Читать книгу Practical Cardiovascular Medicine - Elias B. Hanna - Страница 2

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8  Part 1: CORONARY ARTERY DISEASE 1 Non-ST-Segment Elevation Acute Coronary Syndrome Appendix 1. Complex angiographic disease- Moderate disease progression Appendix 2. Women and ACS, elderly patients and ACS, CKD Appendix 3. Bleeding, transfusion, patients on chronic warfarin or NOAC, gastrointestinal bleed Appendix 4. Antiplatelet and anticoagulant therapy Appendix 5. Difference between plaque rupture and plaque erosion Appendix 6. Spontaneous coronary artery dissection Appendix 7. Harmful effects of NSAIDs and cyclooxygenase-2 inhibitors in CAD Appendix 8. Additional ideas on the physiology of hs-troponin-Role of hs-troponin in primary prevention QUESTIONS AND ANSWERS References 2 ST-Segment Elevation Myocardial Infarction 1. DEFINITION, REPERFUSION, AND GENERAL MANAGEMENT 2. STEMI COMPLICATIONS Appendix 1. Out-of-hospital cardiac arrest: role of early coronary angiography and therapeutic hypothermia QUESTIONS AND ANSWERS References Other acute therapies Early discharge Prognosis ICD Shock (+ SHOCK trial and CULPRIT-SHOCK trial, references 69 and 73) RV shock (+ reference 89 above) Mechanical complications Arrhythmias Aneurysm and pseudo-aneurysm Post-MI pericarditis LV thrombus Prognosis Cardiac arrest Note 3 Stable Ischemic Heart Disease and Approach to Chronic Chest Pain Appendix 1. Notes on various surgical grafts Appendix 2. Coronary vasospasm (variant angina, Prinzmetal angina) Appendix 3. Microvascular endothelial dysfunction Appendix 4. Women with chest pain and normal coronary arteries Appendix 5. Diagnostic strategy for ischemia with non-obstructed coronary arteries (INOCA) Appendix 6. Myocardial bridging Appendix 7. Coronary collaterals, chronic total occlusion Appendix 8. Hibernation, stunning, ischemic preconditioning QUESTIONS AND ANSWERS References

9  Part 2: HEART FAILURE (CHRONIC AND ACUTE HEART FAILURE, SPECIFIC CARDIOMYOPATHIES, AND PATHOPHYSIOLOGY) 4 Heart Failure DEFINITION, TYPES, CAUSES, AND DIAGNOSIS OF HEART FAILURE 1. DEFINITION AND TYPES OF HEART FAILURE I. Heart failure is diagnosed clinically, not by echocardiography II. After HF is defined clinically, echocardiography is used to differentiate the three major types of HF 2. CAUSES OF HEART FAILURE I. Systolic HF or HF with reduced EF (HFrEF) II. HF with preserved EF (HFpEF) III. Right HF 3. DIAGNOSTIC TESTS I. Echocardiography II. BNP III. ECG IV. Coronary angiography and other ischemic tests V. Diastolic stress testing VI. Endomyocardial biopsy VII. Cardiac MRI CHRONIC TREATMENT OF HEART FAILURE 1. TREATMENT OF SYSTOLIC HEART FAILURE I. Treat the underlying etiology: target BP and CAD II. Value of revascularization in ischemic cardiomyopathy: STICH trial III. Role of viability testing and ischemic testing IV. Drugs that affect survival in EF<40% V. Specifics of drugs that affect survival VI. Drugs that improve symptoms and morbidity VII. Devices VIII. Other therapeutic measures IX. Prognosis 2. TREATMENT OF HFPEF ACUTE HEART FAILURE AND ACUTELY DECOMPENSATED HEART FAILURE I. Triggers of acute decompensation II. Profiles of acute HF: congestion without low cardiac output, congestion with low cardiac output III. Treatment of acute HF: diagnosis and treatment of triggers IV. Treatment of acute HF: diuretics, cardiorenal syndrome, aggressive decongestion, ultrafiltration V. Treatment of acute HF: vasodilators VI. Treatment of acute HF: IV inotropic agents VII. In-hospital and pre-discharge use of ACE-I/ARB, angiotensin-neprilysin inhibition, and β-blockers VIII. Treatment of acute HF: O₂, non-invasive ventilatory support (CPAP, BiPAP), intubation IX. Summary: keys to the treatment of acute HF (Table 4.2) X. Discharge XI. Inability of severe HF to tolerate vasodilatation or hemodialysis XII. Outpatient monitoring of HF and prevention of hospitalization Appendix 1. Management of isolated or predominant RV failure QUESTIONS AND ANSWERS References Diuretics 5 Additional Heart Failure Topics 1. SPECIFIC CARDIOMYOPATHIES 2. ADVANCED HEART FAILURE: HEART TRANSPLANT AND VENTRICULAR ASSIST DEVICES (VADs) 3. PATHOPHYSIOLOGY OF HEART FAILURE AND HEMODYNAMIC ASPECTS QUESTIONS AND ANSWERS References

