Get more medical books and resources at www.medicalbr.tk CARDIOLOGY SECRETS Fifth Edition GLENN N. LEVINE, MD, FACC, FAHA Professor of Medicine, Baylor College of Medicine; Director, Cardiac Care Unit, Michael E. DeBakey VA Medical Center, Houston, Texas 1600 John F. Kennedy Blvd. Ste 1800 Philadelphia, PA 19103-2899 Cardiology Secrets, Fifth Edition ISBN: 978-0-323478700 Copyright © 2018 by Elsevier, Inc. All rights reserved. Glenn N. Levine retains copyright for the original images used in the Work. No part of this publication may be reproduced or transmitted in any form or by any means, electronic or mechanical, including photocopying, recording, or any information storage and retrieval system, without permission in writing from the publisher. Details on how to seek permission, further information about the Publisher’s permissions policies, and our arrangements with organizations such as the Copyright Clearance Center and the Copyright Licensing Agency can be found at our website: www.elsevier.com/permissions. This book and the individual contributions contained in it are protected under copyright by the Publisher (other than as may be noted herein). Notices Knowledge and best practice in this field are constantly changing. As new research and experience broaden our understanding, changes in research methods, professional practices, or medical treatment may become necessary. Practitioners and researchers must always rely on their own experience and knowledge in e valuating and using any information, methods, compounds, or experiments described herein. In using such information or methods they should be mindful of their own safety and the safety of others, i ncluding parties for whom they have a professional responsibility. With respect to any drug or pharmaceutical products identified, readers are advised to check the most current information provided (i) on procedures featured or (ii) by the manufacturer of each product to be administered, to verify the recommended dose or formula, the method and duration of administration, and contraindications. It is the responsibility of practitioners, relying on their own experience and knowledge of their patients, to make diagnoses, to determine dosages and the best treatment for each individual patient, and to take all appropriate safety precautions. To the fullest extent of the law, neither the Publisher nor the authors, contributors, or editors assume any liability for any injury and/or damage to persons or property as a matter of products liability, negligence or otherwise, or from any use or operation of any methods, products, instructions, or ideas contained in the material herein. Previous editions copyrighted 2014, 2010, 2001, AND 1995 Library of Congress Cataloging-in-Publication Data Names: Levine, Glenn N., editor. Title: Cardiology secrets / [edited by] Glenn N. Levine. Other titles: Secrets series. Description: Fifth edition. | Philadelphia, PA : Elsevier, [2018] | Series: Secrets | Includes bibliographical references and index. Identifiers: LCCN 2017002964 | ISBN 9780323478700 (pbk. : alk. paper) Subjects: | MESH: Heart Diseases | Diagnostic Techniques, Cardiovascular | Study Guide Classification: LCC RC682 | NLM WG 18.2 | DDC 616.1/20076--dc23 LC record available at https://lccn.loc.gov/2017002964 Content Strategist: James Merritt Content Development Specialist: Kayla Smull Publishing Services Manager: Deepthi Unni Project Manager: Dr. Atiyaah Muskaan Design Direction: Ryan Cook Marketing Manager: Melissa Darling Printed in China Last digit is the print number: 9 8 7 6 5 4 3 2 1 CONTRIBUTORS Suhny Abbara, MD, FACR, FSCCT Sheilah A. Bernard, MD, FACC Professor, Department of Radiology Associate Program Director, IM Residency Program Chief, Cardiothoracic Imaging, UTSW Medical Department of Medicine, Section of Cardiology Center Boston Medical Center, Boston University School of Division of Cardiothoracic Imaging Medicine UT Southwestern Medical Center Boston, MA USA Dallas, Texas, USA Ozlem Bilen, MD David Aguilar, MD Cardiology Fellow Associate Professor of Medicine Emory School of Medicine, Division of Cardiology Department of Medicine, Division of Cardiology Atlanta, GA Baylor College of Medicine Itamar Birnbaum, MD