36

Pulmonary Vascular Disease Dermot O’Callaghan and Sean P. Gaine .............................................. 661

37

Diseases of the Aorta Eric M. Isselbacher ................................................................................. 681

Part XI. ADDITIONAL TOPICS 38

Pregnancy and Cardiovascular Disease Samuel C. B. Siu and Jack M. Colman ................................................. 693

39

Heart Disease in the Elderly Michael W. Rich ...................................................................................... 705

40

Cardiovascular Complications in Patients With Renal Disease Richard A. Preston, Simon Chakko, and Murray Epstein .................. 729

41

Assessment of Patients With Heart Disease for Fitness for Noncardiac Surgery Joseph Savino and Lee A. Fleisher ....................................................... 747

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Contents 42

Cardiovascular Gene and Cell Therapy Eddy Kizana, Federica del Monte, Sian E. Harding, and Roger J. Hajjar ........................................................................... 763

43

Preventive Cardiology Michael Miller ......................................................................................... 789

44

Peripheral Arterial Disease James J. Jang and Jonathan L. Halperin ............................................. 807

Index .................................................................................................................. 829

CONTRIBUTORS JONATHAN ABRAMS, MD • Interim Section Chief of Cardiology, Professor of Medicine, University of New Mexico, School of Medicine, Albuquerque, NM SATYA REDDY ATMAKURI, MD • Cardiology Fellow, The Methodist DeBakey Heart Center, Baylor College of Medicine, Houston, TX DAVID G. BENDITT, MD • Professor of Medicine, Cardiovascular Division, University of Minnesota Medical School, Minneapolis, MN NIRAT BEOHAR, MD • Assistant Professor of Medicine, Northwestern Cardiovascular Institute, Northwestern Memorial Hospital, Northwestern University, Chicago, IL ROBERT W. W. BIEDERMAN, MD, FACC • Director Cardiac MRI, Allegheny General Hospital; Assistant Professor of Medicine, Drexel College of Medicine, Pittsburgh, PA DANIEL G. BLANCHARD, MD, FACC • Professor of Medicine, University of California, San Diego, School of Medicine, and UCSD Medical Center; Director, Cardiology Fellowship Program and Chief of Clinical Cardiology, UCSD Thornton Hospital, San Diego, CA EDMUND A. W. BRICE, MB ChB, PhD, FCP (SA) • Senior Lecturer, Department of Medicine, University of Stellenbosch; Cardiologist, Tygerberg Academic Hospital, Cape Town, South Africa JAMES F. BURKE, MD, FACC • Clinical Assistant Professor of Medicine, Jefferson Medical College, Philadelphia; Director, Cardiovascular Disease Fellowship Program, The Lankenau Hospital, Wynnewood, PA CHRISTOPHER P. CANNON, MD • Associate Professor of Medicine, Cardiovascular Division, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA SIMON CHAKKO, MD, FACP, FACC • Chief, Cardiology Section, Miami Veterans Affairs Medical Center; Professor of Medicine, Department of Medicine, University of Miami School of Medicine, Miami, FL PATRICK M. COLLETTI, MD • Professor of Radiology, University of Southern California, Keck School of Medicine; Chief of MRI, USC Imaging Science Center, Los Angeles, CA JACK M. COLMAN, MD, FRCPC, FACC • Staff Cardiologist, University Health Network and Mount Sinai Hospitals; Staff Cardiologist, Toronto Congenital Cardiac Centre for Adults; Associate Professor (Medicine), University of Toronto, Toronto, Canada PATRICK J. COMMERFORD, MB ChB, FCP (SA) • Professor and Head of the Division of Cardiology, University of Cape Town; New Groote Schuur Hospital, Cape Town, South Africa CHARLES J. DAVIDSON, MD • Professor of Medicine, Northwestern Cardiovascular Institute, Northwestern Memorial Hospital, Northwestern University, Chicago, IL FEDERICA DEL MONTE, MD, PhD • Cardiology Division, Harvard Medical School; Cardiology Laboratory of Integrative Physiology and Imaging, Massachusetts General Hospital; Cardiovascular Research Center, Charlestown, MA ANTHONY N. DEMARIA, MD • Professor of Medicine, Judith and Jack White Chair in Cardiology, Division of Cardiovascular Medicine, University of California, San Diego, School of Medicine; Director, Cardiovascular Center, UCSD Medical Center, San Diego, CA xiii

