Oxford Handbook of Cardiology 2nd Edition

Book Preface

Exercise ECG
A commonly used test involving a treadmill, blood pressure (BP) measurement, and continuous electrocardiograph (ECG) monitoring. Overall sensitivity for coronary heart disease is around 68 % and specifi city is 77 % .
This increases when considering prognostically signifi cant disease, which has a sensitivity of 86 % . The test improves to have a predictive accuracy of > 90 % in intermediate- to high-risk patients (older men with ischaemic symptoms). The test is of least value in populations that are least likely to be suffering from ischaemic heart disease; e.g. asymptomatic middle-aged women have a positive predictive value of <50 % .
Indications
• Diagnosis of ischaemic heart disease (IHD): intermediate- or high-probability IHD, vasospastic angina.
• Post-myocardial infarction (MI): pre-discharge (submaximal test in days 4–7 to assess prognosis, decide upon exercise programme, and evaluate treatment), late post-discharge (symptom-limited 3–6 weeks).
• Pre- and post-revascularization.
• Evaluation of arrhythmias: optimizing rate-responsive pacemaker function, evaluation of known or suspected exercise-induced arrhythmias, and evaluation of treatment of above.
Contraindications
• Fever/acute viral illness.
• Myocarditis/pericarditis.
• Severe aortic stenosis.
• Aortic dissection.
• Uncontrolled hypertension.
• Overt cardiac failure.
• Unstable angina or acute phase of MI.
• Signifi cant resting arrhythmia (e.g. uncontrolled atrial fi brillation or
complete heart block).
• Known severe left main stem (LMS) or LMS equivalent disease.
• Physical disability.
• ECG abnormality rendering interpretation of ST segment diffi cult (e.g. left bundle branch block (LBBB), left ventricular hyphetrophy (LVH) with strain or digoxin ECG changes).

Content

Contributors vii
Symbols and abbreviations ix
1 Cardiac investigations 1
2 Drugs for the heart 81
3 Valvular heart disease 143
4 Infective endocarditis 187
5 Coronary artery disease 211
6 Cardiac catheterization and intervention 309
7 Heart failure 367
8 Heart muscle diseases 417
9 Pericardial diseases 459
10 Arrhythmias 477
11 Invasive electrophysiology 541
12 Congenital heart disease 589
13 Multisystem disorders 617
14 Cardiovascular disease in less-developed
countries 653
15 Heart disease in pregnancy 673
16 Eponymous syndromes 697
17 Cardiovascular emergencies 709
18 Practical procedures 783
Appendix: Clinical trials 831
Index 837