Oxford Handbook of Cardiology (Oxford Medical Handbooks)

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Oxford Handbook of
Cardiology
SECOND EDITION

Edited by

Punit Ramrakha
Consultant Cardiologist,
Stoke Mandeville Hospital,
Aylesbury and Hammersmith Hospital, London, UK
and

Jonathan Hill
Clinical Senior Lecturer and Consultant Cardiologist,
King’s College Hospital,
King’s College London, UK

1
1
Great Clarendon Street, Oxford OX2 6DP
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© Oxford University Press, 2012
© Punit Ramrakha and Jonathan Hill (Editor’s contribution), 2012
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Second edition published 2012
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ISBN 978–0–19–964321–9
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Oxford University Press makes no representation, express or implied, that the drug
dosages in this book are correct. Readers must therefore always check the product
information and clinical procedures with the most up-to-date published product
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and recommendations are for the non-pregnant adult who is not breastfeeding.
 v

Contents

Contributors vii
Symbols and abbreviations ix

1 Cardiac investigations 1
2 Drugs for the heart 81
3 Valvular heart disease 143
4 Infective endocarditis 187
5 Coronary artery disease 211
6 Cardiac catheterization and intervention 309
7 Heart failure 367
8 Heart muscle diseases 417
9 Pericardial diseases 459
10 Arrhythmias 477
11 Invasive electrophysiology 541
12 Congenital heart disease 589
13 Multisystem disorders 617
14 Cardiovascular disease in less-developed
countries 653
15 Heart disease in pregnancy 673
16 Eponymous syndromes 697
17 Cardiovascular emergencies 709
18 Practical procedures 783
Appendix: Clinical trials 831

Index 837
This page intentionally left blank
 vii

Contributors

Dominic Abrams Tevfik Ismail

St Bartholomew’s and Great Royal Brompton Hospital,
Ormond Street Hospitals, London, UK
London, UK
Graham Jackson
Zoe Astroulakis Guy’s and St Thomas’ Hospitals,
King’s College Hospital, London, UK
London, UK
Ajay Jain
Richard Campbell Barts and The London NHS Trust,
King’s College Hospital, London, UK
London, UK
Andrew Kelion
Navin Chandra Royal Brompton and Harefield
London Deanery, UK NHS Foundation Trust,
London, UK
Jo Chikwe
Mount Sinai Medical Center, Paul Leeson
New York, USA John Radcliffe Hospital,
Oxford, UK
Christopher Critoph
The Heart Hospital, London, UK Bongani Mayosi
Groote Schuur Hospital,
Shay Cullen Cape Town, South Africa
The Heart Hospital, London, UK
Catherine Nelson-Piercy
Mark Early King’s College London and
St Bartholomew’s Hospital, Imperial College Healthcare Trust,
London, UK London, UK
Andrew B Goldstone Michal Papadakis
University of Pennsylvania, St George’s University,
Philadelphia, PA, USA London, UK
Patrick Gordon Sanjay Prasad
King’s College Hospital, Royal Brompton Hospital,
London, UK London, UK
Daniel Heaton Eberhard Ritz
University College Hospital, Ruperto Carola University of
London, UK Heidelberg, Germany
Steve Humphries Toby Rogers
University College London, King’s College Hospital,
London, UK London, UK
viii CONTRIBUTORS

Sanjay Sharma Helen Williams

St George’s University of London, Southwark Health and
London, UK Social Care and South London
Cardiac and Stroke Networks,
Muzahir Tayebjee London, UK
Leeds Teaching Hospitals NHS
Trust, Leeds, UK
 ix