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Contributors

RAJAT DEO, MD • Cardiology Fellow, University of Texas Southwestern Medical Center, Dallas, TX TARA L. DIMINO, MD • Cardiology Fellow, The Lankenau Hospital and Institute for Medical Research, Wynnewood, PA MARK DOYLE, PhD • Cardiac MRI Physicist, Allegheny General Hospital, Pittsburgh, PA GREGORY ENGEL, MD • Cardiology Fellow, Cardiac Electrophysiology, Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, CA MURRAY EPSTEIN, MD • Professor of Medicine, Department of Medicine, University of Miami School of Medicine, Miami, FL JOHN FARMER, MD • Associate Professor of Medicine, Baylor College of Medicine; Chief, Section of Cardiology, Ben Taub Hospital, Houston, TX JONATHAN E. E. FISHER, MD • Department of Medicine (Cardiology), Mount Sinai School of Medicine, New York, NY LEE A. FLEISHER, MD, FACC • Robert D. Dripps Professor and Chair, Department of Anesthesia, University of Pennsylvania School of Medicine, Philadelphia, PA VICTOR FROELICHER, MD • Professor of Medicine, Stanford University School of Medicine; Cardiology Division, VA Palo Alto Health Care Systems, Palo Alto, CA SEAN P. GAINE, MD, PhD, FRCPI • Consultant Respiratory Physician, National Pulmonary Hypertension Unit, Mater Misericordiae Hospital, University College Dublin, Dublin, Ireland MICHAEL H. GOLLOB, MD, FRCPC • Assistant Professor, Department of Medicine, University of Ottawa, Ottawa, Canada MARTIN E. GOLDMAN, MD • Dr. Arthur and Hilda Master Professor of Medicine (Cardiology); Director, Echocardiography Laboratory, Zena and Michael A. Wiener Cardiovascular Institute, Marie-Josee and Henry R. Kravis Center for Cardiovascular Health, Mount Sinai School of Medicine, New York, NY STEPHEN S. GOTTLIEB, MD • Professor of Medicine, University of Maryland School of Medicine; Director, Heart Failure and Transplantation, University of Maryland Hospital, Baltimore, MD ANTONIO M. GOTTO, JR., MD, DPhil • The Stephen and Suzanne Weiss Dean, Professor of Medicine, Weill Medical College of Cornell University, New York, NY ROGER J. HAJJAR, MD, FACC • Associate Professor of Medicine, Harvard Medical School; Director, Cardiology Laboratory of Integrative Physiology and Imaging, Massachusetts General Hospital, Cardiovascular Research Center, Charlestown, MA JONATHAN L. HALPERIN, MD • Robert and Harriet Heilbrunn Professor of Medicine (Cardiology), Mount Sinai School of Medicine; Director, Clinical Cardiology Services, The Zena and Michael A. Weiner, Cardiovascular Institute, The Marie-Josée and Henry R. Kravis Center for Cardiovascular Health, New York, New York SIAN E. HARDING, PhD • Professor, National Heart Lung Institute, Imperial College, London, United Kingdom ROBERT J. HENNING, MD, FACP, FCCP, FACC • Professor of Medicine, Division of Cardiology, Department of Medicine, University of South Florida College of Medicine; James A. Haley Hospital, Moffitt Hospital, and Tampa General Hospital, Tampa, FL JULIEN I. E. HOFFMAN, MD • Professor Emeritus, University of California, San Francisco, CA ERIC M. ISSELBACHER, MD • Medical Director, Thoracic Aortic Center, Massachusetts General Hospital; Assistant Professor of Medicine, Harvard Medical School, Boston, MA

