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AE Berezin, VA Vizir, OV Demidenko MINISTRY OF HEALTH OF UKRAINE ZAPORIZHZHIA STATE MEDICAL UNIVERSITY Department Internal Medicine no2 A. E. Berezin, V. A. Vizir, O. V. Demidenko CARDIOVASCULAR DISEASE («INTERNAL MEDICINE» MODULE 2) PART 1 The executive task force for students of medical faculty of 5th cource Zaporizhzhia 2018 UDC 616.12(075.8) B45 Ratified on meeting of the Central methodical committee of Zaporizhzhia State Medical University and it is recommended for the use in educational process for foreign students. (Protocol no 5 from 24 may 2018 ) Reviewers: V. V. Syvolap - MD, PhD, professor, Head of Department of Propedeutics of In- ternal Diseases with the Course of Patients’ Care, Zaporizhzhia State Medical Uni- versity; O. V. Kraydashenko - MD, PhD, professor, Head of Department of Clinical Pharmacology, Pharmacy and Pharmacotherapy with the Course of Cosmetology, Zaporizhzhia State Medical University. Authors: A. E. Berezin - MD, PhD, professor, Department of Internal Diseases 2; V. A. Vizir - MD, PhD, professor, Department of Internal Diseases 2; O. V. Demidenko -MD, PhD, Head of Department of Internal Diseases 2. Berezin A. E. B45 Cardiovascular diseases («Internal Medicine». Modul 2). Part 1=Серцево-судинні захворювання («Внутрішня медицина». Модуль 2). Ч. 1 : The executive task force for students of 5th course of medical faculty / A. E. Berezin, V. A. Vizir, O. V. Demidenko. – Zaporizhzhia : ZSMU, 2018. – 220 p. The executive task force is provided for students of 5th courses of medical faculties for helping to study of some topics in the fields of cardiovascular diseases incorporated into the discipline «Internal Medicine». There is the information about the most impor- tant topics regarding diagnosis of cardiac diseases. 2 CONTENT Index of acronyms 4 CHAPTER 1. THE RESTING ELECTROCARDIOGRAM 8 CHAPTER 2. RHYTHM AND CONDUCTION DISCORDERS. PRIN- CIPAL MECHANISMS 87 CHAPTER 3. RHYTHM AND CONDUCTION DISCORDERS. CON- TEMPORARY MANAGEMENT 167 SQUEEZES 219 References. 222 3 Index of acronyms ACE angiotensin-converting enzyme ACEI ACE inhibitors ACEI angiotensin-converting enzyme inhibitor ACM alcoholic cardiomyopathy ACS acute coronary syndrome AHA American Heart Association AHF acute heart failure AHMD alcoholic heart muscle disease ANP atrial natriuretic peptide APA aldosterone-producing adenomas APAH associated pulmonary arterial hypertension APCs atrial premature complexes ARB angiotensin receptor blockers ARVC arrhythmogenic right ventricular cardiomyopathy ARVD arrhythmogenic right ventricular dysplasia ASD atrial septal defect AV atrioventricular AVNRT Atrioventricular Nodal Reentrant Tachycardia BAS balloon atrial septostomy BB beta-adrenoblockers BNP B-type natriuretic peptide BP blood pressure Bpm beats per minute; BSAC British Society for Antimicrobial Chemotherapy CA calcium antagonists CABG coronary artery bypass grafting CAD coronary artery disease CCB calcium channel blocker CCSC Canadian Cardiovascular Society Classification CHD coronary heart disease CHF chronic heart failure CI cardiac index CK creatine kinase CMR cardiac magnetic resonance imaging CNS central nervous system CO cardiac output COPD chronic obstructive pulmonary disease CPAP continuous positive airway pressure CPR cardiopulmonary resuscitation CRP C-reactive protein CT computed tomography CTD connective tissue disease CTEPH chronic thromboembolic pulmonary hypertension CV cardiovascular diseases 4 CVP central venous pressure CVVH continuous veno-venous hemofiltration DAD delayed after-depolarization DCM dilated cardiomyopathy DIC disseminated intravascular coagulation DM diabetes mellitus DOC deoxycorticosterone EA electrical axis EAD early afterdepolarization; ECG electrocardiogram EF ejection fraction EnaC epithelial Na+ channel ERA endothelin receptor antagonist ESC European cardiology Association ESRD renal failure; GFR glomerular filtration rate GP glycoprotein GRA glucocorticoid-remediable aldosteronism HACEK group organisms: Haemophilus species, Actinobacillus actinomyce- temcomitans, Cardiobacterium hominis, Eikenella species, Kingella kingae. HCM hypertrophic cardiomyopathy HDL- C high-density lipoprotein cholesterol HF heart failure HIV human immunodeficiency virus i.v. intravenous IABC intra-aortic balloon counter-pulsation ICD implantable cardioverter-defibrillator IDC implantable defibrillator-cardioverter IE infective endocarditis IGF insulin-like growth factor INR international normalized ratio IPAH idiopathic pulmonary arterial hypertension ISH isolated systolic hypertension IVDU Intravenous drug use IVUS intravascular ultrasound JET functional ectopic tachycardia LA left arm LAFB left anterior fascicular block LBBB left bundle branch block LL left leg LMWH low molecular weight heparin LMWH low molecular weight heparin