Interventional Cardiology: 900 Questions: An Interventional Cardiology Board Review

384 Pages·2007·6.37 MB·English

by  Debabrata Mukherjee

900 Questions:
An Interventional Cardiology
Board Review

900 Questions:
An Interventional Cardiology
Board Review
EDITORS
Debabrata Mukherjee, MD
AssociateProfessorofMedicine
Director,CardiacCatheterizationLaboratories
GillFoundationProfessorofInterventionalCardiology
GillHeartInstituteandDivisionofCardiovascularMedicine
UniversityofKentucky
Lexington,Kentucky
Leslie Cho,MD
Director,Women’sCardiovascularCenter
MedicalDirector,PreventiveCardiologyandRehabilitation
DepartmentofCardiovascularMedicine
ClevelandClinicFoundation
Cleveland,Ohio
DavidJ. Moliterno, MD
ProfessorandVice-ChairmanofMedicine
Chief,CardiovascularMedicine
JeffersonMorrisGillProfessorofCardiology
GillHeartInstituteandDivisionofCardiovascularMedicine
UniversityofKentucky
Lexington,Kentucky
DonnaA.Gilbreath
ManagingEditor
GillHeartInstituteandDivisionofCardiovascularMedicine
UniversityofKentucky
Lexington,Kentucky
AcquisitionsEditor:FrancesR.DeStefano
ManagingEditor:NicoleDernoski
ProjectManager:JenniferHarper
SeniorManufacturingManager:BenjaminRivera
MarketingManager:AngelaPanetta
ArtDirector:RisaClow
ProductionServices:LaserwordsPrivateLimited,Chennai,India
Printer:VictorGraphics,Inc.
©2007byLIPPINCOTTWILLIAMS&WILKINS,aWoltersKluwerbusiness
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Allrightsreserved.Thisbookisprotectedbycopyright.Nopartofthisbookmaybe
reproducedinanyformorbyanymeans,includingphotocopying,orutilizedbyany
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governmentemployeesarenotcoveredbytheabove-mentionedcopyright.
Weappreciatethatevenwiththebestofeffortsfromtheauthors,editors,and
publishersthatsomeofthequestionsoranswersinthistextbookmayneedrefinement.
So,too,whiletheobjectwastocarefullydesigneachquestionwithasinglebestanswer,
somequestionsmaybemorecontroversialthanintendedormayhavemorethanone
reasonableresponse.Withthesepointsinmindandwithourhopestocontinually
improvethisbookwithfutureeditions,commentsregardingthisfirsteditionare
welcomedandcanbesenttoDr.DebabrataMukherjee([email protected])orDr.
DavidMoliterno([email protected]).
PrintedintheUSA
LibraryofCongressCataloging-in-PublicationData
900questions:aninterventionalcardiologyboardreview/editors,
DebabrataMukherjee...[etal.].
p.;cm.
ISBN-13:978-0-7817-7349-2
ISBN-10:0-7817-7349-0
1.Heart—Diseases—Treatment—Examinations,questions,etc.2.Cardiovascular
system—Diseases—Treatment—Examinations,questions,etc.I.Mukherjee,Debabrata.
II.Title:Ninehundredquestions.
[DNLM:1.CardiovascularDiseases—ExaminationQuestions.2.Cardiovascular
Diseases—therapy—ExaminationQuestions.WG18.2Z99912007]
RC683.8.N5642007
616.1(cid:1)20076—dc22
2006027893
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10 9 8 7 6 5 4 3 2 1
‘‘Tomyparents,fortheirinfinitepatience,love,andunderstanding,who
continuetobemysourceofinspiration,andtomywonderfulwife,
Suchandra,forherloveandsupport’’
DebabrataMukherjee
‘‘ToNathanielandBenjamin,mysonsandsuppliersoflife’simportant
questions,andtoJudith,mywifeandpartnerinfindingtheanswers’’
DavidJ.Moliterno

