Cardiac Intensive Care

791 Pages·2018·16.8 MB·English

by  David L. Brown

CARDIAC
INTENSIVE
CARE
David L. Brown, MD
Professor of Medicine (Cardiovascular Disease)
Washington University School of Medicine
St. Louis, Missouri
THIRD EDITION
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CARDIAC INTENSIVE CARE, THIRD EDITION ISBN: 978-0-323-52993-8
Copyright © 2019 by Elsevier, Inc.
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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
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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
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contained in the material herein.
Previous editions copyrighted 2010, 1998.
Library of Congress Control Number: 2018944851
Executive Content Strategist: Robin Carter
Senior Content Development Specialist: Jennifer Shreiner
Publishing Services Manager: Catherine Jackson
Senior Project Manager/Specialist: Carrie Stetz
Design Direction: Amy Buxton
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This edition of Cardiac Intensive Care is dedicated to the students, residents,
and fellows who teach and inspire me much more than I do in return.
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F O R E WO R D
“If you always do what you always did, you will always get what textbook delivers a comprehensive and deep treatment of the
you always got.” pathophysiologic principles, foundational basic and clinical
Albert Einstein science, and pragmatic clinical practice essential to the diagnosis,
assessment, and treatment of patients with cardiac critical illness.
With the aim of improving survival from in-hospital cardiac From the basics of recognition and management of mechanical
arrest after myocardial infarction, in 1961, Desmond Julian, the complications of myocardial infarction and cardiogenic shock
legendary British cardiologist, proposed a “special intensive-care to the essential topics of medical ethics and end-of-life care in
unit…staffed by suitably experienced people throughout 24 hours, the CICU, authoritative experts present the landmark studies,
since it is unreasonable to expect good results when the care latest advances, and practical pearls in the field. The liberal
of patients is entrusted to [the] inexperienced.” With central incorporation of figures and videos enhances the accessibility
tenets of regionalized specialty care, collaborative teamwork with of the material to the reader.
specialized nursing, and continuous physiologic monitoring, the While advances in practice have markedly improved survival
initial coronary care units were reported to achieve impressive and quality of life in many domains of cardiovascular medicine,
reductions in mortality after myocardial infarction. Since then, the the nature of the conditions and severity of illness encountered
characteristics of the patients we care for, the medical problems in the CICU continue to confer unacceptably high rates of
that we encounter, and the technologies that we deploy in the morbidity and mortality. These facts challenge the field to respond
cardiac intensive care unit (CICU) have all changed radically. The with new research and insightful attention to evolving organi-
fast-paced progression of cardiac critical care toward increasing zational models and individual processes of care. This textbook
complexity requires that those who oversee or practice in the is a welcomed companion for practitioners seeking to provide
CICU embrace a forward-looking culture of continuous redesign state-of-the-art care in the high-stakes environment of cardiac
and quality improvement; to do so effectively also requires the intensive care.
practitioner to maintain a broad fund of knowledge that keeps David A. Morrow, MD, MPH
to the cutting edge while building on the fundamentals of Professor of Medicine
cardiovascular medicine and critical care. Harvard Medical School;
Now in its third edition, Cardiac Intensive Care, edited by Director, Levine Cardiac Intensive Care Unit
David L. Brown, MD, is uniquely positioned with a focus on Brigham and Women’s Hospital
cardiac critical care, distilling more than a half century of advances Boston, Massachusetts
in state-of-the-art contemporary cardiac intensive care. This
vii
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For personal use only. No other uses without permission. Copyright ©2018. Elsevier Inc. All rights reserved.