Symbols and abbreviations

4 male
5 female
7 approximately
8 equal to
9 plus or minus
i increased
d decreased
n normal
l leading to
p primary
s secondary
* degrees
b cross-reference
Y internet reference
2D two-dimensional
3D three-dimensional
AAD antiarrhythmic drug
Ab antibody
ABG arterial blood gas(es)
ABL abetalipoproteinaemia
AC attenuation correction
ACC American College of Cardiology
ACE angiotensin-converting enzyme
ACE-I angiotensin-converting enzyme inhibitor
A2Ch apical two-chamber
A3Ch apical three-chamber
A4Ch apical four-chamber
A5Ch apical five-chamber
ACLS advanced cardiac life support
ACS acute coronary syndrome
ACT activated clotting time
ACUITY Acute Catheterization and Urgent Intervention Triage
Strategy trial
AD afterdepolarization
ADA adenosine deaminase
ADMA asymmetric-dimethyl arginine
x SYMBOLS AND ABBREVIATIONS

ADP adenosine diphosphate

AF atrial fibrillation
AFB acid-fast bacilli
AFL atrial flutter
AFP alpha-feto protein
AFCAPS/ Airforce/Texas Coronary Atherosclerosis Prevention
TexCAPS Study
AHA American Heart Association
A-HeFT African-American Heart Failure Trial
AI aortic insufficiency
AICD automated implantable cardioverter defibrillator
AIDS acquired immune deficiency syndrome
AIH aortic intramural haematoma
AIIRA angiotensin II receptor antagonist
AIRE Acute Infarction Ramipril Efficacy
ALCAPA anomalous left coronary artery arising from the
pulmonary artery
ALLHAT Antihypertensive and Lipid-Lowering Treatment to
Prevent Heart Attack
ALP alkaline phosphatase
ALS advanced life support
ALT alanine aminotransferase
AMI acute myocardial infarction
AMP adenosine monophosphate
ANA antinuclear antibodies
ANCA anti-neutrophil cytoplasmic antibodies
AP anteroposterior
APC atrial premature complex
APSAC anistreplase
APSIS Angina Prognosis Study in Stockholm
aPTT activated partial thromboplastin time
AR aortic regurgitation
ARB angiotensin receptor blocker
ARDS acute respiratory distress syndrome
ARVC arrhythmogenic right ventricular myopathy
AS aortic stenosis
ASCOT Anglo-Scandinavian Cardiac Outcomes Trial
ASD atrial septal defect
ASE American Society of Echocardiography
ASH asymmetric septal hypertrophy
ASIST Atenolol Silent Ischaemia Study
 SYMBOLS AND ABBREVIATIONS xi
AST aspartate transaminase
AT antithrombin
ATLAS Assessment of Treatment with Lisinopril and
Survival (study)
ATP antitachycardia pacing
ATTR transthyretin molecule
AV aortic valve/atrioventricular
AVN atrioventricular node
AVNERP atrioventricular nodal effective refractory period
AVNRT atrioventricular node re-entrant tachycardia
AVP arginine vasopressin
AVR aortic valve replacement
AVRT atrioventricular re-entrant tachycardia
AWCL anterograde Wenckebach cycle length
BARI Bypass Angioplasty Revascularization Investigation
BBB bundle branch block
BBV blood-borne virus
BCT broad complex tachycardia
bd twice daily
BEAUTIFUL Morbidity–Mortality Evaluation of Ivabradine in Patients
with CAD and Left Ventricular Systolic Dysfunction
BHAT Beta-blockers Heart Attack Trial
BHS British Hypertension Society
BLS basic life support
BMD Becker’s muscular dystrophy
BMI body mass index
BMS bare metal stent
BNF British National Formulary
BNP B-type natriuretic protein
BP blood pressure
bpm beats per minute
BSA body surface area
BSAC British Society for Antimicrobial Chemotherapy
CABG coronary artery bypass graft
CAD coronary artery disease
CAPRICORN Carvedilol Prospective Randomized Cumulative Trial
CAPRIE Clopidogrel versus Aspirin in Patients at Risk of Ischemic
Events (study)
CARDS Collaborative Atorvastatin Diabetes Study
CARE Cholesterol and Recurrent Events
CARE-HF Cardiac Resynchronization in Heart Failure
xii SYMBOLS AND ABBREVIATIONS

