GLOSSARY

Aerobic capacity See Maximal oxygen uptake.

Aerobic exercise Exercise during which the energy needed is supplied by in­spired oxygen.

AJterload The sum of all loads against which the myocardial fibers must shorten during systole (the end-diastolic volume of the ventricle, aortic impedance, arterial resistance, peripheral vascular resistance, mass of blood in the aorta, viscosity of the blood); that is, the load the muscle must move after it starts to contract.

Age-predicted maximal heart rate Mean highest heart rate attained during effort by individuals at various ages.

Arteriovenous oxygen difference (A - V02 difference) The difference between the oxygen content of arterial and venous blood.

Blood volume (= intravascular volume), the sum of plasma volume and red cell mass.

Cardiac output The volume of blood pumped from a ventricle of the heart per unit of time; cardiac output is the product of heart rate and stroke volume (CO= HR X SV).

Cardiomyopathy A disorder of the myocardium of unknown cause, which is not associated with other disorders.

333

334 Glossary

Compliance Distensibility of left ventricle or arteries; the ratio of change in ventricular volume to the change in ventricular diastolic pressure or the ratio of change in arterial volume to the change in arterial diastolic pressure (VIP).

Compliance (patient) Adherence to a prescribed therapeutic regimen; for ex­ample, number of pills ingested divided by the number prescribed.

Conditioning Augmentation of the energy capacity of muscle through an ex­erCIse program.

Dilated cardiomyopathy Another term for congestive cardiomyopathy, pri­mary heart muscle disease (idiopathic cardiomegaly in Africa).

Ejection fraction (EF) The difference between LV (left ventricle) end-diastolic volume and LV end-systolic volume.

Endurance The ability to resist fatigue. Includes muscular endurance, which is a local or specific endurance, and cardiovascular endurance, which is a more general, total body endurance.

Ergometer An apparatus or device, such as a treadmill, a stationary bicycle, or steps, used for measuring the physiological effects of exercise.

Exercise prescription Individualized exercise program involving the duration, frequency, intensity, and mode of exercise.

Flexibility The range of motion of the body's joints.

Hypertension (in the elderly) Blood pressure exceeding 160/95 mm Hg in the sitting position.

Hypertrophic cardiomyopathy Idiopathic hypertrophic subaortic stenosis, mus­cular sub aortic stenosis, or asymmetrical septal hypertrophy.

Impedance Resistance to phasic flow (as encountered with the discontinuous pumping action of the heart).

Inotropic Affecting force or energy of muscular contraction.

Intermittent work Exercises performed with alternate periods of rest, as op­posed to continuous work.

Interval training A training program that alternates bouts of heavy or very heavy work with periods of rest or light work.

Ischemia A local, usually temporary, deficiency of blood supply to some part of the body, often caused by a constriction or an obstruction of the blood vessel supplying the area.

Isometric (static) contraction A muscular contraction in which there is no change in the angle of the involved joint(s) and little or no change in the length of the contracting muscle. Tension is developed but no mechanical work is performed.

335

Isotonic (dynamic) contraction Contraction of a muscle occurring when equal tension on the muscle is maintained while the length of the muscle is de­creased during the performance of work or exercise.

Left ventricular volume (L VV) Volume of blood contained in the left venticle, usually at end-diastole.

Lenegre's disease Idiopathic fibrosis of the His Purkinje system.

Lev's disease Fibrocalcific changes in the cardiac skeleton invading the His Purkinje system that lead to various degrees of heart block.

Maximal oxygen uptake (V02 max) The maximal rate at which oxygen can be consumed per minute. The best physiological index of total body endur­ance. Also referred to as aerobic power, maximal oxygen intake, maximal oxygen consumption, and cardiovascular endurance capacity.

Met The name for a resting metabolic unit, independent of body weight. One met is the equivalent of approximately 1.2 callmin. The oxygen equiv­alent of 1 met is 3.5 to 4.0 mllkg/min. The term met is now preferred for energy requirement or utilization.

Oxygen debt The quantity of oxygen above normal resting levels used in the period of recovery after any specific exercise or muscular activity.

Oxygen pulse The amount of oxygen removed from the blood per heartbeat. Calculated by dividing the oxygen intake by the heart rate over a given period of time.

Oxygen transport system (V02) Composed of the stroke volume (SV), the heart rate (HR), and the arterial-mixed venous oxygen difference (A-V02 diff). Mathematically, it is defined as V02 = SV - A-V02 difference.

Peripheral resistance The resistance offered by the arterioles and capillaries to the flow of blood from the arteries to the veins. An increase in peripheral resistance causes a rise in blood pressure.

