bluuebunny/crossref_metadata_2025 huggingface dataset:
Neurology
Authors: Stacey Victoria
Published: May 2013

The unconscious patient - Headache - Migraine - Subarachnoid haemorrhage (SAH) - Epilepsy - Status epilepticus - Acute stroke - Transient ischaemic attack - Motor weakness - Falls in older people - SAQs
Renal emergencies
Authors: Stacey Victoria
Published: May 2013

Introduction - Acute kidney injury - Renal replacement therapy - Hyperkalaemia - Rhabdomyolysis - SAQs
Endocrinology
Authors: Stacey Victoria
Published: May 2013

Diabetic ketoacidosis - Hyperosmolar non-ketotic ‘coma’ (HONK) - Hypoglycaemia - Acute adrenocortical insufficiency - Cushing’s syndrome - Phaeochromocytoma - Thyroid emergencies - Pituitary disease - Calcium disorders - SAQs
Infectious diseases
Authors: Stacey Victoria
Published: May 2013

Sepsis - Fever (including neutropenic sepsis) - Central nervous system infections - Meningococcal meningitis and septicaemia - Needlestick injuries - SAQs
Toxicology
Authors: Stacey Victoria
Published: May 2013

Introduction - General principles of poisoning management - Toxidromes - Paracetamol poisoning - Salicylate poisoning - Tricyclic antidepressant poisoning - Carbon monoxide poisoning - SAQs
FRCS Trauma and Orthopaedics Viva
Authors: Davies Nev , Jackson Will , Price Andrew , Rees Jonathan , Lavy Chris
Published: May 2013

FRCS Trauma and Orthopaedics Viva offers a unique approach to this high stakes exam, from the team behind the highly successful Oxford revision course. Based on the principle that viva candidates improve their technique by observing and learning from others, the author team have created a best-practice formula for dealing with the individual scenarios. Set out in a simple format, viva topics are introduced by an initial clinical photograph, radiograph or diagram, followed by sets of questions with the suggested answers on the next page.
The epistemological basis of personal recovery
Authors: Slade Mike
Published: May 2013

Personal recovery—the development of a meaningful and purposeful life that is worth living—is an inherently subjective experience. Mental health services have been influenced by post-Enlightenment values which position subjective experience as subordinate to observation, experimentation, and phenomenological form. If mental health services are to fully support recovery, some basic epistemological assumptions that are embedded, though rarely explicitly, in mental health practice will need to be reconsidered. This chapter explores the limitations of nomothetic knowledge, successionist notions of causality, and (at a higher level) the Apollonian world view. It argues that there is a need to give greater primacy to individual experience, and that a constructivist epistemology is a more helpful basis for recovery-oriented mental health services.
Recovery and the partitioning of scientific authority in psychiatry
Authors: Porter Douglas , Zachar Peter
Published: May 2013

This chapter explores the topic of scientific authority in psychiatry—focusing on both the validation of diagnostic constructs and their role in relation to recovery. The authors will argue that scientific authority is not superseded by the opinions of laypersons, but must also be tempered in the light of the experiences of patients, clients, or consumers. It will also be argued that the partitioning of authority should be a dynamic process. General guidelines that can be articulated for the development of diagnostic constructs cannot be simply generalized to complicated issues such as recovery. There are well-known value issues inherent in the concept of mental disorder, but in some cases these issues could be considered to be minimally evaluative. It is doubtful whether recovery-related concepts such as living as independently as possible and fulfillment could ever be construed as minimally evaluative. A scientific approach to recovery can still be beneficial, but recovery and the process of recovery cannot be regimented along scientific lines as readily as can diagnostic constructs.
Is recovery a model?
Authors: Thornton Tim
Published: May 2013

The idea of recovery in mental healthcare is contested both because of empirical disagreements about the prognosis for those with a mental illness, and because of fundamental disagreements about what “recovery” should be taken to mean. The recovery movement emphasizes the importance of an individual's own perspective on what recovery might mean to him or her (i.e. what meanings and values to attach to future projects). However, in addition, the very idea of whether recovery should in general be understood in this way rather than, for example, within a narrower biomedical framework, is contested. This chapter examines two different conceptions of how the latter conflict can be approached and hence why the disagreement runs so deeply.
Urological neoplasia
Authors: Reynard John , Brewster Simon , Biers Suzanne
Published: May 2013

Basic pathology and molecular biology 236

Wilms’ tumour and neuroblastoma 238

Radiological assessment of renal masses 242

Benign renal masses 244

Renal cell carcinoma: pathology, staging, and prognosis 246

Renal cell carcinoma: epidemiology and aetiology 250

Renal cell carcinoma: presentation and investigation 252

Renal cell carcinoma (localized): surgical treatment I ...
Bladder cancer
Authors: James Nicholas , Southgate Elizabeth , Zarkar Anjali
Published: May 2013

Chapter 8b discusses the considerable controversy as to the optimal management of localized, muscle invasive bladder cancer. Surgical removal of the bladder is considered the ‘gold standard’ in many countries but there is no randomized trial to underpin this statement, and many patients are unfit for surgery. Reported 5-year survival rates with radiotherapy are remarkably similar to surgical series. Thus even if surgery is genuinely better than radiotherapy for patients fit for both approaches, there are many patients for whom radical surgery is simply not suitable and hence bladder-preserving techniques are appropriate.
Uterus
Authors: Powell Melanie , Taylor Alexandra
Published: May 2013

