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Cardiology First and second edition authors Anjana Siva Mark Noble Mohamed K Al-Obaidi Third edition authors Ajay Jain Matthew Ginks 4 th Edition CRASH COURSE SERIES EDITOR Dan Horton-Szar BSc(Hons) MBBS(Hons) MRCGP Northgate Medical Practice, Canterbury, Kent, UK FACULTY ADVISOR Michael Frenneaux MBBS(Hons) MD FRCP FRACP FACC FESC FMedSci Regius Professor of Medicine, School of Medicine and Dentistry, University of Aberdeen, Aberdeen, UK Cardiology Antonia Churchhouse BMedSci(Hons) MBChB Core Medical Trainee, London Deanery, London, UK Julian Ormerod PhD MRCP Specialist Registrar in Cardiology, Great Western Hospital, Swindon, UK Edinburgh London New York Oxford Philadelphia St Louis Sydney Toronto 2013 Senior Content Strategist: Jeremy Bowes Senior Content Development Specialist: Ailsa Laing Project Manager: Andrew Riley Designer: Christian Bilbow Icon illustrations: Geo Parkin Illustration manager: Jennifer Rose © 2013 Elsevier Limited. All rights reserved. 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). First edition 1999 Second edition 2004 Third edition 2008 Fourth edition 2013 ISBN: 978-0-7234-3632-4 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 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 evaluating 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, including 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. The Publisher's policy is to use paper manufactured from sustainable forests Printed in China Series editor foreword The Crash Course series first published in 1997 and now, 16 years on, we are still going strong. Medicine never stands still, and the work of keeping this series relevant for today’s students is an ongoing process. These fourth editions build on the success of the previous titles and incorporate new and revised material, to keep the series up-to-date with current guidelines for best practice, and recent developments in medical research and pharmacology. We always listen to feedback from our readers, through focus groups and student reviews of the Crash Course titles. For the fourth editions we have completely re-written our self-assessment material to keep up with today’s ‘single-best answer’ and ‘extended matching question’ formats. The artwork and layout of the titles has also been largely re-worked to make it easier on the eye during long sessions of revision. Despite fully revising the books with each edition, we hold fast to the principles on which we first developed the series. Crash Course will always bring you all the information you need to revise in compact, manageable volumes that integrate basic medical science and clinical practice. The books still maintain the balance between clarity and conciseness, and provide sufficient depth for those aiming at distinction. The authors are medical students and junior doctors who have recent experience of the exams you are now facing, and the accuracy of the material is checked by a team of faculty advisors from across the UK. I wish you all the best for your future careers! Dr Dan Horton-Szar v Intentionally left as blank Prefaces Authors Cardiology is an exciting and dynamic specialty that combines bedside history taking and clinical examination with a broad range of investigations and interventions. The specialty is constantly growing, and advances in diagnostics, technologies, and therapeutics are reflected in this fully revised 4th Edition. Having been through the rigours of medical school exams ourselves (some more recently than others!), we are aware that assessments are also changing. Hence we have also developed an up to date self-assessment section, the majority of which is based on the popular “Best of Five” format. We aim primarily to equip you with the knowledge needed to pass your exams, but hope that this book also gives you the opportunity to further your interest and en- joyment of cardiology. Best of luck with your studies! Antonia Churchhouse and Julian Ormerod Faculty Advisor Cardiology has seen huge advances over the past three decades and is one of the most popular and competitive specialties. Lives saved by lifestyle modification and treatment of hypertension and lipid disorders together with revascularisation and secondary prevention strategies are reflected in our national statistics which show dramatic reductions in cardiovascular mortality over the last 20 years. Impressive improvements in quality-of-life and prognosis have also resulted from contemporary treatment of systolic heart failure. Nevertheless, cardiovascular disease remains the major cause of premature death and the major challenge to clinical medicine in the 21st century, not only in western societies but increasingly in developing countries as well. There have been some notable areas in which little progress in therapy has been made, particularly in the syndrome of heart failure with normal ejection fraction. This Crash Course in Cardiology is designed to arm the reader with the knowledge base needed for a clinical introduction to this fascinating specialty. The book provides a comprehensive but we hope readable overview. We have aimed to convey the enthusiasm and excitement that the specialty inspires in us. It begins with history taking and physical examination and proceeds to describe investigations commonly used in cardiology. The next few chapters focus on the evaluation of common presenting symptoms in cardiology. Subsequent chapters focus on common presentations of patients with cardiovascular disorders and a summary of common cardiovascular disorders. vii Prefaces Like the other books in this series, the material is contemporary, the content accessible and the coverage comprehensive. We hope that students will enjoy reading this book. Michael Frenneaux viii Contents Series editor foreword . v Cardiac catheterization . 32 Prefaces . vii Cardiac computed tomography . 33 5. Chest pain . 35 1. History . 1 Differential diagnosis of chest pain . 35 Aim of history taking . 1 History to focus on the differential Presenting complaint . 1 diagnosis of chest pain . 35 Systems review . 5 Presenting complaint . 35 Past medical history . 6 Examination of patients who have chest pain . 36 Family history . 6 Investigation of patients who have Social history . 6 chest pain . 37 Drug history . 7 New onset central chest pain at rest in an Allergies . 7 ill patient . 40 Presenting history findings . 7 6. Dyspnoea . 43 2. Examination . 9 Differential diagnosis of dyspnoea . 43 How to begin the examination . 9 History to focus on the differential diagnosis of dyspnoea. 43 Observation . 9 Examination of dyspnoeic patients. 43 Examination of the hands. 10 Investigation of dyspnoeic patients . 45 Examination of the pulse . 10 Dyspnoea at rest of recent onset in an ill Taking the blood pressure . 11 patient . 47 Examination of the face . 11 7. Syncope . 49 Examination of the jugular venous pressure . 11 Differential diagnosis of syncope . 49 Examination of the praecordium . 12 History to focus on the differential diagnosis of syncope . 49 Finishing off the examination . 14 Examination of patients who present with Presenting your findings . 15 syncope . 50 3. How to write a clerking . 17 Investigation of patients who present with syncope . 51 Documentation of the history . 17 Syncope of recent onset in an ill patient . 53 Documentation of the examination findings . 18 8. Palpitations . 55 At the end of the clerking . 18 Differential diagnosis of palpitation .

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