P R E FAC E
The first edition of Cardiac Intensive Care was published in 1998 At the twentieth anniversary of the publication of the first
and the second in 2010. New editions of textbooks attempt to edition, the loss of contributors to earlier editions is inevitable.
keep pace with the rapid changes in patient demographics, new Giants of cardiology who contributed their time and expertise
understanding of pathophysiology, and advances in treatment. to writing chapters in earlier editions who are no longer with
Formats of textbooks evolve as technology improves and our us include H.J.C. Swan, Kanu Chatterjee, Bill Little, Ralph
understanding grows regarding how and where learners do the Shabetai, Burt Sobel, Bob O’Rourke, and Mark Josephson. Their
actual learning. The third edition of Cardiac Intensive Care is contributions to teaching, mentoring, research, and patient
no exception. As all patient care begins with a grounding in care continue to live on and inspire the next generations of
ethics and the ability to perform an accurate history and physical physicians.
exam, those topics are covered in the beginning of the book. I A project of this magnitude would not be possible without
continue to believe that a strong grounding in the pathophysiology the contributions of many. I would be remiss if I did not
of cardiovascular disease is mandatory to make accurate diagnoses acknowledge the critical contributions of Jennifer Shreiner and
and appropriate treatment decisions. Thus the first chapters of Carrie Stetz from Elsevier, whose tireless efforts along with
the new edition focus on the scientific underpinnings of cardiac constant but gentle encouragement have kept the third edition
intensive care. However, as the field has evolved, chapters on (more or less) on schedule. The artists and copyeditors at Elsevier
specific topics such non–ST segment myocardial infarction, are the best in the business. Responsibility for any mistakes or
unstable angina, coronary spasm, complications of interventional typographical errors that find their way into the finished book
procedures, emergency coronary bypass surgery—all common falls on my shoulders, not theirs. In addition, I am deeply indebted
admission diagnoses to the cardiac intensive care unit (CICU) to the contributing authors. Book chapters do not return much
in the past—are no longer pertinent to the current CICU and in the way of academic currency, but I am eternally grateful to
have been omitted. The new edition has chapters on takotsubo the selfless chapter authors who contributed their time and
cardiomyopathy, acute myocarditis, cardiorenal syndrome, expertise without the expectation of anything in return other
electrical storm, distributive shock, and temporary mechanical than a free copy of the book. Without them, this book would
circulatory support devices—all of which are commonly encoun- not have been possible. I would also like to express my heartfelt
tered in today’s CICU. In recognition of the complexity and gratitude to my boss, Doug Mann (who also edits a cardiology
advanced illness of current CICU patient populations, along textbook for Elsevier that you may have heard of), for hiring
with the recognition of the limitations of care and our obligation me to work at Washington University, for always supporting my
to ensure quality of life as opposed to quantity of life, we have various academic endeavors, and for being a superb role model
added a chapter on palliative care. We have also added audio as a person and an academic cardiologist. Finally, I thank my
clips of heart sounds and videos of procedures and diagnostic family for tolerating the time I spent working on this and other
imaging in the online version of this book, available at Expert- projects.
Consult.com. My hope is to make this textbook more of a living David L. Brown
document than previous editions, with online and social media
discussions of topics relevant to cardiac intensive care.
