Cardiology Crash Course

Esta é uma pré-visualização de arquivo. Entre para ver o arquivo original

Front Cover
	Crash Course: Cardiology
	Copyright
	Series editor foreword
	Prefaces
	Authors
	Faculty Advisor
	Contents
	Chapter 1: History
	Aim of history taking
	Presenting complaint
	Chest pain
	Dyspnoea
	Syncope
	Palpitations
	Ankle swelling
	Systems review
	Respiratory system
	Cough
	Sputum
	Haemoptysis
	Wheeze
	Gastrointestinal system
	Appetite
	Weight loss or gain
	Nausea and vomiting
	Indigestion
	Diarrhoea and constipation
	Central nervous system
	Headache
	Weakness, sensory loss, visual or speech disturbance
	Skin and joints
	Rashes
	Joint pain
	Genitourinary system
	Proteinuria
	Haematuria
	Frequency, hesitancy, nocturia and terminal dribbling
	Impotence and failure of ejaculation
	Past medical history
	Family history
	Social history
	Drug history
	Allergies
	Presenting history findings
	Chapter 2: Examination
	How to begin the examination
	Observation
	Examination of the hands
	Examination of the pulse
	Taking the blood pressure
	Examination of the face
	Examination of the jugular venous pressure
	Kussmaul sign
	Examination of the praecordium
	Inspection
	Palpation
	Auscultation
	Finishing off the examination
	Presenting your findings
	Chapter 3: How to write a clerking
	Documentation of the history
	Systems review
	Risk calculation
	Documentation of the examination findings
	At the end of the clerking
	Further reading
	Sample medical clerking
	Chapter 4: Common investigations
	Electrocardiography
	Lead placement
	Limb leads
	Chest leads
	12-lead electrocardiogram
	Leads I, II and III
	AVR, AVL and AVF
	Chest leads
	QRS axis
	Paper speed
	P wave
	QRS complex
	ST segment
	T wave
	QT interval
	Q waves
	U wave
	Reporting an electrocardiogram
	Exercise electrocardiography
	Indications for exercise testing
	Methods of exercise
	Patient preparation
	Variables measured
	12-lead electrocardiogram
	Blood pressure
	Heart rate response
	Test end-points
	Positive exercise test
	Contraindications to exercise testing
	Echocardiography
	M mode echocardiography
	Two-dimensional echocardiography
	Doppler echocardiography
	Other echocardiography modalities
	Transoesophageal echocardiography
	Stress echocardiography
	Myocardial perfusion imaging
	Methods of stressing the heart
	Multigated acquisition scanning
	Cardiac magnetic resonance
	Positron emission tomography
	Cardiac catheterization
	Technique
	Left heart catheterization and coronary angiography
	Indications
	Patient preparation
	Left ventriculography
	Coronary angiography
	Complications of coronary angiography
	Cardiac computed tomography
	Chapter 5: Chest pain
	Differential diagnosis of chest pain
	History to focus on the differential diagnosis of chest pain
	Presenting complaint
	Past medical history
	Drug history, family history and social history
	Examination of patients who have chest pain
	Inspection
	Cardiovascular system
	Respiratory system
	Gastrointestinal system
	Investigation of patients who have chest pain
	Blood tests
	Electrocardiography
	Chest radiography
	Echocardiography
	Computed tomography and magnetic resonance imaging
	Ventilation/perfusion (V/Q) scan
	Angiography, myocardial perfusion imaging or stress echocardiography
	New onset central chest pain at rest in an ill patient
	Dissection of the thoracic aorta
	Mediastinitis
	Pulmonary embolus
	Chapter 6: Dyspnoea
	Differential diagnosis of dyspnoea
	History to focus on the differential diagnosis of dyspnoea
	Examination of dyspnoeic patients
	Inspection
	Cardiovascular system
	Respiratory system
	Gastrointestinal system
	Investigation of dyspnoeic patients
	Blood tests
	Electrocardiography
	Chest radiography
	Echocardiography
	Computed tomography
	Pulmonary function tests
	Dyspnoea at rest of recent onset in an ill patient
	Pneumothorax
	Acute asthma
	Acute left ventricular failure