10  Part 3: VALVULAR DISORDERS 6 Valvular Disorders 1. MITRAL REGURGITATION 2. MITRAL STENOSIS 3. AORTIC INSUFFICIENCY 4. AORTIC STENOSIS 5. TRICUSPID REGURGITATION AND STENOSIS 6. PULMONIC STENOSIS AND REGURGITATION 7. MIXED VALVULAR DISEASE; RADIATION HEART DISEASE 8. PROSTHETIC VALVES 9. AUSCULTATION AND SUMMARY IDEAS QUESTIONS AND ANSWERS References

11  Part 4: HYPERTROPHIC CARDIOMYOPATHY 7 Hypertrophic Cardiomyopathy QUESTIONS AND ANSWERS References

12  Part 5: ARRHYTHMIAS AND ELECTROPHYSIOLOGY 8 Approach to Narrow and Wide QRS Complex Tachyarrhythmias Further reading 9 Ventricular Arrhythmias QUESTIONS AND ANSWERS References 10 Atrial Fibrillation I. Predisposing factors (see Table 10.1) II. Types of AF III. General therapy of AF IV. Management of a patient who presents with acute, symptomatic AF V. Peri-cardioversion anticoagulation management VI. Antiarrhythmic management after the acute presentation VII. Decisions about long-term anticoagulation, role of clopidogrel, role of triple therapy VIII. Special situation: atrial fibrillation and heart failure. Optimal heart rate in heart failure IX. Special situation: atrial fibrillation with borderline blood pressure or non-AF-related hypotension X. AF burden as a correlate and a driver of HF progression Appendix 1. Optimal heart rate and AF rate for optimal cardiac output Appendix 2. Antiarrhythmic drug therapy Appendix 3. Catheter ablation of atrial fibrillation, surgical ablation, AV nodal ablation Appendix 4. INR follow-up in patients receiving warfarin-Non-vitamin K oral anticoagulants Appendix 5. Bridging anticoagulation in patients undergoing procedures Appendix 6. Management of elevated INR values Appendix 7. Left atrial appendage surgical and percutaneous closure Appendix 8. A common situation: AF and symptomatic pauses or bradycardia Appendix 9. DC cardioversion in patients with a slow ventricular response Appendix 10. AF occurring post-cardiac surgery and AF related to acute transient triggers Appendix 11. Brief asymptomatic runs of AF on device interrogation and association with stroke. Role of rhythm monitoring after cryptogenic stroke QUESTIONS AND ANSWERS References 11 Atrial Flutter and Atrial Tachycardia I. Atrial flutter II. Focal atrial tachycardia III. Multifocal atrial tachycardia (MAT) (or chaotic atrial tachycardia) IV. Ectopic atrial rhythm QUESTIONS AND ANSWERS References Further reading 12 Atrioventricular Nodal Reentrant Tachycardia, Atrioventricular Reciprocating Tachycardia, Wolff–Parkinson–White Syndrome, and Junctional Rhythms QUESTIONS AND ANSWERS Further reading 13 Bradyarrhythmias QUESTIONS AND ANSWERS References 14 Permanent Pacemaker and Implantable Cardioverter Defibrillator Appendix. Cases of PM troubleshooting QUESTIONS AND ANSWERS References Note 15 Basic Electrophysiologic Study I. General concepts; intracardiac electrograms II. AV conduction abnormalities III. Sinus node assessment IV. Ventricular vs. supraventricular tachycardia V. Dual AV nodal pathways VI. AVNRT VII. Accessory pathway, orthodromic AVRT, antidromic AVRT VIII. Atrial flutter IX. Inducible VT X. Mapping for ablation XI. EP electro-anatomical mapping Further reading 16 Action Potential Features and Propagation I. Action potential (see Figures 16.1, 16.2) II. Action potential propagation and mechanisms of arrhythmias III. General mechanism of action of antiarrhythmic agents IV. Modulated receptor hypothesis and use dependence V. Concept of concealed conduction VI. Specific examples of drugs (see also Chapter 10) VII. Amiodarone toxicity VIII. Effect on pacing thresholds and defibrillation thresholds Further reading