Physical work capacity The capacity to perform physical work. Usually measured in oxygen consumption or in kilopond meters per minute while at a specific heart rate (for example, PWC150 or PWC170).

Preload The passive load that establishes the initial muscle length of the car­diac fibers prior to contraction (Starling's law of the heart), that is, the load that stretches the muscle prior to contraction.

Pseudohypertension Elevated blood pressure as measured by a sphyg­momanometer in the presence of normal intra-arterial pressure (secondary to severe arteriosclerosis).

Pulmonary capillary wedge pressure Pressure measured by a catheter wedged in a small branch artery of the pulmonary arterial tree. A reflection ofleft atrial and left ventricular end-diastolic pressure.

336 Glossary

Pulse pressure The mathematical difference between the systolic and diastolic blood pressures.

Rate pressure product (RPP) An index of myocardial oxygen consumption. There is a close correlation between myocardial oxygen consumption and the product of heart rate and mean systolic blood pressure. Sometimes called double product.

Rehabilitation The return of a person disabled by accident or disease to the optimal attainable physical, mental, emotional, social, and economic usefulness, and if employable, an opportunity for gainful employment.

Restrictive cardiomyopathy Amyloidosis.

Sick sinus syndrome Sinoatrial dysfunction that can cause bradycardia, tachy­cardia, or sinus arrest.

Stroke volume (S V) The amount of blood pumped out of the ventricles with each contraction (systole).

Submaximal exercise Exercise at less than maximal intensity; also refers to exercise of less than maximal duration.

Syncope Loss of consciousness due to an interruption in the blood supply to the brain.

Training An exercise program to improve performance.

Valsalva maneuver Production of increased intrathoracic pressure by at­tempted expiration against a closed glottis.

Vasovagal attack Increased vagal activity (as a response to an unpleasant stimulus) producing decreased vascular resistance, bradycardia, yawning, and sweating.

INDEX

Acidosis, in cor pulmonale, 228-229 Acute myocardial infarction

assessment of, 162-163 clinical features of, 160-162 complications of, 163-164 congestive heart failure from, 44-45,

165 early ambulation after, 267-270 etiology of, 159 incidence of, 7 management of, 164-167,301-302 pathophysiology of, 159 vs. pericarditis, 186 prognosis in, 167 risk factors in, 167-168 silent, 160-161, 301 as surgical risk, 315-316

Adaptation, 8, 282-287 Adenocarcinoma, 201 Afterload

increased, 262 reduction in, 300

Aging, 2-6 Alcohol, in dilated cardiomyopathy, 175 Alpha blockers, 77, 115-116, 297 Alprenolol, 302

Alzheimer's disease, 3-4, 220 Amarosis fugax, 214 Ambulation

after discharge, 270-271 early, after myocardial infarction, 267-

270 Amiloride, 174 Amiodarone, 180 Amoxycillin, 198, 201, 305 Ampicillin, 201, 305 Amyloid heart disease, 180-185

cardiomyopathy from, 52-53 vs. constrictive pericarditis, 190 vs. hypertrophic cardiomyopathy, 179

Amyloidosis, 48-49, 305-306 Anemia

angina with, 153 chronic, 5, 50

Anesthesia epidural, 322 general, 322-323 local,321 spinal, 321-322

Aneurysms of abdominal aorta, 210-211 repair of, 325-326

337

338 Index

Aneurysms (continued) ruptured, 325, 326 of thoracic aorta, 206-210 ventricular, 163-164, 166

Angina, 152 abdominal, 212 after eating, 7-8 on effort, 7, 301 in hypothyroidism, 239, 306 Prinzmetal's, 152-153, 159 as surgical risk, 316 unstable, 153, 158, 316

Angiography digital subtraction, 212, 224 radiocontrast, 224

Angioplasty, percutaneous transluminal, 212,224

Antiadrenergic drugs bradycardia from, 97 carotid sinus syndrome from, 121 in hypertension, 77, 297-298 in left ventricular hypertrophy, 78

Antiarrhythmic drugs in acute myocardial infarction, 164-

165 in hypertrophic cardiomyopathy, 180 side effects of, 307 for ventricular arrhythmias, 104-105,

233 Antibiotics, for endocarditis, 143, 196-

201, 305 Anticoagulants

in acute myocardial infarction, 301-302

in dilated cardiomyopathy, 175 in hyperthyroidism, 237-238 in mitral stenosis, 141-142 prior to surgery, 319 in stroke, 216 in transient ischemic attacks, 307-308