	Pulmonary embolus
	Pneumonia
	Chapter 7: Syncope
	Differential diagnosis of syncope
	History to focus on the differential diagnosis of syncope
	Past medical history
	Drug history
	Family history
	Social history
	Examination of patients who present with syncope
	Cardiovascular system
	Neurological system
	Fingerprick test for blood glucose
	Investigation of patients who present with syncope
	Blood tests
	Electrocardiography
	Holter monitor
	Tilt test
	Chest radiography
	Echocardiography
	Electrophysiological study of the heart
	Electroencephalography
	Syncope of recent onset in an ill patient
	Differentiating features of syncope
	Cardiac causes
	Aortic stenosis
	Tachyarrhythmias
	Bradyarrhythmias
	Cardiomyopathies
	Prolonged QT interval
	Brugada syndrome
	Circulatory causes
	Hypovolaemia
	Septic shock
	Classic postural hypotension
	Obstruction of pulmonary arteries
	Cerebrovascular causes
	Stroke and transient cerebral ischaemia
	Vertebrobasilar syndrome
	Other neurological causes
	Metabolic causes
	Chapter 8: Palpitations
	Differential diagnosis of palpitation
	Rapid palpitations
	Slow palpitations
	Disorders causing increased stroke volume
	History to focus on the differential diagnosis of palpitation
	Nature of the palpitation
	Severity of palpitation
	Likely underlying causes of palpitation
	Examination of patients who have palpitation
	General observation
	Cardiovascular system
	Pulse
	Blood pressure
	Jugular venous pressure
	Apex beat
	Heart sounds
	Respiratory system
	Gastrointestinal system
	Limbs
	Investigation of patients who have palpitation
	Biochemical tests
	Electrocardiography
	12-lead electrocardiography
	24-h electrocardiography
	Exercise electrocardiography
	Vagotonic manoeuvres
	Adenosine administration
	Echocardiography
	Electrophysiological study
	Other investigations
	Chapter 9: Peripheral oedema
	Differential diagnosis of oedema
	History to focus on the differential diagnosis of peripheral oedema
	Past medical history
	Drug history
	Social history
	Examination of patients who have oedema
	Cardiovascular system
	Respiratory system
	Gastrointestinal system
	Renal system
	Examination of the oedema
	Investigation of patients who have oedema
	Blood tests
	Urine tests
	Arterial blood gases
	Electrocardiography
	Chest radiography
	Echocardiography
	Ultrasound
	Important aspects
	Salt and water retention
	Increase in extracellular water and intravascular blood volume
	Hypertension treated with calcium antagonists
	Chapter 10: Heart murmur
	Differential diagnosis of a heart murmur
	History to focus on the differential diagnosis of a heart murmur
	Presenting complaint
	Past medical history
	Social history
	Examination of patients who have a heart murmur
	General observation
	Hands
	Cardiovascular system
	Pulse
	Blood pressure
	Jugular venous pressure
	Praecordium
	Peripheral vascular system
	Peripheral oedema
	Respiratory system
	Gastrointestinal system
	Investigation of patients who have a heart murmur
	Blood tests
	Chest radiography
	Electrocardiography
	Echocardiography
	Transthoracic echocardiography
	Transoesophageal echocardiography
	Cardiac catheterization
	Chapter 11: High blood pressure
	Differential diagnosis
	History to focus on the differential diagnosis of high blood pressure
	Presenting complaint
	Past medical history
	Drug history
	Family history
	Social history
	Examination of patients who have high blood pressure
	Blood pressure
	Cardiovascular examination
	Respiratory system
	Gastrointestinal system
	Limbs
	Eyes
	Other findings on examination
	Investigation of patients who have high blood pressure
	Ambulatory blood pressure monitoring
	Home blood pressure monitoring
	Blood tests
	Urinalysis
	Electrocardiography
	Chest radiography
	Echocardiography
	Investigations to exclude secondary hypertension
	Chapter 12: Fever associated with a cardiac
symptom or sign
	Differential diagnosis
