Clinical Guide To Cardiology

Clinical Guide toCardiology

The Clinical Guides SeriesSeries Editor: Christian CammThe Clinical Guides are a brand new resource for junior doctors and medical students.They provide practical and concise day-to-day information on common conditions, symptoms and problems faced in the clinical environment. They are easy to navigate and allowswift access to information as it is needed, with step-by-step guidance on decision making, investigations and interventions, and how to survive and thrive on clinical rotationand attachment.This new title is also available as an e-book.For more details, please seewww.wiley.com/buy/9781118755334or scan this QR code:

Clinical Guide toCardiologyEdited byChristian F. CammJohn Radcliffe Hospital, Oxford, UKA. John CammSt. George’s University of London, London, UK

This edition first published 2016 2016 by John Wiley & Sons, LtdRegistered office:John Wiley & Sons, Ltd, The Atrium, Southern Gate, Chichester, West Sussex, PO19 8SQ, UKEditorial offices:9600 Garsington Road, Oxford, OX4 2DQ, UKThe Atrium, Southern Gate, Chichester, West Sussex, PO19 8SQ, UK111 River Street, Hoboken, NJ 07030-5774, USAFor details of our global editorial offices, for customer services and for information about how to apply for permission toreuse the copyright material in this book please see our website at www.wiley.com/wiley-blackwellThe right of the authors to be identified as the authors of this work has been asserted in accordance with the UKCopyright, Designs and Patents Act 1988.All rights reserved. No part of this publication may be reproduced, stored in a retrieval system, or transmitted, in any formor by any means, electronic, mechanical, photocopying, recording or otherwise, except as permitted by the UK Copyright,Designs and Patents Act 1988, without the prior permission of the publisher.Designations used by companies to distinguish their products are often claimed as trademarks. All brand names andproduct names used in this book are trade names, service marks, trademarks or registered trademarks of their respectiveowners. The publisher is not associated with any product or vendor mentioned in this book. It is sold on the understandingthat the publisher is not engaged in rendering professional services. If professional advice or other expert assistance isrequired, the services of a competent professional should be sought.The contents of this work are intended to further general scientific research, understanding, and discussion only and arenot intended and should not be relied upon as recommending or promoting a specific method, diagnosis, or treatment byhealth science practitioners for any particular patient. The publisher and the author make no representations or warrantieswith respect to the accuracy or completeness of the contents of this work and specifically disclaim all warranties, includingwithout limitation any implied warranties of fitness for a particular purpose. In view of ongoing research, equipmentmodifications, changes in governmental regulations, and the constant flow of information relating to the use of medicines,equipment, and devices, the reader is urged to review and evaluate the information provided in the package insert orinstructions for each medicine, equipment, or device for, among other things, any changes in the instructions or indicationof usage and for added warnings and precautions. Readers should consult with a specialist where appropriate. The factthat an organization or Website is referred to in this work as a citation and/or a potential source of further informationdoes not mean that the author or the publisher endorses the information the organization or Website may provide orrecommendations it may make. Further, readers should be aware that Internet Websites listed in this work may havechanged or disappeared between when this work was written and when it is read. No warranty may be created orextended by any promotional statements for this work. Neither the publisher nor the author shall be liable for any damagesarising herefrom.Library of Congress Cataloging-in-Publication DataClinical guide to cardiology / edited by Christian F. Camm, A. John Camm.p. ; cm.Includes bibliographical references and index.ISBN 978-1-118-75533-4 (pbk.)I. Camm, Christian F. (Christian Fielder), editor. II. Camm, A. John, editor.[DNLM: 1. Heart Diseases–diagnosis. 2. Heart Diseases–therapy. WG 141]RC682616.1′ 2–dc232015025343A catalogue record for this book is available from the British Library.Wiley also publishes its books in a variety of electronic formats. Some content that appears in print may not be available inelectronic books.Cover image: iStockphoto/ NerthuzSet in 8.5/10.5pt Frutiger Light by Aptara Inc., New Delhi, India12016