Houston, Texas, USA Fellow Eric H. Awtry, MD, FACC Department of Medicine, Division of Cardiology Associate Professor of Medicine Baylor College of Medicine Boston University School of Medicine Houston, Teaxs, USA Associate Chair for Clinical Affairs, Cardiovascular Yochai Birnbaum, MD FACC, FAHA Medicine Section Professor of Medicine Boston Medical Center John S. Dunn Chair in Cardiology Research and Boston, Massachusetts, USA Education Jose L. Baez-Escudero, MD, FACC, FHRS The Department of Medicine, Section of Cardiology Section Head, Cardiac Pacing and Electrophysiology Baylor College of Medicine Robert and Suzanne Tomsich Department of Houston, TX 77030 Cardiovascular Medicine Fernando Boccalandro, MD FACC FSCAI CPI Cleveland Clinic Florida Odessa Heart Institure - ProCare Weston, FL, USA Vice Chief of Staff Faisal Bakaeen Medical Center Hospital Health Care System Staff Surgeon and Professor of Surgery Department of Cardiology Department of Thoracic and Cardiovascular Medical Director Surgery, Heart and Vascular Institute Permian Research Foundation Cleveland Clinic Assistant Clinical Professor Cleveland, Ohio, USA Department of Internal Medicine Texas Tech University Health Science Center Gary J. Balady, MD Odessa, Texas, USA Director, Non Invasive Cardiovascular Laboratories Section of Cardiovascular Medicine Biykem Bozkurt, MD, PhD, FACC, FAHA, FACP, Boston Medical Center FESC, FHFSA Professor of Medicine Professor of Medicine Boston University School of Medicine Medicine Chair (Medical Care Line Executive) DeBakey VA Medical Center Dr. Luc M. Beauchesne, MD FRCPC FACC The Mary and Gordon Cain, Chair Director Adult Congenital Heart Disease Program W.A. “Tex” and Deborah Moncrief, Jr., Chair Division of Cardiology Vice-Chair of Department of Medicine at Baylor University of Ottawa Heart Institute College of Medicine Ottawa, Ontario, Canada Associate Director, Cardiovascular Research Institute Director, Winters Center for Heart Failure Research, Baylor College of Medicine, Houston Texas vii viii CONTRIBUTOR Blase Carabello, MD Nadeen N. Faza, MD Professor and Chief, Cardiology Cardiovascular Disease Fellow Director, East Carolina Heart Institute Department of Cardiology East Carolina University Baylor College of Medicine Houston, Texas, USA Jaya Chandrasekhar, MBBS, MRCP, FRACP Division of Cardiology Savitri Fedson, MA, MD Icahn School of Medicine at Mount Sinai Associate Professor New York, New York, USA Department of Medicine, Baylor College of Medicine Michael E. Debakey Medical Center Leslie T. Cooper Jr., M.D. Associate Professor Professor of Medicine Center for Medical Ethics and Health Policy, Baylor Chair, Cardiovascular Department College of Medicine Mayo Clinic in Florida Houston, Texas, USA Jacksonville, FL, USA G. Michael Felker, MD, MHS, FACC, FAHA, FHFSA Luke Cunningham, MD Professor of Medicine Fellow Chief, Heart Failure Section, Division of Cardiology Cardiovascular Diseases Duke University School of Medicine Baylor College of Medicine Durham, NC USA Houston, Texas, USA James J. Fenton, MD , FCCP Ali E. Denktas, MD, FACC, FSCAI Clinical Associate Professor Director, Cardiac Catheterization Laboratories National Jewish Health Michael E. DeBakey VA Medical Center Denver, Colorado, USA Associate Professor of Medicine Baylor College of Medicine Michael E. Field, M.D. Houston, Texas, USA Associate Professor of Medicine Director of Cardiac Arrhythmia Service Anita Deswal, MD, MPH University of Wisconsin School of Medicine & Public Chief of Cardiology Health Director, Heart Failure Program 600Highland Avenue, MC3248 Michael E. DeBakey VA Medical Center Madison, WI 53792 Professor of Medicine Baylor College of Medicine Scott D. Flamm, M.D., M.B.A. Houston, Texas, USA Section Head, Cardiovascular Imaging Imaging, and Heart and Vascular Institutes Haytham Elgharably, MD Professor of Radiology Resident Department of Diagnostic Radiology Thoracic & Cardiovascular Surgery Department Cleveland Clinic Lerner College of Medicine of Case Cleveland Clinic Foundation Western Reserve University Cleveland, Ohio, United States Cleveland, Ohio, USA Lothar Faber, MD, FESC, FACC Lee A. Fleisher, MD, FACC, FAHA Professor Robert D. Dripps Professor and Chair of Clinic