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  SPECIFICATION
CARDIOLOGY: AN ILLUSTRATED TEXTBOOK (2-VOLS SET) (hb)2012
Author: KANU CHATTERJEE
ISBN: 9789350252758
Year: 2012
Publisher: JAYPEE BROTHERS MEDICAL PUBLISHERS PVT LTD.
Category: CARDIOLOGY
Edition: 1
Format: Hard Cover
Language: English
Pages: 2170
 ABOUT THE TITLE
Author: Kanu Chatterjee

Untitled Document
 TABLE OF CONTENTS
Section 1
BASIC CARDIOLOGY
1. Cardiac Anatomy 3
Melvin D Cheitlin, Philip C Ursell
Pericardium and Heart in the Mediastinum 3
Cardiac Surface Anatomy 6
Internal Structure of the Heart 8
Right Atrium 8
Tricuspid Valve 10
Right Ventricle 11
Pulmonic Valve 12
Pulmonary Arteries 13
Left Atrium 13
Mitral Valve 13
Left Ventricle 14
Aortic Valve 15
Conduction System 16
Coronary Arteries 18
Intramural Vessels 19
Coronary Veins 19
Cardiac Lymphatics 21
Cardiac Innervation 21
2. Cardiac Function in Physiology and Pathology 23
Joel S Karliner, Jeffrey Zimmet
Beta-adrenergic Receptor-mediated Signaling 23
Calcium Regulation 24
Links Between B-adrenergic Signaling and
Calcium Regulation 24
Mitochondria 24
Cardiac Hypertrophy 26
?1-adrenergic Receptors and Hypertrophy 26
Congestive Heart Failure 27
Micro-RNAs 28
Ischemia/Reperfusion Injury 28
Mechanisms of Cardioprotection 28
Aging 30
3. Coronary Circulation in Physiology
and Pathology 34
Kanu Chatterjee
Coronary Vascular Anatomy 34
Regulation of Coronary Blood Flow 34
Coronary Vascular Resistance 35
Modulation of Coronary Blood Flow 36
Coronary Collateral Circulation 39
Coronary Circulation in Pathologic States 40
Section 2
CARDIOVASCULAR PHARMACOLOGY
4. Diuretics 53
Michael E Ernst
Normal Renal Solute Handling 53
History and Classification of the Diuretic Compounds 53
Clinical Pharmacology of the Diuretic Compounds 55
Adaptive Responses to Diuretic Administration 56
Individual Diuretic Classes 57
Clinical Use of Diuretics in Cardiovascular Diseases 62
Adverse Effects of Diuretics 67
5. Vasodilators and Neurohormone Modulators 71
Gary S Francis, Suma Konety
Vasodilator Drugs and Low Blood Pressure 72
Arteriolar Vasodilators 72
Renin-angiotensin-aldosterone System
(RAAS) Blockers 74
Mineralocorticoid (Aldosterone) Receptor Blockers 78
Phosphodiesterase Type 5 Inhibitors 81
Intravenous Vasodilators 82
Oral B-adrenergic Blocking Drugs 83
6. Positive Inotropic Drugs 89
Carl V Leier, Garrie J Haas, Philip F Binkley
Intravenously Administered, Short-term Positive
Inotropic Therapy 89
7. Antilipid Agents 104
Jennifer G Robinson
Appropriate Uses 104
Statins 105
Add-on to Statin Therapy 110
Bile Acid Sequestrants 111
Ezetimibe 111
Niacin 112
Triglyceride-lowering Therapy 113
Fibrates 113
Omega-3 Fatty Acids 114
Drugs in Development 114
8. Antithrombotic and Antiplatelet Agents 116
Louis P Kohl, Ethan Weiss
Clotting—A Primer 116
Antithrombotic Agents 119
Ave-5206 121
Vitamin K Antagonists (VKA) 121
Ati-5923 122
Direct Factor Xa Inhibitors 122
Direct Thrombin Inhibitors 124
Antiplatelet Agents 127
Section 3
DIAGNOSIS
9. History 143
Kanu Chatterjee
The History 143
10. Physical Examination 151
Kanu Chatterjee
General Appearance 151
Measurement of Arterial Pressure 153
Auscultation 160
11. Plain Film Imaging of Adult
Cardiovascular Disease 174
Brad H Thompson, Edwin JR van Beek
Chest Film Technique 174
Overview of Cardiomediastinal Anatomy 175
Cardiac Anatomy on Chest Radiographs 176
Cardiac Chamber Enlargement 177
Radiographic Manifestations of Congestive Heart
Failure 179
Volume 1
xviii
Cardiology: An Illustrated Textbook
Cardiac Calcifications 182
Acquired Valvular Heart Disease 183
Pericardial Disorders 187
12. Electrocardiogram 189
Donald Brown
Basis of Electrocardiography 189
Component Parts of the Electrocardiogram 191
Lead Systems Used to Record the
Electrocardiogram 191
Common Electrode Misplacements 192
Other Lead Systems 194
Identification of Atrial Activity 194
Characterization of QRS Complex 201
ST-T Wave Abnormalities 206
The “U” Wave 206
The QT Interval 207
13. ECG Exercise Testing 209
Abhimanyu (Manu) Uberoi, Victor F Froelicher
Before the Test 209
Methodology of Exercise Testing 211
During the Test 213
After the Test 220
Screening 221
14. The Left Ventricle 228
Rakesh K Mishra, Nelson B Schiller
Systolic Function 228
Contrast-enhanced Echocardiography 236
Other Echo-derived Indices of
LV Systolic Function 237
Strain-derived Indices 237
Recognizing the Etiology of Cardiac Dysfunction 237
Dilated Cardiomyopathy 238
Hypertrophic Cardiomyopathy 238
Restrictive Cardiomyopathy 239
Left Ventricular Noncompaction 240
Visual Qualitative Indicators of Systolic Dysfunction 240
Diastolic Function 242
15. Ventricular Function—Assessment and
Clinical Application 252
Kanu Chatterjee, Wassef Karrowni,
William Parmley
Determinants of Left Ventricular Performance 252
Left Ventricular Pump Function 255
Heart Rate 258
Diastolic Function 259
Right Ventricular Function 260
16. Transthoracic Echocardiography 265
Byron F Vandenberg, Richard E Kerber
Chamber Quantitation 265
Doppler ECHO 269
Diastolic Function 270
Pulmonary Hypertension 272
Pericardial Disease 273
Valvular Heart Disease 274
Infective Endocarditis 285
Intracardiac Masses 285
Contrast Echocardiography 286
Cardiac Resynchronization Therapy 289