Contributors

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ALEXANDER IVANOV, MD • Attending, Somerset Medical Center, Somerville; and Robert Wood Johnson University Hospital, New Brunswick, NJ SEI IWAI, MD • Assistant Professor of Medicine, Weill Medical College of Cornell University, New York, NY DIWAKAR JAIN, MD • Professor of Medicine, Director, Nuclear Cardiology Laboratory, Section of Cardiovascular Medicine, Drexel University College of Medicine, Philadelphia, PA JAMES J. JANG, MD • Cardiology Fellow, Mount Sinai Medical Center, New York, NY WILLIAM B. KANNEL, MD, MPH, FACC • Professor of Medicine and Public Health, Framingham Study/Boston University School of Medicine, Framingham, MA NORMAN M. KAPLAN, MD • Clinical Professor of Medicine, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX ADOLF W. KARCHMER, MD • Professor of Medicine, Harvard Medical School;Chief, Division of Infectious Diseases, Beth Israel Deaconess Medical Center, Boston, MA EDWARD K. KASPER, MD, FACC • Associate Professor of Medicine, Chief, Cardiology Division, Johns Hopkins Bayview Medical Center, Baltimore, MD ARNOLD M. KATZ, MD, DMed (Hon), FACP, FACC • Professor of Medicine Emeritus, University of Connecticut School of Medicine, Farmington, CT; Visiting Professor of Medicine and Physiology, Dartmouth Medical School, Hanover, NH EDDY KIZANA, MB BS, FRACP • Department of Cardiology and Gene Therapy Research Unit, Westmead Hospital, Westmead, New South Wales, Australia NEAL S. KLEIMAN, MD • Associate Professor of Medicine, Director, Cardiac Catheterization Laboratories, The Methodist DeBakey Heart Center, Baylor College of Medicine, Houston, TX PETER R. KOWEY, MD, FACC • Professor of Medicine, Jefferson Medical College, Philadelphia; Chief, Division of Cardiovascular Disease, Main Line Health Heart Center, Lankenau, Bryn Mawr; and Paoli Hospitals, Wynnewood, PA JAMES A. DE LEMOS, MD • Coronary Care Unit Director, Parkland Memorial Hospital; Associate Professor of Medicine, University of Texas Southwestern Medical Center, Dallas, TX BRUCE B. LERMAN, MD • Hilda Altschul Master Professor of Medicine; Chief, the Maurice and Corinne Greenberg Division of Cardiology; Director, Cardiac Electrophysiology Laboratory, Weill Medical College of Cornell University, New York, NY FEI LÜ, MD, PhD • Assistant Professor of Medicine, Cardiovascular Division, Department of Medicine, University of Minnesota Medical School; Director, Cardiac Electrophysiology Laboratory, Fairview-University Medical Center, Minneapolis, MN STEVEN M. MARKOWITZ, MD • Associate Professor of Medicine, Assistant Director, Cardiac Electrophysiology Laboratory, Weill Medical College of Cornell University, New York, NY DAVENDRA MEHTA, MD, PhD, FRCP, FACC • Director, Cardiac Electrophysiology Section, Cardiovascular Institute; Associate Professor of Medicine, Mount Sinai School of Medicine, New York, NY MICHAEL MILLER, MD, FACC, FAHA • Associate Professor of Medicine, Epidemiology, and Preventive Medicine; Director, Center for Preventive Cardiology, University of Maryland Medical Center, Baltimore, MD SUNEET MITTAL, MD • Associate Professor of Medicine, Weill Medical College of Cornell University, New York, NY YALE NEMERSON, MD • Phillip J. and Harriet L. Goodhart Professor of Medicine, Professor of Biochemistry, Mount Sinai School of Medicine, New York, NY