Antidepressants, tricyclic, 79 Antihypertensive drugs, 75-78, 275,

296-298 in aortic dissection, 207, 210 carotid sinus syndrome from, 121 in cerebrovascular disease, 213 in congestive heart failure, 60-61 syncope from, 115

Antiplatelet drugs in acute myocardial infarction, 302 prior to surgery, 313-314, 319 in transient ischemic attacks, 215, 307

Anturane, 302 Aorta

abdominal, 210-213 aging of, 19-20 dissection of, 206-210 thoracic, 205-210

Aortic insufficiency acute aortic regurgitation in, 133 laboratory examination in, 133 pathology of, 132 pathophysiology of, 132 physical findings in, 132-133 valve replacement in, 133-134

Aortic regurgitation, 132, 133, 134 Aortic stenosis

as anesthetic risk, 323 angina with, 153 clinical findings in, 128-129 differential diagnosis in, 129-130,276,303 evaluation of, 130-131 heart failure from, 47 incidence of, 127-128 laboratory examination in, 129-130 murmur in, 128, 129-130,276, 303 pathophysiology of, 128 rheumatic vs. calcific, 128 as surgical risk, 318 valve replacement in, 131,276,303

Aortic valve replacement in aortic insufficiency, 133-134 in aortic stenosis, 131, 276, 303 risks in, 328

Arrhythmias, 83-84. See also under specific arrhythmias

absence of, 105 acute, 233 acute decompensation from, 45 atrial,99-101 chest pain with, 86 in chronic obstructive pulmonary dis-

ease, 231-234 in coronary heart disease, 155 dizziness with, 87-88 palpitation with, 88-89 paroxysmal,99-105 prevalence of, 18 supraventricular, 233 as surgical risk, 317 symptoms correlated with, 85-91 syncope with, 88, 122 therapy for, 306-307 ventricular, 101-105, 233

Arteries aging of, 19-20 coronary, 11-14,46, 235 mesenteric, 212-213 renal, 211-212

Arteriography, in coronary heart disease, 155-156, 158

Arteriosclerosis, coronary, 12-14 Arteritis

Takayasu's, 206 temporal, 219-220, 240-241

Arthritis, with constrictive pericarditis, 189, 241

Aspirin in pericarditis, 186, 188 in transient ischemic attacks, 215, 307

Asthma, 228 Atenolol, 297 Atheroma of Von Albertini, 151 Atherosclerosis, 150-151

and aneurysms of thoracic aorta, 206 in hypothyroidism, 239 prevalence of, 7, 12

Atrial fibrillation, 98 chronic, 233 in hyperthyroidism, 237-238 paroxysmal, 100

Atropine in carotid sinus syndrome, 121 in glossopharyngeal neuralgia, 122 in vasovagal syncope, 117

Automaticity, 96 Autonomic nervous system, 113-114,

118 A V block, 94-95, 96-97, 98

Ballistocardiography, 20 Balloon, intra-aortic, 137 Barlow's syndrome, 307 Baroreceptor reflexes, in hypertension,

69 Bed rest, in acute myocardial infarction,

164 Behavior modification, 244, 255 Beriberi, 50 Beta agonists

arrhythmias from, 231-232 responsiveness to, 30-31, 294

Beta blockers in acute myocardial infarction, 104,

165, 168, 302 in angina of effort, 301

in aortic dissection, 207 carotid sinus syndrome from, 121 in coronary heart disease, 157 in hypertension, 76, 296-297 in hyperthyroidism, 237

339

in hypertrophic cardiomyopathy, 180 in hypotension, 120 in hypothyroidism, 239 in multifocal atrial tachycardia, 233 in Prinzmetal's angina, 159 responsiveness to, 31-32 side effects of, 274, 293-295, 296-297 syncope from, 116 in unstable angina, 158

Bifascicular block, 98 Blanching time, 221-223 Block

AV, 94-95, 96-97, 98 bifascicular, 98

Blood pressure. See also Hypertension; Hypotension, orthostatic

changes with aging in, 27-28, 263, 265 diurnal patterns of, 71 preoperative, 320-321

Bradyarrhythmias, 95-98 Holter monitoring of, 89, 97-98

Brain aging of, 3-4 blood supply to, 111-113

Breathlessness, in dilated cardiomy-opathy, 174

Bromocriptine, 116 Bronchitis, 228 Bronchodilators

afterload reduction from, 300 arrhythmias from, 231, 233

Buerger's disease, 224

Calcium-transport inhibitors in coronary heart disease, 157-158 in hypertension, 77-78, 298 in Prinzmetal's angina, 159