13  Part 6: PERICARDIAL DISORDERS 17 Pericardial Disorders 1. ACUTE PERICARDITIS 2. TAMPONADE 3. PERICARDIAL EFFUSION 4. CONSTRICTIVE PERICARDITIS QUESTIONS AND ANSWERS References Further reading

14  Part 7: CONGENITAL HEART DISEASE Chapter 18: Congenital Heart Disease 1. ACYANOTIC CONGENITAL HEART DISEASE 2. CYANOTIC CONGENITAL HEART DISEASE 3. MORE COMPLEX CYANOTIC CONGENITAL HEART DISEASE AND SHUNT PROCEDURES QUESTIONS AND ANSWERS References

15  Part 8: PERIPHERAL ARTERIAL DISEASE 19 Peripheral Arterial Disease 1. LOWER EXTREMITY PERIPHERAL ARTERIAL DISEASE I. Clinical tips II. Clinical classification of PAD – Critical limb ischemia, acute limb ischemia, atheroembolization III. Diagnosis of PAD IV. Medical therapy of PAD V. Revascularization for PAD VI. Notes on the technical aspects of surgical and percutaneous therapies VII. Management of acute limb ischemia VIII. Management of lower extremity ulcers (Table 19.6) 2. CAROTID DISEASE I. Assessment of carotid stenosis II. Medical therapy of carotid stenosis III. Revascularization of asymptomatic carotid stenosis IV. Revascularization of symptomatic carotid stenosis V. Main risks of CEA and carotid stenting VI. CEA versus carotid stenting VII. Carotid disease in a patient undergoing CABG VIII. Subtotal and total carotid occlusions 3. RENAL ARTERY STENOSIS I. Forms of renal artery stenosis II. Screening and indications to revascularize renal artery stenosis III. Notes QUESTIONS AND ANSWERS References 20 Aortic Diseases I. Aortic dissection II. Thoracic aortic aneurysm III. Abdominal aortic aneurysm References