Chapter 9 discusses gynecology and external beam radiotherapy in the uterus, vulva, and vagina.
Head and neck cancer
Authors: Nutting Christopher , Saunders Michele
Published: May 2013

Chapter 12 discusses head and neck cancer and how it should be discussed by a multidisciplinary team comprising specialist surgeons, oncologists, pathologists, radiologists, and palliative care doctors, together with dieticians, speech and language therapists, and clinical nurse specialists. At this time decisions as to the modality of treatment(s) to be used should be made, including surgery, radiotherapy, and chemotherapy.
Optic Neuritis
Authors: Miller Aaron E. , DeAngelis Teresa M.
Published: May 2013

Optic neuritis (ON) is an ophthalmological syndrome commonly encountered in inflammatory and demyelinating diseases of the central nervous system. Here we review the cardinal clinical examination findings, the possible associated systemic diseases in which ON can manifest, and the recommended diagnostic evaluation and therapeutic measures.
Lambert-Eaton Myasthenia Syndrome
Authors: Miller Aaron E. , DeAngelis Teresa M.
Published: May 2013

Lambert-Eaton myasthenia syndrome (LEMS) is an autoimmune-mediated disorder of the neuromuscular junction, which involves autoantibodies to voltage-gated calcium channels on the presynaptic membrane. In this chapter, we discuss the characteristic clinical features of LEMS, its electrophysiological distinction from MG, as well as its paraneoplastic presentation. We also review the immunotherapeutic management options in cases with severe weakness and those refractory to tumor removal.
Acute Inflammatory Demyelinating Polyneuropathy (Guillain-Barré Syndrome)
Authors: Miller Aaron E. , DeAngelis Teresa M.
Published: May 2013

Acute inflammatory demyelinating polyneuropathy (AIDP), also known as Guillain-Barré syndrome (GBS), is a common acute neurological presentation encountered in both the outpatient setting and hospital wards. The hallmark of the disorder is the development of ascending motor paralysis with loss of deep tendon reflexes. In this chapter, we outline the classical clinical and laboratory findings in GBS as well as critical therapeutic and supportive measures along with prognosis.
Neurobiology of Depression as a Comorbidity of Epilepsy
Authors: Sankar Raman , Mazarati Andrey
Published: May 2013

In his review on melancholia, Lewis describes Hippocrates as having had the perception that the condition was reciprocally connected to epilepsy.1 Recent epidemiological studies have supported the notion that depression is more frequent among patients with epilepsy (preceding the diagnosis of epilepsy) than among case controls2 and that depression is seven times more likely among adults presenting with a new-onset seizure disorder than among controls.3 Depression has been identified as the most frequent psychiatric comorbidity in patients with epilepsy.4 Hermann et al. have summarized estimates of the prevalence of lifetime-to-date major depression among patients with epilepsy as ranging from 8% to 48%, with a mean and a median approximating 30%.5 Hermann and colleagues also stated that psychiatric comorbidities contributed to a lowered health-related quality of life (HRQOL) in epilepsy.6 Further, their study revealed an association of symptom checklist scores with the chronicity of temporal lobe epilepsy (TLE). Interictal psychiatric symptoms adversely influenced the HRQOL to a greater extent than the frequency, severity, and chronicity of seizures.7 Consideration of the psychiatric comorbidities in treatment decisions involving drug selection have been reviewed for adult8 as well as pediatric9 patients with epilepsy.
Neurology of Brain Death
Authors: Wijdicks Eelco F.M.
Published: May 2013

Chapter 2 discusses the neurology and pathology of brain death, clinical and ancillary examination protocols for adults, the apnea test, and the clinical determination of brain death in children. It also discusses errors and alleged recoveries, and legal definitions and obligations.
The Challenge of Suicide Prevention in Later Life
Authors: Conwell Yeates , O’Riley Alisa
Published: May 2013

As the world’s population of older adults increases, deaths by suicide in late life will become an increasing public health problem. In this chapter, our objectives are three-fold. First, we review the epidemiology of suicide in late life. Next, we discuss risk and protective factors for suicidal behavior in older adults. Third, we review promising approaches to late life suicide prevention that represent both high risk and population-oriented approaches. Finally, we conclude with a discussion of future directions for how we might work toward addressing the problem of late life suicide via additional research, the implementation of public health interventions, and changes to public policy.
Neuroimaging Studies of Bipolar Disorder in Youth
Authors: Singh Manpreet K. , DelBello Melissa P. , Chang Kiki D
Published: May 2013

Bipolar disorder is a serious psychiatric disorder in youth associated with significant long-term morbidity and mortality. Yet, the etiopathogenesis of this illness is poorly understood. Recent advances in brain imaging have helped clarify the brain changes associated with this disorder at an early age. Specifically, bipolar disorder appears to involve abnormalities in discrete brain networks that may include prefrontal, subcortical, and cerebellar regions. The expression of the symptoms of bipolar disorder does not appear to result from single, localized brain lesions, but rather are emergent properties of dysfunction of these brain networks. As neuroimaging techniques continue to advance, the underlying neural basis of bipolar disorder will be clarified.
Mitochondrial Genetics and Bipolar Disorder
Authors: Clay Hayley B. , Fuke Satoshi , Kato Tadafumi , Konradi Christine
Published: May 2013

Evidence for mitochondrial pathology in bipolar disorder (BPD) comes from a variety of sources. An array of single nucleotide polymorphisms (SNPs) in the mitochondrial genome, as well as in nuclear-encoded mitochondrial genes has been implicated in BPD. In addition, changes in mitochondria-relevant gene levels, mitochondrial function, Ca2+ dynamics, and cellular resilience have been observed. Psychiatric symptoms in inherited mitochondrial disorders overlap with symptoms in BPD, and some cases of BPD might have a maternal inheritance pattern, typical for mitochondrial disorders. Of further evidence, mood stabilizers used to treat BPD increase mitochondrial gene expression and viability.