Candida infection, in prosthetic valve en­docarditis, 196

Captopril, in dilated cardiomyopathy, 174-175

Carbamazepine, 122 Carcinoid heart disease, 52 Cardiac function

changes with aging in, 36-37, 259-264 in hypertension, 67-68 tests of, 20-33

340 Index

Cardiac output changes with aging in, 260-261 distribution of, 264 low, 43 maximal,27 resting, 20

Cardiac rupture, 163, 166, 187 Cardiac tamponade, 186-188 Cardiogenic shock, 165-166 Cardiomyopathy(ies)

of aging, 305-306 alcoholic, 48 diabetic, 52-53 dilated, 171-175 hypertrophic. See Hypertrophic

cardiomyopathy infiltrative, 48-49, 51 restrictive, 52

Cardiothoracic ratio, 18 Carotid bruit, 215 Carotid sinus syndrome, 120-122,307 Catecholamines

in cardiogenic shock, 166 sensitivity to, 31

Catheterization, in congestive heart fail­ure, 57-58

Cerebrovascular disease, 213-220, 275, 307-308, 313

Chemoreceptor reflexes, in hypertension, 69

Chest pain. See also Angina in acute myocardial infarction, 160-

161 with arrhythmia, 86

Chloral hydrate, in acute myocardial in-farction, 164

Chlordiazepoxide, 164 Chlorpromazine, 115 Cholesterol level, 156, 251 Cigarette smoking, 150, 152, 156, 272 Circumferential fiber shortening, 22-23 Claudication, intermittent, 221 Clonidine, 77, 298 Collagen-vascular diseases, 239-241 Compliance

arterial, 70-71 patient, 252-256, 274, 292-293

Conduction disturbances, 7, 16,83-84 from acute myocardial infarction, 166 AV block, 94-95, 96-97, 98 bifascicular block, 98 in coronary heart disease, 155

Holter monitoring of, 95 as surgical risk, 317

Congestive heart failure, 7, 35 acute, 44-45, 61-62, 165 backward, 42 chronic, 46-49, 51-52 chnical presentation of, 42-44 diagnostic evaluation of, 53-58 diastolic, 42, 52-53 etiology of, 44-53 forward,42 high-output, 41, 49-50 left, 41, 42-43, 46-49 pathophysiology of, 37-42 right, 41-42, 43, 45, 51-52 as surgical risk, 317-318 therapy for, 58-62, 276-277, 298-300 in uremia, 234

Contractility aging effect on, 38-39, 262, 306 with hypothyroidism, 238

Contractions, premature, 99-101 Coronary artery disease, 11-14

heart failure from, 46 and renal insufficiency, 235

Coronary bypass surgery, 326-327 constrictive pericarditis from, 189 rehabilitation after, 274 as surgical risk, 316-317

Coronary heart disease, 149 clinical syndromes of, 152-153 death concern with, 285-286 delay in seeking help in, 286-287 denial with, 285-286 emotional reaction to, 282-283 evaluation of, 153-156 incidence of, 150, 281 management of, 156-159 pathology of, 150-151 pathophysiology of, 151-152 rehabilitation in, 266-275, 282 return to work with, 283-284 risk factors in, 153 sexual activity with, 284-285 Type A behavior, 285

Cor pulmonale, 227-228 arrhythmias in, 231-234 chronic right heart failure from, 51 clinical findings in, 228-229 pathophysiology of, 228 therapy of, 229-231

Corticosteroid therapy

in stroke, 216 in temporal arteritis, 219-220, 240-241

Coughing, syncope from, 123 Coxiella infections, 195-196 Coxsackie B virus, 185-186 Creatinine clearance, in hypertension, 70

Death, concern with, 285-286 Dementia, 3-4, 220 Denial, 285-286 Dental work, and endocarditis, 200-201,

305 Dependence, 2 Dependent rubor, 223 Depression, 283 Diabetes mellitus, 236, 301 Diastole, dysfunction of, 42, 52-53 Diastolic left ventricular filling rate, 23-

24 Diet, 8, 245-246

goals in, 252 low in saturated fats, 251-252 in obesity, 246-248, 272 sodium reduction, 248-251

Digitalis in acute myocardial infarction, 165 bradyarrhythmia from, 97 in congestive heart failure, 59-60, 298-

299 in cor pulmonale, 230-232 in dilated cardiomyopathy, 174 in hyperthyroidism, 237, 306 in hypertrophic cardiomyopathy, 180,

