Harrison's Cardiovascular Medicine 2/E

657 Pages·2013·45.31 MB·English

by  Loscalzo, Joseph

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2nd Edition
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HARRISON S
CardiovasCular
MediCine
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Derived from Harrison’s Principles of Internal Medicine, 18th Edition
Editors
Dan L. Longo, anthony s. Fauci,
md md
Professor of Medicine, Harvard Medical School; Chief, Laboratory of Immunoregulation;
Senior Physician, Brigham and Women’s Hospital; Director, National Institute of Allergy and Infectious Diseases,
Deputy Editor, New England Journal of Medicine, National Institutes of Health,
Boston, Massachusetts Bethesda, Maryland
DEnnis L. KaspEr, stEphEn L. hausEr,
md md
William Ellery Channing Professor of Medicine, Robert A. Fishman Distinguished Professor
Professor of Microbiology and Molecular Genetics, and Chairman, Department of Neurology,
Harvard Medical School; Director, Channing Laboratory, University of California, San Francisco,
Department of Medicine, Brigham and Women’s Hospital, San Francisco, California
Boston, Massachusetts
J. Larry JamEson, , JosEph LoscaLzo, ,
md phD md phD
Robert G. Dunlop Professor of Medicine; Hersey Professor of the Theory and Practice of Medicine,
Dean, University of Pennsylvania School of Medicine; Harvard Medical School; Chairman, Department of Medicine;
Executive Vice-President of the University of Pennsylvania Physician-in-Chief, Brigham and Women’s Hospital,
for the Health System, Philadelphia, Pennsylvania Boston, Massachusetts
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2nd Edition
’
TM
HARRISON S
CardiovasCular
MediCine
EDitor
Joseph Loscalzo, mD, phD
Hersey Professor of the Theory and Practice of Medicine, Harvard Medical School;
Chairman, Department of Medicine; Physician-in-Chief, Brigham and Women’s Hospital,
Boston, Massachusetts
New York Chicago San Francisco Lisbon London Madrid Mexico City
Milan New Delhi San Juan Seoul Singapore Sydney Toronto
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contents
Contributors . . . . . . . . . . . . . . . . . . . . . . . . . . . . .vii 13 Diagnostic Cardiac Catheterization and
Coronary Angiography . . . . . . . . . . . . . . . . . .117
Preface . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ix
Jane A. Leopold, David P. Faxon
SECTION I
SECTION III
IntroductIon to cardIovascular
Heart rHytHm dIsturbances
dIsorders
14 Principles of Electrophysiology . . . . . . . . . . . . .128
1 Basic Biology of the Cardiovascular System . . . . . .2 David D. Spragg, Gordon F. Tomaselli
Joseph Loscalzo, Peter Libby, Jonathan Epstein
15 The Bradyarrhythmias . . . . . . . . . . . . . . . . . . .137
2 Epidemiology of Cardiovascular Disease . . . . . . .20 David D. Spragg, Gordon F. Tomaselli
Thomas A. Gaziano, J. Michael Gaziano
16 The Tachyarrhythmias . . . . . . . . . . . . . . . . . . .151
3 Approach to the Patient with Possible Francis Marchlinski
Cardiovascular Disease . . . . . . . . . . . . . . . . . . . .28
Joseph Loscalzo
SECTION IV
dIsorders of tHe Heart
SECTION II
dIagnosIs of cardIovascular 17 Heart Failure and Cor Pulmonale . . . . . . . . . . .182
dIsorders Douglas L. Mann, Murali Chakinala
4 Chest Discomfort . . . . . . . . . . . . . . . . . . . . . . .34 18 Cardiac Transplantation and
Thomas H. Lee Prolonged Assisted Circulation . . . . . . . . . . . . .201
Sharon A. Hunt, Hari R. Mallidi
5 Dyspnea . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .42
Richard M. Schwartzstein 19 Congenital Heart Disease in the Adult . . . . . . .207
John S. Child, Jamil Aboulhosn
6 Hypoxia and Cyanosis . . . . . . . . . . . . . . . . . . . .49