17. Stress Echocardiography 291
Ellen EI Gordon, Richard E Kerber
Using Stress Echocardiography in
Clinical Decisions 291
The Future of Stress Echo 305
18. Transesophageal Echocardiography 309
Seyed M Hashemi, Paul Lindower,
Richard E Kerber
History 309
Guidelines 309
Performance 309
Safety 310
Views 310
Major Clinical Applications 310
Structural Valve Assessment 313
Acute Aortic Dissection 316
Procedural Adjunct or Intraoperative TEE 316
19. Real Time Three-dimensional
Echocardiography 319
Manjula V Burri, Richard E Kerber
Technique 320
Clinical Applications 324
Future Directions 339
Limitations 342
20. Intravascular Coronary Ultrasound and Beyond 349
Teruyoshi Kume, Yasuhiro Honda,
Peter J Fitzgerald
Intravascular Ultrasound 349
Optical Coherence Tomography 364
Angioscopy 370
Spectroscopy 374
21. Cardiovascular Nuclear Medicine—
Nuclear Cardiology 381
Elias H Botvinick
Pathophysiologic Considerations 382
Myocardial Perfusion Imaging 385
Risk Assessment of General and Specific
Patient Populations 393
Positron Emission Tomography Perfusion and
Metabolism 394
Imaging Myocardial Viability 395
Imaging Perfusion 397
Quantitation of Regional Coronary Flow and
Flow Reserve 397
Blood Pool Imaging—Equilibrium Radionuclide
Angiography and First Pass Radionuclide
Angiography 398
First Pass Curve Analysis 398
Equilibrium Gated Imaging—ERNA 399
The Value of Functional Imaging 401
Phase Analysis 401
Imaging Myocardial Sympathetic Innervation 401
Radiation Concerns 402
22. Cardiac Computed Tomography 408
Isidore C Okere, Gardar Sigurdsson
Technical Aspects 408
Coronary Artery Disease 414
Myocardium and Chambers 417
xix
Contents
Pulmonary Veins 418
Cardiac Veins 419
Valvular Disease 420
Pericardium 421
Masses 422
Incidental Findings 423
Future 423
23. Cardiovascular Magnetic Resonance 431
Robert M Weiss
Diagnosis of Epicardial Coronary Artery Stenosis 432
Assessment of Global and Regional Left Ventricular
Function at Rest and during Inotropic Stress 432
Myocardial Perfusion Imaging 433
Cardiovascular Magnetic Resonance Coronary
Angiography 433
Unrecognized Myocardial Infarction 433
Dilated Cardiomyopathy 434
Hypertrophic Cardiomyopathy 437
Restrictive Cardiomyopathy 439
Cardiovascular Magnetic Resonance-guided
Therapy 440
Valvular Heart Disease 440
Diseases with Right Ventricular
Predominance 442
Miscellaneous Conditions 445
24. Molecular Imaging of Vascular Disease 450
Eric A Osborn, Jagat Narula, Farouc A Jaffer
Molecular Imaging Fundamentals 450
Molecular Imaging Modalities 452
Molecular Imaging of Vascular Disease Processes 453
25. Cardiac Hemodynamics and
Coronary Physiology 470
Amardeep K Singh, Andrew Boyle,
Yerem Yeghiazarians
Cardiac Catheterization—The Basics 470
Catheterization Computations 472
Cardiac Cycle Pressure Waveforms 473
Hemodynamics in Valvular Heart Disease 474
Hemodynamics in Cardiomyopathy 479
Hemodynamics in Pericardial Disease 481
Coronary Hemodynamics 482
26. Cardiac Biopsy 485
Vijay U Rao, Teresa De Marco
History and Devices 485
Techniques 485
Safety and Complications 487
Analysis of EMB Tissue 487
Indications 488
Disease States 491
Cardiac Transplantation 497
27. Swan-Ganz Catheters: Clinical Applications 503
Dipti Gupta, Wassef Karrowni, Kanu Chatterjee
Historical Perspective and Evolution of
Catheter Designs 503
Placement of Balloon Flotation Catheters 503
Normal Pressures and Waveforms 504
Abnormal Pressures and Waveforms 506
Clinical Applications 507
Indications for Pulmonary Artery Catheterization 512
Complications 512
28. Coronary Angiography and Catheterbased
Coronary Intervention 517
Elaine M Demetroulis, Mohan Brar
Indications for Coronary Angiography 517
Contraindications for Coronary Angiography 518
Patient Preparation 518
Sites and Techniques of Vascular Access 519
Catheters for Coronary Angiography 520
Catheters for Bypass Grafts 522
Arterial Nomenclature and Extent of Disease 523
Angiographic Projections 524
Normal Coronary Anatomy 524
Congenital Anomalies of the Coronary Circulation 528
General Principles for Coronary and/or
Graft Cannulation 531
The Fluoroscopic Imaging System 535
Characteristics of Contrast Media 535
Contrast-induced Renal Failure 536
Access Site Hemostasis 536
Complications of Cardiac Catheterization 537
Lesion Quantification 539
Degenerated Saphenous Vein Grafts 540
Lesion Calcification 540
Physiologic Assessment of Angiographically
Indeterminate Coronary Lesions 541
Clinical Use of Translesional Physiologic
Measurements 541
Non-atherosclerotic Coronary Artery Disease
and Transplant Vasculopathy 542
Potential Errors on Interpretation of
the Coronary Angiogram 543
Percutaneous Coronary Intervention 544
Pharmacotherapy for PCI 545
Parenteral Anticoagulant Therapy 548
Equipment for Coronary Interventions 549
Percutaneous Transluminal Coronary Angioplasty 550
Coronary Stents 550
Types of Stents 551
Stent Deployment 551
Adjunctive Coronary Interventional Devices 551
Embolic Protection Devices for Venous
Bypass Graft PCI 552
Clinical Outcomes 553
Procedural Success and Complications
Related to Coronary Intervention 555
Complications Specific to PCI 555
Section 4
ELECTROPHYSIOLOGY
29. Arrhythmia Mechanisms 565
Mark Anderson
Arrhythmia Initiation 565