This chapter will examine the physiology and genetics of mitochondria, and how our current knowledge of mitochondrial function and genetics can explain some of the pathophysiology of BPD. While BPD might not be a mitochondrial disorder in the traditional sense, recent improvement of our understanding of somatic mutation rates and heteroplasmy of mitochondria could shed new light on how slightly aberrant bioenergetic mechanisms could lead to BPD and possibly other psychiatric disorders.
Medical Care of Traumatic Brain Injury
Authors: Wijdicks Eelco F. M , Rabinstein Alejandro A
Published: May 2013

New traumatic brain contusions may rapidly result in increased intracranial pressure. This chapter discusses how to recognize early increased intracranial pressure (ICP) and indications for placement of a monitoring device. The first line of ICP control is provided in this chapter. The effects and side effects of different osmotic diuretics are discussed.
Sorting Out and Treating Encephalitis
Authors: Wijdicks Eelco F. M , Rabinstein Alejandro A
Published: May 2013

The diagnosis of encephalitis is easy, finding the cause is not. The differential diagnosis of the main forms of acute encephalitis is discussed here. Medical therapy and indications for brain biopsy are mentioned.
Neurological Worsening After Subarachnoid Hemorrhage
Authors: Wijdicks Eelco F. M , Rabinstein Alejandro A
Published: May 2013

Patients with a subarachnoid hemorrhage have a proclivity to deteriorate. Common causes include rebleeding, hydrocephalus, and cerebral vasospasm. Prevention of complications—neurologic and medical—is key to reduce morbidity. Diagnostic and therapeutic recommendations are provided.
Options in Acute Spinal Cord Compression
Authors: Wijdicks Eelco F. M , Rabinstein Alejandro A
Published: May 2013

For these patients there is an immediate urgency to prevent permanent paralysis. For many physicians this is one of the most uncomfortable situations. The immediate medical treatment with corticosteroids and indications for acute neurosurgical decompression are discussed.
Choices in Refractory Status Epilepticus
Authors: Wijdicks Eelco F. M , Rabinstein Alejandro A
Published: May 2013

Many seizures stop with benzodiazepines and fosphenytoin, but what are the options when seizures return? What are the readily available choices and what works? These options are discussed.
Deterioration from Brain Metastasis
Authors: Wijdicks Eelco F. M , Rabinstein Alejandro A
Published: May 2013

Deteriorating patients with metastasis or malignant brain tumor in close proximity to the brainstem may be due to hemorrhage or brain edema. Options for stabilization and indications for urgent debulking are discussed.
Stupor After Brain Surgery
Authors: Wijdicks Eelco F. M , Rabinstein Alejandro A
Published: May 2013

Successful brain surgery, but no awakening of the patient. Evaluation, interpretation of neuroimaging, and potential causes are discussed.
Autonomic Failure in Guillain-Barré Syndrome
Authors: Wijdicks Eelco F. M , Rabinstein Alejandro A
Published: May 2013

Dysautonomia is common in severe forms of GBS, paralytic ileus is a concern in all immobilized bedridden patients with GBS. Treatment of these autonomic disorders is provided here.
Diabetes Insipidus After Brain Tumor Surgery
Authors: Wijdicks Eelco F. M , Rabinstein Alejandro A
Published: May 2013

Diabetes insipidus is a difficult management problem after surgery for resection of a centrally located brain tumor. Fluid management, administration of vasopressin, and monitoring of effect of treatment are discussed.
Drug Interactions
Authors: Wijdicks Eelco F. M , Rabinstein Alejandro A
Published: May 2013

Drug interactions are common, but frequently not noticed. Some are very concerning and clinically relevant. An example of how antiepileptic drugs interact with warfarin is discussed.
Pitfalls of Brain Death Determination
Authors: Wijdicks Eelco F. M , Rabinstein Alejandro A
Published: May 2013

Brain death determination and confounders. The potential for errors and how to avoid them are listed.
Cardiovascular Examination
Authors: Shub Clarence
Published: May 2013

The physical examination, including the general appearance of the patient, is an extremely important component of cardiology examinations. Important clues to a cardiac diagnosis can be obtained from inspection of the patient. Blood pressure should always be determined in both arms and in the legs if there is any suspicion of coarctation of the aorta. The patient should be examined in both the supine and the left lateral decubitus position. Abnormal waveforms in the jugular veins reflect abnormal hemodynamics of the right side of the heart. Heart sounds, including clicking, splitting, intensity, and snap, should be evaluated. Murmurs should also be evaluated because they may indicate conditions requiring treatment.
Essential Molecular Biology of Cardiovascular Diseases
Authors: Tom Cindy W. , Simari Robert D.
Published: May 2013