ix
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C O N T R I B U TO R S
Masood Akhtar, MD, FHRS, MACP, Andreia Biolo, MD, ScD Leslie T. Cooper Jr, MD
FACC, FAHA Professor of Medicine Chair
Aurora Cardiovascular Services Coordinator, Post-Graduate Program in Cardiovascular Department
Director of Electrophysiology Research Cardiology Mayo Clinic
Aurora Sinai/Aurora St. Luke’s Medical Federal University of Rio Grande do Sul; Jacksonville, Florida
Centers; Heart Failure and Cardiac Transplant Group
Adjunct Clinical Professor of Medicine Section of Cardiology Harold L. Dauerman, MD
University of Wisconsin School of Medicine Hospital de Clinicas de Porto Alegre Division of Cardiology
and Public Health Porto Alegre, Brazil University of Vermont Larner College of
Milwaukee, Wisconsin Medicine
Daniel Blanchard, MD Burlington, Vermont
William R. Auger, MD Professor of Medicine
Profess of Clinical Medicine Director, Cardiology Fellowship Program Elyse Foster, MD
UCSD Healthcare University of California–San Diego Professor of Medicine
La Jolla, California La Jolla, California Department of Cardiology
University of California–San Francisco
Richard G. Bach, MD David L. Brown, MD San Francisco, California
Professor of Medicine Professor of Medicine (Cardiovascular
Washington University School of Medicine; Disease) Stephanie Gaydos, MD
Director, Cardiac Intensive Care Unit Washington University School of Medicine Congenital Cardiology Fellow
Director, Hypertrophic Cardiomyopathy St. Louis, Missouri Medical University of South Carolina
Center Charleston, South Carolina
Barnes-Jewish Hospital Clifton W. Callaway, MD, PhD
St. Louis, Missouri Professor of Emergency Medicine Mark Gdowski, MD
Executive Vice-Chairman of Emergency Cardiology Fellow
Raquel R. Bartz, MD, MMCI Medicine Barnes-Jewish Hospital
Division Chief, Critical Care Medicine Ronald D. Stewart Endowed Chair of Washington University School of Medicine
Department of Anesthesiology Emergency Medicine Research St. Louis, Missouri
Duke University School of Medicine University of Pittsburgh School of Medicine
Durham, North Carolina Pittsburgh, Pennsylvania Timothy Gilligan, MD, MS, FASCO
Associate Professor of Medicine
Eric R. Bates, MD Matthew J. Chung, MD Department of Hematology and Medical
Professor of Internal Medicine Interventional Cardiology Fellow Oncology
Department of Internal Medicine Department of Internal Medicine Vice-Chair for Education, Taussig Cancer
Division of Cardiovascular Diseases Cardiovascular Division Institute
University of Michigan Washington University School of Medicine Director of Coaching, Center for Excellence
Ann Arbor, Michigan St. Louis, Missouri in Healthcare Communication
Cleveland Clinic
Brigitte M. Baumann, MD, MSCE Richard F. Clark, MD Cleveland, Ohio
Professor Professor
Department of Emergency Medicine Department of Emergency Medicine Michael M. Givertz, MD
Cooper Medical School of Rowan University University of California–San Diego School Medical Director, Heart Transplant and
Camden, New Jersey of Medicine; Circulatory Support Program
Director Brighman and Women’s Hospital;
Richard C. Becker, MD Division of Medical Toxicology Professor of Medicine
Professor UCSD Medical Center; Harvard Medical School
Department of Internal Medicine Medical Director, San Diego Division Boston, Massachusetts
University of Cincinnati College of California Poison Control System
Medicine San Diego, California Prospero B. Gogo Jr, MD
Cincinnati, Ohio Division of Cardiology
Wilson S. Colucci, MD University of Vermont Larner College of
Dmitri Belov, MD Professor of Medicine and Physiology Medicine
Assistant Professor of Medicine Boston University School of Medicine; Burlington, Vermont
Director, Advanced Heart Failure Chief, Section of Cardiovascular Medicine
Department of Cardiology Co-Director, Cardiovascular Center
Albany Medical Center Boston Medical Center
Albany, New York Boston, Massachusetts
xi
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xii Contributors