305 pharmacokinetics of, 294 and quinidine, 307 in renal failure, 236 toxicity of, 97, 273, 293

Digital subtraction angiography, 212, 224

Digoxin. See Digitalis Diltiazem, 239 Disopyramide, 104, 307 Diuretics

in acute myocardial infarction, 165 carotid sinus syndrome from, 121 in congestive heart failure, 60, 300 in cor pulmonale, 230 in dilated cardiomyopathy, 174 in hypertension, 76, 296 in hypertrophic cardiomyopathy, 180 reactions to, 273

in stroke, 216 syncope from, 115

341

Dizziness, with arrhythmias, 87-88, 97 L-Dopa, 116 Dopamine, in cardiogenic shock, 166 Doxycycline, in Coxiella endocarditis,

196 Drop attacks, 214 Drugs

interactions between, 79, 293 pharmacokinetics of, 293-295 preoperative, 319 reactions to, 273-274 syncope from, 114-116 unnecessary, 293

Dye dilution techniques, 20 Dyspnea, exertional, 53 Dysrhythmias. See Arrhythmias

Echocardiogram in amyloid heart disease, 182-184 in congestive heart failure, 57 in coronary heart disease, 155 and gated cardiac blood pool scintig­

raphy,28 in hypertrophic cardiomyopathy, 178-

180 of left ventricular wall thickness, 14 M-mode, 20-21, 155

Edema acute pulmonary, 304 in congestive heart failure, 43

Ejection fraction, 21-22 Elastic hose, 119 Electrocardiogram. See also Holter moni-

toring in amyloid heart disease, 182 in congestive heart failure, 56 dynamic, 84 in hypertrophic cardiomyopathy, 178 normal,17-18 preoperative, 314,319

Embolism cerebral, 218-219 from endocarditis, 194, 200

Emphysema, 228 Endarterectomy, carotid, 215, 216 Endocarditis, 8, 52

acute bacterial, 136 Coxiella, 195-196 duration of, 198-199 infective, 136, 190-201, 304-305

342 Index

Endocarditis (continued) nonbacterial thrombotic, 143,201-202 prophylaxis in, 200-201 prosthetic valve, 196-197 subacute bacterial, 136, 190-195 surgery in, 199-200 treatment of, 197-198

Endocrine system in diseases of, 236-239, 306 in hypertension, 71-72

Epilepsy, syncope from, 109-110, 111 Erythrocytosis, in cor pulmonale, 230 Erythromycin, in endocarditis, 198,201,

305 Escape rhythms, 97 Esophageal spasm, 301 Exercise

altered response to, 264-265 appropriate, 266 and cardiac output, 260-261 for coronary heart disease, 156, 270-

272 and stroke volume, 262-263

Exercise testing, 26-33, 36 in congestive heart failure, 57 in coronary heart disease, 154

Fainting. See Syncope Fatalism, 285-286 Fick technique, 20 Fistulas, systemic arteriovenous, 50 Fludrocortisone, 119 Fluid retention, 39, 234, 235 Frank-Starling mechanism, 39-41 Fungal infections, in prosthetic valve en-

docarditis, 196 Furosemide, 296, 300

Gated cardiac blood pool scintigraphy, 28

Gentamicin, in endocarditis, 197, 201, 305

Haloperidol, 115 Heart

anatomy of, 14-16 electrophysiology of, 17-18 performance measures, 20-33 physical examination of, 24-26 x-rays of, 18-19

Heart failure. See Congestive heart fail­ure

Heart rate, 27, 259-260, 265 Heart sounds, 24-26

in acute myocardial infarction, 161 in congestive heart failure, 55 in coronary heart disease, 153-154

Hemodialysis, 235, 236 Hemorrhage

intracerebral, 217-218 subarachnoid,218

Heparin in acute myocardial infarction, 165 in endocarditis, 197 in unstable angina, 158

Hepatic disease, 50 Holter monitoring, 84-85

of conduction disturbances, 95 in coronary heart disease, 155 in management of symptoms, 98 normal readings in, 105 predominant rhythms in, 91-92 with symptoms of arrhythmia, 85-91,

97-98 Hydralazine

in congestive heart failure, 60-61 in hypertension, 297

Hyperkalemia, 300 Hypertension, 65

and aortic dissection, 207 arterial, 7, 46 arterial compliance in, 70-71 and autonomic functions, 113 and blood flow to brain, 112 cardiac changes in, 67-68 in cerebrovascular disease, 213, 217 clinical findings in, 72-74 and coronary heart disease, 156 decapitated, 46, 72-73 diastolic, 65 endocrine changes in, 71-72 epidemiology of, 66-67 vs. hypertrophic cardiomyopathy,

