Table Of ContentThe ESC Textbook of
Intensive and Acute
Cardiovascular Care
EUROPEAN SOCIETY OF CARDIOLOGY PUBLICATIONS
The ESC Textbook of Cardiovascular Medicine (Third Edition)
Edited by A. John Camm, Thomas F. Lüscher, Gerald Maurer, and Patrick W. Serruys
The ESC Textbook of Preventive Cardiology
Edited by Stephan Gielen, Guy De Backer, Massimo Piepoli, and David Wood
The EHRA Book of Pacemaker, ICD, and CRT Troubleshooting: Case-b ased learning
with multiple choice questions
Edited by Harran Burri, Carsten Israel, and Jean- Claude Deharo
The EACVI Echo Handbook
Edited by Patrizio Lancellotti and Bernard Cosyns
The ESC Handbook of Preventive Cardiology: Putting prevention into practice
Edited by Catriona Jennings, Ian Graham, and Stephan Gielen
The EACVI Textbook of Echocardiography (Second Edition)
Edited by Patrizio Lancellotti, José Luis Zamorano, Gilbert Habib, and Luigi Badano
The EHRA Book of Interventional Electrophysiology: Case-b ased learning with
multiple choice questions
Edited by Hein Heidbuchel, Matthias Duytschaever, and Harran Burri
The ESC Textbook of Vascular Biology
Edited by Robert Krams and Magnus Bäck
The ESC Textbook of Cardiovascular Development
Edited by José Maria Pérez- Pomares and Robert Kelly
The EACVI Textbook of Cardiovascular Magnetic Resonance
Edited by Massimo Lombardi, Sven Plein, Steffen Petersen, Chiara Bucciarelli- Ducci,
Emanuela R. Valsangiacomo Buechel, Cristina Basso, and Victor Ferrari
The ESC Textbook of Sports Cardiology
Edited by Antonio Pelliccia, Hein Heidbuchel, Domenico Corrado, Mats Börjesson, and
Sanjay Sharma
The ESC Handbook of Cardiac Rehabilitation
Edited by Ana Abreu, Jean- Paul Schmid, and Massimo Piepoli
The ESC Textbook of Intensive and Acute Cardiovascular Care (Third Edition)
Edited by Marco Tubaro, Pascal Vranckx, Eric Bonnefoy-Cudraz, Susanna Price, and Christiaan Vrints
FORTHCOMING
The ESC Textbook of Cardiovascular Imaging (Third Edition)
Edited by José Luis Zamorano, Jeroen Bax, Juhani Knuuti, Patrizio Lancellotti, Bogdan
Popescu, Fausto Pinto, and Udo Sechtem
The ESC Textbook of
Intensive
and Acute
Cardiovascular
Care
THIRD EDITION
EDITORS
Marco Tubaro
Pascal Vranckx
CO-E DITORS
Eric Bonnefoy-Cudraz
Susanna Price
Christiaan Vrints
1
3
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First Edition published in 2011
Second Edition published in 2015
Third Edition published in 2021
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DOI: 10.1093/ med/ 9780198849346.001.0001
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Preface
Intensive cardiac care (procedures) saves lives and reduce car- ACVC has expanded the recommended treatment from a pre-
diac disability in acute cardiac patients. This treatment is to be vious focus on in-hospital intensive care, with emphasis on the
delivered by specially trained and accredited cardiologists, nurses intensive cardiac care units (ICCUs), to intensive and acute car-
and paramedics working in specially designed and equipped fa- diovascular care wherever it is needed (including pre-hospital,
cilities. The urgent nature of some acute cardiac presentations ambulances, emergency rooms, ICCUs, wards, operating theaters,
dictates the need to apply acute cardiac care as early as possible, etc.). This is in accord with the realization of the need for a con-
at the prehospital and or emergency room scenario. Prompt and tinuum mode of treatment and the incorporation of the specific
accurate diagnosis, meticulous monitoring and urgent treat- groups under the ACVC. Therefore, the effort for this new edition
ment are indicated in a wide variety of cardiovascular condi- of the ESC Textbook of Acute and Intensive Cardiovascular Care is
tions, including acute coronary syndromes, acute decompensated timely and highly appreciated.
heart failure, life-threatening rhythm disturbances, myocarditis, For simplicity and consecutiveness, the table of contents in
pulmonary embolism, infective endocarditis, as well as compli- the current edition has been maintained similar to that of the
cations of cardiac interventions and other acute maladies (i.e. second edition. However, the content has been improved and
infection, haemorrhage, trauma) whereby chronic heart disease updated and a new chapter (Chapter 50) is now fully dedicated
may jeopardize the short-term prognosis. to implanted cardiac support devices. A special mention is to be
The Association for Acute CardioVascular Care (ACVC) of dedicated to Chapter 3 on ‘Intensive Cardiovascular Care Units:
the European Society of Cardiology (ESC) has set out to pi- structure, organization and staffing’ which reflects the reality that
oneer this subspeciality of cardiology. The ESC Textbook of three levels of acute cardiac care may function in different hos-
Intensive and Acute Cardiovascular Care is a major asset. It is pitals. Some can apply only limited acute coronary care, while
the only textbook completely dedicated to the field of acute car- others can provide the full scope of advanced, comprehensive, in-
diovascular and intensive care. It contains all the basic neces- tensive, and acute cardiac care (level III).