for Cardiology Anesthesiology Heart and Diabetes Centre NRW, University Clinic of Critical Care Professor of Medicine the Ruhr University Bochum Perelman School of Medicine D 32545 Bad Oeynhausen, Germany University of Pennsylvania Michael E. Farkouh, MD, MSc, FACC, FAHA Philadelphia, PA Chair and Director Laura Epstein Flink, MD MS Peter Munk Centre of Excellence in Multinational Assistant Clinical Professor Clinical Trials Division of Cardiology/UCSF University Health Network San Francisco VA Medical Center Director, Heart & Stroke Richard Lewar Centre of San Francisco, California Excellence in Cardiovascular Research University of Toronto Amy French, MD Toronto, Canada Department of Cardiology Boston Medical Center/Boston University School of Medicine Boston, MA, USA CONTRIBUTOR ix Marat Fudim, MD Jose A. Joglar, MD, FACC, FAHA, FHRS Department of Medicine, Division of Cardiology Professor of Internal Medicine Duke University Medical Center Fellowship Program Director, Clinical Cardiac Durham, NC, USA Electrophysiology Director of Cardiology, Parkland Memorial Hospital Stephen A. Gannon, MD Elizabeth Thaxton Page and Ellis Batten Teaching Fellow in Medicine Page Professorship in Clinical Cardiac Bio Med Medicine Electrophysiology Research Brown University UT Southwestern Medical Center Providence, Rhode Island Dallas, Texas, USA Nicholas Governatori, MD Douglas R. Johnston, MD, FACS Assistant Residency Program Director Staff Surgeon Thomas Jefferson University Department of Thoracic and Cardiovascular Surgery Philadelphia, PA 19147 Cleveland Clinic Cindy Grines, MD Cleveland, OH USA Corporate Vice Chief of Academic Affairs Lee Joseph, MD Cardiovascular Medicine Fellow William Beaumont Hospital Internal Medicine, Cardiovascular Medicine Royal Oak, Michigan University of Iowa Gabriel B. Habib Sr, MS, MD, FACC, FCCP, FAHA Iowa City, Iowa, USA Professor of Medicine Waleed T. Kayani, MD Department of Medicine, Division of Cardiology Interventional Cardiology Fellow Baylor College of Medicine Department of Medicine, Section of Cardiology Houston, Texas, USA Baylor College of Medicine, Houston, Texas, USA Ihab Hamzeh, MD., FACC Thomas A. Kent, MD Baylor College of Medicine Professor and Director of Cerebrovascular Research Houston, Texas, USA and Education Tomoya Timothy Hinohara, MD Department of Neurology Resident Physician Baylor College of Medicine Department of Internal Medicine Houston, Texas, USA Duke University Medical Center Jimmy L. Kerrigan, MD Durham, North Carolina, USA General Cardiology Fellow Vu Hoang, MD Robert and Suzanne Tomsich Department of Cardiology Fellow Cardiovascular Medicine Department of Internal Medicine, Division of Sydell and Arnold Miller Family Heart & Vascular Cardiology Institute Baylor College of Medicine Cleveland Clinic Foundation Houston, Texas, USA Cleveland, Ohio, USA Brian D. Hoit, MD Elias Kfoury, MD, RPVI Professor of Medicine and Physiology and Division of Vascular Surgery Biophysics Cheyenne Regional Medical Center Case Western Reserve University Cheyenne, WY Harrington Heart & Vascular Institute Shaden Khalaf, MD University Hospitals Cleveland Medical Center Cardiology Fellow at Baylor College of Medicine Cleveland OH 44106 Houston, Texas, USA Hani Jneid, MD, FACC, FAHA, FSCAI Mirza Umair Khalid, MD Associate Professor of Medicine Cardiology Fellow Director of Interventional Cardiology Research Department of Medicine, Division of Cardiology Baylor College of Medicine Baylor College of Medicine Director of Interventional Cardiology Houston, Texas, USA The Michael E. DeBakey VA Medical Center Houston, Texas, USA Esther S.H. Kim, MD, MPH Associate Professor of Medicine Division of Cardiovascular Medicine Vanderbilt Heart and Vascular Institute Nashville, TN x CONTRIBUTOR Panos Kougias, MD, FACS Geno J. Merli, MD, MACP, FHM, FSVM Associate Professor of Surgery Professor of Medicine & Surgery Baylor College of Medicine Senior Vice President, Associate Chief Medical Houston, Texas, USA Officer Co-Director, Jefferson Vascular Center Amar Krishnaswamy, MD Thomas Jefferson University Hospital Program Director, Interventional Cardiology Philadelphia, PA Department of Cardiovascular Medicine Heart and Vascular Institute Stephanie