175-176, 179 intravascular volume in, 71 left ventricular hypertrophy in, 68 orthostatic hypotension in, 71 pathophysiology of, 67-72 patient compliance in, 252-256 pseudo-, 73-74 pulmonary, 142, 228 reflexive changes in, 69 and renal function, 69-70, 234-235 renin-dependent, 71-72, 234

renovascular, 74, 211-212 secondary, 74 and sodium intake, 248, 249-250 as surgical risk, 317 systolic, 65, 70-71, 72, 179,298 treatment of, 74-79, 275, 296-298

Hyperthyroidism, 50, 237-238 Hypertrophic cardiomyopathy

vs. aortic stenosis, 129 clinical findings in, 176-177 diagnosis of, 175-176 diastolic dysfunction with, 53 echo cardiogram in, 178-180 electrocardiogram in, 178 incidence of, 175 left heart failure from, 47 prognosis with, 180 therapy of, 180, 276, 305

Hypertrophy asymmetric septal, 178 reversal of, 78-79 ventricular, 14-15,68, 175-176

Hypokalemia with antihypertensive drugs, 275, 2% in chronic obstructive pulmonary dis­

ease, 231 with diuretics, 300

Hyponatremia, 296 Hypotension, orthostatic, 7, 117

and autonomic function, 113-114, 118 and blood flow to brain, 113 from drugs, 114-116 hyperadrenergic, 117-118 in hypertension, 71 hypoadrenergic, 118 management of, 119-120

Hypothyroidism, 238-239 Hypoxia, in cor pulmonale, 228, 230

Impedance, 28-29, 262-263 Indapamide, 298 Independence, 1-2 Indomethacin

in postural hypotension, 119 in relapsing pericarditis, 188

Infarct, size of, 166 Infarction

acute myocardial. See Acute myocar­dial infarction

in cerebrovascular disease, 213 right ventricular, 51

Intra-aortic balloon, 137

Intravascular volume, in hypertension, 71

Isosorbide dinitrate, 157 Isotope perfusion scanning, 162-163

Kaposi's sarcoma, 50 Kidney failure. See Renal failure

343

Laxatives, in acute myocardial infarction, 164

Lerichesyndrome, 221 Lidocaine

in acute myocardial infarction, 165 in acute ventricular arrhythmias, 233

Lungs. See Pulmonary disease

Mannitol, in stroke, 216 Marfan's syndrome, 205-206 Medications. See Drugs Mesenteric arteries, occlusive disease of,

212-213 Methyldopa

carotid sinus syndrome from, 121 for hypertension, 77, 297-298 for left ventricular hypertrophy, 78

Mitral regurgitation acute, 136-137 from acute myocardial infarction, 166-

167 chronic, 137-138 infective endocarditis in, 136, 192 management of, 138-139 mitral prolapse in, 137-138 papillary muscle dysfunction in, 134-

136 pathology of, 134-136

Mitral stenosis, 139-142 heart failure from, 47 laboratory examination in, 141 management of, 141-142 pathology of, 139-140 physical findings in, 140-141 silent, 304

Mitral valve calcification of, 303 prolapse of, 137-138,303 replacement of, 304, 328 systolic anterior movement of, 178

Monckenberg sclerosis, 151 Morphine, 301 Murmurs

in acute myocardial infarction, 161-162

344 Index

Murmurs (continued) in aortic stenosis, 128, 129-130, 276,

303 Austin Flint, 133 in congestive heart failure, 55 in hypertrophic cardiomyopathy, 176-

177 in myxoma, 144 in normal individuals, 25 in subacute bacterial endocarditis, 192

Muscles, performance data on, 29-30 Myocardial disease

amyloid heart disease, 52-53, 179, 180-185,190

dilated cardiomyopathy, 171-175 hypertrophic cardiomyopathy. See

Hypertrophic cardiomyopathy Myocardial infarction. See Acute my­

ocardial infarction Myocardial revascularization. See Coro-

nary bypass surgery Myocardiopathy, primary, 47-49 Myocarditis, viral, 48 Myocardium, contractility of, 38-39 Myxedema

vs. chronic idiopathic pericardial effu­sion, 190

and hypothyroidism, 238, 239, 306 Myxomas, 143-145

Nervous system, 113-114, 118 Netlamicin, 197 Neuralgia, glossopharyngeal, 122 Nifedipine, 159 Nitrates

in angina of effort, 301 in aortic dissection, 207 carotid sinus syndrome from, 121 in congestive heart failure, 60-61 in coronary heart disease, 157 in Prinzmetal's angina, 159 syncope from, 115, 273-274 in unstable angina, 158

