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Hemodynamic Rounds: Interpretation of Cardiac Pathophysiology from Pressure Waveform Analysis, 3rd Edition

ISBN: 978-1-118-20997-4
496 pages
October 2011, Wiley-Blackwell
Hemodynamic Rounds: Interpretation of Cardiac Pathophysiology from Pressure Waveform Analysis, 3rd Edition (1118209974) cover image
The essential resource on cardiac hemodynamics-now in a new edition

Hemodynamic Rounds, Third Edition is intended to help cardiologists and other members of the medical community enhance their understanding of cardiac physiology and its associated hemodynamic presentations in health and disease, including the basic principles of flow and pressure measurements; systemic as well as coronary hemodynamics in normal and diseased states; and changes in hemodynamics following interventional procedures ranging from valvuloplasty to stent placement.

Like its popular predecessors, this new edition draws on case studies to illustrate characteristic cardiac hemodynamic findings and discuss the essential methods used in interpreting pressure waveforms as a diagnostic and monitoring tool.

The text is organized into chapters on specific areas of the heart, common cardiac anomalies, and hemodynamic situations resulting from different therapeutic procedures, and includes both normal and abnormal pressure waveforms. This new edition includes thoroughly revised and updated chapters on specific topics, including:

  • Mitral stenosis and mitral valvuloplasty
  • Low-gradient aortic valve stenosis
  • Pitfalls of right heart hemodynamics
  • Aortic and pulmonary balloon valvuloplasty
  • Coronary hemodynamics for angioplasty and stenting
  • Hemodynamic evaluation of stenotic bioprosthetic mitral valves
  • Evaluation of hypertrophic obstructive cardiomyopathies
  • Understanding cardiac pathophysiology from bedside hemodynamic study

Hemodynamic Rounds, Third Edition, is the only book on the market that specifically addresses comprehensive cardiac hemodynamic findings, reviewing blood pressure tracings collected from the cardiac catheterization lab on all aspects of cardiovascular disease, as well as normal cardiac function. It is an indispensable tool for all physicians, nurses, and students measuring and interpreting cardiac waveforms in cardiac diagnosis and monitoring.

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CONTRIBUTORS xiii

PREFACE xv

INTRODUCTION xvii

SECTION I: FUNDAMENTALS AND CLINICAL APPLICATIONS OF HEMODYNAMICS 1

PART 1: HEMODYNAMIC WAVEFORMS: NORMAL AND PATHOPHYSIOLOGIC 7

1 Pressure Wave Artifacts: Measurement Systems and Artifacts 9
Morton J. Kern and Steven Appleby

2 Pitfalls of Right-Heart Hemodynamics 17
Morton J. Kern and Steven Appleby

3 The Tricuspid Valve 23
Morton J. Kern and Steven Appleby

4 The Left-Sided V Wave 33
Morton J. Kern and Steven Appleby

5 The LVEDP 43
Morton J. Kern and Steven Appleby

6 Simultaneous Left and Right Ventricular Pressure Measurements 49
Morton J. Kern and Steven Appleby

7 Effects of Nitroglycerin 55
Morton J. Kern and Steven Appleby

8 Pulsus Alternans 63
Morton J. Kern and Steven Appleby

PART 2: VALVULAR HEART DISEASE 69

9 Aortic Stenosis 71
Abhay Laddu and Michael J. Lim

10 Aortic Regurgitation 89
Robert H. Neumayr and Michael J. Lim

11 Aortic Regurgitation—Case Presentations 97
Morton J. Kern

12 Abnormal Hemodynamics After Prosthetic Aortic Root Reconstruction: Aortic Stenosis or Insufficiency? 105
Morton J. Kern, Frank V. Aguirre, and Marco Guerrero

13 Acute Aortic Insufficiency—Case Presentation 111
Krystof J. Godlewski, J. David Talley, and Glenn T. Morris

14 Multivalvular Regurgitant Lesions 117
Morton J. Kern, Frank V. Aguirre, Thomas J. Donohue, and Richard G. Bach

15 The Hemodynamic Dilemma of Combined Mitral and Aortic Stenosis 123
William M. Suh and Morton J. Kern

16 Determination of the Source and Severity of a Transvalvular Left Ventricular Outflow Tract Gradient in Patients with a Prosthetic Aortic Valve 129
Michael Ragosta, D. Scott Lim, and James Bergin

17 Mitral Valve Gradients—Section I 135
Morton J. Kern and Frank V. Aguirre

18 Mitral Valve Gradients—Section II: Mitral Stenosis and Pulsus Alternans 143
Morton J. Kern

19 Mitral Valve Gradients—Section III 149
Elie Azrak, Morton J. Kern, Richard G. Bach, and Thomas J. Donohue

20 Mitral Valve Gradients—Section IV: Left Ventricular Puncture for Hemodynamic Evaluation of Double Prosthetic Valve Stenosis 155
Morton J. Kern