Preface
Insightfulquestionshavebeenusedthroughtheagesasa themiscellaneousremainingareas coveredbytheboard
metrictoassessone’sknowledge,butwhencoupledwith examination,includingperipheralvasculardisease,ethics,
carefully delivered answers they can become a powerful statistics,andepidemiology,aswellasachapterdirected
teaching tool. This book of questions and annotated atimprovingtest-takingskills.
answers covering the field of interventional cardiology Also essential to the quality and appropriateness of
is meant to serve as a helpful resource for individuals thequestionsandannotatedanswersistheexpertiseofthe
preparingfortheinterventionalcardiovascularmedicine chapterauthors.Wearefortunatetohaveassembledthe
board examination as well as for clinicians who wish to ‘‘who’swhoofacademicinterventionalcardiology’’.The
performanin-depthself-assessmentonindividualtopics 59 contributing authors from leading medical centers
or the full spectrum. The book has many key features, around the world have over 4,600 articles cited in
whichwebelievewillmakethereadersuccessfulinpassing PubMed. We are greatly indebted to these authors who
theboardsandimprovingclinicalpractice. arerecognizedbothfortheirinterventionalexpertiseand
Offoremostimportance,theareascoveredarerele- fortheirteachingskills.Intheend,thetruevalueofthis
vantnotonlytotheday-to-daypracticeofinterventional textbook is not only the relevance of the questions, the
cardiology, but have also been patterned in scope and outstanding quality of the authors, butalso the value of
contenttotheactualboardexamination.Thebookbegins the annotated answers. The text includes 910 questions
withseveralchaptersdedicatedtotheanatomyandphys- and 254 figures and tables. The corresponding answers
iology associated with interventional cardiology and the havebeenappropriatelydetailedtoproviderelevantfacts
pathobiology of atherosclerosis and inflammation. This andinformationaswellasup-to-datejournalcitations.
corresponds to the 15% of the board examination tar- Thepracticeofinterventionalcardiologyisexciting,
getingmaterialinbasicscience.Thesubsequentchapters rewarding, and a privilege each of us enjoys. Likewise,
focusontheessentialinterventionalpharmacotherapyof it has been our privilege to work with the superb
antiplatelets, anticoagulants, and other commonly used contributors,ourcolleaguesininterventionalcardiology,
medications in the catheterization laboratory and out- aswellastheeditorialteamattheUniversityofKentucky
patient setting for patients with atherosclerosis. These and Lippincott Williams and Wilkins. It is our personal
chapterscorrespondtothenext15%oftheboardscenter- hope that you will enjoy this book and that it will be a
ing on pharmacology. A similar-sized 15% of the board valuableresourcetoyouinpassingtheboardexamination
examination is directed toward imaging, and the book and providing the highest quality care possible to your
includesspecificchaptersonradiationsafety,catheteriza- patients.
tionlaboratoryequipmentandtechnique,contrastagents,
andintravascularultrasound.Thetwolargestareasofthe DEBABRATAMUKHERJEE,MD
examination, each covering25%of thecontent, include LESLIECHO,MD
case selection–management and procedural techniques.
DAVIDJ.MOLITERNO,MD
Thereviewbookdedicates25chapterstocomprehensively
covertheseareas. Finally,wehaveincludedchapters for
vii