sary comprehensive, yet practical information needed for the As in the previous editions, the print textbook is accompanied
optimal implementation of acute cardiac care. This includes by an expanded and more comprehensive online edition, which is
the recommended organization and function of the service, de- expected to be yearly updated.
tailed description of the laboratory tests, special cardiac evalu- The editors and authors of the third edition of the ESC Textbook
ation techniques, procedures, pharmacological and invasive of Intensive and Acute Cardiovascular Care should be congratu-
therapeutic interventions used for the practice of intensive car- lated on the completion of this major task. I am confident that this
diac care. A detailed description and recommendations for the endeavor will contribute to the daily conductance of acute cardiac
management of the various diseases in need for acute cardiac care and provide mandatory learning material for the education
care is also included. of cardiologists and allied staff training in the field.
Cardiology in general, and specifically the field of intensive car-
diac care, is constantly evolving. There is a constant new inflow of Professor Yonathan Hasin
information, introduction of updated evidence-based guidelines Founding chairperson of the Working Group on Acute Cardiac
and new and improved therapeutic techniques (including organ Care of the ESC
supportive therapy for the critically ill patients). Currently, the Ariel University Medical School
Contents
Symbols and abbreviations xi SECTION II
Contributors xxix The pre- hospital phase and the emergency
department
1 Intensive and acute cardiovascular care: an
introduction 1 8 The emergency medical system 65
Eric Bonnefoy-Cudraz, Susanna Price, Marco Tubaro, Olivier Hoogmartens, Michiel Stiers, Koen Bronselaer,
Pascal Vranckx, and Christiaan Vrints and Marc Sabbe
9 Out- of- hospital cardiac arrest 76
Jerry P Nolan and Christian Hassager
SECTION I
10 Chest pain in the emergency department and the
Intensive and acute cardiovascular care
chest pain unit 88
Christiaan Vrints, Janina Stepinska, and Marc J Claeys
2 Training and certification in intensive and acute
cardiovascular care 5 11 Acute dyspnoea in the emergency
Susanna Price and Eric Bonnefoy-Cudraz department 103
Eleni Michou, Nikola Kozhuharov, Jasmin Martin, and
3 Intensive cardiovascular care units: structure,
Christian Mueller
organization, and staffing 11
Eric Bonnefoy-Cudraz and Tom Quinn
4 The heart team 25 SECTION III
Sergio Leonardi, Thomas Modine, and Stephan
Monitoring and investigations in the
Windecker
intensive cardiovascular care unit
5 Patient safety and clinical governance 33
Matthew Parkin and Tom Quinn
12 Pathophysiology and clinical assessment of the
6 Ethical issues in cardiac arrest and acute cardiac cardiovascular system (including pulmonary
care: a European perspective 43 artery catheterization) 115
Jean- Louis Vincent and Jacques Creteur Alessandro Sionis, Etienne Gayat, and
Alexandre Mebazaa
7 Quality of care assessment in acute
cardiac care 54 13 The respiratory system 127
Fiona Ecarnot and François Schiele Antoine Vieillard- Baron
viii Contents
14 Neurological assessment of the acute cardiac 26 Chest tubes 331
care patient 134 Giulio Maurizi, Camilla Vanni, and Erino Angelo Rendina
Mathieu van der Jagt, Jeroen JH Bunge, and
27 Renal support therapy 338
Fabio S Taccone
Claudio Ronco, Stefano Romagnoli, and Zaccaria Ricci
15 Monitoring of the kidneys, liver, and other
28 Percutaneous (short- term) mechanical circulatory
vital organs 147
support 351
Karl Werdan, Brijesh Patel, Matthias Girndt, Henning
Holger Thiele and Pascal Vranckx
Ebelt, Jochen Schröder, and Sebastian Nuding
16 Blood gas analysis: acid– base, fluid, and 29 Nutrition support in acute cardiac care 360
Michael P Casaer and Greet Van den Berghe
electrolyte disorders 165
Farah Shariff and Richard Paul 30 Physiotherapy in critically ill patients 373
Rik Gosselink and Jean Roeseler
17 Interpretation and clinical use of chest
radiographs 181
Alexander Parkhomenko, Olga S Gurjeva, and
Tetyana Yalynska SECTION V
18.1 Echocardiography and thoracic ultrasound 201 The laboratory in intensive and acute
Frank A Flachskampf, Pavlos Myrianthefs, and cardiovascular care