	Rare conditions
	History to focus on the differential diagnosis of fever
	Presenting complaint
	Past medical history
	Drug history
	Social history
	Examination of patients who have a fever associated with a cardiac symptom or sign
	Temperature
	Hands
	Facies
	Cardiovascular system
	Pulse
	Blood pressure
	Jugular venous pressure
	Praecordium
	Respiratory system
	Gastrointestinal system
	Skin
	Investigation of patients who have a fever associated with a cardiac symptom or sign
	Blood tests
	Blood cultures
	Full blood count
	Other blood tests
	Urinalysis
	Electrocardiography
	Chest radiography
	Transthoracic echocardiography
	Transoesophageal echocardiography
	Pericardiocentesis
	Chapter 13: Angina pectoris
	Definition of angina pectoris
	Pathophysiology of angina pectoris
	Risk factors for coronary artery disease
	Clinical features of angina pectoris
	Symptoms
	Signs
	Investigation of angina pectoris
	Coronary angiography
	Management of angina pectoris
	Management of the risk factors
	Treatment of the angina
	Drug therapy
	Aspirin
	β-Blockers
	Calcium channel antagonists
	Nitrates
	Potassium channel openers
	New anti-anginals
	Management plan for angina pectoris
	Revascularization
	Percutaneous intervention
	Advantages of PCI
	Disadvantages of PCI
	Complications of PCI
	Coronary artery bypass grafting
	Complications of coronary artery bypass grafting
	Minimally invasive coronary artery bypass grafting
	Unstable angina
	Management
	Further reading
	Chapter 14: Acute myocardial infarction
	Definition of acute myocardial infarction
	Clinical features of acute myocardial infarction
	History
	Presenting complaint
	Past medical history
	Examination
	Cardiovascular system
	Investigation of acute myocardial infarction
	Blood tests
	Indicators of myocardial damage
	Troponin T and troponin I
	Creatine kinase
	Renal function and electrolytes
	Blood glucose
	Full blood count
	Serum cholesterol
	Electrocardiography
	ECG changes in non-ST-elevation myocardial infarction
	Chest radiography
	Echocardiography
	Management of acute myocardial infarction
	Treatment
	Indications for primary PCI
	Contraindications
	Other agents used for acute myocardial infarction
	Aspirin
	Other antiplatelet agents
	Diamorphine
	β-Blockers (β-adrenoceptor antagonists)
	Oxygen
	Non-acute management
	Cardiac rehabilitation
	Summary of management of ischaemic chest pain
	Heart block after myocardial infarction
	Management of postmyocardial infarction heart block
	Cardiogenic shock after myocardial infarction
	Chapter 15: Supraventricular tachyarrhythmias
	Sinus tachycardia
	Causes
	Premature atrial complexes
	Nodal and junctional ectopics
	Atrial tachycardia
	Causes
	Investigation and diagnosis
	Management
	Atrioventricular junctional tachycardia
	Clinical features
	Management
	Atrioventricular nodal re-entry tachycardia
	Clinical features
	Diagnosis
	Management
	Wolff-Parkinson-White syndrome
	Characteristics of the bundle of Kent
	Tachycardias associated with Wolff-Parkinson-White syndrome
	Clinical features
	Management
	Drug therapy
	Ablation therapy
	Atrial flutter
	Investigations and diagnosis
	Management
	Atrial fibrillation
	Causes
	Investigations and diagnosis
	Management
	Anticoagulation and atrial fibrillation
	Anticoagulation and cardioversion of AF
	Investigation of patients who have supraventricular tachyarrhythmias
	Blood tests
	Electrocardiography
	24- or 48-h electrocardiography
	Chest radiography
	Echocardiography
	Electrophysiological studies
	Atrioventricular nodal blocking manoeuvres
	Carotid sinus massage
	Adenosine administration
	Actions of adenosine
	Drugs used to treat tachyarrhythmias
	Further reading
	Chapter 16: Ventricular arrhythmias
	Ventricular ectopic beats
	Clinical features
	Management
	Definition of ventricular tachyarrhythmias
	Ventricular tachycardia
	Clinical features
	Diagnosis
	Management
	Electrophysiological studies
