Table Of ContentThe ESC Textbook of
Intensive and Acute
Cardiovascular Care
European Society of Cardiology publications
The ESC Textbook of Cardiovascular Medicine (Second Edition)
Edited by A. John Camm, Thomas F. Lüscher, and Patrick W. Serruys
The EAE Textbook of Echocardiography
Editor-in-Chief: Leda Galiuto, with Co-editors: Luigi Badano, Kevin Fox, Rosa Sicari,
and José Luis Zamorano
The ESC Textbook of Intensive and Acute Cardiovascular Care (Second Edition)
Edited by Marco Tubaro, Pascal Vranckx, Susanna Price, and Christiaan Vrints
Forthcoming
The ESC Textbook of Cardiovascular Imaging (Second Edition)
Edited by José Luis Zamorano, Jeroen Bax, Juhani Knuuti, Patrizio Lancellotti, Luigi
Badano, and Udo Sechtem
The EHRA Book of Pacemaker, ICD, and CRT Troubleshooting: Case-based learning
with multiple choice questions
Edited by Harran Burri, Carsten Israel, and Jean-Claude Deharo
The ESC Textbook of Preventive Cardiology
Edited by Stephan Gielen, Guy De Backer, Massimo Piepoli, and David Wood
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 ESC Textbook of
Intensive
and Acute
Cardiovascular
Care
SECOND EDITION
Edited by
Marco Tubaro
Pascal Vranckx
Co-editors
Susanna Price
Christiaan Vrints
1
3
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Second edition published 2015
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Preface
During the last decade, acute cardiac care has emerged as a sepa- administrators trying to set up the service to the clinicians, nurses,
rate medical and nursing subspecialty of cardiology. In recognition and paramedics taking care of these patients.
of this evolution, the European Society of Cardiology established The book comes with access to a website, which has an online
the Acute Cardiac Care Association (ACCA), alongside other as- version of the text, all the references and figures, numerous videos,
sociations representing the recognized subspecialties of cardiol- and images that are downloadable to PowerPoint. It contains 78
ogy, namely cardiac intervention, electrophysiology, imaging, and chapters, divided into 11 sections, covering a wide variety of issues
heart failure. such as pre- and post-hospital care, the structure and function of
Acute cardiac care involves the treatment of cardiac patients intensive cardiac care units (ICCUs), procedures and diagnostic
in need of intensive care primarily related to acute cardiovascu- techniques in the ICCU, as well as the description and manage-
lar disease, but also other acute conditions whereby chronic heart ment of the acute cardiovascular illnesses and their commonly as-
disease may jeopardize the short-term prognosis. These unstable sociated comorbidities.
patients are in need of adequate, prompt, professional, and com- The new edition contains an updated version of the old chapters,
prehensive care, including diagnosis, management, and moni- as well as six new chapters: patient safety and clinical governance;
toring to be delivered from the pre-hospital phase and through the heart team; ultrasound-guided vascular access; implanted
hospitalization until stabilization. Their needs can best be met in cardiac support; donor organ management; and palliative care in
specially designed and equipped units (mobile intensive care unit the ICCU. The editors combined two chapters: echocardiography
and intensive cardiac care unit) operated by adequately trained with thoracic ultrasound; hyperglycaemia, diabetes with other en-
physicians, nurses, and paramedics. docrine emergencies. The new edition is larger than the first edi-
The major determinant of the short- and long-term progno- tion of the book, to incorpo rate these changes.
sis of these patients is their cardiac condition, and therefore they As in the previous edition, each chapter begins with a useful
should be taken care of primarily by a cardiologist. Nevertheless, summary box and a list of the contents. Each ends with a conclud-
basic training in cardiology should be complemented by further ing paragraph and a personal perspective.
training to gain additional expertise in intensive cardiac and gen- It is expected that this ESC Textbook of Intensive and Acute
eral care. The recommendations for the medical fellowship in Cardiovascular Care, with its large amount of easily accessible,
intensive cardiac care (including a detailed core curriculum and useful information, will be of added value to those who work in
syllabus), as well as the requirements for accreditation, were in- the field, both for its educational merit as well as to the busy physi-
troduced by ACCA. cian who quickly wants to look something up.