30. Antiarrhythmic Drugs 578
Rakesh Gopinathannair, Brian Olshansky
Arrhythmia Mechanisms and Antiarrhythmic Drugs 579
Indications for Antiarrhythmic Drug Therapy 579
Proarrhythmia 579
Classification Scheme 579
Vaughan-Williams Classification 579
Miscellaneous Drugs 594
Newer Drugs 594
Emerging Antiarrhythmic Drugs 595
xx
Cardiology: An Illustrated Textbook
Antiarrhythmic Drug Selection in Atrial Fibrillation 595
Out-patient versus in-hospital Initiation for
Antiarrhythmic Drug Therapy 595
Antiarrhythmic Drugs in Pregnancy and Lactation 596
Comparing Antiarrhythmic Drugs to Implantable
Cardioverter Defibrillators in Patients at
Risk of Arrhythmic Death 596
Antiarrhythmic Drug-device Interactions 597
31. Electrophysiology Studies 601
Indrajit Choudhuri, Masood Akhtar
Cardiac Electrophysiology Study: Philosophy,
Requirements and Basic Techniques 601
Fundamentals of the Cardiac
Electrophysiology Study 605
Programmed Electrical Stimulation and
Associated Electrophysiology 609
Cardiac Electrophysiology Study for
Evaluation of Drug Therapy 624
Electrophysiology Study to Guide Ablative Therapy 624
Complications 625
32. Syncope 627
Vijay Ramu, Fred Kusumoto, Nora Goldschlager
Epidemiology 628
Diagnostic Tests 629
Approach to the Evaluation of Syncope 638
Specific Patient Groups 639
Syncope and Driving 642
33. Atrial Fibrillation 647
Vasanth Vedantham, Jeffrey E Olgin
Definition and Classification 647
Epidemiology 647
Etiology and Pathogenesis 649
Diagnosis 652
Management 653
34. Supraventricular Tachycardia 665
Renee M Sullivan, Wei Wei Li, Brian Olshansky
Classification 665
Diagnosis 674
Treatments 678
35. Clinical Spectrum of Ventricular Tachycardia 686
Masood Akhtar
Monomorphic Ventricular Tachycardia 687
Polymorphic Ventricular Tachycardia 692
36. Bradycardia and Heart Block 698
Arthur C Kendig, James B Martins
Conduction System Anatomy and Development 698
Bradycardia Syndromes/Diseases 698
Clinical Presentation 700
Measurement/Diagnosis 700
Sinus Node Disease 700
AV Node Disease 700
Hemiblock 701
Bundle Branch Block 702
Treatment 702
37. Arrhythmogenic Right Ventricular
Dysplasia/Cardiomyopathy 705
Richard NW Hauer, Frank I Marcus,
Moniek GJP Cox
Molecular and Genetic Background 706
Epidemiology 708
Clinical Presentation 708
Clinical Diagnosis 709
Non-classical ARVD/C Subtypes 713
Differential Diagnosis 713
Molecular Genetic Analysis 714
Prognosis and Therapy 714
38. Long QT, Short QT and Brugada Syndromes 718
Seyed M Hashemi, Peter J Mohler
LQT Syndrome 718
SQT Syndrome 722
Brugada Syndrome 724
39. Surgical and Catheter Ablation of
Cardiac Arrhythmias 728
Yanfei Yang, David Singh, Nitish Badhwar,
Melvin Scheinman
Supraventricular Tachycardia 728
Atrioventricular Nodal Re-entrant Tachycardia 729
Wolff-Parkinson-White Syndrome and
Atrioventricular Re-entrant Tachycardia 730
Focal Atrial Tachycardia 731
Atrial Flutter 734
Ablation of Ventricular Tachycardia in Patients
with Structural Cardiac Disease 736
Idiopathic Ventricular Tachycardia 744
40. Cardiac Resynchronization Therapy 758
David Singh, Nitish Badhwar
CRT: Rational for Use 758
CRT in Practice 759
Summary of CRT Benefit 761
Prediction of Response to CRT Therapy 762
Role of Dyssynchrony Imaging 764
Dyssynchrony Summary 767
LV Lead Placement 767
CRT Complications 767
Emerging CRT Indications 768
41. Ambulatory Electrocardiographic Monitoring 777
Renee M Sullivan, Brian Olshansky,
James B Martins, Alexander Mazur
Holter Monitoring 777
Event Recorders 780
Mobile Cardiac Outpatient Telemetry 782
Implantable Loop Recorders 783
Key Considerations in Selecting A
Monitoring Modality 783
42. Cardiac Arrest and Resuscitation 788
Christine Miyake, Richard E Kerber
Overview or Background 788
Basic Life Support 792
Advanced Cardiac Life Support 795
Cessation of Resuscitation 799
Post-resuscitation Care 800
43. Risk Stratification for Sudden Cardiac Death 804
Dwayne N Campbell, James B Martins
Healthy Athletes 804
Brugada Syndrome 805
Long QT Interval Syndrome 805
Early Repolarization 805
Short QT Syndrome 805
xxi
Contents
Catecholamine Polymorphic Ventricular
Tachycardia 805
Wolff-Parkinson-White Syndrome 805
Arrhythmogenic Right Ventricular Cardiomyopathy 806
Hypertrophic Cardiomyopathy 806
Marfan Syndrome 806
Noncompaction 806
Congenital Heart Disease 806
Non-ischemic Cardiomyopathy 807
Coronary Artery Disease 807
44. Cardiocerebral Resuscitation for
Primary Cardiac Arrest 811
Jooby John, Gordon A Ewy
Etiology and Pathophysiology of Cardiac Arrest 812
Drug Therapy in Cardiac Resuscitation 821
Cardiac Resuscitation Centers 822
Ending Resuscitative Efforts 823
Section 5
CORONARY HEART DISEASES
45. Coronary Heart Disease: Risk Factors 829
Bilal Aijaz, Vera Bittner
CHD Screening and Prevention 830
Clustering and Multiplicative Effects of Risk Factors 830
CHD Risk Estimation 830
Measures to Evaluate Risk Prediction Models 832
Traditional CHD Risk Factors 833
Emerging Risk Factors 838
Sub-clinical Atherosclerosis 839
Translating Risk Factor Screening into Event
Reduction 840
46. Changing Focus in Global Burden of
Cardiovascular Diseases 844
Rajeev Gupta, Prakash C Deedwania
CVD in High Income Countries 844
Low and Middle Income Countries 845
Risk Factors 849
