Concise Cardiology

This book aims to provide an easily read general account of clinical cardiology. It is primarily designed to meet the needs of medical students, but should be helpful to advanced students in nursing and paramedical fields, as well as providing a review text for medical interns and residents. The book may help to practice modern medicine in a humane way. This means utilizing all possibilities available, but, at the same time, recognizing their limitations. Since progress in the field of cardiology advances rapidly the physician can only keep up with it by understanding diagnostic and therapeutic measures rather than by memorizing mUltiple facts. The need for a book such as this one has already been proven by the wide acceptance in Europe of the first two German editions (authored by M. K.). Indeed, this success prompted the collaborative effort represented here. Along with the translation into English, the authors have tried to maintain an international perspective, in tune with the greater global awareness and cooperation of the 1990s.

1 Importance of cardiovascular diseases for morbidity and mortality.- 2 History taking and physical examination.- 2.1 History.- 2.2 Physical examination.- 2.2.1 Inspection, palpation, percussion.- 2.2.2 Blood-pressure measurement.- 2.2.3 Auscultation.- 2.2.4 Documentation.- 3 Cardiovascular testing (except exercise testing, see 4.2.2).- 3.1 Electrocardiography.- 3.2 Phonocardiography, pulse-wave recordings.- 3.3 Echocardiography.- 3.4 Indicator dye dilution method.- 3.5 Radiologic examination of the thorax.- 3.6 Determination of the heart volume.- 3.6.1 Diagnostic importance and physiological adaption of the heart volume.- 3.6.2 Subtraction angiography.- 3.7 Nuclear imaging techniques (see also 4.2.3).- 3.7.1 Radionuclide ventriculography.- 3.7.2 Thallium scintigraphy.- 3.8 Computed tomography, positron emission tomography, nuclear magnetic resonance.- 3.9 Cardiac catheterization.- 3.10 Cardiovascular measurements.- 4 Atherosclerosis.- 4.1 Coronary heart disease.- 4.1.1 Definition.- 4.1.2 Pathophysiology.- 4.1.3 Coronary arteries.- 4.1.4 Collaterals.- 4.1.5 Development of coronary artery stenoses.- 4.1.6 Implications of coronary heart disease, risk factors, progression.- 4.1.7 Prognosis.- 4.2 Diagnosis.- 4.2.1 History and physical examination.- 4.2.2 Exercise ECG.- 4.2.3 Nuclear imaging techniques.- 4.2.4 Coronary arteriography.- 4.3 Clinical course of angina pectoris.- 4.3.1 Stable angina pectoris.- 4.3.2 Unstable angina.- 4.3.3 Angina pectoris at rest.- 4.4 Differential diagnosis of angina pectoris, cardiac and non-cardiac chest pain.- 4.5 Therapy of angina pectoris.- 4.5.1 General measures.- 4.5.2 Antianginal drug therapy, thrombosis prophylaxis.- 4.5.3 Pharmacodynamics of antianginal agents.- 4.5.4 Surgical and angioplasty revascularization.- 4.6 Myocardial infarction.- 4.6.1 Definition, classification.- 4.6.2 Development of myocardial infarction.- 4.6.3 Pathologic, angiographic and angioscopic findings.- 4.6.4 Clinical manifestations.- 4.6.5 Diagnosis.- 4.6.6 Therapeutic interventions and diagnostic procedures in acute myocardial infarction.- 4.6.7 Complicated myocardial infarction, ventricular aneurysm.- 4.6.8 Cardiac rehabilitation, diagnostic procedures after infarction.- 4.6.9 Non-transmural myocardial infarction.- 4.6.10 Cardiac rehabilitation.- 4.6.11 Psychologic support of post-infarct patients.- 4.6.12 General lifestyle, chronic drug therapy.- 5 Inflammatory cardiac disorders.- 5.1 Endocarditis.- 5.1.1 Bacterial endocarditis.- 5.1.2 Rheumatic endocarditis.- 5.1.3 Rare manifestations of endocarditis.- 5.2 Myocarditis, pericarditis.- 6 Aortic disorders.- 6.1 Inflammatory diseases of the aorta, luetic, and Takayasu’s aortitis.- 6.2 Aortic aneurysms.- 7 Cardiac valvular disorders.- 7.1 Importance, classification, and etiology.- 7.2 Mitral stenosis.- 7.2.1 Etiology.- 7.2.2 Pathophysiology.- 7.2.3 Clinical manifestations and course.- 7.2.4 Treatment.- 7.3 Mitralinsufficiency.- 7.3.1 Etiology.- 7.3.2 Clinical manifestations.- 7.3.3 Clinical course, therapy.- 7.3.4 Anticoagulation in mitral valve disorders.- 7.4 Aortic stenosis.- 7.4.1 Occurrence, etiology.- 7.4.2 Clinical manifestations.- 7.4.3 Clinical course, therapy.- 7.4.4 Indications for surgery and surgical methods.