Nitroglycerin, 157, 158, 273-274 Nitroprusside, 207, 294 Nocturia, 53 Nursing homes, 2

Obesity, 246-248, 272 Occlusive disease

acute, 224 atherosclerotic, 221-224

of mesenteric arteries, 212-213 of renal arteries, 211-212 surgery in, 324-325

Opiates, in acute myocardial infarction, 164

Orthostatic hypotension. See Hypoten­sion, orthostatic

Overweight, 246-248, 272 Oxygen consumption

maximal, 26-28, 263, 264-265 myocardial, 151-152

Oxygen therapy in acute myocardial infarction, 165 in cor pulmonale, 229-230

Pacemaker, artificial anesthesia with, 323 in carotid sinus syndrome, 121 education about, 277 failure 0 f, 123 in glossopharyngeal neuralgia, 122 implant of, 329 in sick sinus syndrome, 98

Paget's disease, 50 Palpitation, with arrhythmia, 88-89 Papillary muscle dysfunction, 134-136 Parkinsonism, 116 Patient education, 245, 254, 272-273 Penicillin, for endocarditis, 143, 197-

198,199,201,305 Percutaneous transluminal angioplasty,

212, 224 Pericardial disease

acute infective pericarditis, 185-186 cardiac tamponade, 186-188 chronic idiopathic pericardial effusion,

190 constructive pericarditis, 188-190 relapsing pericarditis, 188

Pericardial effusion acute tamponade with, 187 chronic idiopathic, 190

Pericarditis acute infective, 185-186 constrictive, 188-190 vs. myocardial infarction, 186 relapsing, 188 in rheumatoid arthritis, 241 tuberculous, 189 uremic, 235-236 viral, 185-186

Pericardium, aspiration of, 187-188

Petechiae, 180-181 Pharmacokinetics, 293-295 Phenytoin, for glossopharyngeal neural-

gia, 122 Pindolol, 120 Polymyalgia rheumatica, 219, 240 Postural hypotension. See Hypotension,

orthostatic Potassium replacement therapy, 275, 296 Prazosin, 77, 115, 297 Prednisolone

for relapsing pericarditis, 188 for temporal arteritis, 219-220, 241

Premature atrial contractions (P ACs), 99-101

Premature ventricular contractions (PVCs), 101

Prevention, 167-168,243-244,272-273 PR interval, 17 Probenecid, 198 Progesterone, 231 Propranolol

in acute myocardial infarction, 302 carotid sinus syndrome from, 121 in hyperthyroidism, 237 for multifocal atrial tachycardia, 233 pharmacokinetics of, 293-295, 296-

297 Psoriasis, 50 Pulmonary disease

arrhythmias in, 231-234 chronic obstructive, 51, 228, 231-234 cor pulmonale, 51, 227-231 as surgical risk, 314, 318 valvular, 142-143 vascular, 51

Pulse, in congestive heart failure, 54-55 Pulsus paradoxus, in cardiac tamponade,

186, 187

QRS interval, 17 Quinidine, 104, 307

Radiation therapy in carotid sinus syndrome, 121 mediastinal, restrictive cardiomy­

opathy from, 52 Radiocontrast angiography, 224 Radionuclide studies, 57

in acute myocardial infarction, 162-163 in atherosclerotic occlusive disease, 224 in coronary heart disease, 155

Raynaud's disease, 224-225 Regurgitation

aortic, 132, 133, 134 mitral. See Mitral regurgitation

Rehabilitation, 265-266 in aortic valve disease, 275-276 with cardiac pacemaker, 277 in congestive heart failure, 276-277 in coronary heart disease, 266-275 in hypertension, 275

345

in hypertrophic obstructive cardiomy­opathy, 276

Renal arteries, occlusive disease of, 211-212

Renal failure, 234 in congestive heart failure, 39 and drug metabolism, 292 in hypertension, 69-70, 296 increased cardiac output in, 50 pathophysiology of, 234-236 peri operative, 313 in subacute bacterial endocarditis, 195 therapy of, 236

Renin-angiotensin-aldosterone system, 72, 212, 234-235

Reserpine, 77, 298 Rheumatic heart disease, 132, 134 Rheumatoid arthritis, with constrictive

pericarditis, 189, 241 Risk factors

assessment for surgery, 314-319 modification of, 167-168, 243-244,

272-273 Rupture

of aneurysm, 187, 325, 326 cardiac, 163, 166, 187

Salbutamol, 300 Salt. See Sodium Saturated fats, 251-252 Scintigraphy, gated cardiac blood pool,