16  Part 9: OTHER CARDIOVASCULAR DISEASE STATES 21 Pulmonary Embolism and Deep Vein Thrombosis 1. PULMONARY EMBOLISM I. Presentation of pulmonary embolism (PE) and risk factors II. Probability of PE III. Initial workup IV. Specific PE workup V. Submassive or intermediate-high risk PE, pulmonary hypertension, and thrombolysis VI. PE and chronic pulmonary hypertension VII. Acute treatment of PE VIII. Duration of anticoagulation IX. Thrombophilias X. PE prognosis and long-term follow-up 2. DEEP VEIN THROMBOSIS I. Types II. Diagnosis III. Treatment 3. IMMUNE HEPARIN-INDUCED THROMBOCYTOPENIA I. Incidence II. Diagnosis III. Treatment QUESTIONS AND ANSWERS References 22 Shock and Fluid Responsiveness 1. SHOCK I. Shock definition and mechanisms II. Goals of shock treatment III. Immediate management of any shock IV. Sepsis and septic shock V. Cardiogenic shock 2. FLUID RESPONSIVENESS Appendix. Hemodynamic equations, transfusion, and miscellaneous concepts QUESTIONS AND ANSWERS References Note 23 Hypertension 1. HYPERTENSION I. Definition II. ACC and ESC targets of therapy and rationale III. Treatment of hypertension: timing, first-line drugs, compelling indications for specific drugs IV. Resistant hypertension V. Secondary hypertension VI. Peripheral vs. central aortic pressure: therapeutic implications VII. First-line antihypertensive drugs VIII. Second-line antihypertensive drugs IX. Orthostatic hypotension and extremely labile HTN 2. ACUTE SEVERE HYPERTENSION: HYPERTENSIVE EMERGENCIES AND URGENCIES I. Definitions II. Treatment of hypertensive emergencies III. Treatment of hypertensive urgencies IV. Specific situations (see Table 23.5) QUESTIONS AND ANSWERS References 24 Dyslipidemia I. Indications for therapy II. Notes on LDL, HDL, and triglycerides III. Drugs: LDL-lowering drugs IV. Drugs: TG/HDL-treating drugs and lifestyle modification V. Metabolic syndrome VI. Diabetes and cardioprotective diabetic drugs VII. Elevated hs-CRP (high-sensitivity C-reactive protein test) ≥2 mg/l VIII. Chronic kidney disease (CKD) IX. Causes of dyslipidemia to consider X. Side effects of specific drugs: muscle and liver intolerance with statins, fibrates, and niacin XI. Aspirin is ineffective in primary prevention QUESTIONS AND ANSWERS References 25 Pulmonary Hypertension I. Definition II. Categories of PH III. Two tips in the evaluation of PH IV. Hypoxemia in patients with PH V. Diagnosis: echocardiography; right and left heart catheterization VI. Treatment QUESTIONS AND ANSWERS References 26 Syncope I. Neurally mediated syncope (reflex syncope) II. Orthostatic hypotension and postural orthostatic tachycardia syndrome III. Cardiac syncope IV. Other causes of syncope V. Syncope mimic: seizure (see Table 26.1) VI. Clinical clues (see Table 26.2) VII. Diagnostic evaluation of syncope ( Figure 26.1 ) VIII. Tilt table testing (see Table 26.4)^{10, 40} IX. Indications for hospitalization X. Treatment of vasovagal syncope, orthostatic hypotension, and POTS QUESTIONS AND ANSWERS References 27 Chest Pain, Dyspnea, Palpitations 1. CHEST PAIN I. Causes (see Table 27.1) II. Features III. Management of chronic chest pain IV. Management of acute chest pain 2. ACUTE DYSPNEA I. Causes (see Table 27.2) II. Notes III. Management 3. PALPITATIONS I. Causes II. Diagnosis References 28 Infective Endocarditis and Cardiac Rhythm Device Infections 1. INFECTIVE ENDOCARDITIS I. Clinical diagnosis II. Echocardiography: timing and indications III. Organisms IV. Morphology V. Anatomical complications VI. Indications for valvular surgery and special situations 2. CARDIAC RHYTHM DEVICE INFECTIONS I. Organisms and mechanisms of infection II. Diagnosis III. Diagnosis in patients with bacteremia but no local or TEE signs of infection IV. Management References 29 Preoperative Cardiac Evaluation I. Steps in preoperative evaluation II. Surgical risk: surgery’s risk and patient’s risk III. CARP and DECREASE V trials IV. Only the highest-risk coronary patients require revascularization preoperatively V. Preoperative percutaneous revascularization VI. Surgery that needs to be performed soon after stent placement VII. Preoperative β-blocker therapy VIII. Other interventions that improve outcomes IX. Severe valvular disease X. Perioperative hypertension XI. Preoperative management of patients with pacemakers or ICDs QUESTIONS AND ANSWERS References 30 Miscellaneous Cardiac Topics 1. CARDIAC MASSES I. Differential diagnosis of a cardiac mass II. Cardiac tumors; focus on atrial myxoma 2. PREGNANCY AND HEART DISEASE I. High-risk cardiac conditions during which pregnancy is better avoided ⁹ II. Cardiac conditions that are usually well tolerated during pregnancy, but in which careful cardiac evaluation and clinical and echo follow-up are warranted ⁹ III. Cardiac indications for cesarean section IV. Mechanical prosthetic valves in pregnancy: anticoagulation management V. Peripartum cardiomyopathy (PPCM) VI. Cardiovascular drugs during pregnancy (see Table 30.2) VII. Arrhythmias during pregnancy VIII. MI and pregnancy IX. Hypertension and pregnancy 3. HIV AND HEART DISEASE I. Pericardial disease II. HIV cardiomyopathy III. Pulmonary hypertension (PH) IV. CAD 4. COCAINE AND THE HEART I. Myocardial ischemia II. Other cardiac complications of cocaine 5. CHEMOTHERAPY AND HEART DISEASE I. Cardiomyopathy II. Myocardial ischemia III. Atrial fibrillation 6. CHEST X-RAY I. Chest X-ray in heart failure (see Figures 30.2, 30.3) II. Various forms of cardiomegaly (see Figure 30.4) III. Left atrial enlargement; aortic dilatation IV. Lateral chest X-ray V. Chest X-ray in congenital heart disease QUESTIONS AND ANSWERS References