Contributors
RobertJ.Applegate,MD SorinJ.Brener,MD
Director,CardiovascularTrainingProgram AssociateProfessorofMedicine
WakeForestUniversitySchoolofMedicine DepartmentofMedicine
Winston-Salem,NorthCarolina CaseWesternReserveUniversity;
StaffPhysician
DepartmentofCardiovascularMedicine
JosephBabb,MD
ClevelandClinicFoundation
ProfessorofMedicine Cleveland,Ohio
DepartmentofInternalMedicine,CardiologyDivision
BrodySchoolofMedicine
IvanP.Casserly,MD
EastCarolinaUniversity;
Director,CardiacCatheterizationLaboratories AssistantProfessorofMedicine
PittCountyMemorialHospital CardiologyDivision
Greenville,NorthCarolina UniversityofColorado;
DirectorofInterventionalCardiology
DenverVAMedicalCenter
ThomasM.Bashore,MD Denver,Colorado
ProfessorofMedicine
DivisionofCardiovascularMedicine;
LeslieCho,MD
Director,FellowshipTrainingProgram
Director,Women’sCardiovascularCenter
andAdultCongenitalandValvularDiseaseProgram
MedicalDirector,PreventiveCardiology
DukeUniversityMedicalCenter
andRehabilitation
Durham,NorthCarolina
DepartmentofCardiovascularMedicine
ClevelandClinicFoundation
MatthewC.Becker,MD Cleveland,Ohio
FellowinCardiovascularDisease
DepartmentofCardiovascularMedicine AntonioColombo,MD
ClevelandClinicFoundation
ChiefofInvasiveCardiology
Cleveland,Ohio
Universita` Vita-Salute
andSanRaffaeleScientificInstitute
andColumbusHospitals
DeepakL.Bhatt,MD
Milan,Italy
AssociateProfessorofMedicine
Staff,Cardiac,Peripheral,andCarotidIntervention
DepartmentofCardiovascularMedicine HaroldL.Dauerman,MD
ClevelandClinicFoundation ProfessorofMedicine
Cleveland,Ohio UniversityofVermont;
Director,CardiovascularCatheterizationLaboratories
FletcherAllenHealthCare
DavidC.Booth,MD
Burlington,Vermont
EndowedProfessorMedicine
GillHeartInstituteand
StevenR.Daugherty,PhD
DivisionofCardiovascularMedicine
UniversityofKentucky; AssistantProfessorofPsychology
ChiefofCardiology AssistantProfessorofPreventiveMedicine
LexingtonVAMedicalCenter RushMedicalCollege
Lexington,Kentucky Chicago,Illinois
ix
x Contributors
StephenG.Ellis,MD HussamHamdalla,MD
ProfessorofMedicine AssistantProfessorofMedicine
DepartmentofCardiovascularMedicine GillHeartInstituteand
ClevelandClinicLernerCollegeofMedicine DivisionofCardiovascularMedicine
CaseWesternReserveUniversity; UniversityofKentucky
Director,CardiacCatheterizationLaboratories Lexington,Kentucky
ClevelandClinicFoundation
RobertA.Harrington,MD
Cleveland,Ohio
ProfessorofMedicine
Director,CardiovascularClinicalTrials
NezarFalluji,MD,MPH
Co-Director,CardiovascularResearch
ClinicalInstructor DukeClinicalResearchInstitute
GillHeartInstitute DepartmentofMedicine,DivisionofCardiology
DivisionofCardiovascularMedicine DukeUniversityMedicalCenter
UniversityofKentucky Durham,NorthCarolina
Lexington,Kentucky
HowardC.Herrmann,MD
ProfessorofMedicine
DavidP.Faxon,MD
CardiovascularDivision
DirectorofStrategicPlanning
UniversityofPennsylvaniaSchoolofMedicine;
DepartmentofMedicine
Director,InterventionalCardiologyandCardiac
BrighamandWomen’sHospital;
CatheterizationLaboratories
ProfessorofMedicine
HospitaloftheUniversityofPennsylvania
DepartmentofMedicine
Philadelphia,Pennsylvania
HarvardMedicalSchool
Boston,Massachusetts L.DavidHillis,MD
ProfessorandViceChair
JoelA.Garcia,MD DepartmentofInternalMedicine
UniversityofTexasSouthwesternMedicalCenter
InterventionalCardiologyandResearchFellow
Dallas,Texas
DepartmentofCardiology
UniversityofColorado AliceK.Jacobs,MD
Denver,Colorado
ProfessorofMedicine
DepartmentofMedicine,SectionofCardiology
ThomasGehrig,MD BostonUniversitySchoolofMedicine;
Director,CardiacCatheterizationLaboratories
CardiologyFellow
andInterventionalCardiology
DivisionofCardiovascularMedicine
BostonMedicalCenter
DukeUniversityMedicalCenter
Boston,Massachusetts
Durham,NorthCarolina
JohnLynnJefferies,MD,MPH
BernardGersh,MB,ChB,DPhil AssistantProfessor
ProfessorofMedicine AdultandPediatricCardiology
CardiologyDiseases BaylorCollegeofMedicine
MayoClinicCollegeofMedicine DivisionsofAdultCardiovascularDiseases
Rochester,Minnesota andPediatricCardiology
TexasChildren’sHospital
TexasHeartInstituteatSt.Luke’sEpiscopalHospital
JohnC.Gurley,MD,MBA
Houston,Texas
ProfessorofMedicine
HaniJneid,MD
Director,InterventionalCardiologyFellowship
GillHeartInstitute DivisionofCardiology
DivisionofCardiovascularMedicine MassachusettsGeneralHospital
UniversityofKentucky andHarvardMedicalSchool
Lexington,Kentucky Boston,Massachusetts