Chapter 1: Basic Cardiac Structure and Function

Introduction Knowledge of normal cardiac structure and function is crucial to understanding diseases that afflict the heart. This chapter reviews basic cardiac anatomy and electrophysiology as well as the events that lead to cardiac contraction. Cardiac Anatomy and Histology Although the study of cardiac anatomy dates back to ancient times, interest in this field has […]

Chapter 2: The Cardiac Cycle: Mechanisms of Heart Sounds and Murmurs

Introduction Cardiac diseases often cause abnormal findings on physical examination, including pathologic heart sounds and murmurs. These findings are clues to the underlying pathophysiology, and proper interpretation is essential for successful diagnosis and disease management. This chapter describes heart sounds in the context of the normal cardiac cycle and then focuses on the origins of […]

Chapter 3: Cardiac Imaging and Catheterization

Introduction Imaging plays a central role in the assessment of cardiac function and pathology. Traditional modalities such as chest radiography, echocardiography (echo), cardiac catheterization with angiography, and nuclear imaging are fundamental in the diagnosis and management of cardiovascular diseases. These procedures are being increasingly supplemented by newer techniques, including computed tomography (CT) and magnetic resonance […]

Chapter 4: The Electrocardiogram

Introduction Cardiac contraction relies on the organized flow of electrical impulses through the heart. The electrocardiogram (ECG) is an easily obtained recording of that activity and provides a wealth of information about cardiac structure and function. This chapter presents the electrical basis of the ECG in health and disease and leads the reader through the […]

Chapter 5: Atherosclerosis

Introduction Atherosclerosis is the leading cause of mortality and morbidity in the developed world. Through its major manifestations of cardiovascular disease and stroke, it likely will become the leading global killer by the year 2020. Commonly known as “hardening of the arteries,” atherosclerosis derives its name from the Greek roots athere-, meaning “gruel,” and -skleros, […]

Chapter 6: Ischemic Heart Disease

Introduction In 1772, the British physician William Heberden reported a disorder in which patients developed an uncomfortable sensation in the chest when walking. Labeling it angina pectoris, Heberden noted that this discomfort would disappear soon after the patient stood still but would recur with similar activities. Although he did not know the cause, it is […]

Chapter 7: Acute Coronary Syndromes

Introduction Acute coronary syndromes (ACS) are lifethreatening conditions that can punctuate the course of patients with coronary artery disease at any time. These syndromes form a continuum that ranges from an unstable pattern of angina pectoris to the development of a large acute myocardial infarction (MI), a condition of irreversible necrosis of heart muscle ( […]

Chapter 8: Valvular Heart Disease

Introduction This chapter describes the pathophysiologic abnormalities in patients with common valvular heart diseases. Each of the conditions is discussed separately because unifying principles do not govern the behavior of all stenotic or regurgitant valves. Effective patient management requires accurate identification of the valvular lesion, a determination of its severity, and a clear understanding of […]

Chapter 9: Heart Failure

Introduction The heart normally accepts blood at low filling pressures during diastole and then propels it forward at higher pressures in systole. Heart failure is present when the heart is unable to pump blood forward at a sufficient rate to meet the metabolic demands of the body (forward failure), or is able to do so […]

Chapter 10: The Cardiomyopathies

Introduction The cardiomyopathies are a group of heart disorders in which the major structural abnormality is limited to the myocardium. These conditions often result in symptoms of heart failure, and although the underlying cause of myocardial dysfunction can sometimes be identified, the etiology frequently remains unknown. Excluded from the classification of this group of diseases […]