L. Mick, MD Cleveland Clinic Cardiac Surgeon, Surgical Director of Transcatheter Cleveland, OH, USA Aortic Valve Program Cardiothoracic Surgery, Heart and Vascular Institute Michael H. Kroll, MD Cleveland Clinic Professor and Chief Cleveland, OH, USA Division of Benign Hematology The University of Texas MD Anderson Cancer Center Curtiss Moore, MD Houston, Texas, USA Clinical Fellow Residency Nitin Kulkarni, MD University of Texas Southwestern Medical Center Cardiology Fellow Dallas, Texas, USA Division of Cardiology UT Southwestern Medical Center Ajith Nair, MD Dallas, Texas, USA Department of Medicine, Division of Cardiology Baylor College of Medicine Richard A. Lange, MD, MBA Houston, Texas 77030 President Dean, Paul L. Foster School of Medicine Vijay Nambi, MD PhD Rick and Ginger Francis Endowed Professor Staff Cardiologist and Associate Professor of Texas Tech University Health Sciences Center El Medicine Paso Department of Medicine, Division of Cardiology El Paso, Texas, USA Michael E DeBakey Veterans Affairs Hospital and Baylor College of Medicine Salvatore Mangione, MD Houston, Texas, USA Associate Professor of Medicine SKMC of Thomas Jefferson University Heidi Nicewarner, MD, MPH 1001 Locust Street Cardiology Fellow Philadelphia, PA 19096 Section of Cardiovascular Medicine Boston Medical Center Sharyl R. Martini, MD PhD Boston, MA, USA Medical Director VA National Telestroke Program E. Magnus Ohman, MD, FRCPI, FACC Department of Veterans Affairs Professor of Medicine Assistant Professor The Kent and Siri Rawson Director, Duke Program Department of Neurology for Advanced Coronary Disease Baylor College of Medicine Vice-Chair, Department of Medicine – Development Houston, Texas, USA and Innovation Associate Director, Duke Heart Center James McCord, MD Senior Investigator, Duke Clinical Research Institute Heart and Vascular Institute Department of Medicine, Division of Cardiovascular Henry Ford Hospital Medicine Wayne State University Duke University Medical Center Detroit, Michigan, USA Durham, NC USA Roxana Mehran, MD, FACC Nicolas Palaskas, MD Professor of Medicine (Cardiology) and Population Cardiology Fellow Health Science and Policy Internal Medicine/Cardiology Director of Interventional Cardiovascular Research Baylor College of Medicine and Clinical Trials Houston, Texas, USA The Zena and Michael A. Weiner Cardiovascular Institute Icahn School of Medicine at Mount Sinai New York, NY, USA CONTRIBUTOR xi Lavannya M. Pandit, M.D. Moises Rodriguez-Manero, MD, PhD Assistant Professor of Medicine Division of Cardiac Electrophysiology Department of Internal Medicine, Division of Cardiology Department Pulmonary, Critical Care, Sleep Medicine Section Complejo Hospital Universitario de Santiago Michael E. DeBakey Veterans Affairs Medical Center IDIS (Instituto para el Desarrollo e Integración de Baylor College of Medicine la Salud) Houston, Texas. USA CIBERCV (Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares) Niraj R. Patel, M.D. Santiago de Compostela (A Coruña) Physician in Nuclear Medicine, Nuclear Cardiology Spain and PET/CT Imaging Michael E. DeBakey VA Medical Center Eric E. Roselli, MD, FACS Assistant Professor of Radiology Director of the Aorta Center Baylor College of Medicine Department of Thoracic and Cardiovascular Surgery Houston, Texas, USA Cleveland Clinic Heart and Vascular Institute Cleveland, Ohio, USA Lawrence Phillips, MD Director, Nuclear Cardiology Zeenat Safdar, MD, MS Division of Cardiology, Department of Medicine Director of Pulmonary Hypertension Care Center NYU School of Medicine and Clinical Research New York, New York, USA Acting Associate Professor, institute of academic medicine Andrew Pipe, CM, MD, LLD(Hon), DSc(Hon) Houston Methodist Hospital Professor, Faculty of Medicine, University of Ottawa Weill Cornell College of Medicine Chief, Division of Prevention and Rehabilitation, Houston, Texas, USA University of Ottawa Heart Institute Ottawa, Ontario, Canada Catalina Sanchez-Alvarez, MD Internal Medicine Resident Charles V. Pollack Jr., MA, MD, FACEP, FAAEM, Department of Internal Medicine FAHA, FESC, FCPP Mayo Clinic Florida Professor of Emergency Medicine and Associate Jacksonville, Florida, USA Provost Thomas Jefferson University