Joseph Loscalzo 20 Valvular Heart Disease . . . . . . . . . . . . . . . . . . .219
Patrick O’Gara, Joseph Loscalzo
7 Edema . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .54
Eugene Braunwald, Joseph Loscalzo 21 Cardiomyopathy and Myocarditis . . . . . . . . . . .248
Lynne Warner Stevenson, Joseph Loscalzo
8 Palpitations . . . . . . . . . . . . . . . . . . . . . . . . . . . .61
Joseph Loscalzo 22 Pericardial Disease . . . . . . . . . . . . . . . . . . . . . .273
Eugene Braunwald
9 Physical Examination of
the Cardiovascular System . . . . . . . . . . . . . . . . .63 23 Tumors and Trauma of the Heart . . . . . . . . . . .284
Patrick T. O’Gara, Joseph Loscalzo Eric H. Awtry, Wilson S. Colucci
10 Approach to the Patient with a Heart Murmur . . .76 24 Cardiac Manifestations of Systemic Disease . . . .289
Patrick T. O’Gara, Joseph Loscalzo Eric H. Awtry, Wilson S. Colucci
11 Electrocardiography . . . . . . . . . . . . . . . . . . . . . .89 25 Infective Endocarditis . . . . . . . . . . . . . . . . . . .294
Ary L. Goldberger Adolf W. Karchmer
12 Noninvasive Cardiac Imaging: 26 Acute Rheumatic Fever . . . . . . . . . . . . . . . . . .309
Echocardiography, Nuclear Cardiology, Jonathan R. Carapetis
and MRI/CT Imaging. . . . . . . . . . . . . . . . . . .101
27 Chagas’ Disease . . . . . . . . . . . . . . . . . . . . . . . .316
Rick A. Nishimura, Panithaya Chareonthaitawee,
Louis V. Kirchhoff, Anis Rassi, Jr.
Matthew Martinez
v
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vi Contents
28 Cardiogenic Shock and Pulmonary Edema . . . .320 38 Diseases of the Aorta . . . . . . . . . . . . . . . . . . . .467
Judith S. Hochman, David H. Ingbar Mark A. Creager, Joseph Loscalzo
29 Cardiovascular Collapse, Cardiac Arrest, and 39 Vascular Diseases of the Extremities . . . . . . . . .476
Sudden Cardiac Death . . . . . . . . . . . . . . . . . . .328 Mark A. Creager, Joseph Loscalzo
Robert J. Myerburg, Agustin Castellanos
40 Pulmonary Hypertension . . . . . . . . . . . . . . . . .490
Stuart Rich
SECTION V
dIsorders of tHe vasculature
SECTION VI
30 The Pathogenesis, Prevention, and cardIovascular atlases
Treatment of Atherosclerosis . . . . . . . . . . . . . .340
41 Atlas of Electrocardiography . . . . . . . . . . . . . . .500
Peter Libby
Ary L. Goldberger
31 Disorders of Lipoprotein Metabolism . . . . . . . .353
42 Atlas of Noninvasive Cardiac Imaging . . . . . . .517
Daniel J. Rader, Helen H. Hobbs
Rick A. Nishimura, Panithaya Chareonthaitawee,
32 The Metabolic Syndrome . . . . . . . . . . . . . . . .377 Matthew Martinez
Robert H. Eckel
43 Atlas of Cardiac Arrhythmias . . . . . . . . . . . . . .526
33 Ischemic Heart Disease . . . . . . . . . . . . . . . . . .385 Ary L. Goldberger
Elliott M. Antman, Andrew P. Selwyn,
44 Atlas of Percutaneous Revascularization . . . . . .539
Joseph Loscalzo
Jane A. Leopold, Deepak L. Bhatt,
34 Unstable Angina and Non-ST-Segment David P. Faxon
Elevation Myocardial Infarction . . . . . . . . . . . .407
Appendix
Christopher P. Cannon, Eugene Braunwald
Laboratory Values of Clinical Importance .......549
35 ST-Segment Elevation Myocardial Infarction . . .415 Alexander Kratz, Michael A. Pesce,
Elliott M. Antman, Joseph Loscalzo Robert C. Basner, Andrew J. Einstein
36 Percutaneous Coronary Interventions and Review and Self-Assessment . . . . . . . . . . . . . . .575
Other Interventional Procedures . . . . . . . . . . .434 Charles Wiener, Cynthia D. Brown,
David P. Faxon, Deepak L. Bhatt Anna R. Hemnes
37 Hypertensive Vascular Disease . . . . . . . . . . . . .443
Theodore A. Kotchen Index . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .615
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contrIbutors
Numbers in brackets refer to the chapter(s) written or cowritten by the contributor.