17  Part 10: CARDIAC TESTS: ELECTROCARDIOGRAPHY, ECHOCARDIOGRAPHY, AND STRESS TESTING 31 Electrocardiography I. Overview of ECG leads and QRS morphology II. Stepwise approach to ECG interpretation III. Rhythm and rate IV. QRS axis in the limb leads and normal QRS progression in the precordial leads V. P wave: analyze P wave in leads II and V₁ for atrial enlargement, and analyze PR interval (see Figures 31.18, 31.19) VI. Height of QRS: LVH, RVH VII. Width of QRS. Conduction abnormalities: bundle brunch blocks VIII. Conduction abnormalities: fascicular blocks IX. Low QRS voltage and electrical alternans X. Assessment of ischemia and infarction: Q waves XI. Assessment of ischemia: ST-segment depression and T-wave inversion XII. Assessment of ischemia: differential diagnosis of ST-segment elevation XIII. Assessment of ischemia: large or tall T wave XIV. QT analysis and U wave XV. Electrolyte abnormalities, digitalis effect and digitalis toxicity, hypothermia, PE, poor precordial R-wave progression XVI. Approach to tachyarrhythmias XVII. Approach to bradyarrhythmias: AV block XVIII. Abnormal automatic rhythms that are not tachycardic XIX. Electrode misplacement Appendix 1. Supplement on STEMI and Q‐wave MI: phases and localization Appendix 2. Spread of electrical depolarization in various disease states using vector illustration ( Figures 31.100 – 31.103 ) QUESTIONS AND ANSWERS References Further reading 32 Echocardiography 1. GENERAL ECHOCARDIOGRAPHY I. The five major echocardiographic views and the myocardial wall segments II. Global echo assessment of cardiac function and structure III. Doppler and assessment of valvular regurgitation and stenosis IV. Summary of features characterizing severe valvular regurgitation and stenosis (see Tables 32.1, 32.2) V. M-mode echocardiography VI. Pericardial effusion VII. Echocardiographic determination of LV filling pressure and diastolic function VIII. Additional echocardiographic hemodynamics IX. Prosthetic valves X. Brief note on Doppler physics and echo artifacts 2. TRANSESOPHAGEAL ECHOCARDIOGRAPHY (TEE) VIEWS Appendix. Note on LV mechanics and myocardial tissue strain Further reading 33 Stress Testing, Nuclear Imaging, Coronary CT Angiography, Cardiac MRI, Cardiopulmonary Exercise Testing I. Indications for stress testing II. Contraindications to all stress testing modalities III. Stress testing modalities IV. Diagnostic yields and pitfalls of stress ECG and stress imaging V. Mechanisms of various stress modalities VI. Nuclear stress imaging (see Figures 33.3, 33.4, 33.5) VII. Coronary CT angiography and coronary calcium scoring VIII.Cardiac MRI: summary of applications and findings IX.Cardiopulmonary exercise testing (CPET) References