Global Response for Combating CVD 850
47. Evaluation of Chest Pain 854
Kirsten E Fleischmann, Raveen Pal
Scope 854
History 854
Differential Diagnosis 854
Patient’s Description 855
Angina 855
Past Medical History 856
Physical Examination 856
Investigations 858
Estimation of Risk 859
Diagnostic Testing 859
48. Acute Coronary Syndrome I (Unstable Angina
and Non-ST-Segment Elevation Myocardial
Infarction): Diagnosis and Early Treatment 871
Saket Girotra, Theresa M Brennan
Pathophysiology 871
Clinical Features 873
Risk Stratification—Putting it All Together to
Determine the Optimal Treatment Strategy 875
Early Medical Therapy 877
Early Invasive or Initial Conservative Strategy 884
Revascularization 885
49. Acute Coronary Syndrome II (ST-Elevation
Myocardial Infarction and Post Myocardial
Infarction): Complications and Care 892
Theresa M Brennan, Patricia Lounsbury,
Saket Girotra
Pathophysiology 893
Clinical Presentation 894
Reperfusion 902
Early Medical Therapy 906
Post Myocardial Infarction Care 909
Complications 912
Special Considerations 914
Continued Medical Therapy for Patients with
A Myocardial Infarction 916
Discharge 919
50. Management of Patients with Chronic Coronary
Artery Disease and Stable Angina 927
Prakash C Deedwania, Enrique V Carbajal
Current Therapeutic Approaches for
Stable Angina 927
Antianginal Drug Therapy 928
Newer Antianginal Drugs 929
Combination Therapy 930
Other Drugs in Patients with Stable Angina
and Chronic CAD 930
Role of Myocardial Revascularization 931
Comparison of Revascularization with
Pharmacological Antianginal Therapy 931
Medical Therapy versus Percutaneous
Revascularization or Strategies Comparing
Invasive versus Optimal Medical Therapy 933
51. Variant Angina 938
Reza Ardehali, John Speer Schroeder
Incidence and Predisposing Risk Factors 938
Pathophysiology 939
Clinical Presentation 939
Diagnosis 940
Differential Diagnosis 942
Management 943
Natural History and Prognosis 946
52. Cardiogenic Shock in Acute
Coronary Syndromes 949
Sanjay K Shah, Eugen Ivan, Andrew D Michaels
Incidence 949
Mortality 949
Predictors of Cardiogenic Shock 950
Pathophysiology 950
Pathology 951
Other Cardiac Causes of Cardiogenic Shock 951
Diagnostic Evaluation 954
Medical Management 954
Mechanical Support 954
Revascularization 957
53. Acute Right Ventricular Infarction 960
James A Goldstein
Patterns of Coronary Compromise Resulting
in RVI 960
xxii
Cardiology: An Illustrated Textbook
Right Ventricular Mechanics and Oxygen
Supply-demand 961
Effects of Ischemia on RV Systolic and Diastolic
Function 961
Determinants of RV Performance in
Severe RVI 961
Natural History of Ischemic RV Dysfunction 962
Effects of Reperfusion on Ischemic RV
Dysfunction 963
Rhythm Disorders and Reflexes Associated
with RVI 964
Mechanical Complications Associated
with RVI 964
Clinical Presentations and Evaluation 964
Noninvasive and Hemodynamic Evaluation 965
Differential Diagnosis of RVI 965
Therapy 965
54. Surgical Therapy in Chronic Coronary
Artery Disease 969
Joss Fernandez, Samad Hashimi,
Karam Karam, Jose Torres, Robert Saeid Farivar
Technique of Surgical Therapy for
Chronic Coronary Artery Disease 969
Indications for Surgical Coronary
Revascularization Advantages of CABG
Over Medical Treatment 970
Comparing CABG to PTCA 971
The Changing CABG Population 971
When CABG may be Indicated 971
When CABG is not Indicated 972
Risk Factors for in-hospital Mortality
Following CABG 972
Outcomes of Surgery 975
Major Clinical Trials in Chronic Coronary
Artery Disease 976
Section 6
VALVULAR HEART DISEASES
55. Aortic Valve Disease 985
Blase A Carabello
Aortic Stenosis 985
Aortic Regurgitation 992
56. Mitral Valve Disease 1000
Satyavan Sharma, Bharat V Dalvi
Normal Mitral Valve Morphology and Function 1000
Global Burden of Rheumatic Heart Disease 1000
Mitral Stenosis 1001
Mitral Regurgitation 1007
57. Tricuspid Valve Disease:
Evaluation and Management 1018
Pravin M Shah
Embryology 1018
Valve Anatomy 1019
Normal Tricuspid Valve Function 1019
Tricuspid Valve Dysfunction 1019
Clinical Presentation 1021
Laboratory Diagnosis 1021
Treatment 1023
58. Congenital Pulmonic Stenosis 1028
Jullien Hoffman
Valvar Pulmonic Stenosis 1028
Isolated Infundibular Stenosis 1034
Supravalvar Stenosis 1035
59. Catheter-based Treatment of Valvular
Heart Disease 1040
Hjalti Gudmundsson, Philip A Horwitz
Catheter-based Treatment of Mitral
Valve Disease 1040
Catheter-based Treatment of Pulmonary
Valve Disease 1044
Percutaneous Tricuspid Balloon Valvuloplasty 1045
Catheter-based Therapies for Aortic Stenosis 1045
Summary/Future Directions 1048
60. Infective Endocarditis 1052
Ehrin J Armstrong, Ann Bolger,
Henry F Chambers
Epidemiology 1052
Pathogenesis 1054
Microbiology 1057
Patient Presentation and Diagnosis 1059
Management 1062
61. Prosthetic Heart Valves 1072
Byron F Vandenberg
Risk of Valve Replacement 1072
Types of Prosthetic Valves 1073
Selecting the Optimal Prosthesis 1079
Prosthesis-patient Mismatch 1081
Long-term Management 1084
Long-term Complications 1090
62. Antithrombotic Therapy in
Valvular Heart Disease 1098
Michael H Crawford
General Considerations 1098
Prophylactic Antithrombic Therapy 1099
Native Valvular Heart Disease 1100