CARISA Combination Assessment of Ranolazine in Stable

Angina
CARMEN Randomized controlled Multicentre Trial
CASINO Calcium Sensitizer or Inotropic Agent or None in
Low Output Heart Failure
CCB calcium-channel blocker
CCF congestive cardiac failure
CCS Canadian Cardiovascular Society
CCU coronary care unit
CEA carcinoembryonic antigen
CFAE complex and fractionated atrial electrogram
CFP colour Doppler flow propagation
CHADS Congestive heart failure, Hypertension, Age >75,
Diabetes mellitus and previous Stroke)
CHARM Candesartan in Heart Failure—Assessment of
Mortality and Morbidity
CHARM-Preserved Effects of Candesartan in Patients with Chronic
Heart Failure and Preserved Left Ventricular
Ejection Fraction
CHB complete heart block
CHD coronary heart disease/congenital heart disease
CHF congestive heart failure
CK creatine kinase
CKD chronic kidney disease
CIBIS Cardiac Insufficiency Bisoprolol Study
CMR cardiac MRI
CMV cytomegalovirus
CNS central nervous system
CO cardiac output
COMMIT Clopidogrel and Metoprolol in Myocardial
Infarction Trial
COMPANION Comparison of Medical Therapy, Pacing and
Defibrillation in Heart Failure
COPD chronic obstructive pulmonary disease
COPERNICUS Carvedilol Prospective Randomized Cumulative
Survival (study)
CORONA Controlled Rosuvastatin Multinational Trial in
Heart Failure
COURAGE Clinical Outcomes Utilizing Revascualrization and
Aggressive Drug Evaluation trial
COX-2 cyclo-oxygenase 2
CPAP continuous positive airway pressure
CPR cardiopulmonary resuscitation
 SYMBOLS AND ABBREVIATIONS xiii
CPVT catecholaminergic polymorphic ventricular
tachycardia
CrCl creatinine clearance
CREST calcinosis, Raynaud phenomenon, oseophageal
dysmotility, sclerodactyly, and telangiectasia
CRP C-reactive protein
CRT cardiac resynchronization therapy
CS coronary sinus
CT computed tomography
CTO chronic total occlusion
CTPA CT pulmonary angiography
CURE Clopidogrel in Unstable Angina to Prevent
Recurrent Events
CURRENT-OASIS7 Clopidogrel Optimal Loading Dose Usage to
Reduce Recurrent Events/Optimal Antiplatelet
Strategy for Intervention
CV cardiovascular
CVA cerebrovascular accident
CVC central venous catheter
CVD cardiovascular disease
CVP central venous pressure (line)
CVS cardiovascular system
CW continuous wave
CXR chest X-ray
DALY disability-adjusted life year
DANAMI Danish Acute Myocardial Infarction
DBP diastolic blood pressure
DC direct current
DCM dilated cardiomyopathy
DES drug-eluting stent
DHF diastolic heart failure
DHP dihydropyridine
DIC disseminated intravascular coagulation
DIG Digitalis Investigation Group
DM diabetes mellitus/dermatomyositis
DMARD disease-modifying anti-rheumatic drug
DMD Duchenne’s muscular dystrophy
DOI dimensionless obstructive index
DVLA Driver and Vehicle Licensing Agency
DVT deep vein thrombosis
EBV Epstein–Barr virus
xiv SYMBOLS AND ABBREVIATIONS