Jamil Aboulhosn, MD UCLA Adult Noninvasive Cardiodiagnostics Laboratory, Ronald
Assistant Professor, Departments of Medicine and Pediatrics, Reagan-UCLA Medical Center, Los Angeles, California [19]
David Geffen School of Medicine, University of California,
Los Angeles, Los Angeles, California [19] Wilson S. Colucci, MD
Thomas J. Ryan Professor of Medicine, Boston University School
Elliott M. Antman, MD of Medicine; Chief of Cardiovascular Medicine, Boston Medical
Professor of Medicine, Harvard Medical School; Brigham and Center, Boston, Massachusetts [23, 24]
Women’s Hospital, Boston, Massachusetts [33, 35]
Mark A. Creager, MD
Eric H. Awtry, MD Professor of Medicine, Harvard Medical School; Simon C. Fireman
Assistant Professor of Medicine, Boston University School of Scholar in Cardiovascular Medicine; Director, Vascular Center,
Medicine; Inpatient Clinical Director, Section of Cardiology, Brigham and Women’s Hospital, Boston, Massachusetts [38, 39]
Boston Medical Center, Boston, Massachusetts [23, 24]
Robert H. Eckel, MD
Robert C. Basner, MD
Professor of Medicine, Division of Endocrinology, Metabolism and
Professor of Clinical Medicine, Division of Pulmonary, Allergy, and
Diabetes, Division of Cardiology; Professor of Physiology and
Critical Care Medicine, Columbia University College of Physicians
Biophysics, Charles A. Boettcher, II Chair in Atherosclerosis,
and Surgeons, New York, New York [Appendix]
University of Colorado School of Medicine, Anschutz Medical
Deepak L. Bhatt, MD, MPH Campus, Director Lipid Clinic, University of Colorado Hospital,
Associate Professor of Medicine, Harvard Medical School; Chief Aurora, Colorado [32]
of Cardiology, VA Boston Healthcare System; Director, Integrated
Andrew J. Einstein, MD, PhD
Interventional Cardiovascular Program, Brigham and Women’s
Assistant Professor of Clinical Medicine, Columbia University
Hospital and VA Boston Healthcare System; Senior Investigator,
College of Physicians and Surgeons; Department of Medicine,
TIMI Study Group, Boston, Massachusetts [36, 44]
Division of Cardiology, Department of Radiology, Columbia
Eugene Braunwald, MD, MA (Hon), ScD (Hon) FRCP University Medical Center and New York-Presbyterian Hospital,
Distinguished Hersey Professor of Medicine, Harvard Medical New York, New York [Appendix]
School; Founding Chairman, TIMI Study Group, Brigham and
Jonathan A. Epstein, MD, DTMH
Women’s Hospital, Boston, Massachusetts [7, 22, 34]
William Wikoff Smith Professor of Medicine; Chairman,
Cynthia D. Brown, MD Department of Cell and Developmental Biology; Scientific Director,
Assistant Professor of Medicine, Division of Pulmonary and Critical Cardiovascular Institute, University of Pennsylvania, Philadelphia,
Care Medicine, University of Virginia, Charlottesville, Virginia Pennsylvania [1]
[Review and Self-Assessment]
David P. Faxon, MD
Christopher P. Cannon, MD Senior Lecturer, Harvard Medical School; Vice Chair of Medicine
Associate Professor of Medicine, Harvard Medical School; Senior for Strategic Planning, Department of Medicine, Brigham and
Investigator, TIMI Study Group, Brigham and Women’s Hospital, Women’s Hospital, Boston, Massachusetts [13, 36, 44]
Boston, Massachusetts [34]
J. Michael Gaziano, MD, MPH
Jonathan Carapetis, PhD, MBBS, FRACP, FAFPHM Professor of Medicine, Harvard Medical School; Chief, Division of
Director, Menzies School of Health Research, Charles Darwin Aging, Brigham and Women’s Hospital; Director, Massachusetts
University, Darwin, Australia [26] Veterans Epidemiology Center, Boston VA Healthcare System,
Boston, Massachusetts [2]
Agustin Castellanos, MD
Professor of Medicine, and Director, Clinical Electrophysiology,
Thomas A. Gaziano, MD, MSc
Division of Cardiology, University of Miami Miller School of
Assistant Professor, Harvard Medical School; Assistant Professor,
Medicine, Miami, Florida [29]
Health Policy and Management, Center for Health Decision