	Torsades de pointes
	Clinical features
	Management
	Ventricular fibrillation
	Clinical features
	Management
	Drugs used to treat ventricular tachycardia and fibrillation
	Non-pharmacological treatments of ventricular tachyarrhythmias
	Radiofrequency ablation
	Implantable cardioverter defibrillators
	Further reading
	Chapter 17: Cardiac arrest and resuscitation
	Basic life support
	Principle of chest compressions
	Recovery position
	Management of upper airway obstruction by foreign material
	Advanced life support
	Points to note about advanced life support
	Protocol
	Airway ventilation and protection
	Placing the defibrillator pads
	The ventricular tachycardia/fibrillation arm of the advanced life support algorithm
	The non-VT/VF arm of the ALS algorithm
	In-hospital cardiac arrest
	Further reading
	Chapter 18: Bradyarrhythmias
	Definition of bradyarrhythmias
	Sinus bradycardia
	Sinus node disease
	Tachy-brady syndrome (sick sinus syndrome)
	Management
	Atrioventricular block
	First-degree atrioventricular block
	Second-degree atrioventricular block
	Mobitz type I heart block - Wenckebach phenomenon
	Mobitz type II heart block
	2:1 or 3:1 heart block
	Third-degree or complete heart block
	Bundle branch block
	Left bundle branch block
	Right bundle branch block
	Investigation of bradyarrhythmias
	Electrocardiography
	Blood tests
	Chest radiography
	Echocardiography
	Pacemakers
	Indications for a permanent pacemaker
	Indications for temporary pacing
	Pacemaker insertion
	Complications of pacemaker insertion
	Types of pacemaker
	Pacemaker syndrome
	Further reading
	Chapter 19: Heart failure
	Definition of heart failure
	Pathophysiology of heart failure
	Normal myocardial response to work
	The failing heart's response to work
	Salt and water retention in heart failure
	Other neurohumoral factors
	Natriuretic peptides
	Cytokines
	Endothelin
	Galectin-3
	Causes of cardiac failure
	Precipitants
	Clinical features of heart failure
	Forward effects
	Backward effects
	Symptoms
	Examination of patients who have heart failure
	Cardiovascular system
	Respiratory system
	Gastrointestinal system
	Investigation of heart failure
	Blood tests
	Electrolytes and renal function
	Full blood count
	Liver function tests
	Brain natriuretic peptide
	Arterial blood gases
	Electrocardiography
	Chest radiography
	Echocardiography
	Cardiac catheterization
	Management of heart failure
	Management of acute left ventricular failure
	Management of acute right ventricular failure
	Management of chronic heart failure
	Angiotensin-converting enzyme inhibitors
	Clinical use of angiotensin-converting enzyme inhibitors
	Angiotensin II receptor blockers
	β-Blockers
	Diuretics
	Aldosterone antagonists
	Nitrates
	Digoxin
	Pharmacokinetics
	Side effects
	Hydralazine
	Cardiac resynchronization therapy
	Further reading
	Chapter 20: Cardiomyopathy
	Definition of cardiomyopathy
	Dilated cardiomyopathy
	Clinical features
	Investigation
	Chest radiography
	Electrocardiography
	Echocardiography
	Cardiac catheterization
	Magnetic resonance imaging
	Blood tests
	Management
	Hypertrophic cardiomyopathy
	Clinical features
	Diagnosis and investigations
	Electrocardiography
	Continuous ambulatory electrocardiography
	Echocardiography
	Exercise testing
	Prognosis
	Management
	Device therapy
	Percutaneous treatment (alcohol septal ablation)
	Surgery
	Restrictive cardiomyopathy
	Clinical features
	Management
	Arrhythmogenic right-ventricular cardiomyopathy
	Takotsubo cardiomyopathy
	Further reading
	Chapter 21: Pericarditis and pericardial effusion
	Acute pericarditis
	Clinical features
	History
	Examination
	Investigation
	Blood tests
	Electrocardiography
	Chest
radiography
	Echocardiography
	Management
	Dressler syndrome
	Constrictive pericarditis
	Clinical features
	Examination
	Investigation
	Management
	Pericardial effusion
	Causes
	Clinical features
	History
