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eureka eureka Cardiovascular Medicine Cardiovascular eureka Medicine Paul Morris, David Warriner, Allison Morton medicine made clear Core science and medicine in one book eureka – an innovative series for students that fully integrates core science, clinical medicine and surgery. With its engaging and authoritative text, featuring insightful clinical cases, graphic narratives, SBAs and a wealth of other learning tools, Eureka has everything students need to succeed in medicine and pass their exams. Morris, Warriner, Morton Warriner, Morris, > First principles chapter explains key > Clinical cases teach you to think like a structures, processes and concepts doctor > Clinical essentials chapter sets out > Graphic narratives bring cases to life diagnostic approach and treatment options > Starter questions stimulate curiosity and learning > Disease-based clinical chapters describe acute, chronic and > Clinical SBA chapter helps you revise emergency cardiovascular and pass your exams presentations Series Editors: Janine Henderson, David Oliveira, Stephen Parker www.eurekamedicine.com EurekaCardio_COVER_19mm_Amend.indd 1 11/08/2015 14:43 eureka Cardiovascular Medicine eureka Cardiovascular Medicine Paul Morris MBChB MRCP BMedSci Allison Morton BMedSci MBChB Specialist Registrar in Cardiology PhD FRCP Sheffield Teaching Hospitals NHS Consultant Cardiologist Foundation Trust Heartcare Western Australia Clinical Research Fellow Bunbury, WA University of Sheffield Honorary Senior Lecturer Sheffield, UK University of Sheffield, UK David Warriner BSc MBChB MRCP DipSEM Specialist Registrar in Cardiology Sheffield Teaching Hospitals NHS Foundation Trust Sheffield, UK Series Editors Janine Henderson MRCPsych Stephen Parker BSc MS DipMedEd MClinEd FRCS MB BS Programme Director Consultant Breast and General Hull York Medical School Paediatric Surgeon York, UK St Mary’s Hospital Newport, UK David Oliveira PhD FRCP Professor of Renal Medicine St George’s, University of London London, UK London • Philadelphia • New Delhi • Panama City © 2015 JP Medical Ltd. Published by JP Medical Ltd, 83 Victoria Street, London, SW1H 0HW, UK First reprint 2015 Tel: +44 (0)20 3170 8910 Fax: +44 (0)20 3008 6180 Email: [email protected] Web: www.jpmedpub.com The rights of Paul Morris, David Warriner and Allison Morton to be identified as the authors of this work have been asserted by them in accordance with the Copyright, Designs and Patents Act 1988. All rights reserved. No part of this publication may be reproduced, stored or transmitted in any form or by any means, electronic, mechanical, photocopying, recording or otherwise, except as permitted by the UK Copy- right, Designs and Patents Act 1988, without the prior permission in writing of the publishers. Permissions may be sought directly from JP Medical Ltd at the address printed above. All brand names and product names used in this book are trade names, service marks, trademarks or reg- istered trademarks of their respective owners. The publisher is not associated with any product or vendor mentioned in this book. Medical knowledge and practice change constantly. This book is designed to provide accurate, authoritative information about the subject matter in question. However readers are advised to check the most current information available on procedures included and check information from the manufacturer of each product to be administered, to verify the recommended dose, formula, method and duration of administration, adverse effects and contraindications. It is the responsibility of the practitioner to take all appropriate safety precautions. Neither the publisher nor the authors assume any liability for any injury and/or damage to per- sons or property arising from or related to use of material in this book. This book is sold on the understanding that the publisher is not engaged in providing professional medical services. If such advice or services are required, the services of a competent medical professional should be sought. Every effort has been made where necessary to contact holders of copyright to obtain permission to repro- duce copyright material. If any have been inadvertently overlooked, the publisher will be pleased to make the necessary arrangements at the first opportunity. ISBN: 978-1-907816-82-6 British Library Cataloguing in Publication Data A catalogue record for this book is available from the British Library Library of Congress Cataloging in Publication Data A catalog record for this book is available from the Library of Congress Publisher: Richard Furn Development Editors: Thomas Fletcher, Paul Mayhew, Alison Whitehouse Editorial Assistants: Sophie Woolven, Katie Pattullo Copy Editor: Kim Howell Graphic narratives: James Pollitt Cover design: Forbes Design Page design: Designers Collective v eureka Series Editors’ Foreword Today’s medical students need to know a great deal to be effective as tomorrow’s doctors. This knowledge includes core science and clinical skills, from understanding biochemical pathways to communicating with patients. Modern medical school curricula integrate this teaching, thereby emphasising how learning in one area can support and reinforce another. At the same time students must acquire sound clinical reasoning skills, working with complex information to understand each individual’s unique medical problems. The Eureka series is designed to cover all aspects of today’s medical curricula and reinforce this integrated approach. Each book can be used from first year through to qualification. Core biomedical principles are introduced but given relevant clinical context: the authors have always asked themselves, ‘why does the aspiring clinician need to know this?’ Each clinical title in the series is grounded in the relevant core science, which is introduced at the start of each book. Each core science title integrates and emphasises clinical relevance throughout. Medical and surgical approaches are included to provide a complete and integrated view of the patient management options available to the clinician. Clinical insights highlight key facts and principles drawn from medical practice. Cases featuring unique graphic narratives are presented with clear explanations that show how experienced clinicians think, enabling students to develop their own clinical reasoning and decision making. Clinical SBAs help with exam revision while Starter questions are a unique learning tool designed to stimulate interest in the subject. Having biomedical principles and clinical applications together in one book will make their connections more explicit and easier to remember. Alongside repeated exposure to patients and practice of clinical and communication skills, we hope Eureka will equip medical students for a lifetime of successful clinical practice. Janine Henderson, David Oliveira, Stephen Parker vi About the Series Editors Janine Henderson is the MB BS undergraduate Programme Director at Hull York Medical School (HYMS). After medical school at the University of Oxford and clinical training in psychiatry, she combined her work as a consultant with postgraduate teaching roles, moving to the new Hull York Medical School in 2004. She has a particular interest in modern educational methods, curriculum design and clinical reasoning. David Oliveira is Professor of Renal Medicine at St George’s, University of London (SGUL), where he served as the MBBS Course Director between 2007 and 2013. Having trained at Cambridge University and the Westminster Hospital he obtained a PhD in cellular immunology and worked as a renal physician before being appointed as Foundation Chair of Renal Medicine at SGUL. Stephen Parker is a Consultant Breast and General Paediatric Surgeon at St Mary’s Hospital, Isle of Wight. He trained at St George’s, University of London, and after service in the Royal Navy was appointed as Consultant Surgeon at University Hospital Coventry. He has a particular interest in e-learning and the use of multimedia platforms in medical education. About the Authors Paul Morris is a Specialist Registrar in Cardiology. He enjoys teaching medical students and junior doctors and has extensive experience of writing exam questions and developing clinical assessment tools. He is also a Clinical Research Fellow in Cardiovascular Science at the University of Sheffield, working on the computational modelling of cardiovascular physiology. David Warriner is a Specialist Registrar in Cardiology in South Yorkshire. He teaches undergraduates and postgraduates in lectures, tutorials and on the wards. He has developed novel interactive tools for understanding the pathophysiology of cardiovascular disease and still enjoys learning about cardiology as much as he does teaching it. Allison Morton is a cardiologist in Bunbury, Western Australia. Previously she was a Consultant Cardiologist at Sheffield Teaching Hospitals, where she ran the clinical cardiology training for medical students, giving lectures and examining students on the MBChB course. She teaches candidates for the clinical PACES exam and is proud of her 100% pass rate! vii Preface The World Health Organization ranks cardiovascular disease as the leading cause of death, accounting for three in every ten deaths worldwide and frequently presenting as an emergency requiring immediate management. Irrespective of speciality, all doctors need to be confident in dealing with cardiovascular disease. To achieve this, it is not enough to learn clinical medicine alone. One must also understand the scientific principles and mechanisms,