This updated version of the textbook on acute and intensive
Professor Yonathan Hasin
cardiovascular care has set out to include relevant medical and
practical information needed for the optimal operation of an up- Cardiovascular Institute,
to-date acute cardiac care service. It is intended as a key reference Poria Medical Centre,
for training and accreditation in this specialty, yet the broad range
MP Lower Galilee, Israel
of topics serves the needs of all acute cardiac care providers, from
To the memory of Magda Heras—a pioneer in the field of acute cardiac care,
and a great friend and colleague of many of the authors of this textbook
Contents
Symbols and abbreviations xi SECTION II
The intensive cardiac care unit
Contributors xix
10 Recommendations for the structure,
INTRODUCTION organization, and operation of intensive
cardiac care units 75
1 Intensive and acute cardiac care:
Menachem Nahir, Doron Zahger, and Yonathan Hasin
an introduction 3
Susanna Price, Marco Tubaro, Pascal Vranckx, and 11 The intensive cardiac care unit team 83
Christiaan Vrints Tom Quinn and Eva Swahn
2 Training and certification in acute 12 The heart team in acute cardiac care 87
cardiac care 5 Arie Pieter Kappetein and Stephan Windecker
Magda Heras, Alessandro Sionis, and Susanna Price
13 Ethical issues in cardiac arrest and acute
3 Patient safety and clinical governance 13 cardiac care: a European perspective 91
Elizabeth Haxby and Susanna Walker Jean-Louis Vincent
4 Databases, registries, and quality of care 20
SECTION III
Nicolas Danchin, Fiona Ecarnot, and François Schiele
Monitoring and investigations in the
SECTION I intensive cardiac care unit
The pre-hospital phase and the
14 Pathophysiology and clinical assessment of the
emergency department
cardiovascular system (including pulmonary
artery catheter) 101
5 Sudden cardiac death: epidemiology and
Romain Barthélémy, Etienne Gayat, and
prevention 33
Alexandre Mebazaa
Hans-Richard Arntz
15 The respiratory system 111
6 Cardiopulmonary resuscitation and the post-
Antoine Vieillard-Baron
cardiac arrest syndrome 39
Jerry P Nolan 16 Neurological assessment of the acute
cardiac care patient 117
7 The emergency medical system 47
Cathy S De Deyne and Jo Dens
Marc Sabbe, Koen Bronselaer, and Olivier Hoogmartens
17 Monitoring of the kidneys, liver, and
8 Chest pain and chest pain units 56
other vital organs 126
Eric Durand, Aures Chaib, and Nicolas Danchin
Karl Werdan, Brijesh Patel, Matthias Girndt, Henning
9 Acute dyspnoea in the emergency Ebelt, Jochen Schröder, and Sebastian Nuding
department 65
Christian Mueller
viii contents
18 Blood gas analysis: acid–base, fluid, and 33 Physiotherapy in critically ill patients 284
electrolyte disorders 135 Rik Gosselink and Jean Roeseler
Richard Paul, Pavlos Myrianthefs, George Baltopoulos,
34 Donor organ management 292
and Shaun McMaster
Arne P Neyrinck, Patrick Ferdinande, Dirk Van
19 Clinical assessment and monitoring of chest Raemdonck, and Marc Van de Velde
radiographs 148
Alexander Parkhomenko, Olga S Gurjeva, and
SECTION V
Tetyana Yalynska
The laboratory in intensive and
20 Echocardiography and thoracic ultrasound 160 acute cardiac care
Frank A Flachskampf, Pavlos Myrianthefs, and
Ruxandra Beyer 35 The use of biomarkers for acute
21 Ultrasound-guided vascular access in cardiovascular disease 305
intensive/acute cardiac care 174 Allan S Jaffe
Richard Paul 36 Biomarkers in acute coronary syndromes 314
22 Computed tomography angiography and other Evangelos Giannitsis and Hugo A Katus
applications of computed tomography 181 37 Biomarkers in acute heart failure 321
Michiel A de Graaf, Arthur JHA Scholte, Lucia Kroft, and Rajiv Choudhary, Kevin Shah, and Alan Maisel
Jeroen J Bax
38 Biomarkers of coagulation and
23 Cardiac magnetic resonance in the intensive
thrombosis 330
and cardiac care unit 196 Anne-Mette Hvas, Erik L Grove, and
Juerg Schwitter and Jens Bremerich
Steen Dalby Kristensen
SECTION IV 39 Biomarkers of renal and hepatic failure 337
Mario Plebani, Monica Maria Mion, and
Procedures in intensive cardiac care unit
Martina Zaninotto
24 Mechanical ventilation 209
Gihan Abuella and Andrew Rhodes SECTION VI
25 Non-invasive ventilation 219 Acute coronary syndromes