Murali Chakinala, MD Sciences, Harvard School of Public Health; Associate Physician in
Associate Professor of Medicine, Division of Pulmonary and Cardiovascular Medicine, Department of Cardiology, Brigham and
Critical Care Medicine, Washington University School of Medicine, Women’s Hospital, Boston, Massachusetts [2]
St. Louis, Missouri [17]
Ary L. Goldberger, MD
Panithaya Chareonthaitawee, MD Professor of Medicine, Harvard Medical School; Wyss Institute for
Associate Professor of Medicine, Mayo Clinic College of Medicine, Biologically Inspired Engineering, Harvard University; Beth Israel
Rochester, Minnesota [12, 42] Deaconess Medical Center, Boston, Massachusetts [11, 41, 43]
John S. Child, MD, FACC, FAHA, FASE Anna R. Hemnes, MD
Streisand Professor of Medicine and Cardiology, Geffen School of Assistant Professor, Division of Allergy, Pulmonary, and Critical
Medicine, University of California, Los Angeles (UCLA); Director, Care Medicine, Vanderbilt University Medical Center, Nashville,
Ahmanson-UCLA Adult Congenital Heart Disease Center; Director, Tennessee [Review and Self-Assessment]
vii
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viii Contributors
Helen H. Hobbs, MD Francis Marchlinski, MD
Professor of Internal Medicine and Molecular Genetics, University Professor of Medicine; Director, Cardiac Electrophysiology, University
of Texas Southwestern Medical Center, Dallas, Texas; Investigator, of Pennsylvania Health System, Philadelphia, Pennsylvania [16]
Howard Hughes Medical Institute, Chevy Chase, Maryland [31]
Matthew Martinez, MD
Judith S. Hochman, MD Lehigh Valley Physician Group, Lehigh Valley Heart Specialists,
Harold Snyder Family Professor of Cardiology; Clinical Chief, Allentown, Pennsylvania [12, 42]
Leon Charney Division of Cardiology; Co-Director, NYU-HHC
Clinical and Translational Science Institute; Director, Cardiovascular Robert J. Myerburg, MD
Clinical Research Center, New York University School of Professor, Departments of Medicine and Physiology, Division of
Medicine, New York, New York [28] Cardiology; AHA Chair in Cardiovascular Research, University of
Miami Miller School of Medicine, Miami, Florida [29]
Sharon A. Hunt, MD, FACC
Professor, Division of Cardiovascular Medicine, Stanford University, Rick A. Nishimura, MD, FACC, FACP
Palo Alto, California [18] Judd and Mary Morris Leighton Professor of Cardiovascular Diseases;
Professor of Medicine; Consultant, Division of Cardiovascular
David H. Ingbar, MD Diseases and Internal Medicine, Mayo Clinic College of Medicine,
Professor of Medicine, Pediatrics, and Physiology; Director, Rochester, Minnesota [12, 42]
Pulmonary Allergy, Critical Care and Sleep Division, University of
Minnesota School of Medicine, Minneapolis, Minnesota [28] Patrick T. O’Gara, MD
Professor of Medicine, Harvard Medical School; Director, Clinical
Adolf W. Karchmer, MD Cardiology, Brigham and Women’s Hospital, Boston, Massachusetts
Professor of Medicine, Harvard Medical School; Division of [9, 10, 20]
Infectious Diseases, Beth Israel Deaconess Medical Center,
Boston, Massachusetts [25] Michael A. Pesce, PhD
Professor Emeritus of Pathology and Cell Biology, Columbia
Louis V. Kirchhoff, MD, MPH University College of Physicians and Surgeons; Columbia
Professor of Internal Medicine (Infectious Diseases) and Epidemiology, University Medical Center, New York, New York [Appendix]
Department of Internal Medicine, The University of Iowa,
Iowa City, Iowa [27] Daniel J. Rader, MD
Cooper-McClure Professor of Medicine and Pharmacology,
Theodore A. Kotchen, MD University of Pennsylvania School of Medicine, Philadelphia,
Professor Emeritus, Department of Medicine; Associate Dean for Pennsylvania [31]
Clinical Research, Medical College of Wisconsin, Milwaukee,
Wisconsin [37] Anis Rassi, Jr., MD, PhD, FACC, FACP, FAHA
Scientific Director, Anis Rassi Hospital, Goiânia, Brazil [27]
Alexander Kratz, MD, PhD, MPH