21 Simplified Mitral Valve Gradient Calculation by Cui et al. 161
Morton J. Kern

22 Invasive Assessment of Mitral Regurgitation: Comparison of Hemodynamic Parameters 163
Morton J. Kern

23 The Pulmonary Valve 167
Morton J. Kern

24 Percutaneous Balloon Valvuloplasty 173
Zoltan Turi and Morton J. Kern

PART 3: VALVULOPLASTY 197

25 Mitral Valve Gradients and Valvuloplasty 199
Morton J. Kern and Frank V. Aguirre

26 Reduction of Mitral Regurgitation After Aortic Valvuloplasty 205
Ted Feldman

27 Aortic Valvuloplasty in a Very Elderly Woman 211
Ted Feldman

28 Mitral Valve Gradient with Dobutamine Stress Testing 217
Ted Feldman

29 Left-Heart Catheterization and Mitral Balloon Valvuloplasty in a Patient with a Mechanical Aortic Valve 223
Douglas L. Kosmicki and Andrew D. Michaels

PART 4: HEMODYNAMICS OF PERICARDIAL CONSTRAINT, MYOCARDIAL RESTRICTION, AND TAMPONADE 229

30 Constrictive Physiology 231
Stuart T. Higano, Elie Azrak, Naeem K. Tahirkheli, and Morton J. Kern

31 Post-Cardiac Surgical Constrictive Pericardial Disease 247
Elie Azrak and Morton J. Kern

32 Pericardial Compressive Hemodynamics 253
Morton J. Kern and Frank V. Aguirre

33 Unusual Hemodynamics of Constrictive Physiology 261
Morton J. Kern and Frank V. Aguirre

34 Cardiac Tamponade 269
Morton J. Kern and Frank V. Aguirre

35 Tamponade in a Patient with AIDS-Related Non-Hodgkin’s Lymphoma 277
Elie Azrak, Morton J. Kern, and Richard G. Bach

36 A Novel Assessment for Constrictive Pericarditis in a Complex Patient 283
Justin A. Strote, Larry S. Dean, Steven L. Goldberg, Eric V. Krieger, and Douglas K. Stewart

37 Why Does Kussmal’s Sign and Pulsus Paradoxus Occur? 289
Morton J. Kern

PART 5: ARRYTHMIAS 293

38 Cardiac Arrhythmias 295
Morton J. Kern, Thomas J. Donohue, Richard G. Bach, and Frank V. Aguirre

39 Pacemaker Hemodynamics 301
Morton J. Kern and Ubeydullah Deligonul

PART 6: HYPERTROPHIC OBSTRUCTIVE CARDIOMYOPATHY 307

40 Hypertrophic Cardiomyopathy 309
Morton J. Kern, Steven Appleby, and Ted Feldman

PART 7: CORONARY HEMODYNAMICS 337

41 Coronary Hemodynamics 339
Morton J. Kern

42 Hemodynamic and Intravascular Ultrasound Assessment of an Ambiguous Left Main Coronary Artery Stenosis 367
Massoud A. Leesar and Garry S. Mintz

43 Renal Hemodynamics: Theory and Practical Tips 379
Tariq S. Siddiqui, Ziad Elghoul, Syed T. Reza, and Massoud A. Leesar

PART 8: ADULT CONGENITAL ANOMALIES 387

44 Adult Congenital Anomalies 389
Morton J. Kern, Robin Abdulmalek, Frank V. Aguirre, Thomas J. Donohue, and Richard G. Bach

45 Case Studies in Congenital Cardiac Anomalies 399
Ralf J. Holzer and Ziyad M. Hijazi

PART 9: EXTRA HEARTS 409

46 Extra Hearts: Unusual Hemodynamics of Heterotopic Transplant and Ventricular Assist Devices 411
Morton J. Kern, Ubeydullah Deligonul, and Leslie Miller

PART 10: RIGHT VENTRICULAR DYSFUNCTION 427

47 Hemodynamic Manifestations of Ischemic Right-Heart Dysfunction 429
James A. Goldstein

SECTION II: CLINICAL AND BEDSIDE APPLICATIONS OF HEMODYNAMICS 437

48 Hemodynamic Evaluation of Dyspnea 445
James A. Goldstein

49 Bedside Evaluation of Low-Output Hypotension 449
James A. Goldstein

50 Hemodynamic Evaluation of Right-Heart Failure 455
James A. Goldstein

INDEX 459

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Bruce R. Hopkins is a senior partner with the firm Polsinelli Shughart PC. He is also the author or coauthor of more than twenty-five books, all published by Wiley, including The Law of Tax-Exempt Organizations, Ninth Edition; The New Form 990; and Nonprofit Law Made Easy. Hopkins earned his juris doctorate and master of laws degrees at The George Washington University. He has practiced law for forty years and is a member of the District of Columbia and Missouri bars.

Virginia C. Gross is a shareholder of Polsinelli Shughart PC. Ms. Gross concentrates her practice in the field of nonprofit law and is a frequent writer and speaker on nonprofit issues. She is listed in The Best Lawyers in America for nonprofit organizations/charity law for 2008 and 2009. She is a coauthor of The New Form 990, published by Wiley. Ms. Gross earned her juris doctorate at the University of Texas. She is a member of the District of Columbia, Texas, Missouri, and Kansas bars.

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