Molecular biologic tools are helpful in the diagnosis of cardiovascular diseases. Polymerase chain reaction is a powerful tool for amplifying minute portions of DNA for analysis. Sensitive PCR tests have been developed for various diseases by extracting DNA from a small blood sample. The identification of genes associated with disease has been the focus of an enormous effort in biomedical science. Genetic diseases can be associated with single-gene or multigene abnormalities. Of the many types of diseases that affect the cardiovascular system, an increasing number have been identified as resulting from single-gene (monogenic) or polygenic mutations. Several of these diseases are reviewed.
Principles of Echocardiography
Authors: Tsang Teresa S. M.
Published: May 2013

This chapter summarizes the central role of echocardiography in both the initial diagnosis and the quantification of the nature and severity of specific cardiovascular diseases. It is important to appreciate the relative strengths, weaknesses, and incremental value of information obtained by different echocardiographic methods. The appropriateness criteria for use of transthoracic echocardiography and TEE were published jointly in 2007 by leading professional organizations in the field. Appropriate, uncertain, and inappropriate indications for the use of echocardiography are reviewed.
Nuclear Imaging
Authors: Askew III J. Wells , Miller Todd D.
Published: May 2013

Nuclear imaging techniques are commonly used to evaluate myocardial perfusion at rest and with stress, to measure left ventricular function and volume, and to determine the presence or absence of myocardial viability. Nuclear cardiology is based on the administration of a radiopharmaceutical consisting of a radionuclide (isotope) with or without a complexing agent (depending on the type of study) in order to image the cardiovascular system. Nuclear imaging is primarily used for measuring left ventricular volume and ejection fraction; assessing myocardial perfusion; assessing left ventricular size, function, and wall motion; and detecting right-to-left shunts. Limitations are also reviewed.
Cardiopulmonary Exercise Testing in Clinical Medicine
Authors: Allison Thomas G.
Published: May 2013

Cardiopulmonary exercise testing is an important tool in a state-of-the-art, comprehensive cardiovascular center. Cardiopulmonary exercise testing is useful for accurate assessment of aerobic capacity, establishment of prognosis in various forms of cardiac disease, verification of symptomatic status (functional class), determination of appropriateness and timing of surgery for patients who have cardiac disease, exercise prescription, evaluation of benefits of various forms of intervention, and establishment of differential diagnosis of dyspnea on exertion. Interpretation of test results and sample cases are also included.
Atrial Fibrillation and Flutter
Authors: Brady Peter A.
Published: May 2013

Atrial fibrillation (AF) is the most common sustained arrhythmia, estimated to affect approximately 6 million Americans. Atrial flutter (AFL) is closely related to AF. Approximately 200,000 cases of AFL are diagnosed each year in the United States, and AFL is the most common indication for catheter ablation. Without treatment, AF is associated with an increased risk of death, thromboembolism, and stroke. In a patient with AF, rate regularization may result from transition to AFL or development of complete heart block. Less commonly, it may result from onset of a junctional or ventricular tachycardia. Primary goals in the management of AF are relief of symptoms and prevention of consequences (thromboembolism and tachycardia-induced cardiomyopathy). Restoring and maintaining normal sinus rhythm is preferred for patients with symptoms, whereas controlling the rate may be appropriate for asymptomatic patients or those who have multiple comorbid conditions. Nonpharmacologic approaches to managing AF and AFL include ablation of the AV node (with permanent pacemaker implantation), left atrial ablation aimed at isolation of the pulmonary and other thoracic veins, and surgical approaches.
Evaluation and Management of Pregnancy-Associated Arrhythmias
Authors: Brady Peter A.
Published: May 2013

The presentation and management of heart rhythm disorders arising during pregnancy and lactation are similar to those in nonpregnant patients. However, patients who present with a heart rhythm disorder during pregnancy deserve special consideration. Accurate rhythm diagnosis and assessment of symptom severity (especially hemodynamic symptoms) are mandatory. Arrhythmias that result in hemodynamic compromise (usually in patients with structural heart disease) are of major concern—not only because of potential harm to the mother but also because of potential harm to the fetus through reduced placental blood flow. Risks of antiarrhythmic drug therapy during pregnancy include risk to the mother and risk to the fetus. Cardioversion is safe during pregnancy and should be an early option in the management of arrhythmia, especially in the presence of hemodynamic compromise.
Cardiac Resynchronization Therapy
Authors: Lin Grace , Hayes David L.
Published: May 2013

Cardiac resynchronization therapy (CRT) is the term applied to reestablishing synchrony between left ventricular free wall and ventricular septal contraction. Approximately one-third of patients with dilated cardiomyopathy also have a conduction delay due to left bundle branch block, resulting in left ventricular dyssynchrony and worsening heart failure. In these patients, CRT may promote left ventricular reverse remodeling and improve symptoms and mortality from heart failure. CRT is achieved through biventricular pacing, with placement of a left ventricular lead in addition to a right ventricular lead. Indications for CRT, implantation techniques, prediction of response, and clinical trials are reviewed in this chapter.
Heart Disease in Athletes
Authors: Hammill Stephen C.
Published: May 2013