Associate Professor of Pathology and Cell Biology, Columbia Stuart Rich, MD
University College of Physicians and Surgeons; Director, Core Professor of Medicine, Department of Medicine, Section of
Laboratory, Columbia University Medical Center, New York, Cardiology, University of Chicago, Chicago, Illinois [40]
New York [Appendix]
Richard M. Schwartzstein, MD
Thomas H. Lee, MD, MSc Ellen and Melvin Gordon Professor of Medicine and Medical
Professor of Medicine, Harvard Medical School; Network President, Education; Associate Chief, Division of Pulmonary, Critical Care,
Partners Healthcare System, Boston, Massachusetts [4] and Sleep Medicine, Beth Israel Deaconess Medical Center, Harvard
Medical School, Boston, Massachusetts [5]
Jane A. Leopold, MD
Associate Professor of Medicine, Harvard Medical School; Andrew P. Selwyn, MD, MBCHB
Brigham and Women’s Hospital, Boston, Massachusetts [13, 44] Professor of Medicine, Harvard Medical School; Brigham and
Women’s Hospital, Boston, Massachusetts [33]
Peter Libby, MD
Mallinckrodt Professor of Medicine, Harvard Medical School; David D. Spragg, MD
Chief, Cardiovascular Medicine, Brigham and Women’s Hospital, Assistant Professor of Medicine, Johns Hopkins University,
Boston, Massachusetts [1, 30] Baltimore, Maryland [14, 15]
Joseph Loscalzo, MD, PhD Lynne Warner Stevenson, MD
Hersey Professor of the Theory and Practice of Medicine, Professor of Medicine, Harvard Medical School; Director,
Harvard Medical School; Chairman, Department of Medicine; Heart Failure Program, Brigham and Women’s Hospital,
Physician-in-Chief, Brigham and Women’s Hospital, Boston, Boston, Massachusetts [21]
Massachusetts [1, 3, 6–10, 20, 21, 33, 35, 38, 39]
Gordon F. Tomaselli, MD
Hari R. Mallidi, MD Michel Mirowski, MD Professor of Cardiology; Professor of Medicine
Assistant Professor of Cardiothoracic Surgery; Director of and Cellular and Molecular Medicine; Chief, Division of Cardiology,
Mechanical Circulatory Support, Stanford University Medical Johns Hopkins University, Baltimore, Maryland [14, 15]
Center, Stanford, California [18]
Charles M. Wiener, MD
Douglas L. Mann, MD Dean/CEO Perdana University Graduate School of Medicine,
Lewin Chair and Chief, Cardiovascular Division; Professor of Selangor, Malaysia; Professor of Medicine and Physiology, Johns
Medicine, Cell Biology and Physiology, Washington University Hopkins University School of Medicine, Baltimore, Maryland
School of Medicine, St. Louis, Missouri [17] [Review and Self-Assessment]
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Preface
Harrison’s Principles of Internal Medicine has been a respected it. As knowledge about these complex systems expands,
information source for more than 60 years. Over time, the opportunity for identifying unique therapeutic targets
the traditional textbook has evolved to meet the needs of increases, holding great promise for definitive interven-
internists, family physicians, nurses, and other health care tions in the future. Regenerative medicine is another area
providers. The growing list of Harrison’s products now of cardiovascular medicine that is rapidly achieving trans-
includes Harrison’s for the iPad, Harrison’s Manual of Medi- lation. Recognition that the adult human heart can repair
cine, and Harrison’s Online. This book, Harrison’s Cardiovas- itself, albeit sparingly with typical injury, and that cardiac
cular Medicine, now in its second edition, is a compilation precursor (stem) cells reside within the myocardium to do
of chapters related to cardiovascular disorders. this can be expanded, and can be used to repair if not
Our readers consistently note the sophistication of regenerate a normal heart is an exciting advance in the
the material in the specialty sections of Harrison’s. Our field. These concepts represent a completely novel para-
goal was to bring this information to our audience in digm that will revolutionize the future of the subspecialty.