	Examination
	Possible mechanisms for pulsus paradoxus
	Investigation
	Electrocardiography
	Management
	Further reading
	Chapter 22: Valve disease
	Rheumatic fever
	Causes
	Clinical features
	Investigations
	Management
	Mitral stenosis
	Causes
	Clinical features
	Examination
	Investigations
	Electrocardiography
	Chest radiography
	Echocardiography
	Cardiac catheterization
	Management
	Medical management
	Mitral valvuloplasty
	Surgical management
	Open mitral valvotomy
	Closed mitral valvotomy
	Mitral valve replacement
	Mitral regurgitation
	Pathophysiology
	Clinical features
	Examination
	Mitral valve prolapse
	Investigations
	Electrocardiography
	Chest radiography
	Echocardiography
	Cardiac catheterization
	Management
	Medical management
	Surgical management
	Mitral valve repair
	Mitral valve replacement
	Aortic stenosis
	Pathophysiology
	Clinical features
	Examination
	Investigations
	Electrocardiography
	Chest radiography
	Echocardiography
	Cardiac catheterization
	Management
	Medical management
	Percutaneous and trans-apical valves
	Surgical management
	Aortic regurgitation
	Pathophysiology
	Clinical features
	Examination
	Investigations
	Electrocardiography
	Chest radiography
	Echocardiography
	Cardiac catheterization
	Management
	Medical management
	Surgical management
	Assessing the severity of a valve lesion
	Tricuspid regurgitation
	Causes
	Ebstein anomaly
	Clinical features
	Management
	Other valve lesions
	Prosthetic heart valves
	Further reading
	Chapter 23: Infective endocarditis
	Definition of infective endocarditis
	Epidemiology of infective endocarditis
	Pathophysiology of infective endocarditis
	Clinical features of infective endocarditis
	History
	Examination
	Investigation of a patient who has infective endocarditis
	Blood tests
	Blood cultures
	Full blood count
	Erythrocyte sedimentation rate and C-reactive protein
	Renal function
	Liver function tests
	Electrocardiography
	Urinanalysis
	Chest radiography
	Echocardiography
	Management of infective endocarditis
	Antibiotic therapy
	Choice of antibiotic regimen
	Duration of antibiotic therapy
	Monitoring antibiotic therapy
	Complications of infective endocarditis
	Monitoring of patients who have infective endocarditis
	Further reading
	Chapter 24: Hypertension
	Definition of hypertension
	Causes of hypertension
	Clinical features of hypertension
	History
	Examination
	Investigation of a patient who has hypertension
	Investigation of secondary hypertension
	Management of hypertension
	Importance of treating hypertension
	Non-pharmacological management
	Pharmacological management
	Recommended treatment of hypertension
	Follow-up of patients who have hypertension
	Cardiovascular risk
	Phaeochromocytoma
	Clinical features
	Investigations
	Management
	Further reading
	Chapter 25: Congenital heart disease
	Definition of congenital heart disease
	Causes of congenital heart disease
	Complications of congenital heart disease
	Atrial septal defect
	Clinical features
	History
	Examination
	Investigation
	Electrocardiography
	Chest radiography
	Echocardiography
	Cardiac catheterization
	Magnetic resonance imaging
	Management
	Patent foramen ovale
	Ventricular septal defect
	Clinical features
	History
	Examination
	Investigation
	Chest radiography
	Echocardiography
	Magnetic resonance imaging
	Management
	Patent ductus arteriosus
	Clinical features
	History
	Examination
	Management
	Coarctation of the aorta
	Clinical features
	History
	Examination
	Investigation
	Electrocardiography
	Chest radiography
	Echocardiography
	Cardiac catheterization
	Magnetic resonance imaging
	Management
	Other lesions in congenital heart disease
	Notes on pulmonary hypertension and Eisenmenger syndrome
	Pulmonary hypertension
	Eisenmenger syndrome
	Further reading
	Self-Assessment
	Best of fives (BOFs)
	Extended-matching questions (EMQs)
	BOF answers
	EMQ answers
	Glossary
	Index