ContentsContributors, viiAcronyms and Abbreviations, viiiAbout the Companion Website, xivPART 1 Examination Techniques, 11. Examination Techniques, 3PART 2 Approach to Presenting Complaints, 112. Chest Pain, 133. Shortness of Breath, 284. Loss of Consciousness, 475. Palpitations, 626. Cardiac Murmurs, 727. Shock, 928. Oedema, 106PART 3 Conditions, 1179. Acute Coronary Syndrome, 11910. Stable Angina, 13811. Heart Failure, 14712. Infective Endocarditis, 16013. Arrhythmias, 17214. Valvular Heart Disease, 19315. Cardiomyopathy, 21416. Hypertension, 23217. Pericardial Disease, 24518. Congenital Heart Disease, 261PART 4 Imaging, 27719. Electrocardiogram, 27920. Transoesophageal Echocardiogram, 29321. Trans-Thoracic Echocardiogram, 299v

vi Contents22. Cardiac MRI, 30623. Cardiac CT, 31324. Cardiac Catheterization, 320PART 5 Interventional Therapies, 32725. Pacemakers and Implantable Cardiac Defibrillators, 32926. Percutaneous Coronary Intervention and Angioplasty, 33827. Valvuloplasty, 34828. Transcatheter Aortic Valve Implantation, 35229. Cardiac Ablation, 359PART 6 Pharmacology, 36530. Anti-Arrhythmic Agents, 36731. Beta-Blockers, 37532. Calcium-Channel Blockers, 38033. Nitrates, 38534. Drugs Targeting the Angiotensin Axis, 38935. Diuretics, 39336. Anticoagulants, 39937. Antiplatelets, 40938. Lipid Regulation, 414Index, 417

ContributorsLaura Ah-KyeKing’s College Hospital NHS Foundation Trust,London, UKFritz-Patrick JahnsKing’s College Hospital NHS Foundation Trust,London, UKKristopher BennettWhipps Cross Hospital, London, UKSophie MaxwellWalsall Manor Hospital, Walsall, UKChristian F. CammJohn Radcliffe Hospital, Oxford, UKBlair MerrickHammersmith Hospital, London, UKLucy CarpenterBarts Health NHS Trust, London, UKMadeline MooreKing’s College Hospital NHS Foundation Trust,London, UKYang ChenImperial College Healthcare NHS Trust,London, UKSarah MorrowChelsea and Westminster Hospital, London,UKJi-Jian ChowImperial College Healthcare NHS Trust,London, UKRahul K. MukherjeeKing’s College Hospital NHS Foundation Trust,London, UKJames CranleyPapworth Hospital NHS Foundation Trust,Cambridge, UKAnna RobinsonKing’s College Hospital NHS Foundation Trust,London, UKGeorge DaviesOxford University Hospitals NHS Trust, Oxford, UKAkshay GargKing’s College Hospital NHS Foundation Trust,London, UKHarminder S. GillKing’s College Hospital NHS Foundation Trust,London, UKKatie GloverGuy’s and St Thomas’ NHS Foundation Trust,London, UKStephanie HicksKing’s College Hospital NHS Foundation Trust,London, UKArvind SinghalChelsea and Westminster Hospital NHSFoundation Trust, London, UKNicholas SunderlandKing’s College Hospital NHS Foundation Trust,London, UKAnneline te RieleUniversity Medical Centre, Utrecht,the NetherlandsMaria TsakokHammersmith Hospital, London, UKRobert A. WatsonImperial College Healthcare NHS Trust,London, UKvii

