Manual of Outpatient Cardiology

507 Pages·2012·5.974 MB·English

by  Norman Gray, J. Franklin Richeson (auth.), John D. Bisognano, Ron Beck, Ryan Connell (eds.)

Manual of Outpatient
Cardiology

John D. Bisognano
G. Ronald Beck (cid:129) Ryan W. Connell
(Editors)
Manual of Outpatient
Cardiology
Editors
Dr. John D. Bisognano, M.D., Ph.D Ryan W. Connell, M.D
Department of Internal Medicine Department of Internal Medicine
Division of Cardiology Division of Cardiology
University of Rochester University of Rochester
Medical Center Medical Center
Rochester, New York Rochester, New York
USA USA
G. Ronald Beck, M.S
Department of Internal Medicine
Division of Cardiology
University of Rochester
Medical Center
Rochester, New York
USA
ISBN 978-0-85729-943-7 e-ISBN 978-0-85729-944-4
DOI 10.1007/978-0-85729-944-4
Springer London Dordrecht Heidelberg New York
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Library of Congress Control Number: 2011941507
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Foreword
All health care providers need to know how to diagnose and
treat common cardiovascular diseases for one simple reason:
cardiovascular diseases are common and deadly. The preva-
lence of cardiovascular diseases is enormous: 8% of adult
Americans have diabetes, 23% of men and 19% of women
smoke, 33% have hypertension, and 33% are obese [1]. In the
United States, cardiovascular diseases cause over 780,000
heart attacks and 400,000 deaths each year [1]. Cardiovascular
diseases are the biggest cause of death and disability across
the globe [2].
However, it is challenging to keep up with the latest
advancements in cardiovascular diagnostics and therapies.
The pace of medical research is accelerating, with the spread
of genetic testing, the explosion of clinical trials, and the pro-
liferation of treatment guidelines.
The Manual of Outpatient Cardiology provides a concise
and authoritative guide for a variety of health care providers
who do not necessarily specialize in cardiology: primary care
physicians, physician assistants, nurse practitioners, residents,
and students. We have divided the book into three parts: car-
diovascular diagnostics, cardiac diseases, and cardiac symp-
toms. We have included the most recent guidelines of both
the American College of Cardiology and the American Heart
Association to make this manual the most authoritative and
reliable outpatient guide available.
The section on Cardiac Diagnostics is a guide to health care
providers who are confronted with patients with common
cardiovascular diseases, and who must choose the best and
most cost-efficient set of tests. This section discusses when to
v
vi Foreword
use specific tests, such as stress tests and cardiac ultrasound,
while weighing the risks and benefits. The chapters on
Common Cardiac Diseases emphasize conditions seen every
day in the clinics of general medical doctors and specialists,
including common diseases such as hypertension and dyslipi-
demia. The final section, Approach to the Patient, summarizes
the most up to date strategy to evaluate and treat common
symptoms, including chest pain, dizziness, and palpitations.
We hope this Manual of Outpatient Cardiology will be use-
ful to a wide range of readers who want to learn more about
cardiovascular diseases encountered every day in the clinic.
We thank our contributors and members of the Cardiology
Division of University of Rochester Medical Center for their
knowledge and expertise in preparing this book.
Rochester, NY, USA Charles J. Lowenstein