28 Sedatives

in acute myocardial infarction, 164 syncope from, 116

Seizures, syncope from, 109-11 0, 111 Septal defect, 166 Sexual activity, 6, 284-285 Shock, cardiogenic, 165-166 Shunts, left-to-right, 51 Sick sinus syndrome, 98, 307 Sinus bradycardia, 98

346 Index

Sinus node function, 92-94, 96 Sodium

reduction in, 248-251 retention of, 39, 234, 235

Sodium nitroprusside, 207, 294 Staphylococcal infections, 191, 198-199 Stenosis. See Aortic stenosis; Mitral ste-

nOSIS

Stokes-Adams attack, 122, 307 Streptococcal infections, 191, 197-198 Streptokinase, 166 Streptomycin, 197-198 Stress, cardiac performance during, 26-

33 Stroke, completed, 215-216, 275 Stroke volume, 20, 27, 261-263, 265 Subclavian steal syndrome, 215 Sulfinpyrazone, 302, 307 Surgery, 311-312

anesthesia for, 321-323 evaluation prior to, 312-314 management prior to, 319-321 monitoring of, 324 organ reserve in, 323-324 risk assessment for, 9, 314-319

Swallowing, syncope from, 123 Syncope, 109-110

with arrhythmias, 88, 97, 122 and autonomic function, 113-114 and blood supply to brain, 111-113 carotid sinus, 120-122,307 clinical approach in, 123-124 from drugs, 114-116 postmicturition, 123 from postural hypotension, 117-120 from seizures, 109-110, 111 unusual causes of, 123 vasovagal, 116-117

Systemic lupus erythematosus, 201 Systolic anterior movement, 178 Systolic time intervals, 20

Tachycardia multifocal atrial, 233 supraventricular, 91, 99-101 ventricular, 91, 101-103

Tamponade, 186-188 Temperature regulation, 319-320 Tetracycline, in Coxiella endocarditis,

196 Thiazides, 296, 300 Thromboangiitis obliterans, 224

Thrombosis, 159 Thyroid replacement therapy, 239 Thyrotoxicosis,S, 49-50, 237-238, 306 Thyroxine, 238-239 Timolol, 302 Tongue, in amyloid heart disease, 181 Transient ischemic attacks, 214-215,

307-308 Tricuspid valvular disease, 142 Two-step test, 26 Type A behavior, 285

Uremia. See Renal failure Urinary retention, 123

Valves. See also Aortic valve replace­ment; Mitral valve

endocarditis from prosthetic, 196-197 Valvular heart disease, 7. See also Aortic

stenosis; Mitral stenosis as anesthetic risk, 323 heart failure from, 46-47 as surgical risk, 318 tricuspid, 142 valve replacement in, 327-328

Valvular incompetence, 45. See also Aortic regurgitation; Mitral regur­gitation

Valvular insufficiency. See also Aortic insufficiency; Mitral insufficiency

heart failure from, 47 pulmonic, 142

Vancomycin, 201 Vascular disease

aneurysms, 206-211 cerebral, 213-220, 275, 307-308, 313 occlusive, 211-213, 221-224 peripheral, 220-225 surgery in, 324-326

Vasodilators in acute myocardial infarction, 165 in angina, 157, 158, 159, 301 in arrhythmias, 233, 299-300, 305 arteriolar, 76-77 carotid sinus syndrome from, 121 in cerebrovascular disease, 215 in congestive heart failure, 61 in cor pulmonale, 231 in dilated cardiomyopathy, 174-175 in hypertension, 76-77, 235, 297-298 in hypothyroidism, 239 in mitral stenosis, 141

in renal failure, 235 in sick sinus syndrome, 307 syncope from, 115, 273-274 venous, 235

Vasospasm primary, 224-225 secondary, 225

Ventricular ectopy, 231, 233 Ventricular unloading,' in congestive

heart failure, 60-61 Verapamil

in acute supraventricular arrhythmias, 233

in angina of effort, 301

in atrial fibrillation, 299-300, 305 in hypertension, 298 in hypothyroidism, 239 in mitral stenosis, 141 in sick sinus syndrome, 307

Vertebrobasilar insufficiency, 215 V02max, 26-28, 263, 264-265

Warfarin, 141 Water retention, 39, 234, 235 Weight control, 246-248, 272

X-rays, chest, 18-19

347