Rheumatic Valvular Heart Disease 1100
Mitral Valve Prolapse 1100
Calcified or Degenerative Valvular Disease 1100
Prosthetic Valves 1100
Bioprosthetic Valves 1101
Valvuloplasty and Valve Repair 1101
Management Issues 1101
Guidelines for Valvular Heart Diseases 1104
Volume 2
xxiii
Contents
Section 7
VASCULAR DISEASES
63. Evaluation and Management of
the Patient with Essential Hypertension 1129
Edward D Frohlich
Evaluation of the Patient with Hypertension 1129
Antihypertensive Therapy 1133
Hemodynamic Concepts 1135
Clinical Pharmacologic Concepts 1136
Treatment Algorithms Advocated Over
the Years 1142
64. Peripheral Vascular and
Cerebrovascular Disease 1145
Babak Haddadian, Suhail Allaqaband,
Tanvir Bajwa
Peripheral Arterial Disease 1145
Carotid Artery Disease 1155
Renal Artery Stenosis 1157
Subclavian Artery Stenosis 1159
Vertebrobasilar Artery Stenosis 1160
Mesenteric Ischemia 1160
65. Aortic Dissection 1166
Ariane Neyou
Predisposing Factors 1166
Classification 1168
Clinical Manifestations 1169
Diagnosis 1170
Treatment 1171
66. Endovascular Treatment of Aortic
Aneurysm and Dissection 1175
AM Timothy, DM Chuter
History of Endovascular Aortic Repair 1176
Stent Graft Design: The Lessons of Experience 1176
Anatomic Substrate for Endovascular
Aneurysm Repair 1177
Current Stent Graft Designs for Abdominal
Aortic Aneurysm (AAA) 1177
Adjunctive Devices and Techniques 1178
Endoleak 1179
Late-occurring Complications of
Endovascular Aneurysm Repair 1179
Follow-up Imaging 1180
Branched and Fenestrated Stent Grafts 1180
Current Thoracic Aortic Stent Graft Designs 1181
Endovascular Repair of Thoracic Aortic
Aneurysms 1181
Thoracic Aortic Dissection 1181
Acute Type B Dissection 1182
Chronic Type B Dissection 1183
Complications of Thoracic Endovascular
Aortic Repair 1184
Intramural Hematoma 1185
Penetrating Aortic Ulcer 1185
67. Autonomic Dysfunction and
the Cardiovascular System 1187
Milena A Gebska, Christopher J Benson
Autonomic Regulation of the Cardiovascular
System 1187
Autonomic Testing 1190
Primary Chronic Autonomic Failure 1193
Secondary and Congenital Autonomic Failure 1194
Chronic Orthostatic Intolerance 1195
Syndromes Associated with Episodic
Autonomic Failure 1197
Autonomic Perturbations Associated with
Cardiovascular Conditions 1198
Section 8
HEART FAILURE
68. Heart Failure: Epidemiology 1207
Kanu Chatterjee
Epidemiology 1207
Prevalence 1207
Incidence 1209
Secular Trends 1211
69. Heart Failure: Diagnosis 1213
Kanu Chatterjee
Analysis of Symptoms 1213
Physical Examination 1214
Electrocardiogram 1215
Chest Radiograph 1218
Echocardiography 1218
Radionuclide Ventriculography 1219
Cardiac Magnetic Resonance 1220
Cardiac Tomography 1220
Routine Laboratory Tests 1221
Biomarkers 1221
Exercise Tests 1223
Six-minute Walk Test 1224
Coronary Arteriography 1224
Myocardial Ischemia 1224
Endomyocardial Biopsy 1224
Genetics Studies 1225
70. Systolic Heart Failure (Heart Failure
with Reduced Ejection Fraction) 1228
Kanu Chatterjee
Historical Perspective 1228
Ventricular Remodeling 1229
Functional Derangements and Hemodynamic
Consequences 1235
Initial Treatment of Systolic Heart Failure 1235
Symptomatic Systolic Heart Failure 1237
Follow-up Evaluation 1245
71. Diastolic Heart Failure (Heart Failure
with Preserved Ejection Fraction) 1251
Kanu Chatterjee
Definition 1251
Epidemiology 1251
Pathophysiology 1252
Clinical Presentation 1255
Diagnosis 1256
Prognosis 1256
Treatment Strategies 1258
Future Directions 1261
72. Anemia in Patient with Chronic Heart Failure
(Prevalence, Mechanism, Significance
and Treatment) 1264
James Prempeh, Barry M Massie
Overview of the Problem 1264
xxiv
Cardiology: An Illustrated Textbook
Prevalence of Anemia in Heart Failure Patients 1264
Mechanisms Underlying Anemia in Heart
Failure Patients 1264
Prognostic Significance of Anemia in Heart
Failure Patients 1265
Should Anemia be Treated in Heart
Failure Patients? 1265
Safety Concerns Related to ESPS in
A Variety of Anemic Patients 1266
Treatment of Anemia in Heart Failure
Patients 1266
73. Hyponatremia and Congestive Heart Failure 1272
Anne Mani, David J Whellan
Mechanisms Causing Hyponatremia
and Heart Failure 1274
Treatment of Hyponatremia 1276
Role of Diuretic Therapy in Hyponatremia 1276
Role of Vasopressin Receptor Antagonists
in Hyponatremia 1277
Tolvaptan 1277
Lixivaptan 1278
Conivaptan 1279
74. Cardiorenal Syndrome: The Interplay
between Cardiac and Renal Function
in Patients with Congestive Heart Failure 1281
Nestor Mercado, J Thomas Heywood
Epidemiology of Chronic Kidney Disease
in Patients with Heart Failure 1281
Prognosis of Worsening Renal Function 1282
Definition of the Cardiorenal Syndrome 1283
Pathophysiology of the Cardiorenal Syndrome 1286
Role of Decreased Cardiac Output 1286
Role of Elevated Central Venous Pressure 1287
Role of Evidence-based Therapies in Patients
with Heart Failure and the Cardiorenal
Syndrome 1288
Role of Ultrafiltration on Diuretic Resistance
and the Cardiorenal Syndrome 1292
Treatment of the Cardiorenal Syndrome:
An Approach to the Individual Patient 1292
75. Acute Heart Failure Syndromes 1298
Peter S Pang, Michel Komajda,
Mihai Gheorghiade
Definition 1298
Epidemiology 1298
Patient’s Characteristics 1298
Classification 1299