ECG electrocardiograph/electrocardiogram
ECHO echocardiography
ED erectile dysfunction
EF ejection fraction
eGFR estimated glomerular filtration rate
ELISA enzyme-linked immunosorbent assay
ELISPOT enzyme-linked immunospot
ELITE Evaluation of Losartan in the Elderly
EMD electromechanical dissociation
EMF endomyocardial fibrosis
eNOS endothelial nitric oxide synthase
EOA effective orifice area
EOL end of life
EP electrophysiology
EPHESUS Eplerenone Post-Acute Myocardial Infarction Heart
Failure Efficacy and Survival Study
EPO erythropoietin
ERA Estrogen Replacement and Atherosclerosis
ERI elective replacement indicator
ERICA Efficcacy of Ranolazine in Chronic Angina
ERNV equilibrium radionuclide ventriculography
ERO effective regurgitant orifice
ERP effective refractory period
ESC European Society of Cardiology
ESM ejection systolic murmur
ESPRIT Estrogen in the Prevention of Reinfarction Trial
ESR erythrocyte sedimentation rate
ET endotracheal
EUROPA European Trial on Reduction of Cardiac Events with
Perindopril in Stable Coronary Artery Disease
FAME FFR vs. Angiography for Multivessel Evaluation
FAT focal atrial tachycardia
FBC full blood count
FDA Food and Drug Administration
FFP fresh frozen plasma
FFR fractional flow reserve
FGR fetal growth retardation
FH familial hyperlipidaemia/hypercholesterolaemia
FLAP 5-lipoxygenase activation protein
Fr French gauge
FSH facioscapulohumeral muscular dystrophy
 SYMBOLS AND ABBREVIATIONS xv
GFR glomerular filtration rate
GGT gamma glutamyl transferase
GI gastrointestinal
GISSI Gruppo Italiano per lo Studio della Sopravvivenza
nell’Infarto Miocardio
GP general practitioner/glycoprotein
GTN glyceryl trinitrate
GUSTO Global Utilization of Streptokinase and Tissue
Plasminogen Activator for Occluded Coronary
Arteries
HACEK Haemophilus, Actinobacillus, Cardiobacterium,
Eikenella, and Kingella spp.
Hb haemoglobin
HbA1c glycosylated haemoglobin
HBIG hepatitis B immunoglobulin
HBV hepatitis B virus
HCG human chorionic gonadotrophin
HCM hypertrophic cardiomyopathy
HCV hepatitis C virus
HDL high-density lipoprotein
HDL-C high-density lipoprotein cholesterol
HDU high-dependency unit
HERS Heart and Estrogen/Progestin Study
HF heart failure
HFNEF heart failure with normal ejection fraction
HFREF heart failure with reduced ejection fraction
HIV human immunodeficiency virus
HLA human leucocyte antigen
H/M heart-to-mediastinum ratio
HOCM hypertrophic obstructive cardiomyopathy
HOPE Heart Outcomes Prevention Evaluation
HORIZONS-AMI Harmonizing Outcomes with Revascularization and
Stents in Acute Myocardial Infarction trial
HOT Hypertension Optimal Treatment
HPS Heart Protection Study
HPS-THRIVE Heart Protection Study: Treatment of HDL to
Reduce the Incidence of Vascular Events
HR heart rate
HRA high right atrium
HRT hormone replacement therapy
HSVB His synchronous ventricular premature beat
HT hypertension
xvi SYMBOLS AND ABBREVIATIONS