References
1. Roger VL et al. Heart disease and stroke statistics 2011 update: a
report from the American Heart Association. Circulation.
2011;123:e18–209.
2. World Health Organization: Global health observatory data reposi-
tory, causes of death summary tables 2008: h ttp://apps.who.int/
ghodata/?vid = 10012. June 16, 2011.
Contents
Part I Cardiac Diagnostics
1 History and Physical. . . . . . . . . . . . . . . . . . . . . . . . . . 3
Norman Gray and J. Franklin Richeson
2 Evaluation of Heart Rhythms . . . . . . . . . . . . . . . . . . 15
James Gallagher and Christine Tompkins
3 Cardiac Imaging . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 51
Harry E. McCrea and Michael W. Fong
4 Cardiovascular Stress Testing . . . . . . . . . . . . . . . . . . 79
Mohan Rao, Nicholas A. Paivanas,
and James Eichelberger
5 Coronary Artery Evaluation . . . . . . . . . . . . . . . . . . . 105
Michael Katz, Blake Gardner, and John P. Gassler
Part II Common Cardiac Diseases
6 Hypertension . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 135
Melissa Gunasekera, John D. Bisognano,
and G. Ronald Beck
7 Dyslipidemia . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 159
Kevin J. Woolf and Robert C. Block
8 Coronary Artery Disease . . . . . . . . . . . . . . . . . . . . . . 179
Benjamin G. Plank, M. James Doling,
and Peter A. Knight
vii
viii Contents
9 Valvular Heart Disease . . . . . . . . . . . . . . . . . . . . . . . 217
Ryan J. Hoefen and Eugene Storozynsky
10 Ambulatory Arrhythmias . . . . . . . . . . . . . . . . . . . . . 237
Andrew J. Brenyo and Mehmet K. Aktas
11 Congestive Heart Failure . . . . . . . . . . . . . . . . . . . . . . 281
Susan F. Lien and Jeffrey D. Alexis
12 Vascular Diseases – Peripheral/Aorta . . . . . . . . . . . 325
Craig R. Narins, Jason D. Pacos,
and Theodore I. Hirokawa
Part III Approach to the Patient
13 Approach to the Patient with Chest Pain . . . . . . . . 349
Benjamin R. McClintic and Robert L. Rosenblatt
14 Syncope, Work Up and Management . . . . . . . . . . . . 373
Menachem Wakslak and David T. Huang
15 Palpitations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 391
Matthew Jonovich and Burr Hall
16 New Murmur . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 407
Angelo J. Pedulla and Bryan Henry
17 Approach to the Patient with Dyspnea . . . . . . . . . . 427
Christopher D. Lang and Imran N. Chaudhary
18 Preoperative Cardiovascular Risk Assessment
for Non-cardiac Surgery. . . . . . . . . . . . . . . . . . . . . . . 445
John E. Reuter and John C. Teeters
19 Approach to the Patient with Cardiovascular
Disease and Activity Limitations . . . . . . . . . . . . . . . 465
Ryan W. Connell and Duncan D. Wormer
Index . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 489
List of Contributors
Mehmet K. Aktas , M.D. Division of Cardiology –
Electrophysiology , University of Rochester
Medical Center , Rochester , NY , USA
Jeffrey D. Alexis , M.D. Division of Cardiology,
Department of Internal Medicine ,
University of Rochester Medical Center ,
Rochester , NY , USA
G. Ronald Beck , M.S. Department of Internal Medicine
Division of Cardiology , University of Rochester Medical
Center , Rochester , NY , USA
John D. Bisognano , M.D., Ph.D. Division of Cardiology,
Department of Internal Medicine , University of Rochester
Medical Center , Rochester , NY , USA
Robert C. Block , M.D., MPH Department of
Community and Preventive Medicine , The University
of Rochester School of Medicine and Dentistry ,
Rochester , NY , USA
Andrew J. Brenyo , M.D. Division of Cardiology ,
University of Rochester Medical Center ,
Rochester , NY , USA
Imran N. Chaudhary , MB, BS Division of Cardiology ,
University of Rochester Medical Center ,
Rochester , NY , USA
ix
x List of Contributors
Ryan W. Connell , M .D. Division of Cardiology,
Department of Internal Medicine,
University of Rochester Medical Center ,
Rochester , NY , USA
M. James Doling , M.D. Division of Cardiology ,
University of Rochester Medical Center ,
Rochester , NY , USA
James Eichelberger , M.D. Division of Cardiology,
Department of Medicine , University of Rochester ,
Rochester , NY , USA
Michael W. Fong , M.D. Division of Cardiology ,
University of Southern California , Los Angeles ,
CA , USA
James Gallagher , M.D. Division of Cardiology,
Department of Medicine , University of Rochester
Medical Center , Rochester , NY , USA
Blake Gardner , M.D. Division of Cardiology,
Department of Medicine , University of Rochester
Medical Center , Rochester , NY , USA
John P. Gassler , M.D. Division of Cardiology,
Department of Medicine , University of Rochester
Medical Center , Rochester , NY , USA
Norman Gray Jr, M.D. Division of Cardiology ,
University of Rochester Medical Center ,
Rochester , NY , USA
Melissa Gunasekera , M.D. Department of Medicine ,
University of Rochester Medical Center ,
Rochester , NY , USA