Sarah J. Goodlin, MD Brian D. Hoit, MD Jason N. Katz, MD, MHS
Chief of Geriatrics Professor of Medicine, Physiology, and Associate Professor of Medicine
VA Portland Health Care System Biophysics Associate Professor of Surgery
Associate Professor of Medicine Case Western Reserve University; Divisions of Cardiology and Pulmonary &
Oregon Health & Science University Director of Echocardiography Critical Care Medicine
Portland, Oregon Harrington Heart & Vascular Center University of North Carolina School of
University Hospital Cleveland Medical Medicine;
Barry Greenberg, MD Center UNC Health Care System Director,
Distinguished Professor of Medicine Cleveland, Ohio Cardiovascular Critical Care, Mechanical
Director, Advanced Heart Failure Treatment Circulatory Support, and the
Program Ruth Hsiao, MD Cardiogenic Shock Program
University of California–San Diego Chief Medical Resident Medical Director, UNC Mechanical Heart
La Jolla, California Department of Internal Medicine Program
University of California–San Diego Medical Director, Cardiac Intensive Care
David Gregg IV, MD La Jolla, California Unit
Associate Professor of Medicine and Medical Director, Cardiovascular and
Cardiology Robert C. Hyzy, MD Thoracic Surgical Intensive Care Unit
Medical University of South Carolina Medical Director, Critical Care Medicine and Critical Care Service
Charleston, South Carolina Unit UNC Center for Heart and Vascular Care
Professor of Medicine Chapel Hill, North Carolina
George Gubernikoff, MD Division of Pulmonary and Critical Care
Director, Noninvasive Cardiology Medicine Mohamad Kenaan, MD
Medical Director, Center for Aortic Diseases University of Michigan Medical School Clinical Assistant Professor
NYU Winthrop Hospital Ann Arbor, Michigan Michigan State University College of
Mineola, New York Human Medicine
Jacob C. Jentzer, MD Division of Cardiovascular Medicine
Colleen Harrington, MD Assistant Professor of Medicine Spectrum Health–Meijer Heart Center
Assistant Professor of Medicine Department of Cardiovascular Diseases
Division of Cardiovascular Medicine Division of Pulmonary and Critical Care Briana N. Ketterer, MD
UMass Memorial Medicine, Department of Internal Hospice and Palliative Care Fellow
Worcester, Massachusetts Medicine University of Pittsburgh Medical Center
Mayo Clinic Pittsburgh, Pennsylvania
Nazish K. Hashmi, MD Rochester, Minnesota
Assistant Professor Holly Keyt, MD
Department of Anesthesiology Joyce Ji, MD Assistant Professor of Medicine
Duke University Medical Center Resident Physician University of Texas Health San Antonio
Durham, North Carolina Department of Internal Medicine San Antonio, Texas
Barnes-Jewish Hospital
Alan C. Heffner, MD St. Louis, Missouri Jon A. Kobashigawa, MD
Director of Critical Care Associate Director
ECMO Medical Director Lauren H. Jones, MD Cedars-Sinai Heart Institute;
Pulmonary and Critical Care Consultants Anesthesiology Resident Director, Advanced Heart Disease Section
Carolinas Medical Center Department of Anesthesiology Director, Heart Transplant Program
Charlotte, North Carolina Duke University Medical Center Cedars-Sinai Medical Center
Durham, North Carolina Los Angeles, California
Bettina Heidecker, MD
Head, Heart Failure and Cardiomyopathies Ulrich Jorde, MD Richard Koch, MD
Charité, Campus Benjamin Franklin Professor of Medicine Fellow
Berlin, Germany Section Head Medical Toxicology
Heart Failure, Cardiac Transplantation, and University of California–San Diego
Maureane Hoffman, MD, PhD Mechanical Circulatory Support San Diego, California;
Pathology and Laboratory Medicine Service Vice-Chief, Division of Cardiology Staff Physician
Durham Veterans Affairs Medical Center; Montefiore Medical Center Naval Hospital Sigonella
Department of Pathology Albert Einstein College of Medicine Sigonella, Italy
Duke University Medical Center New York, New York
Durham, North Carolina Sándor J. Kovács, PhD, MD
Rochelle Judd, NP Professor of Medicine, Physiology,
Adult Congenital Cardiology Nurse Biomedical Engineering, and Physics