18  Part 11: CARDIAC TESTS: INVASIVE CORONARY AND CARDIAC PROCEDURES 34 Angiographic Views: Coronary Arteries and Grafts, Left Ventricle, Aorta, Coronary Anomalies, Peripheral Arteries, Carotid Arteries I. Right coronary artery II. Left coronary artery III. Coronary angiography views. Recognize the angle of a view: LAO vs. RAO, cranial vs. caudal IV. Coronary angiography views. General ideas: cranial vs. caudal views V. Coronary angiography views. General ideas: foreshortening and identifying branches VI. Left coronary views (see Figure 34.8) VII. Right coronary views VIII. Improve the angiographic view in case of vessel overlap or foreshortening: effects of changing the angulation, effects of respiration, and vertical vs. horizontal heart IX. Saphenous venous graft views X. LIMA-to-LAD or LIMA-to-diagonal views XI. Left ventriculography XII. Aortography for assessment of aortic insufficiency XIII. Coronary anomalies XIV. Lower extremity angiography XV. Carotid angiography QUESTIONS AND ANSWERS Further reading 35 Cardiac Catheterization Techniques, Tips, and Tricks I. View for the engagement of the native coronary arteries: RAO vs. LAO II. Design of the Judkins and Amplatz catheters (see Figures 35.2–35.7) III. Engagement of the RCA (see Figure 35.8) IV. How to gauge the level of the RCA origin in relation to the aortic valve level V. What is the most common cause of failure to engage the RCA? What is the next step? VI. Tiger or JR4 catheter engages the conus branch. What is the next step? VII. Left coronary artery engagement: general tips VIII. Management of a JL catheter that is sub-selectively engaged in the LAD or LCx IX. Specific maneuvers for the Amplatz left catheter X. If you feel that no torque is getting transmitted, what is the next step? XI. Appropriate guide catheters for left coronary interventions XII. Appropriate guide catheters for RCA interventions (Figure 35.20) XIII. Selective engagement of SVGs: general tips XIV. Specific torque maneuvers for engaging the SVGs XV. Appropriate catheters for engaging SVGs (see Figure 35.24) XVI. Engagement of the left internal mammary artery graft XVII. Left ventricular catheterization XVIII. Engagement of anomalous coronary arteries XIX. Specific tips for coronary engagement using a radial approach XX. Damping and ventricularization of the aortic waveform upon coronary engagement, and role of side-hole catheters XXI. Technique of right heart catheterization 36 Hemodynamics I. Right heart catheter (see Figure 36.1) II. Overview of pressure tracings: differences between atrial, ventricular, and arterial tracings (Figures 36.2, 36.3, 36.4) III. RA pressure abnormalities IV. Pulmonary capillary wedge pressure (PCWP) abnormalities V. LVEDP VI. Cardiac output and vascular resistances VII. Shunt evaluation VIII. Valvular disorders: overview of pressure gradients and valve area calculation IX. Dynamic LVOT obstruction X. Pericardial disorders: tamponade and constrictive pericarditis (see Figures 36.23, 36.24) XI. Exercise hemodynamics XII.Additional hemodynamic caveats in AF Appendix 1. Advanced hemodynamic calculation: a case of shunt with pulmonary hypertension QUESTIONS AND ANSWERS: ADDITIONAL HEMODYNAMIC CASES References Suggested reading: 37 Intracoronary Imaging 1. INTRAVASCULAR ULTRASOUND (IVUS) I. Image basics II. Plaque types III. Basic IVUS measurements IV. Interpretation of how a severe stenosis may look mild angiographically, yet severe by IVUS; significance of lesion haziness (see Figure 37.16) V. Endpoints of stenting VI. Assessment of lesion significance by IVUS VII. Assessment of left main by IVUS 2. OPTICAL COHERENCE TOMOGRAPHY (OCT) References Further reading 38 Percutaneous Coronary Interventions and Complications, Intra-Aortic Balloon Pump, Ventricular Assist Devices, and Fractional Flow Reserve I. Major coronary interventional devices II. Stent thrombosis, restenosis, and neoatherosclerosis III. Peri-PCI antithrombotic therapy (see Table 38.3) IV. Complex lesion subsets V. Sheath management VI. Post-PCI mortality and coronary complications VII. Femoral access complications VIII. Renal, stroke, and atheroembolic complications IX. Intra-aortic balloon pump (IABP) or intra-aortic balloon counterpulsation X. Percutaneous LV assist device: Impella and TandemHeart XI. Extracorporeal membrane oxygenation (ECMO) XII. Fractional flow reserve (FFR) QUESTIONS AND ANSWERS Further reading

19  Appendix Appendix General review questions QUESTIONS I. NSTEMI and STEMI (Answers on pages 901–903) II. Stable CAD (Answers on pages 903–905) III. Heart failure and cardiomyopathies (Answers on pages 905–909) IV. Valvular disorders (Answers on pages 909–913) V. Arrhythmias (Answers on pages 913–916) VI. Congenital heart disease (Answers on pages 916–918) VII. Peripheral arterial disease- Pulmonary embolism-Pulmonary hypertension (Answers on pages 918–919) VIII. Hypertension and syncope (Answers on pages 919–920) IX. Pregnancy-Chemotherapy and heart disease- Miscellaneous (Answers on pages 920–921) X. ECG (Answers on pages 921, 922) XI. Echocardiography (Answers on pages 923, 924) XII. Additional hemodynamics (Answers on page 925) XIII. Percutaneous coronary intervention and shock (Answers on pages 926–929) XIV. Radiation in the cardiac catheterization laboratory (Answers on pages 929, 930) ANSWERS I. NSTEMI and STEMI II. Stable CAD III. Heart failure and cardiomyopathies IV. Valvular disorders V. Arrhythmias VI. Congenital heart disease VII. Peripheral arterial disease- Pulmonary embolism-Pulmonary hypertension VIII. Hypertension and syncope IX. Pregnancy-Chemotherapy and heart disease- Miscellaneous X. ECG XI. Echocardiography XII. Additional hemodynamics XIII. Percutaneous coronary intervention and shock XIV. Radiation in the cardiac catheterization laboratory

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