Pathophysiology 1300
Acute Heart Failure Syndromes Management 1301
Clinical Trials in Acute Heart Failure
Syndromes 1306
76. Cardiopulmonary Exercise Testing and
Training in Heart Failure 1312
Ileana L Piña
Normal Response to Exercise 1312
Exercise Response in Heart Failure 1313
Cardiopulmonary Exercise Testing 1314
Indications for CPX Testing in Heart Failure 1316
Exercise Training in Heart Failure 1318
77. Hibernating Myocardium 1323
Kanu Chatterjee
Historical Perspective 1323
Definition 1323
Pathophysiology 1324
Hibernation and Stunning: Clinical Prevalence 1325
Detection of Hibernating Myocardium 1325
Revascularization of Hibernating Myocardium
and Changes in Ventricular Function 1328
Revascularization of Hibernating Myocardium and
Changes in Prognosis 1328
78. Advanced Cardiac Therapies for End Stage
Heart Failure: Cardiac Transplantation and
Mechanical Circulatory Support 1334
Ashrith Guha, Frances Johnson
Identifying Candidates for Advanced
Cardiac Therapies 1335
Heart Transplantation 1338
Mechanical Circulatory Support 1343
79. Palliative Medicine and End of Life
Care in Heart Failure 1352
KellyAnn Light-McGroary
Epidemiology of Heart Failure 1352
Economic Impact of Heart Failure 1352
History of Palliative Care/Definitions 1353
Feasibility of the Use of Palliative Care in
Heart Failure 1354
Issues of Prognostication 1355
Communication and Patient’s Understanding of
their Disease 1355
Suffering in End Stage Heart Failure 1357
Symptom Management in Heart Failure 1357
Management of Implantable Cardiac Devices 1360
Guidelines for Heart Failure 1366
Section 9
MYOCARDIAL AND PERICARDIAL DISEASES
80. Hypertrophic Cardiomyopathy 1377
M Fuad Jan, A Jamil Tajik
Definition 1377
Epidemiology and Genetic Considerations 1377
Pathology 1379
Pathophysiology 1381
Clinical Presentation 1387
Diagnosis 1390
Natural History 1400
Management 1402
Additional Points of Interest 1412
81. Dilated Cardiomyopathy 1424
Jalal K Ghali
Definition 1424
Epidemiology 1425
Pathology 1425
Etiology 1425
Prognosis 1430
Predictors of Mortality 1430
82. Restrictive and Obliterative Cardiomyopathies 1439
G Vijayaraghavan, S Sivasankaran
Restrictive Cardiomyopathies 1440
xxv
Contents
Tropical Endomyocardial Fibrosis (Davie’s Disease) 1442
Right Ventricular Endomyocardial Fibrosis 1444
Left Ventricular Endomyocardial Fibrosis 1446
Loeffler’s Endocarditis 1449
Hemochromatosis 1450
Idiopathic Restrictive Cardiomyopathy 1451
Other Forms of Cardiomyopathies 1452
83. Amyloid Heart Disease 1454
Eveline Oestreicher Stock, Dana McGlothlin
History of Amyloid 1454
Amyloidogenesis 1455
Overview of Cardiac Amyloidosis 1456
Classification of Amyloidosis 1456
Cardiac Amyloidosis 1456
Clinical Features of Cardiac Amyloidosis 1459
Treatment of Amyloid Cardiomyopathy 1464
84. Peripartum Cardiomyopathy 1473
Uri Elkayam, Nudrat Khatri, Mohamad Barakat
Definition 1473
Incidence 1473
Etiology 1473
Risk Factors 1473
Clinical Presentation 1473
Prognosis 1474
Treatment 1475
Labor and Delivery 1475
85. Chemotherapy-induced Cardiomyopathy 1479
Wassef Karrowni, Kanu Chatterjee
Classification of Chemotherapy-induced
Cardiotoxicity 1479
Risk Factors 1480
Pathophysiology of Anthracycline-induced
Cardiomyopathy 1480
Mechanism of Chemotherapy-induced Cardiac
Dysfunction 1482
Diagnosis 1483
Monitoring 1484
Management 1484
Treatment 1486
86. Pericardial Diseases 1489
Masud H Khandaker, Rick A Nishimura
Acute Pericarditis 1489
Chronic Relapsing Pericarditis 1491
Pericardial Effusion and Pericardial Tamponade 1493
Constrictive Pericarditis 1496
87. Radiation-induced Heart Disease 1505
Wassef Karrowni, Kanu Chatterjee
Radiation-induced Pericardial Disease 1505
Radiation-induced Myocardial Disease 1506
Radiation-induced Coronary Artery Disease 1507
Radiation-induced Valvular Heart Disease 1508
Conduction System Disease 1509
Carotid and Other Vascular Disease 1509
Prevention 1509
88. Chagas Disease 1513
Diane C Kraft, Richard E Kerber
Life Cycle 1513
Transmission 1513
Epidemiology 1513
Clinical Manifestations 1513
Echocardiography 1516
Cardiac Magnetic Resonance Imaging 1516
Treatment 1516
Prevention 1517
Chagas Disease in the United States 1517
Section 10
PULMONARY VASCULAR DISEASE AND
ADULT CONGENITAL HEART DISEASE
89. Pulmonary Arterial Hypertension 1521
Dana McGlothlin, David MaJure
Definitions and Classifications 1521
Pathophysiology and Epidemiology of
Pulmonary Arterial Hypertension 1524
Diagnostic Evaluation 1528
Survival and Prognostic Factors of Pulmonary
Arterial Hypertension 1535
Therapeutic Options for the Treatment of
Pulmonary Arterial Hypertension 1536
Treatment Algorithm and Evaluating Response
to Therapy 1541
Therapy of Decompensated Right Heart Failure
in Pulmonary Arterial Hypertension 1542
90. Congenital Heart Disease in the Adult Patient 1550
Deepa Upadhyaya, Elyse Foster
Acyanotic Heart Disease 1551
Congenital Valvar Aortic Stenosis 1551
Supravalvar Aortic Stenosis and Subvalvar
Aortic Stenosis 1554
Coarctation of the Aorta 1554
Right Ventricular Outflow Tract Obstruction 1557
Valvar Pulmonic Stenosis 1557
Subvalvar and Supravalvar Pulmonic Stenosis 1559
Atrial Septal Defects 1559
Ventricular Septal Defects 1562
Patent Ductus Arteriosus 1566