a more compact and usable form. Because the topic is In view of the importance of cardiovascular medicine to
more focused, it is possible to enhance the presentation the field of internal medicine, and the rapidity with which
of the material by enlarging the text and the tables. We the scientific basis for the discipline is advancing, Harrison’s
have also included a Review and Self-Assessment section Cardiovascular Medicine was developed. The purpose of this
that includes questions and answers to provoke reflection sectional is to provide the readers with a succinct overview
and to provide additional teaching points. of the field of cardiovascular medicine. To achieve this
Cardiovascular disease is the leading cause of death in goal, Harrison’s Cardiovascular Medicine comprises the key
the United States, and is rapidly becoming a major cause cardiovascular chapters contained in the eighteenth edition
of death in the developing world. Advances in the ther- of Harrison’s Principles of Internal Medicine, contributed by
apy and prevention of cardiovascular diseases have clearly leading experts in the field. This sectional is designed not
improved the lives of patients with these common, poten- only for physicians-in-training on cardiology rotations, but
tially devastating disorders; yet, the disease prevalence also for practicing clinicians, other health care professionals,
and the risk factor burden for disease (especially obesity and medical students who seek to enrich and update their
in the United States and smoking worldwide) continue to knowledge of this rapidly changing field. The editors trust
increase globally. Cardiovascular medicine is, therefore, of that this book will increase both the readers’ knowledge of
crucial importance to the field of internal medicine. the field, and their appreciation for its importance.
Cardiovascular medicine is a large and growing sub- The first section of the book, “Introduction to Car-
specialty, and comprises a number of specific subfields, diovascular Disorders,” provides a systems overview,
including coronary heart disease, congenital heart disease, beginning with the basic biology of the cardiovascu-
valvular heart disease, cardiovascular imaging, electro- lar system, followed by epidemiology of cardiovascular
physiology, and interventional cardiology. Many of these disease, and approach to the patient. The integration
areas involve novel technologies that facilitate diagnosis of pathophysiology with clinical management is a hall-
and therapy. The highly specialized nature of these disci- mark of Harrison’s, and can be found throughout each
plines within cardiology and the increasing specialization of the subsequent disease-oriented chapters. The book
of cardiologists argue for the importance of a broad view is divided into six main sections that reflect the scope of
of cardiovascular medicine by the internist in helping to cardiovascular medicine: (I) Introduction to the Cardio-
guide the patient through illness and the decisions that vascular System; (II) Diagnosis of Cardiovascular Disor-
arise in the course of its treatment. ders; (III) Heart Rhythm Disturbances; (IV) Disorders
The scientific underpinnings of cardiovascular medi- of the Heart; (V) Disorders of the Vasculature; and (VI)
cine have also been evolving rapidly. The molecular Cardiovascular Atlases.
pathogenesis and genetic basis for many diseases are now Our access to information through web-based jour-
known and, with this knowledge, diagnostics and thera- nals and databases is remarkably efficient. Although
peutics are becoming increasingly individualized. Car- these sources of information are invaluable, the daunting
diovascular diseases are largely complex phenotypes, and body of data creates an even greater need for synthesis
this structural and physiological complexity recapitulates by experts in the field. Thus, the preparation of these
the complex molecular and genetic systems that underlie chapters is a special craft that requires the ability to distill
ix
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