IABP intra-aortic balloon pump

IAP incremental atrial pacing
ICD implantable cardiac defibrillator
ICegram intracardiac electrogram
IE infective endocarditis
IgA immunoglobulin A
IgG immunoglobulin G
IGF insulin-like growth factor
IHD ischaemic heart disease
IJV internal jugular vein
IM intramuscular
IMAGE International Multicenter Angina Exercise (study)
123
I-MIBG iodine-123-metaiodobenzylguanidine
IMPROVE-IT Improved Reduction of Outcomes: Vytorin Efficacy
International trial
in. inch
INR international normalized ratio
IONA Impact of Nicorandil in Angina
I-Preserved Irbesartan in Heart Failure with Preserved Ejection
Fraction
IRMER Ionising Radiation Medical Exposure Regulations
ISR in-stent restenosis
iu international unit
ISIS-2 second International Study of Infarct Survival
ITU intensive therapy unit
IV intravenous
IVC inferior vena cava
IVIG intravenous immunoglobulin
IVP incremental ventricular pacing
IVUS intravascular ultrasound/ultrasonography
JL4 Judkins Left 4 (catheter)
JR4 Judkins Right 4 (catheter)
JUPITER Justification for the Use of Statins in Primary Prevention
JVP jugular venous pressure/pulse
LA left atrium/atrial
LAA left atrial appendage
LAD left anterior descending (coronary artery)
LAE left atrial enlargement
LAHB left anterior hemiblock
LAO left anterior oblique (projection)
LAX long axis (view)
 SYMBOLS AND ABBREVIATIONS xvii
LBBB left bundle branch block
LCA left coronary artery
LCB left coronary bypass (catheter)
LDH lactate dehydrogenase
LDL low-density lipoprotein
LDL-C low-density lipoprotein cholesterol
LEADERS Biolimus-eluting stent with biodegradable polymer versus
sirolimus-eluting stent with durable polymer for coronary
revascularization trial
LFT liver function test
LGMD limb-girdle muscular dystrophy
LIFE Losartan Intervention For Endpoint reduction
LIJ left internal jugular
LIMA left internal mammary artery
LIPID Long-term Intervention with Pravastatin in Ischaemic
Disease
LIPV left inferior pulmonary vein
LLSE linear least squares estimation
LMCA left main coronary artery
LMS left main stem (coronary artery)
LMWH low molecular weight heparin
LPA left pulmonary artery
Lp(a) lipoprotein(a)
LPHB left posterior hemiblock
LQTS long QT syndrome
LRC-CPPT Lipid Research Clinics Coronary Primary Prevention Trial
LSE left sternal edge
LSPV left superior pulmonary vein
LV left ventricle/ventricular
LVAD left ventricular assist device
LVEDP left ventricular end-diastolic pressure
LVEDV left ventricular end-diastolic volume
LVEF left ventricular ejection fraction
LVF left ventricular function/failure
LVH left ventricular hypertrophy
LVIDd left ventricular internal diameter in diastole
LVIDs left ventricular internal diameter in systole
LVNC left ventricular non-compaction
LVOT left ventricular outflow tract
LVSD left ventricular systolic dysfunction
MACE major adverse cardiac events
xviii SYMBOLS AND ABBREVIATIONS

MADIT Muiticenter Automatic Defibrillator Implantation Trial

MAOI monoamine oxidase inhibitor
MARISA Monotherapy Assessment of Ranolazine in Stable Angina
MD muscular dystrophy
ME mid-oesophageal
MEF2A myocyte enhancer factor 2A
MERIT-HF Metoprolol CR/XL Randomised Intervention Trial in
Congestive Heart Failure
MERLIN-TIMI Metabolic Efficiency with Ranolazine for Less Ischemia in
Non-ST-Elevation Acute Coronary Syndromes –
Thrombolysis in Myocardial Infarction
MI myocardial infarction
MIC minimum inhibitory concentration
MIRACL Myocardial Ischemia Reduction with Acute Cholesterol
Lowering
MIRACLE Multicenter InSync Randomized Clinical Evaluation
MIST Migraine Intervention with Starflex Technology trial
MPA main pulmonary artery
MPS myocardial perfusion scintigraphy
MR mitral regurgitation/modified release/magnetic resonance
MRA magnetic resonance angiography
MRI magnetic resonance imaging
MRSA meticillin-resistant Staphylococcus aureus
MS mitral stenosis
MSCT multislice computed tomography
mSv milli-Sievert
MUGA mulitgated acquisition
MUSTT Multicenter Unsustained Tachycardia Trial
MV mitral valve
MVA mitral valve area
MVD multivessel disease
MVO2 myocardial oxygen consumption
MVP mitral valve prolapse
MVR mitral valve replacement
NaI(Tl) sodium iodide activated by non-radioactive thallium
NBM nil by mouth
NBTV non-bacterial thrombotic vegetations
NCD non-communicable disease
NCEP-ATP National Cholesterol Education Program—Adult
Treatment Panel
NCT narrow complex tachycardia