The medical community, the public, and athletes all have concerns about identifying persons at risk for sudden cardiac death. Physicians are frequently asked to assess the suitability of an athlete to participate in a particular sport. Typically, compared with nonathletes, athletes have a slower minimal heart rate, a higher percentage of sinus pauses lasting longer than 2 seconds, and more Mobitz I atrioventricular block because of higher vagal tone that occurs with conditioning. Guidelines recommend that athletes be screened initially by obtaining a history and conducting a physical examination. If the history identifies previous near syncope, syncope, palpitations, or a family history of sudden cardiac death, or if the physical examination identifies a serious heart murmur or other cardiac problem, the athlete should have an electrocardiogram, an echocardiogram, and stress testing.
Antiarrhythmic Drugs
Authors: Brady Peter A.
Published: May 2013

In general terms, antiarrhythmic drugs work in 1 of 2 ways: to slow the velocity of the propagating wave front (the action of drugs that predominantly block sodium channels) or to increase the amount of cardiac tissue that is refractory and, therefore, cannot be excited by the propagating wave front (predominantly drugs that block potassium channels). In this way, antiarrhythmic drugs act to alter the myocardial-electrical substrate to decrease the stability of sustained reentrant circuits. In some circumstances, drugs may either slow conduction too much or alter the refractoriness of remote parts of the reentrant circuit that increases, rather than decreases, the stability of the reentrant circuit and, in this way, may be proarrhythmic.
Valvular Stenosis
Authors: Nishimura Rick A.
Published: May 2013

Aortic stenosis and mitral stenosis are reviewed in this chapter. Causes, clinical presentation, laboratory tests, natural history, and treatment are covered for each type of valvular stenosis. Controversial issues in the management of patients with aortic stenosis are also reviewed.
Valvular Regurgitation
Authors: Nishimura Rick A.
Published: May 2013

Mitral regurgitation and aortic regurgitation are reviewed in this chapter. Causes, pathophysiology, clinical presentation, evaluation, natural history, and treatment are covered for each type of valvular regurgitation. Mitral valve prolapse is also reviewed.
Carcinoid and Drug-Related Heart Disease
Authors: Connolly Heidi M. , Pellikka Patricia A.
Published: May 2013

Progress in the medical and surgical management of patients with metastatic carcinoid tumor has resulted in improved symptoms and survival. However, carcinoid heart disease remains a major cause of morbidity and death. Limited medical treatment options are available for patients with carcinoid valvular disease; for those with severe valvular heart disease, valve replacement has been increasingly used. Clinical and echocardiographic features and management are reviewed in this chapter. Drug-related heart disease, also covered in this chapter, has been linked to some anorexigens, ergot alkaloids, and pergolide.
Prosthetic Heart Valves
Authors: Grogan Martha A. , Miller Fletcher A.
Published: May 2013

Prosthetic valves can only approximate normal human valve hemodynamics, and they carry the risk of unique complications, such as structural failure, thrombosis, hemolysis, and infections. Valve prostheses are classified as mechanical and bioprosthetic valves. Mechanical valves are subdivided into caged-ball, tilting-disk, and bileaflet. Bioprosthetic valves are subdivided into stented heterografts, homografts, and stentless heterografts. The homograft and stentless heterograft valves are designed for implantation in the aortic or pulmonic position. All the other valve types can be implanted in any valve position. Mechanical valves are generally preferred in patients who require long-term anticoagulation for other reasons, such as an existing mechanical prosthesis in another position or atrial fibrillation. Patients unwilling or unable to take warfarin or to comply with long-term monitoring should receive tissue valves. Complications and valve dysfunction are also reviewed.
Pathogenesis of Valvular Heart Disease
Authors: Rajamannan Nalini M.
Published: May 2013

The mechanisms causing valvular disease of the aortic, mitral, tricuspid, and pulmonary valves are examined in this chapter. Sclerosis, stenosis, calcification, and regurgitation are addressed.
The Aorta
Authors: Spittell Peter C.
Published: May 2013

The various conditions affecting the aorta, including atheroembolism, abdominal aortic aneurysm, dissection, penetrating ulcer, intramural hematoma, and rupture are reviewed in this chapter. Causes, clinical presentation, evaluation, natural history, and treatment of conditions affecting the aorta are covered as well.
Pathophysiology of Arterial Thrombosis
Authors: McBane Robert D. , Wysokinski Waldemar E.
Published: May 2013

Atherosclerosis is the most common cause of major disability and death in the United States. The most devastating complication of this disease occurs when a platelet-rich thrombus abruptly occludes arterial blood flow, resulting in acute MI, stroke, or sudden cardiac death. This chapter reviews the basic pathophysiology of arterial thrombosis. The pathophysiology of arterial thrombosis involves platelet-rich thrombus formation over a ruptured atherosclerotic plaque. This process can be partitioned into platelet adhesion, coagulation factor activation, and thrombus propagation through platelet accretion.
Treatment and Prevention of Arterial Thrombosis
Authors: McBane Robert D. , Wysokinski Waldemar E.
Published: May 2013

Each year, 1.45 million Americans have a myocardial infarction and 800,000 Americans have a new or recurrent stroke. These events are thrombotic in nature and are therefore potentially treatable and preventable with the appropriate use of antithrombotic agents. Current antithrombotic therapy targets 3 of the 4 stages of thrombus formation: platelet activation, platelet aggregation, and coagulation cascade activation. There are no effective means to prevent the initial stage of platelet adhesion to injured arterial walls. This chapter reviews the mechanism of action, pharmacology, and clinical use of agents for the prevention and treatment of arterial thrombosis.
Venous and Lymphatic Disorders
Authors: Shields Raymond C.
Published: May 2013

