Pathophysiology of Heart Disease: A Collaborative Project of Medical Students and Faculty , Fifth Edition

478 Pages·2010·24.84 MB·English

by  Leonard S. Lilly

This page intentionally left blank.
7777223377__ffmm..iinndddd iiii 88//1111//1100 88::2266::0055 AAMM
Pathophysiology
of Heart Disease
A Collaborative Project
of Medical Students
and Faculty
FIFTH EDITION
7777223377__ffmm..iinndddd ii 88//1111//1100 88::2266::0044 AAMM
This page intentionally left blank.
7777223377__ffmm..iinndddd iiii 88//1111//1100 88::2266::0055 AAMM
E d i t i o n
5
Pathophysiology
of Heart Disease
A Collaborative Project
of Medical Students
and Faculty
Editor
Leonard S. Lilly, MD
Professor of Medicine
Harvard Medical School
Chief, Brigham and Women’s/Faulkner Cardiology
Brigham and Women’s Hospital
Boston, Massachusetts
7777223377__ffmm..iinndddd iiiiii 88//1111//1100 88::2266::0055 AAMM
Acquisitions Editor: Crystal Taylor
Product Manager: Julie Montalbano
Design and Art Direction: Doug Smock, Jennifer Clements
Production & Composition: MPS Limited, A Macmillan Company
5th Edition
Copyright © 2011, 2007, 2003, 1998, 1993 Lippincott Williams & Wilkins, a Wolters Kluwer business.
351 West Camden Street Two Commerce Square
Baltimore, MD 21201 2001 Market Street
Philadelphia, PA 19103
Printed in China.
All rights reserved. This book is protected by copyright. No part of this book may be reproduced or transmitted in
any form or by any means, including as photocopies or scanned-in or other electronic copies, or utilized by any
information storage and retrieval system without written permission from the copyright owner, except for brief
quotations embodied in critical articles and reviews. Materials appearing in this book prepared by individuals as
part of their offi cial duties as U.S. government employees are not covered by the above-mentioned copyright. To
request permission, please contact Lippincott Williams & Wilkins at Two Commerce Square, 2001 Market Street,
Philadelphia, PA 19103, via email at [email protected], or via website at lww.com (products and services).
9 8 7 6 5 4 3 2 1
Library of Congress Cataloging-in-Publication Data
Pathophysiology of heart disease : a collaborative project of medical students and faculty / editor Leonard S. Lilly.—
5th ed.
p. ; cm.
Includes bibliographical references and index.
ISBN 978-1-60547-723-7
1. Heart—Pathophysiology. I. Lilly, Leonard S. II. Harvard Medical School.
[DNLM: 1. Heart Diseases—physiopathology. WG 210]
RC682.9.P255 2011
616.1’207—dc22
2010029159
DISCLAIMER
Care has been taken to confi rm the accuracy of the information present and to describe generally accepted
practices. However, the authors, editors, and publisher are not responsible for errors or omissions or for any conse-
quences from application of the information in this book and make no warranty, expressed or implied, with respect
to the currency, completeness, or accuracy of the contents of the publication. Application of this information in a
particular situation remains the professional responsibility of the practitioner; the clinical treatments described and
recommended may not be considered absolute and universal recommendations.
The authors, editors, and publisher have exerted every effort to ensure that drug selection and dosage set forth
in this text are in accordance with the current recommendations and practice at the time of publication. However, in
view of ongoing research, changes in government regulations, and the constant fl ow of information relating to drug
therapy and drug reactions, the reader is urged to check the package insert for each drug for any change in indica-
tions and dosage and for added warnings and precautions. This is particularly important when the recommended
agent is a new or infrequently employed drug.
Some drugs and medical devices presented in this publication have Food and Drug Administration (FDA) clear-
ance for limited use in restricted research settings. It is the responsibility of the health care provider to ascertain the
FDA status of each drug or device planned for use in their clinical practice.
To purchase additional copies of this book, call our customer service department at [phone] or fax orders to
[phone]. International customers should call [phone].
Visit Lippincott Williams & Wilkins on the Internet: http://www.lww.com. Lippincott Williams & Wilkins
customer service representatives are available from 8:30 am to 6:00 pm, EST.
7777223377__ffmm..iinndddd iivv 88//1111//1100 88::2266::0055 AAMM
Dedicated in Loving Memory of My Father
DAVID LILLY
(1922–2009)
7777223377__ffmm..iinndddd vv 88//1111//1100 88::2266::0055 AAMM
This page intentionally left blank.
7777223377__ffmm..iinndddd vvii 88//1111//1100 88::2266::0055 AAMM
Foreword
It is axiomatic that when designing any prod- cardiologist at the Brigham and Women’s and
uct or service, the needs of the prospective Faulkner Hospitals, has served as the leader of
user must receive primary consideration. Re- this project. He has brought together a group
grettably, this is rarely the case with medical of talented Harvard medical students and fac-
textbooks, which play a vital role in the edu- ulty who have collaborated closely to produce
cation of students, residents, fellows, practic- this superb introductory text specifi cally de-
ing physicians, and paramedical professionals. signed to meet the needs of medical students
Most books are written for anyone who will during their initial encounters with patients
read—or preferably buy—them. As a conse- with heart disease. While Pathophysiology of
quence, they often provide a little for every- Heart Disease is not meant to be encyclopedic
one but not enough for anyone. Many medical or all inclusive, it is remarkably thorough.
textbooks are reminiscent of the one-room Quite appropriately, the fi rst four editions of
schoolhouse, which included pupils ranging this fi ne book were received enthusiastically,
from the fi rst to the twelfth grade. The need to and Pathophysiology of Heart Disease is now a
deal with subject matter at enormously dispa- required or recommended text at many medi-
rate levels of sophistication interfered with the cal schools not only in the United States, but
educational process. also in other countries. It has been translated
Medical educators appreciate that the needs into other languages, has received two awards
of medical students exposed to a subject for of excellence from the American Medical
the fi rst time differ importantly from those Writers Association, and has inspired several
of practicing physicians who wish to review other student–faculty collaborative book proj-
an area learned previously or to be updated ects. This fi fth edition is not only an updated
on new developments in a fi eld with which but also an expanded version of the fourth edi-
they already have some familiarity. The lack tion. Many of the fi gures have been redrawn
of textbooks designed specifi cally for students and enhanced to display complex concepts in
leads faculty at schools around the country to uncomplicated ways. As such, it will prove to
spend countless hours preparing and duplicat- be even more valuable than its predecessors.
ing voluminous lecture notes, and providing Dr. Lilly and his colleagues—both faculty
students with custom-designed “camels” (a and students—have made a signifi cant and
camel is a cow created by a committee!). unique contribution in preparing this im-
Pathophysiology of Heart Disease: A Col- portant book. Future generations of medical
laborative Project of Medical Students and educators and students, and ultimately the pa-
Faculty, represents a refreshing and innova- tients that they serve, will be indebted to them
tive departure in the preparation of a medical for this important contribution.
text. Students—that is, potential consumers— EUGENE BRAUNWALD, MD
dissatisfi ed with currently available textbooks Distinguished Hersey Professor of Medicine
on cardiology, made their needs clear. For- Harvard Medical School
tunately, their pleas fell on receptive ears. Boston, Massachusetts
Dr. Leonard Lilly, a Professor of Medicine
at Harvard Medical School, and a respected
vii
7777223377__ffmm..iinndddd vviiii 88//1111//1100 88::2266::0055 AAMM
This page intentionally left blank.