Other Acyanotic Lesions 1568
Ebstein’s Anomaly 1568
Cyanotic Congenital Heart Disease 1570
Palliative Shunts 1571
Endocarditis 1572
Pregnancy and Contraception 1572
Tetralogy of Fallot 1572
Truncus Arteriosus 1577
D-transposition of the Great Arteries 1578
Congenitally Corrected Transposition of
the Great Arteries 1582
Total Anomalous Pulmonary Venous Return 1583
Double-outlet Right Ventricle 1584
Tricuspid Atresia/Univentricular Heart 1586
Double-inlet Left Ventricle 1587
Hypoplastic Left Heart 1588
Eisenmenger’s Syndrome 1589
Section 11
SECONDARY DISORDERS OF THE HEART
91. Alcohol and Arrhythmia 1595
Mary Gray
Direct Effects of Ethanol Exposure on Heart
Cells and Tissues 1595
xxvi
Cardiology: An Illustrated Textbook
Ethanol Ingestion and the Normal Cardiac
Conduction System 1595
Binge Drinking and Transient Clinical
Arrhythmias—Holiday Heart 1596
Alcohol Consumption, Chronic Atrial Fibrillation
and Atrial Flutter 1596
Alcohol Consumption and Sudden
Cardiac Death 1597
Summary and Clinical Guidelines 1598
92. Insulin-resistance and Cardiomyopathy 1600
Dipanjan Banerjee, Ronald Witteles,
Michael B Fowler
Epidemiology 1600
Diastolic Heart Failure and Insulin-resistance 1601
Pathophysiology 1602
Myocardial Energy Metabolism 1602
Metabolic Effects of Insulin Resistance—
Energy Metabolism 1603
Other Metabolic Effects of Insulin-resistance 1604
Detection of Metabolic Effects of Insulin-resistance 1604
Structural Effects of Insulin-resistance 1605
93. Cardiac Complications of Substance Abuse 1613
Hugh H West
Magnitude of the Problem 1614
Substances of Abuse 1615
Marijuana, Tetrahydriocannabinol, Hashish 1624
Club Drugs: MDMA, GHB, Ketamine, Rohypnol 1625
Hallucinogenic Drugs 1627
Body Image Drugs 1627
Inhalants 1628
Narcotics 1629
Prescription and Over the Counter Drugs 1630
Alcohol and Tobacco 1631
94. HIV/AIDS and Cardiovascular Disease 1636
Jennifer E Ho, Priscilla Y Hsue
HIV and Coronary Heart Disease 1636
Surrogate Measures of Atherosclerosis 1641
Other Cardiovascular Conditions 1641
95. Systemic Autoimmune Diseases and
the Heart 1648
Tamara Nelson, Jonathan L Halperin,
Scott A Vogelgesang
Rheumatoid Arthritis 1648
Spondyloarthropathies 1651
Polymyositis-dermatomyositis 1653
Mixed Connective Tissue Disease 1654
Systemic Lupus Erythematosus 1654
Antiphospholipid Antibody Syndrome 1656
Coronary Arteritis 1656
Polyarteritis Nodosa 1656
Kawasaki Disease 1657
Churg-Strauss Vasculitis 1657
Wegener’s Granulomatosis 1658
Giant Cell Arteritis 1658
Takayasu’s Arteritis 1658
96. Cardiac Neoplastic Disease 1663
Elena Ladich, Naima Carter-Monroe,
Renu Virmani
Clinical Symptoms 1663
Imaging Techniques 1665
Benign Cardiac Neoplasms 1667
Malignant Tumors 1675
Other Sarcomas 1681
97. Neurogenic and Stress Cardiomyopathy 1689
Hoang Nguyen, Ahsan Chaudhary,
Kunal Mehtani, Stefanie Kaiser, Jonathan Zaroff
Neurogenic Cardiomyopathy 1689
Stress Cardiomyopathy 1693
98. Kidney and the Heart 1697
Mony Fraer
Definition 1697
Epidemiology 1697
Pathophysiology 1698
Cardiovascular Risk Factors in Chronic Kidney
Disease 1698
Spectrum of Cardiovascular Disease in
Chronic Kidney Disease 1700
Diagnostic Tests 1703
Principles of Treatment of Cardiovascular Disease 1704
Kidney Transplant Recipients 1704
99. Endocrine Heart Disease 1713
Aarthi Arasu, Umesh Masharani
Diabetes Mellitus 1713
Thyroid Disease 1716
Pituitary Disorders 1718
Adrenal Disorders 1720
Parathyroid Disorders 1722
Carcinoid Syndrome 1723
100. Cardiovascular Trauma as Seen
by the Cardiologist 1729
Arthur Hill, Melvin D Cheitlin
History 1729
Classification and Physics of Traumatic Injury
to the Cardiovascular System 1730
Classifying the Pathology of Cardiac Trauma 1731
Management of the Acutely Injured Patient
with Thoracoabdominal Injury 1731
Intracardiac Injuries From Both Penetrating
Wounds and Blunt Cardiac Injury 1737
101. Venous Thromboembolism and
Cor Pulmonale 1750
Jorge Velazco, Christopher Spradley,
Bernardo Menajovsky, Alejandro C Arroliga
Venous Thromboembolism 1750
Cor Pulmonale 1763
Section 12
RELEVANT ISSUES IN CLINICAL CARDIOLOGY
102. Noncardiac Surgery in Cardiac Patients 1773
Gabriel Gregoratos, Ameya Kulkarni
Preoperative Cardiac Risk Assessment 1773
Preoperative Diagnostic Testing 1778
Preoperative Risk Mitigation Strategies 1780
Intraoperative Management 1786
Management of Patients with Implanted
Electronic Devices 1787
xxvii
Contents
Postoperative Management 1788
Appendix 1789
103. Gender and Cardiovascular Disease 1798
Susan Zhao, Rita Redberg
Prevalence of IHD in Women 1798
Identification and Management of IHD Risk
Factors in Women 1799
Assessment of Symptoms and Myocardial
Ischemia in Women 1802
Management of IHD in Women 1806
Heart Failure in Women 1809
Sex and Cardiac Arrhythmias 1812
Call for More Sex-specific Research 1813
104. Overview of the Athlete’s Heart 1818
Aaron L Baggish, Paul D Thompson
Historical Perspective 1818
Exercise Physiology and the Athlete’s Heart:
Overview 1818
Exercise-induced Cardiac Remodeling 1819
Issues Relevant to the Cardiovascular Care
of Athletes 1821
105. Cardiovascular Aging 1829
John A Dodson, Mathew S Maurer
Age-related Changes 1830
Clinical Syndromes 1834
Special Issues 1839
Section 13
PREVENTIVE STRATEGIES FOR