LQTS long-QT syndrome LV left ventricle / ventricular 5 LVH left ventricular hypertrophy LVNC left ventricular non-compaction LVOT left ventricular outflow tract MAC mitral annular calcification MBC minimum bactericidal concentration MHC myosin heavy chain MI myocardial infarction MIC minimal inhibitory concentration MR mitral regurgitation MRI magnetic resonance imaging MVP mitral valve prolapsed NBTE nonbacterial thrombotic endocarditis NCCLS USA National Commmittee for Clinical Laboratory Standards NIPPV non-invasive positive pressure ventilation NO nitric oxide NOS nitric oxide synthase NSTEMI non ST-elevation MI NT-proBNP N-terminal fragment of pro- brain natriuretic peptide PA pulmonary artery PAC pulmonary artery catheter PAP pulmonary arterial pressure PCI Percutaneous Coronary Intervention PDEIs phosphodiesterase inhibitors PDGF platelet-derived growth factor PEA pulmonary endarterectomy PH pulmonary hypertension PHIRST Pulmonary arterial Hypertension and ReSponse to Tadalafil PJT paroxysmal functional tachycardia PK pharmacokinetics PK pharmacokinetics PNS peripheral nervous system PP pulse pressure PPCM peripartum cardiomyopathy PSVTs paroxysmal supraventricular tachycardia’s PVCs premature ventricular complexes PVD peripheral vascular disease PVE prosthetic valve endocarditis PVOD pulmonary veno-occlusive disease PVR pulmonary vascular resistance PVT prosthetic valve thrombosis PWP pulmonary wedge pressure RA right arm RAAS rennin-angiotensin-aldosterone system RAP right atrial pressure RBBB right bundle branch block 6 RCM restricted cardiomyopathy RCT randomized controlled trial RHC right heart catheterization RV right ventricle/ventricular SAECG signal-averaging electrocardiography SERCA2 sarcoplasmic reticulum Ca2+ adenosine triphosphatase pump 6MWT 6-minute walking test SNP sodium nitroprusside SNS sympathetic nervous system SVC superior vena cava SVT supraventricular tachycardia t.i.d. three times a day TAPSE tricuspid annular plane systolic excursion TDI tissue Doppler imaging TEE transesophageal echography TEE transesophageal echography TF tissue factor TPG transpulmonary pressure gradient (mean PAP – mean PWP) TTE transthoraxic echography VA ventriculoatrial VF ventricular fibrillation VPC ventricular premature complexes VSR ventricular septal rupture VT ventricular tachycardia WHO World Health Organization WHO-FC World Health Organization functional class WPW Wolff-Parkinson-White syndrome 7 PREFACE The task force is addressed to students of 5th course of medical university for helping to study of some parts of internal medicine in field of cardiovascsular diseas- es. It includes the use of contemporary tools for identification of congenital and ac- quired heart diseases, coronary artery disease, arterial hypertension, heart failure, arr- hythmias, pericardial diseases etc., including objectives, laboratory studies, genetic investigations, biopsy materials, X-ray, multidetector CT, angiography, MRI proce- dures. Etiology and pathophisiology are discussed also separately for each of cardi- ovascular disorders. Diagnostic algorithm and procedures choosing are considered obligatory with an elucidation of contemporary management and prevention of cardi- ovascular diseases. This book has been written in a concise and easy assimilable style to enable rapid understanding of the cardiovascular diseases. It has been structured in a format that incorporates information for quickly reminding and squeezes are ap- plied also. Hopefully, in some way, all of the effort and expertise brought together here will help advance this field. Authors. 8 CHAPTER 1 THE RESTING ELECTROCARDIOGRAM Foreword. What is commonly called an electrocardiogram (ECG) is the graph obtained when the electrical potentials of an electrical field originating in the heart are record- ed at the body surface. Although the ECG gives very useful clinical information, it only provides an approximation of the voltage produced by the source. The ECG has not been able to achieve interesting new insights into its own basic theoretic limita- tions, which some have considered as the solutions of the "forward" problem and the "inverse" problem of electrocardiography. Whereas the former seeks the description of a specific electrocardiographic pattern in response to a specific local or regional intracardiac change in electrical activity, the latter seeks to predict the behavior of the cardiac generator from potentials recorded at the body surface. Nevertheless, recent experimental studies have provided new information capable of expanding the clini- cal usefulness of the ECG, as will be discussed throughout this chapter. The ECG has many uses: It may serve as an independent marker of myocardial disease; it may re- flect anatomic, hemodynamic, molecular, ionic, and
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