- 7.5 Aortic insufficiency.- 7.5.1 Etiology.- 7.5.2 Clinical manifestations.- 7.5.3 Clinical course, therapy.- 7.6 Pulmonary valve disorders.- 7.6.1 Etiology.- 7.6.2 Pathology, pathophysiology.- 7.6.3 Clinical manifestations.- 7.6.4 Therapy.- 7.7 Tricuspid stenosis.- 7.7.1 Pathology, pathophysiology, occurrence.- 7.7.2 Clinical manifestations, management.- 7.8 Tricuspid insufficiency.- 7.8.1 Occurrence, etiology.- 7.8.2 Clinical manifestations, management.- 8 Congenital anomalies of the heart and great vessels.- 8.1 Atrial septal defect.- 8.1.1 Pathology,pathophysiology, occurrence.- 8.1.2 Clinical manifestations, course, management.- 8.2 Ventricular septal defect.- 8.2.1 Pathology, pathophysiology, occurrence.- 8.2.2 Clinical manifestations, course, management.- 8.3 Coarctation of the aorta.- 8.3.1 Pathology.- 8.3.2 Clinical course.- 8.3.3 Clinical manifestations.- 8.3.4 Therapy.- 8.4 Patent ductus arteriosus.- 8.4.1 Occurrence, pathology.- 8.4.2 Clinical manifestations.- 8.4.3 Therapy.- 8.5 Fallot’s tetralogy.- 8.5.1 Pathology.- 8.5.2 Clinical manifestations.- 8.5.3 Therapy.- 8.6 Transposition of the great arteries.- 8.7 Ebstein’s anomaly.- 9 Myocardial diseases (except myocarditis, see 5.2).- 9.1 Terminology, etiology, classification.- 9.1.1 Pathology, pathogenesis, pathophysiology.- 9.2 Dilated cardiomyopathy.- 9.2.1 Definition, occurrence.- 9.2.2 Pathology, pathogenesis, pathophysiology.- 9.2.3 Clinical manifestations.- 9.2.4 Therapy.- 9.3 Hypertrophic form of myocardial disease — Hypertrophic cardiomyopathy.- 9.3.1 Definition.- 9.3.2 Occurrence, pathology, pathogenesis.- 9.3.3 Pathophysiology.- 9.3.4 Clinical course.- 9.3.5 Clinical manifestations.- 9.3.6 Therapy.- 9.4 Restrictive cardiomyopathies.- 10 Systemic and pulmonary hypertension.- 10.1 Systemic hypertension.- 10.1.1 Definition of high blood pressure.- 10.1.2 Pathogenesis.- 10.1.3 Manifestations of blood pressure elevation.- 10.1.4 Clinical manifestations.- 10.1.5 Therapeutic principles, general measures.- 10.1.5.1 Drug therapy.- 10.1.5.1.1 Calcium antagonists.- 10.1.5.1.2 ?-receptor blocking agents.- 10.1.5.1.3 ?-blocking agents, peripheral vasodilators.- 10.1.5.1.4 Clonidine and methyldopa.- 10.1.5.1.5 Angiqtensin converting-enzyme (ACE) inhibitors.- 10.1.5.1.6 Diuretics.- 10.1.5.2 Management of hypertensive crisis.- 10.2 Pulmonary hypertension.- 10.2.1 Etiology, clinical course.- 10.2.2 Clinical manifestations.- 10.2.3 Treatment.- 11 Disorders of circulatory regulation.- 11.1 Hyperkinetic and hypertensive regulatory disorders.- 11.1.1 Definition.- 11.1.2 Occurrence.- 11.1.3 Pathogenesis.- 11.1.4 Clinical manifestations.- 11.1.5 Differential diagnosis, prognosis.- 11.1.6 Therapy.- 11.2 Hypodynamic and hypotonic circulatory disorders, hypotension.- 11.2.1 Definition.- 11.2.2 Clinical manifestations.- 11.2.3 Therapy.- 11.3 Hyperventilation, pseudo dyspnoe.- 12 Cardiac arrhythmias.- 12.1 Classification.- 12.1.1 Classification by underlying disease.- 12.1.2 Classification by heart rate.- 12.1.3 Classification by occurrence.- 12.1.4 Classification by need for therapy.- 12.2 Diagnostic procedures.- 12.2.1 Electrocardiography.- 12.2.2 Holter monitoring.- 12.2.3 Ergometry, exercise electrocardiography.- 12.2.4 His bundle electrocardiography.- 12.2.5 Sinus node recovery time.- 12.2.6 Programmed stimulation.- 12.2.7 Intracardiac mapping.- 12.3 Ventricular extrasystoles, ventricular tachycardia, ventricular fibrillation.- 12.3.1 Clinical manifestations.- 12.3.2 Therapy.- 12.4 Supraventricular extrasystoles, atrial fibrillation and flutter, paroxysmal supraventricular tachycardia.- 12.4.1 Therapy.- 12.5 Bradyarrhythmias.- 12.5.1 Definition, occurrence, manifestations.- 12.5.2 Therapy, pacemakers.- 12.6 Intraventricular conduction disorders.- 12.7 WPW, LGL, and long QT syndromes.- 13 Cardiac failure.- 13.1 Definition, classification.- 13.2 Clinical manifestations.- 13.3 Therapy.- 14 Cardiovascular disorders and sports.- 14.1 Relation between structure and function of the heart, adaptation to increased exercise.- 14.2 Measurement of physical exercise capacity, exercise methods, and measurement targets.- 14.3 Risk of sport.- 14.4 Sports for the healthy.- 14.5 Physical rehabilitation therapy, sport and atherosclerosis, sport in modern society.- References for further reading.