Practitioner Washington University in St. Louis
Medical University of South Carolina St. Louis, Missouri
Charleston, South Carolina
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Contributors xiii
Alexander Kuo, MD Jason Matos, MD Marlies Ostermann, PhD, MD, FICM
Instructor Clinical and Research Fellow Department of Nephrology
Harvard Medical School; Department of Medicine King’s College London
Physician Division of Cardiology Guy’s & St. Thomas’ Hospital & Critical
Department of Anesthesia, Critical Care, Beth Israel Deaconess Medical Center Care
and Pain Medicine Boston, Massachusetts London, United Kingdom
Massachusetts General Hospital
Boston, Massachusetts Sharon McCartney, MD Demosthenes G. Papamatheakis, MD
Assistant Professor Assistant Professor
Milla J. Kviatkovsky, DO, MPH Department of Anesthesiology Department of Medicine
Assistant Clinical Professor of Medicine Duke University Medical Center UC San Diego Health
Department of Hospital Medicine Durham, North Carolina La Jolla, California
University of California–San Diego
La Jolla, California Theo E. Meyer, MD, DPhil Nimesh Patel, MD
Professor of Medicine Cardiology Fellow
A. Michael Lincoff, MD Chief, Clinical Cardiology Department of Internal Medicine
Vice Chairman University of Massachusetts Medical School University of Texas Southwestern Medical
Department of Cardiovascular Medicine UMass Memorial Medical Center Center
Cleveland Clinic Worcester, Massachusetts Dallas, Texas
Cleveland, Ohio
Alicia Minns, MD Richard M. Pescatore II, DO
Mark S. Link, MD Assistant Clinical Professor of Emergency Chief Resident
Professor of Medicine Medicine Department of Emergency Medicine
Director, Cardiac Electrophysiology University of California–San Diego Cooper Medical School of Rowan University
Department of Internal Medicine La Jolla, California Camden, New Jersey
Division of Cardiology
University of Texas Southwestern Medical Joshua D. Mitchell, MD Jay I. Peters, MD
Center Cardiology Fellow Professor and Chief
Dallas, Texas Washington University Medical Center Pulmonary and Critical Care Medicine
St. Louis, Missouri University of Texas Health Science Center
Jacob Luthman, MD San Antonio, Texas
Cardiology Fellow Narain Moorjani, MB ChB, MRCS, MD,
Department of Internal Medicine FRCS(C-Th), MA Abhiram Prasad, MD, FRCP, FESC,
University Hospitals Cleveland Medical Consultant Cardiac Surgeon and Clinical FACC
Center Lead for Cardiac Surgery Professor of Medicine
Cleveland, Ohio Royal Papworth Hospital; Department of Cardiovascular Diseases
Associate Lecturer Mayo Clinic
Judith A. Mackall, MD University of Cambridge Rochester, Minnesota
Director Cambridge, United Kingdom
Cardiac Device Clinic Susanna Price, MBBS, BSc, MRCP,
Division of Cardiology Jonathan D. Moreno, MD, PhD EDICM, PhD, FFICM, FESC
University Hospitals Cleveland Medical Cardiology Fellow Consultant Cardiologist and Intensivist
Center; Department of Medicine Royal Brompton Hospital;
Associate Professor of Medicine Division of Cardiology Honorary Senior Lecturer
Case Western Reserve University Washington University in St. Louis Imperial College
Cleveland, Ohio St. Louis, Missouri London, United Kingdom
Rohit Malhotra, MD Michael S. O’Connor, DO, MPH Thomas M. Przybysz, MD
Associate Professor Staff Anesthesiologist Critical Care Physician
Department of Internal Medicine Assistant Professor Carolinas Medical Center
Division of Cardiology Cleveland Clinic Lerner College of Charlotte, North Carolina
University of Virginia Medicine;
Charlottesville, Virginia Department of Cardiothoracic Claudio Ronco, MD
Anesthesiology Director
Pamela K. Mason, MD Anesthesia Institute Department of Nephrology, Dialysis, and
Associate Professor Cleveland Clinic Transplantation
Department of Internal Medicine Cleveland, Ohio Director
Division of Cardiology International Renal Research Institute
University of Virginia San Bortolo Hospital
Charlottesville, Virginia Vicenza, Italy
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