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Contributors

DERMOT O’CALLAGHAN, MD • Specialist Registrar in Respiratory Medicine, National Pulmonary Hypertension Unit, Mater Misericordiae University Hospital, University College Dublin, Dublin, Ireland RAY A. OLSSON, MD, FACP, FACC, Ch Chem, FRSC • Professor of Medicine, Ed C. Wright Professor of Cardiovascular Research, Department of Internal Medicine, University of South Florida College of Medicine, Tampa, FL LIONEL H. OPIE, MD, DPhil, FRCP • Professor of Medicine, Department of Medicine, University of Cape Town Medical School; Director, Hatter Institute, Cape Heart Center, Cape Town, South Africa JOSEPH P. ORNATO • MD, FACP, FACC, FACEP • Professor and Chairman, Department of Emergency Medicine, Virginia Commonwealth University Medical Center, Richmond, VA FREDRIC J. PASHKOW, MD • Clinical Professor of Medicine, Department of Medicine, John A. Burns School of Medicine, University of Hawaii; Senior Medical Director, Cardiovascular Thrombosis Medical Affairs, Sanofi-Aventis, Honolulu, HI GERALD M. POHOST, MD • Chief of Cardiovascular Medicine, University of Southern California, Division of Cardiovascular Medicine, Los Angeles, CA PHILIP A. POOLE-WILSON, MD, FRCP, FESC, FACC • Professor of Cardiology, Department of Cardiac Medicine, National Heart and Lung Institute, Imperial College, London, London, United Kingdom RICHARD A. PRESTON, MD, MBA • Director, Division of Clinical Pharmacology, Department of Medicine, University of Miami School of Medicine, Miami, FL IAN F. PURCELL, MD, MRCP • Consultant Cardiologist, Freeman Hospital, Newcastle upon Tyne, United Kingdom GAUTHAM P. REDDY, MD, MPH • Assistant Professor of Radiology, University of California, San Francisco, San Francisco, CA MARK J. RICCIARDI, MD • Assistant Professor of Medicine, Northwestern Cardiovascular Institute, Northwestern Memorial Hospital, Northwestern University, Chicago, IL, MICHAEL W. RICH, MD • Associate Professor of Medicine, Cardiovascular Division, Department of Medicine, Washington University School of Medicine; Director, Cardiac Rapid Evaluation Unit, Barnes-Jewish Hospital, St. Louis, MO CLIVE ROSENDORFF, MD, PhD, FRCP, FACP, FACC • Professor of Medicine, Zena and Michael A. Wiener Cardiovascular Institute, Mount Sinai School of Medicine, New York; VA Medical Center, Bronx, NY SCOTT SAKAGUCHI, MD • Associate Professor of Medicine, Cardiovascular Division, Department of Medicine; Director, Cardiac Electrophysiology Fellowship Program, University of Minnesota Medical School, Minneapolis, MN RADHA J. SARMA, MD, FACC, FAHA, FACP • Associate Professor of Clinical Medicine, University of Southern California, Keck School of Medicine; Director, Exercise Lab, and Associate Director of Echocardiography Lab, LAC and USC Medical Center, Los Angeles, CA JOSEPH SAVINO, MD • Associate Professor, Department of Anesthesia, University of Pennsylvania School of Medicine, Philadelphia, PA MARK SCOOTE, MB BS, BSc, MRCP • British Heart Foundation Clinical Research Fellow, Department of Cardiac Medicine, National Heart and Lung Institute, Imperial College London, London, United Kingdom PREDIMAN K. SHAH, MD • Shapell and Webb Chair and Director, Division of Cardiology and Atherosclerosis Research Center, Cedars Sinai Medical Center; Professor of Medicine, David Geffen School of Medicine, UCLA, Los Angeles, CA