Ruxandra Beyer
31 The use of biomarkers for acute cardiovascular
18.2 Echocardiography and thoracic ultrasound 218
Frank A Flachskampf, Pavlos Myrianthefs, and disease 387
Allan S Jaffe
Ruxandra Beyer
19 Computerized tomography: coronary angiography 32 Biomarkers in acute coronary syndromes 400
Jasper Boeddinghaus, Thomas Nestelberger,
and cardiac imaging 224
Raphael Twerenbold, and Christian Mueller
Jeff M Smit, Mohammed El Mahdiui, Michiel A de Graaf,
Arthur JHA Scholte, Lucia Kroft, and Jeroen J Bax 33 Biomarkers in acute heart failure 409
Rajiv Choudhary, Nicholas Wettersten, Kevin Shah, and
20 Cardiac magnetic resonance in the intensive and
Alan Maisel
cardiac care unit 246
Juerg Schwitter and Jens Bremerich 34 Biomarkers of coagulation and thrombosis 425
Anne- Mette Hvas, Erik L Grove, and
Steen Dalby Kristensen
SECTION IV 35 Biomarkers of renal and hepatic failure 434
Mario Plebani, Monica Maria Mion, and
Procedures in the intensive cardiovascular
Martina Zaninotto
care unit
21 Non- invasive ventilation 267
Josep Masip, Kenneth Planas, and Arantxa Mas SECTION VI
22 Mechanical ventilation 284 Acute coronary syndromes
Luigi Camporota and Francesco Vasques
36 Atherosclerosis and thrombosis 447
23 Temporary pacing 306 Lina Badimon and Gemma Vilahur
Bulent Gorenek
37 The universal definition of myocardial
24 Ultrasound- guided vascular access in
infarction 463
intensive/ acute cardiac care 314 Kristian Thygesen, Joseph S Alpert, Allan S Jaffe, and
Richard Paul Harvey D White
25 Pericardiocentesis 323 38 ST- segment elevation myocardial infarction 479
Caterina C De Carlini and Stefano Maggiolini Borja Ibanez and Stefan James
Contents ix
39 Fibrinolytic, antiplatelet, and anticoagulant drugs 51 Donor organ management 691
in acute coronary syndromes 494 Arne P Neyrinck, Patrick Ferdinande, Dirk Van
Sigrun Halvorsen, Giuseppe Gargiulo, Marco Valgimigli, Raemdonck, and Marc Van de Velde
and Kurt Huber
52 Palliative care in the intensive cardiovascular
40 Mechanical complications of myocardial care unit 706
infarction 513 Jayne Wood
Elena Puerto and Héctor Bueno
41 Non- ST- segment elevation acute coronary
syndromes 531 SECTION VIII
Héctor Bueno and José A Barrabés Arrhythmias
42 Percutaneous coronary interventions in acute
53 Atrial fibrillation and supraventricular
coronary syndromes 549
Andreas Mitsis and Marco Valgimigli arrhythmias 719
Demosthenes G Katritsis and A John Camm
43 Coronary artery bypass graft surgery 565
Piroze M Davierwala and Michael A Borger 54 Ventricular tachyarrhythmias 740
Paolo Della Bella, Dagmara Dilling, and Francesca Baratto
44 Sex considerations in acute coronary
syndromes 585 55 Pacemaker and ICDs: troubleshooting 755
Neasa Starr and Haran Burri
Eva Swahn, Joakim Alfredsson, and
Sofia Sederholm Lawesson
SECTION IX
SECTION VII Specific acute cardiovascular conditions
Acute heart failure (including cardiogenic
56 Myocarditis and pericarditis 767
shock)
Massimo Imazio and Stephane Heymans
45 Acute heart failure: epidemiology, classification, 57 Acute valve disease and endocarditis 778
and pathophysiology 603 Gregory Ducrocq, Franck Thuny, Bernard Iung,
Dimitrios Farmakis and Gerasimos Filippatos and Alec Vahanian
46 Acute heart failure: early pharmacological 58 Congenital heart disease in adults 795
therapy 617 Susanna Price, Brian F Keogh, and Lorna Swan
Kieran F Docherty, Jonathan R Dalzell, Mark C Petrie, and
59 Aortic emergencies 805
John JV McMurray
Marc Schepens and Eric Graulus
47 Low cardiac output states and cardiogenic
60 Cardiac complications in trauma 820
shock 633 Lydia Lam, Leslie Kobayashi, and Demetrios Demetriades
Holger Thiele and Suzanne de Waha- Thiele
61 Cardiac emergencies in pregnancy 830
48 Non- pharmacological therapy of acute heart
Mark Johnson and Jolien Roos- Hesselink
failure: when drugs alone are not enough 651
Jeroen Dauw, Wilfried Mullens, Johan Vijgen, 62 Pulmonary hypertension 839
and Pascal Vranckx Massimiliano Palazzini, Nazzareno Galiè, and
Alessandra Manes
49 Heart failure surgery and transplantation 664
Felix Schoenrath, Jan Klages, and Volkmar Falk 63 Pulmonary embolism 849
Stavros Konstantinides, Marcin Kurzyna, and Adam
50 Implanted cardiac support devices 680 Torbicki
Andrew C Morley- Smith, André R Simon, and
John Pepper