Venous and lymphatic diseases, such as venous thromboembolism, heparin-induced thrombocytopenia, antiphospholipid syndrome, lymphedema, edema, and leg ulcers, are frequently encountered in patients who have cardiac or arterial disorders. Understanding the evaluation and management of these problems is an important part of modern cardiovascular practice.
Marfan Syndrome
Authors: Ammash Naser M. , Connolly Heidi M.
Published: May 2013

Marfan syndrome is the most common inherited multisystem disorder of connective tissue. This autosomal dominant condition, first described by Antoine Marfan in 1896, has a reported incidence of 2 to 3 per 10,000 persons, and it has no particular sex, racial, or ethnic predilection. Early identification and appropriate management improve the outcomes among patients with Marfan syndrome, who are prone to life-threatening cardiovascular complications. Genetic characteristics, manifestations, diagnosis, medical and surgical management, and pregnancy in Marfan syndrome are reviewed.
Coronary Artery Disease Epidemiology
Authors: Allison Thomas G.
Published: May 2013

Coronary artery disease develops as a consequence of decreased blood flow to the myocardium due to coronary atherosclerosis. It begins as fatty streaks in the coronaries and other arterial beds early in life. Fatty streaks and some raised lesions have been identified in various autopsy studies in men in their late teens and early 20s and women by their late 20s and early 30s. The development of atherosclerosis appears to follow a complex pathway. Prevalence, incidence, risk factors, and changing trends in coronary artery disease are also reviewed.
Metabolic Syndrome
Authors: Allison Thomas G.
Published: May 2013

Metabolic syndrome is a novel CV risk factor that has generated widespread interest—and controversy—since its inclusion in the Adult Treatment Panel III of the National Cholesterol Education Program. The National Cholesterol Education Program lists 5 characteristics for consideration of metabolic syndrome: large waist circumference, low HDL-C level, high triglyceride level, elevated blood pressure, and impaired fasting glucose level. Controversies surrounding metabolic syndrome, its prevalence, and its relation to other cardiovascular risk factors are reviewed in this chapter.
Pathogenesis of Atherosclerosis
Authors: Blackshear Joseph L. , Kantor Birgit
Published: May 2013

Atherosclerosis is a disease primarily involving pathologic changes in the intima, with reactive changes in the media and adventitia. The prevalence of atherosclerotic lesions is highest in the abdominal aorta, coronary arteries, femoropopliteal arteries, internal carotid arteries, and vertebrobasilar arterial regions. Some arteries, such as the internal mammary artery or the radial artery, are rarely or never affected by atherosclerosis. Major independent risk factors for the development of atherosclerosis include elevated plasma concentrations of total cholesterol and LDL-C, cigarette smoking, hypertension, diabetes mellitus, advancing age, low plasma concentrations of HDL-C, and a family history of premature coronary artery disease. The consensus pathogenetic explanation for the development of atherosclerosis is that cumulative exposure to risk factors over many years results in a cycle or series of episodes of cyclical injury and repair, which culminate in clinical events, including acute coronary thrombotic syndromes, angina, intermittent claudication or acute arterial occlusion, ischemic stroke, and development and rupture of abdominal aortic aneurysm.
Lipid-Lowering Clinical Trials and Medications
Authors: Murphy Joseph G. , Wright R. Scott , Allison Thomas G.
Published: May 2013

This chapter reviews trials that studied the effect of diet and various lipid-lowering medications on reducing the risk of cardiovascular disease. Trials studying the effect of diet on cardiovascular risk were the Lyon Diet Heart Study, the DART trial, the Moradabad Heart Study, and the Step Two Plus Study. Trials studying the effect of statins, nicotinic acid, fibric acid derivatives, bile acid-binding sequestrants, ezetimibe, and other antiatherogenic agents are also reviewed.
Novel Biomarkers of Coronary Artery Disease Risk
Authors: Kullo Iftikhar J.
Published: May 2013

Assessment of cardiovascular risk is necessary to inform preventive and therapeutic interventions. Predictive models based on conventional risk factors have less than desired accuracy in predicting CAD risk in an individual, in part because of the widespread prevalence of these risk factors in the general population. Although most patients who suffer a cardiovascular event will have one or more of the conventional risk factors, so do many adults who do not have CAD. Consequently, there is interest in novel biomarkers that might improve cardiovascular risk stratification. Examples include CRP, fibrinogen, NT-proBNP, Lp (a), LDL particle size and number, Lp-PLA2, and genetic susceptibility variants. This chapter provides a brief update on these ‘novel’ risk markers.
Diabetes Mellitus and Coronary Artery Disease
Authors: Frye Robert L. , Holmes David R.
Published: May 2013

The prevalence of diabetes mellitus has reached epidemic proportions and continues to increase. Type 2 diabetes has been estimated to account for up to 90% to 95% of all diagnosed cases of diabetes. Heart disease is the leading cause of diabetes-related mortality. Almost two-thirds of diabetics die of heart or blood vessel disease, and death rates from heart disease are two to four times higher among diabetic patients than among nondiabetic patients. In addition, diabetes is associated with an increase in the risk of stroke. Cardiologists need to understand that fat cells (adipocytes) are active metabolically and are the source of several cytokines and other substances that not only influence insulin sensitivity and resistance but have profound effects on the cardiovascular system.
Hypertension
Authors: Brady Adrian J. B. , Wright R. Scott , Murphy Joseph G.
Published: May 2013