Acronyms and alaortic valve component of heart sound 2abdominal aortic aneurysmarterial blood gasambulatory blood pressure monitoringAmerican College of Cardiologyangiotensin-converting enzymeangiotensin-converting enzyme inhibitoralbumin:creatinine ratioacute coronary syndromeadrenocorticotropic hormoneadenosine diphosphate-P2Y receptoratrial fibrillationAmerican Heart Associationangiotensin Iangiotensin IIacute kidney injuryalcoholic liver diseasealkaline phosphataseadvanced life supportAmerican Medical Associationacute marginal branchAbbreviated Mental Test scoreantiphospholipid syndromeactivated partial thromboplastin timeaortic regurgitationangiotensin-II receptor blockeracute respiratory distress syndromeaortic stenosisatrial septal defectaspartate aminotransferaseadenosine triphosphateatrioventricularatrioventricular nodeAV-nodal re-entrant tachycardiaalert/responsive to voice/responsive to pain/unresponsiveatrioventricular re-entrant tachycardiaatrioventricular septal defectbilateral adrenocortical hyperplasiaballoon aortic valvuloplastyBritish Cardiovascular Societytwice a daybase excessbeta human chorionic gonadotrophinBoehringer-Mannheim – capillary glucose testbody mass indexbrain natriuretic peptide

Acronyms and Abbreviations ixBPBPHbpmCABGCACCADCath ESCblood pressurebenign prostatic hyperplasiabeats per minutecoronary artery bypass graftcoronary artery calciumcoronary artery disease(coronary) catheterization laboratorycalcium-channel blockercongestive cardiac failurecyclic citrullinated peptidecardiac care unitcreatine kinase – MB isoformchronic kidney diseasecytomegaloviruscoagulase negativecentral nervous systemcardiac outputcoarctation of the aortachronic obstructive pulmonary diseasecyclo-oxygenasecontinuous positive airway pressurecardiopulmonary resuscitationC-reactive proteincardiac resynchronization therapycardiac resynchronization therapy cardiac defibrillatorcomputed tomographycomputed tomography pulmonary angiogramcardiothoracic ratiocardiovascular (system)cerebrovascular accidentcerebrovascular diseasecentral venous pressureX-ray coronary angiographychest X-raydual anti-platelet therapydirect currentdilated cardiomyopathydrug historydihydropyridinediabetic ketoacidosisdiabetes mellitusDriver and Vehicle Licensing Agencydeep vein thrombosisEpstein–Barr viruselectrocardiogramechocardiogramemergency departmentend-diastolic volumeelectroencephalogramejection fractionearly goal-directed therapyestimated glomerular filtration rateexternal loop recorderelectrophysiological studyEuropean Society of Cardiology

x Acronyms and HIEIGGIHDILRIMINRISMNITUIVIVCDIVDUIVUSJVPejection systolic murmurerythrocyte sedimentation rateend-systolic volumeendovascular aneurysm repairfocused assessment with sonography for traumafull blood countfresh frozen plasmafractional flow reservefamily historyfoundation year 2 doctorglucose-6-phosphate dehydrogenaseGlasgow coma scaleglomerular filtration rategastrointestinalguanosine monophosphategastro-oesophageal reflux diseasegeneral practitionerglucorticoid-remediable aldosteronismGlobal Registry of Acute Coronary Eventsglyceryl trinitrateglycyrrhizic acidorganisms associated with culture-negative infective endocarditishaemoglobinglycated haemoglobinhome blood pressure monitoringhuman chorionic gonadotrophinhypertrophic cardiomyopathyhigh density lipoproteinhigh dependency unitheart failureheart failure with preserved ejection fractionheart failure with reduced ejection fractionheparin-induced thrombocytopeniahuman immunodeficiency virushypertrophic obstructive cardiomyopathyhistory of the presenting complaintheart ratehypertensionintra-aortic balloon pumpintercostalimplantable cardioverting defibrillatorintracerebral haemorrhageinfective endocarditisimmunoglobulin Gischaemic heart diseaseinternal loop recorderintramuscularinternational normalized ratioisosorbide mononitrateintensive therapy unitintravenousintraventricular conduction delayintravenous drug userintravascular ultrasoundjugular venous pulse/pressure