Josep Masip, Kenneth Planas, and Arantxa Mas
40 Atherosclerosis and thrombosis 347
26 Temporary pacing 230 Lina Badimon and Gemma Vilahur
Bulent Gorenek
41 The universal definition of myocardial
27 Pericardiocentesis 237 infarction 356
Gerard Martí Aguasca, Bruno Garcia del Blanco, and Kristian Thygesen, Joseph S Alpert, Allan S Jaffe, and
Jaume Sagristà Sauleda Harvey D White
28 Chest tubes 242 42 Systems of care for patients with acute ST
Arthur Atchabahian, Christian Laplace, and Karim elevation myocardial infarction (STEMI
Tazarourte networks) 365
29 Renal support therapy 250 Kurt Huber and Tom Quinn
Claudio Ronco and Zaccaria Ricci 43 ST-segment elevation myocardial
30 Portable (short-term) mechanical circulatory infarction 372
support 259 Adrian Cheong, Gabriel Steg, and Stefan K James
Susanna Price and Pascal Vranckx 44 Fibrinolytic, antithrombotic, and antiplatelet
31 Implanted cardiac support devices 267 drugs in acute coronary syndromes 386
Andrew C Morley-Smith, André R Simon, and John R Peter Sinnaeve and Frans Van de Werf
Pepper
45 Mechanical complications of myocardial
32 Nutrition support in acute cardiac care 276 infarction 398
Michael P Casaer and Greet Van den Berghe José López-Sendón and Esteban López de Sá
contents ix
46 Non-ST-segment elevation acute coronary SECTION IX
syndromes 409 Other acute cardiovascular conditions
Héctor Bueno and José A Barrabés
58 Myocarditis and pericarditis 547
47 Percutaneous coronary interventions in acute
Michel Noutsias and Bernhard Maisch
coronary syndromes 420
Viktor Kočka, Steen Dalby Kristensen, William Wijns, 59 Acute valve disease and endocarditis 560
Petr Toušek, and Petr Widimský Gregory Ducrocq, Franck Thuny, Bernard Iung, and
Alec Vahanian
48 Coronary artery bypass graft surgery 430
Piroze M Davierwala and Friedrich W Mohr 60 Congenital heart disease in adults 571
Susanna Price, Brian F Keogh, and Lorna Swan
49 Cardiogenic shock in patients with acute
coronary syndromes 441 61 Aortic emergencies 580
Holger Thiele and Uwe Zeymer Parla Astarci, Laurent de Kerchove, and Gébrine el Khoury
50 Gender considerations in acute coronary 62 Cardiac complications in trauma 592
syndromes 449 Demetrios Demetriades, Leslie Kobayashi, and Lydia Lam
Eva Swahn, Joakim Alfredsson, and
63 Cardiac emergencies in pregnancy 600
Sofia Sederholm Lawesson
Patrizia Presbitero, Dennis Zavalloni, and Benedetta Agnoli
SECTION VII
SECTION X
Acute heart failure
Concomitant acute conditions
51 Acute heart failure: epidemiology, classification,
64 Acute respiratory failure and acute respiratory
and pathophysiology 459
Dimitrios Farmakis, John Parissis, and distress syndrome 615
Gerasimos Filippatos Luciano Gattinoni and Eleonora Carlesso
52 Acute heart failure: early pharmacological 65 Pulmonary hypertension 626
therapy 470 Nazzareno Galiè, Alessandra Manes, and Massimiliano
Palazzini
Jonathan R Dalzell, Colette E Jackson, John JV McMurray,
and Roy Gardner 66 Pulmonary embolism 634
53 Non-pharmacological therapy of acute heart Adam Torbicki, Marcin Kurzyna, and Stavros
Konstantinides
failure: when drugs alone are not enough 481
Pascal Vranckx, Wilfried Mullens, and Johan Vijgen 67 Stroke 645
Didier Leys, Charlotte Cordonnier, and Valeria Caso
54 Acute heart failure: heart failure surgery and
transplantation 490 68 Acute kidney injury 657
Aikaterini N Visouli and Antonis A Pitsis Sofie A Gevaert, Eric Hoste, and John A Kellum
69 Hyperglycaemia, diabetes, and other endocrine
SECTION VIII
emergencies 668
Arrhythmias
Yves Debaveye, Dieter Mesotten, and Greet Van den
Berghe
55 Conduction disturbances and
pacemaker 503 70 Bleeding and haemostasis disorders 681
Carlo Lavalle, Renato Pietro Ricci, and Massimo Santini Pier Mannuccio Mannucci
56 Atrial fibrillation and supraventricular 71 Anaemia and transfusion 691
arrhythmias 512 Jean-Pierre Bassand, François Schiele, and Nicolas
Demosthenes Katritsis and A John Camm Meneveau
57 Ventricular tachyarrhythmias and implantable 72 Infections, sepsis, and multiorgan dysfunction
cardioverter–defibrillator 529 syndrome 698
Joachim R Ehrlich and Stefan H Hohnloser Julian Arias Ortiz, Raphaël Favory, and Jean-Louis Vincent