Hypertension is the clinical condition of sustained high blood pressure. Untreated, hypertension promotes atherosclerotic peripheral arterial vascular disease, carotid and coronary artery disease. Directly, it causes hypertensive left ventricular hypertrophy and heart failure; renal failure and retinal damage. It is the most important risk factor for hemorrhagic stroke and causes hypertensive encephalopathy. The detection and treatment of hypertension is the single most important and cost effective intervention in cardiovascular medicine worldwide, according to the World Health Organization. While detection of hypertension is straightforward, and effective drugs are both inexpensive and readily available, hypertension remains one of the most important chronic conditions seen by all physicians
Cardiac Biomarkers
Authors: Shapiro Brian P. , Babuin Luciano , Jaffe Allan S.
Published: May 2013

The need for a rapid and reliable diagnosis of myocardial infarction is crucial. Initial efforts focused on clinical assessment and electrocardiography, but over time it became clear that they are often nondiagnostic. Therefore, clinicians now rely heavily on cardiac biomarkers. Guidelines call for the routine assessment of cardiac biomarkers for the diagnosis of myocardial infarction. The cardiac biomarkers cardiac troponin and creatine kinase are reviewed in this chapter: cardiac troponin, creatine kinase, as are their use in acute myocardial infarction diagnosis and prognosis.
Right Ventricular Infarction
Authors: Wright R. Scott
Published: May 2013

Isolated right ventricular myocardial infarction is rare, but an estimated 30% of patients with acute inferior myocardial infarction have clinical or echocardiographic evidence of right ventricular dysfunction or infarction. Right ventricular infarction is frequently underdiagnosed and is associated with an increased in-hospital mortality compared with inferior wall myocardial infarction in patients with preserved right ventricular function. Many studies have shown that patients with right ventricular infarction are a unique subgroup with a distinctive clinical presentation, treatment, and prognosis. Resolution of right ventricular dysfunction is common among patients who survive right ventricular infarction.
Cardiogenic Shock
Authors: Murphy Joseph G.
Published: May 2013

Shock is defined as a physiological state of inadequate blood flow to vital organs that leads to a global reduction in tissue perfusion with subsequent widespread cellular dysfunction. Three types of shock are recognized: hypovolemic shock, distributive shock, and cardiogenic shock. The most common causes of cardiogenic shock are acute MI (including extensive left ventricular injury), right ventricular infarction, ruptured papillary muscle, postinfarct septal rupture, ventricular free wall rupture with tamponade, and, uncommonly, severe ventricular stunning in association with the apical balloon (takotsubo) syndrome. Cardiogenic shock is the leading cause of death among hospitalized patients following acute MI. Cardiogenic shock is the focus of this chapter.
Cardiac Emergencies
Authors: Murphy Joseph G. , Boilson Barry A. , Lloyd Margaret A.
Published: May 2013

This chapter outlines the general principles of managing cardiac emergencies in adults. It is deliberately not an exhaustive review. Sudden cardiac arrest is a leading cause of death in developed nations and is frequently associated with ventricular fibrillation. Resuscitation for cardiac arrest is most successful if defibrillation is performed within the first 5 minutes after collapse. This chapter also reviews management of patients presenting with polymorphic ventricular tachycardia, atrial flutter or fibrillation with rapid ventricular response, paroxysmal supraventricular tachycardia, reciprocating tachycardia, multifocal atrial tachycardia, pacemaker-mediated tachycardia, acute coronary syndromes, pulmonary edema, and hypertensive, structural, metabolic, and toxic emergencies.
Coronary Artery Bypass Surgery
Authors: Sundt III Thoralf M.
Published: May 2013

Surgical coronary revascularization is state-of-the-art therapy for cardiac ischemia. Even with scientific and procedural developments that narrow the gap between surgical and percutaneous revascularization strategies, surgical revascularization continues to demonstrate superior durability and greater long-term cost-effectiveness at the expense of greater invasiveness for the patient. Accordingly, cardiologists should understand the surgical perspective on coronary revascularization, particularly the surgeon's view of preoperative assessment and certain aspects of intraoperative decision making and postoperative care.
Pericardial Diseases
Authors: Melduni Rowlens M.
Published: May 2013

The pericardium is a fibromembranous inelastic sac less than 2 mm in thickness that comprises 2 distinct layers. The outer inelastic fibrous layer anchors the heart in the mediastinum with attachments anteriorly to the manubrium and xiphoid process, posteriorly to the vertebral column, and inferiorly to the diaphragm. The inner serous double layer is divided into the visceral pericardium and the parietal pericardium. The pericardium serves as a protective nondistensible mechanical barrier for the heart by containing and protecting it from acute overdistention. This chapter examines the following pericardial conditions: congenital absence of the pericardium, pericardial cyst, acute pericarditis, pericardial effusion and cardiac tamponade, constrictive pericarditis, restrictive cardiomyopathy, and infilitrative cardiomyopathy.
Pulmonary Embolism
Authors: Iyer Vivek
Published: May 2013

Pulmonary embolism and deep vein thrombosis are essentially 2 clinical manifestations of the same disease process and can be grouped as venous thromboembolism. Venous thromboembolisms can be either unprovoked (idiopathic or primary) or provoked (secondary). Provoking factors include inherited and acquired factors such as the factor V Leiden mutation, cancer, surgery, trauma, and immobility. Morbidity and mortality from pulmonary embolism depend not only on the clot burden but also on the presence and extent of preexisting cardiopulmonary disease and the response of the cardiovascular system to the pulmonary embolism. This chapter focuses on pulmonary embolism.
HIV Infection and the Heart
Authors: Temesgen Zelalem
Published: May 2013