CORONARY ARTERY DISEASES
106. Pathophysiology of Atherothrombosis 1847
PK Shah
Sites of Predilection for Atherosclerosis 1847
107. Dyslipidemia 1856
Mary Malloy, John Kane
Lipid Transport and Lipoprotein Metabolism 1856
Diagnosis of the Dyslipidemias 1859
Hyperlipoproteinemia 1859
Hypoalphalipoproteinemia 1863
Other Management Considerations 1863
108. Smoking and Air Pollution 1873
Joaquin Barnoya, Ernesto Viteri,
Stanton A Glantz
Epidemiology of Smoking and Exposure to
Second-hand Smoke 1874
Active Smoking and Cardiovascular Disease 1874
Second-hand Smoke and Cardiovascular
Disease 1875
Low-tar (“Light”) Cigarettes 1876
Pathophysiology of Tobacco Smoke and
Cardiovascular Disease 1876
Smoking Cessation 1879
Smoke-free Environments and Their Effect on
Heart Attack Admissions 1883
Similar Effects and Mechanisms of Particulate
Air Pollution 1883
Cardiologists as Tobacco Control Advocates 1884
109. Exercise and Rehabilitation 1890
Lisa Bauer, Patrick McBride
Exercise: Definitions 1890
Exercise: Recommendations 1891
Responses to Exercise 1891
Benefits of Exercise 1891
Exercise Capacity 1891
Inflammation and Endothelial Function 1891
Safety Considerations 1892
Cardiac Rehabilitation Definition and Goals 1892
Cardiac Rehabilitation Phases 1892
Cardiac Rehabilitation Core Components 1893
Clinical Population Considerations 1895
Referral 1895
Reimbursement Issues 1895
Section 14
PREVENTIVE STRATEGIES FOR
OTHER CARDIOVASCULAR DISEASES
110. Prevention of Heart Failure 1899
Clay A Cauthen, WH Wilson Tang
Introduction 1899
Staging of Heart Failure 1899
Future Perspectives 1905
111. Stroke: Prevention and Treatment 1908
Harold P Adams
Introduction 1908
Definitions 1908
Stroke as a Symptom 1909
Prevention 1916
General Acute Treatment 1919
Treatment of Acute Ischemic Stroke 1920
Treatment of Acute Hemorrhagic Stroke 1922
General in-hospital Care 1923
Rehabilitation 1924
112. Rheumatic Fever 1927
V Jacob Jose
Pathogenesis 1927
Epidemiology 1928
Diagnosis of Rheumatic Fever 1928
Clinical Features 1929
Treatment 1931
Residual Heart Disease 1933
Management of Chorea 1933
Section 15
EVOLVING CONCEPTS
113. The Genomics of Cardiovascular Disease 1937
Samir B Damani, Eric J Topol
A Genomic Primer 1937
Intermediate Phenotypes 1940
Coronary Artery Disease 1941
Arrhythmias 1942
Cardiovascular Pharmacogenomics 1943
xxviii
Cardiology: An Illustrated Textbook
SNP Profiling Studies 1946
Future Directions 1947
114. Cardiovascular Pharmacogenetics 1951
Deepak Voora, Victor J Dzau,
Geoffrey S Ginsburg
Principles of Pharmacogenetics 1951
hMG-CoA Reductase Inhibitors 1953
Thienopyridines 1956
Aspirin 1958
Warfarin 1958
Diuretics 1960
Beta-blockers 1960
Antiarrhythmic Drugs 1962
Future Directions 1963
115. Preventing Errors in Cardiovascular
Medicine 1969
Robert M Wachter
Modern Approach to Patient Safety 1969
How to Improve Patient Safety? 1970
Communication and Culture 1971
Learning from Mistakes 1972
Creating a Safe Workforce 1973
Preventing Diagnostic Errors 1973
What Can Patients do to Keep
Themselves Safe? 1973
Changing Policy Context for Patient Safety 1973
116. Economics in Cardiovascular Medicine 1976
Paul A Heidenreich
Cost of Cardiovascular Care 1976
Trends in Health Expenditures
(US versus Non-US) 1976
CV Contribution to the Rising Cost of Care 1977
Variation in Resource Use 1977
Resource Scarcity and Value 1977
Basic Concepts of Health Economics 1978
Benchmarks for Cost-effectiveness 1979
Evaluating Uncertainty 1979
Perspective 1980
Efficiency 1980
Government’s Use of Cost-effectiveness 1980
Cost-effectiveness of Individual Treatments
and Strategies 1981
Cost-effectiveness of Quality Improvement
Interventions 1982
Future Estimates of the Cost of
Heart Disease 1983
117. Stem Cell Therapy in Cardiology 1986
Franca S Angeli, Yerem Yeghiazarians
Stem Cell 1986
Skeletal Myoblast 1989
Adipose Tissue Derived Stem Cells 1989
Cardiac Stem Cells 1989
Fetal and Umbilical Cord Blood Cells 1989
Induced Pluripotent Stem Cells 1991
Stem Cell Clinical Trials 1991
Conclusion and Future Directions 1997
118. Gene Therapy and Angiogenesis 2003
Matthew L Springer
Gene Therapy Overview 2003
Basic Concepts of Angiogenesis 2007
Angiogenic Protein Therapy 2011
Angiogenic Gene Therapy 2011
Gene Therapy for Chronic Heart Failure 2014
119. Sleep and the Heart 2020
Tomas Konecny, Virend Somers
Physiologic Sleep 2020
Effects of Non-rapid Eye Movement Sleep on
Cardiovascular Physiology 2020
Effects of Rapid Eye Movement Sleep on
Cardiovascular Physiology 2020
Arousal 2021
Arrhythmias and Sleep 2021
Sleep Disordered Breathing 2022
Diagnosis of Sleep Apnea 2026
Treatment of Obstructive Sleep Apnea 2027
Central Sleep Apnea 2028
120. Integrative Cardiology: The Use of
Complementary Therapies and Beyond 2031
Kevin Barrows
Non-conventional Therapies and Cardiology 2031
What Is Integrative Medicine? 2031
What Is Integrative Cardiology? 2032
Lifestyle Heart Trial 2032
What Other Integrative Medicine Therapies are
Effective for Cardiovascular Conditions? 2032
Dyslipidemia 2032
Hypertension 2037
Coronary Artery Disease 2040
Heart Failure 2044
Botanical Medicines with Adverse
Cardiovascular Effects 2047
Index I-1
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