Paul Schurmann, MD Philadelphia, PA USA Cardiac Electrophysiology Department Cardiology, Section Electrophysiology Mark Pollet, MD, BSE Institution affiliated Houston Methodist/ MEDVAMC Cardiology Fellow Houston, TX 77025 Department of Cardiology Baylor College of Medicine Nishant R. Shah, MD, MPH, MSc Houston, TX, USA Assistant Professor of Medicine Division of Cardiology Stuart B. Prenner, MD Brown University Alpert Medical School Senior Fellow in Cardiovascular Diseases Assistant Professor of Health Services Division of Cardiology, Department of Medicine Policy & Practice Northwestern University Feinberg School of Brown University School of Public Health Medicine Providence, RI, USA Chicago IL USA Sanjiv J. Shah, MD Prabhakar Rajiah, MBBS, MD, FRCR Professor of Medicine Associate Professor of Radiology, Cardiothoracic Department of Medicine, Division of Cardiology Imaging Northwestern University Feinberg School of Associate Director of Cardiac CT and MRI Medicine UT Southwestern Medical Center Chicago, IL, USA Dallas, Texas, USA Tina Shah, MD, FACC Assistant Professor, Baylor College of Medicine Michael E. DeBakey VA Medical Center Houston, Texas, USA xii CONTRIBUTOR Fidaa Shaib, MD, FCCP, FAASM Paaladinesh Thavendiranathan, MD, MSc, SM, Associate Professor of Medicine FRCPC Department of Medicine, Division of Pulmonary, Assistant Professor of Medicine Critical Care, and Sleep Medicine Department of Cardiology and Medical Imaging Baylor College of Medicine University Health Network Houston, Texas, USA University of Toronto Toronto, Ontario Mandeep S. Sidhu, MD, FACC, FAHA Canada ISCHEMIA Clinical Coordinating Center Faculty and Investigator Rahul Thomas, MD Co-Regional Leader, ISCHEMIA and ISCHEMIA CKD Cardiovascular Disease Trials UH Cleveland Medical Center Associate Professor of Medicine Cleveland, Ohio. USA Assistant Dean for Medical Education and Student Kara A. Thompson, MD, FACC Research Assistant Professor Albany Medical College Department of Cardiology Division of Cardiology, MD Anderson Cancer Center Albany Medical Center Houston, Texas, USA Albany, NY Adjunct Professor of Health Care Management Megan Titas, MD Clarkson University Fellow Cardiovascular Medicine Schenectady, NY Boston University Medical Center Boston, MA USA Edward G. Soltesz, MD MPH Staff Surgeon Michael Zhen-Yu Tong, MD, MBA Department of Thoracic and Cardiovascular Surgery Cardiac Surgeon, Surgical director of heart Cleveland Clinic Foundation transplantation, Assistant Professor or Surgery Cleveland, OH, USA Thoracic and Cardiovascular Surgery, Heart and Vascular Institute Sarah A. Spinler, PharmD, FCCP, FAHA, FASHP, Cleveland Clinic AACC, BCPS-AQ Cardiology Cleveland, OH, USA Professor of Clinical Pharmacy Department of Pharmacy Practice and Pharmacy Miguel Valderrábano, MD Administration Associate Professor of Medicine, Weill College of Philadelphia College of Pharmacy Medicine, Cornell University University of the Sciences in Philadelphia Adjunct Associate Professor of Medicine, Baylor Philadelphia, Pennsylvania, USA College of Medicine Director, Division of Cardiac Electrophysiology, Yamin Sun, MD Department of Cardiology Department of Medicine Houston Methodist Hospital Baylor College of Medicine Houston, Texas, USA Houston, Texas, USA Andrew Vekstein, BS Luis A. Tamara, M.D. Medical Student Chief of Nuclear Medicine Department of Thoracic and Cardiovascular Surgery Nuclear Cardiology and PET CT Imaging The Cleveland Clinic Cleveland Michael E De Bakey Veterans Administration Case Western Reserve University Medical Center School of Medicine Associate Professor of Radiology Cleveland, OH Baylor College of Medicine Houston, Texas, USA Salim Virani, MD, PhD Staff Cardiologist/ Associate Professor Victor Tapson, MD, FCCP, FRCP Cardiology/ Cardiovascular Research Professor of Medicine Michael E. DeBakey VA Medical Center and Baylor Director, Center for Pulmonary Vascular Disease College of Medicine Duke University Medical Center Houston, Texas, USA Durham, North Carolina Fawad Virk, MD Alisa Thamwiwat, MD Resident Physician Medical Resident Department of Internal Medicine, Division of Cardiology Baylor College of Medicine Henry Ford Health System Houston, Texas, USA Detroit, Michigan, USA