Cardiac involvement in HIV infection is common, typically presenting clinically as pericardial diseases. HIV cardiomyopathy may present as clinical heart failure, be clinically silent but evidenced as an asymptomatic fall in left ventricular ejection fraction on echocardiography, or be detected only at autopsy as focal myocarditis. Clinical detection of HIV-associated cardiac disease significantly underestimates the true incidence at abnormalities detected by cardiac imaging studies or at autopsy.
Infective Endocarditis
Authors: Anavekar Nandan S. , Sohail M. Rizwan , Murphy Joseph G.
Published: May 2013

Infective endocarditis is an infection on the endocardial surface of the heart, usually affecting the heart valves, a congenital heart shunt, or an intravascular device. This chapter reviews the epidemiology, pathogenesis, organ system manifestations, clinical manifestations, and therapeutic approach for endocarditis. Endocarditis prophylaxis and infections related to cardiovascular devices are also reviewed.
Cardiac Tumors
Authors: Wright R. Scott
Published: May 2013

Primary tumors of the heart are exceedingly rare, accounting for less than 5% of all cardiac tumors; the remaining 95% are metastatic tumors to the heart. The most common primary cardiac tumors in adults are myxomas, usually occurring in the left atrium, followed by lipomas and fibroelastomas. The most common malignant cardiac tumor in adults is angiosarcoma. A malignant lymphoma may occasionally develop in the adult heart. In children, the most common cardiac tumor is rhabdomyoma and the most common malignant tumor is rhabdomyosarcoma. This chapter reviews various types of cardiac tumors and their presenations.
Sleep Apnea and Cardiac Disease
Authors: Kara Tomas , Konecny Tomas , Somers Virend
Published: May 2013

Sleep is often a salutary and restorative time occupying one-third of our lives. In patients with sleep apnea (also called sleep-disordered breathing), sleep can be a period of hemodynamic, respiratory, and electrochemical turmoil that contributes to the initiation, progression, and worsening of outcomes of various forms of cardiovascular disease. The relation between sleep apnea and cardiovascular disease, the subject of this chapter, is gaining particular relevance with the strikingly high and growing prevalence of sleep apnea in the general population and in cardiac patients.
Cardiovascular Trauma
Authors: Wright R. Scott
Published: May 2013

Cardiovascular trauma is a significant cause of death, particularly among young men in our society. Cardiovascular trauma is classified into penetrating injuries; blunt, nonpenetrating trauma; and medical injuries to the heart sustained during an invasive cardiovascular procedure, medical device implantation, or cardiopulmonary resuscitation. Penetrating cardiac injury is due primarily to knife or gunshot injuries, whereas blunt cardiac injury is usually due to automobile or motorcycle accidents or industrial incidents. Iatrogenic cardiac trauma also may occur from cardiopulmonary resuscitation, endomyocardial biopsy, or the use of intravascular catheters, including Swan-Ganz catheters. This chapter reviews the different types of cardiovascular trauma and their diagnosis and treatment.
Acute Brain Injury and the Heart
Authors: Anavekar Nandan S. , Puwanant Sarinya , Chandrasekaran Krishnaswamy
Published: May 2013

Nervous system and cardiovascular system functions are closely intertwined: Cerebral perfusion is dependent on cardiac performance, and much of cardiac function is regulated by higher brain centers. Dysfunction in either organ system can precipitate dysfunction in the other. Acute brain injury may result from vascular injury, trauma, or inflammation. Cardiac sequelae may manifest as fluctuations in blood pressure and hemodynamics, electrocardiographic changes, arrhythmias, and elevations in levels of cardiac biomarkers. The relation between the nervous and cardiovascular systems in the setting of acute brain injury is subject of this chapter.
Heart Failure: Diagnosis and Evaluation
Authors: Rodeheffer Richard J. , Redfield Margaret M.
Published: May 2013

Heart failure has been defined as the pathophysiologic state in which an abnormality of cardiac function prevents the heart from pumping blood at a rate commensurate with metabolic requirements, or allows it to do so only when ventricular filling pressures are excessively increased. However, only some patients with this circulatory pathophysiology manifest the signs and symptoms of the clinical syndrome we call heart failure. This chapter reviews the 4 stages of heart failure and focuses on its diagnosis and evaluation.
Mechanical Ventricular Assist Devices
Authors: Schirger John A. , Park Soon J. , Kushwaha Sudhir S.
Published: May 2013

Congestive heart failure remains a significant burden in terms of both morbidity and mortality in the United States and in the developed world. While there have been remarkable advances in pharmacologic therapy, decreasing hospitalization rates, promoting beneficial myocardial remodeling, and prolonging life, there remains a significant portion of the heart failure population that progresses to end-stage heart failure. Left ventricular assist devices offer opportunities for bridge-to-transplantation in patients with advanced heart failure and dilated, enlarged left ventricles especially with ischemic substrate or arrhythmias and a long wait time. A number of patients who are initially not bridge-to-transplantation candidates can be served with left ventricular assist device as a bridge to candidacy in, for example, reversal of pulmonary hypertension with left ventricular assist device treatment.