Contributors

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SAMUEL C. B. SIU, MD, SM, FRCPC, FACC • Staff Cardiologist, Toronto Congenital Cardiac Centre for Adults; Director of Echocardiography, University Health Network and Mount Sinai Hospitals; Associate Professor (Medicine), University of Toronto, Toronto, Ontario DAVID H. SPODICK, MD, DSc, FACC, FAHA, MACP • Professor of Medicine, Cardiovascular Division, University of Massachusetts Medical School, Worcester, MA KENNETH M. STEIN, MD • Associate Professor of Medicine, Associate Director, Cardiac Electrophysiology Laboratory, Weill Medical College of Cornell University, New York, NY ROBERT M. STEINER, MD • Professor of Radiology, Temple University School of Medicine; Attending Radiologist Temple University Hospital, Philadelphia, PA H. J. C. SWAN, MD, PhD • Professor of Medicine (Emeritus), UCLA School of Medicine; Director (Emeritus) Division of Cardiology, Cedars-Sinai Medical Center, Los Angeles, CA (Deceased) MARK B. TAUBMAN, MD • Professor of Medicine and Chief of Cardiology; Director, Center for Cellular and Molecular Cardiology, University of Rochester School of Medicine and Dentistry, Rochester, NY BARRY L. ZARET, MD • Robert W. Berliner Professor of Medicine, Professor of Diagnostic Radiology; Chief, Section of Cardiovascular Medicine; Associate Chairman for Clinical Affairs, Department of Internal Medicine, Yale University School of Medicine, New Haven, CT

COLOR PLATES Color Plates follow p. 268. COLOR PLATE 1

COLOR PLATE 2

COLOR PLATE 3

COLOR PLATE 4

COLOR PLATE 5

COLOR PLATE 6

COLOR PLATE 7

Apical four-chamber images with color-flow Doppler during diastole and systole. Red flow indicates movement toward the transducer (diastolic filling); blue flow indicates movement away from the transducer (systolic ejection). RA, right atrium; RV, right ventricle; LV, left ventricle. (Chapter 9, Fig. 5; see full caption discussion on pp. 143–144. From ref. 1, with permission.) Parasternal long-axis image showing a multicolored jet (indicating turbulent flow) of aortic regurgitation in the left ventricular outflow tract. The jet is narrow in width, suggesting mild regurgitation. AO, aorta; LA, left atrium; LV, left ventricle. (Chapter 9, Fig. 11A; see complete figure and caption on p. 151 and discussion on pp. 150–151. From ref. 1, with permission.) Parasternal long-axis view in a case of severe mitral regurgitation. The color Doppler jet is directed posteriorly and is eccentric (black arrows). The jet “hugs” the wall of the left atrium (LA) and wraps around all the way to the aortic root (white arrows). LV, left ventricle. (Chapter 9, Fig. 13; see full caption on p. 154 and discussion on p. 152. From ref. 1, with permission.) Apical four-chamber view of an ostium secundum atrial septal defect. On the left, a defect in the mid-atrial septum is present (arrows). On the right, there is color flow through the shunt. RA, right atrium; RV, right ventricle; LA, left atrium; LV, left ventricle. (Chapter 9, Fig. 22A; see complete figure and caption on p. 164 and discussion on pp. 162–163. From ref. 1, with permission.) Exercise (Ex) and rest (R) 99mTc- sestamibi and exercise 18FDG (Isch) images of a 67-yr-old man with angina and no prior myocardial infarction. There is a large area of partially reversible perfusion abnormality involving the septum, anterior wall, and apex (small arrows). Intense 18FDG uptake is present in these areas (solid arrowheads). Coronary angiography showed 90% stenosis of the left anterior descending coronary artery and a 60% stenosis of the left circumflex artery. (Chapter 13, Fig. 10; see full caption on p. 239 and discussion on 238. Reproduced with permission from ref. 71.) Right atrial electroanatomical mapping of automatic atrial tachycardia. Timing of atrial electrograms is color-coded. Red areas represent sites of early activation. Application of radiofrequency current (blue dots) at the earliest site lead to termination of tachycardia. (Chapter 17, Fig. 2; see full caption on p. 311 and discussion on p. 310.) Color-flow Doppler echocardiography demonstrates the high-velocity jet entering the left ventricle (arrow). (Chapter 30, Fig. 4; see full caption on p. 551 and discussion on p. 550.)

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