Patients with known or suspected cardiac disease undergoing general surgery present a common management problem. Anesthesia and surgery are often associated with marked fluctuations of heart rate and blood pressure, changes in…

Penetrating wounds to the heart are, of course, usually lethal unless surgically repaired. Stab wounds to the right ventricle occasionally lead to hemopericardium without progressing to tamponade. The clinical result may be constrictive pericarditis,…

Introduction
Essentials of Diagnosis

• Symptoms and signs of chronic bronchitis and pulmonary emphysema.
• Elevated jugular venous pressure, parasternal lift, edema, hepatomegaly, ascites.
• ECG shows tall, peaked…

The heart may be involved in a number of systemic syndromes. Many of these have been mentioned briefly in prior subsections of this chapter. The pericardium, myocardium, heart valves, and coronary…

Primary cardiac tumors are rare and constitute only a small fraction of all tumors that involve the heart or pericardium. Metastases from malignant tumors elsewhere are more frequent. Tumors involving the heart…

Inflammation can lead to a thickened, fibrotic, adherent pericardium that restricts diastolic filling and produces chronically elevated venous pressures. In the past, tuberculosis was the most common cause of constrictive pericarditis, but the process now…

Primary pulmonary hypertension is defined as pulmonary hypertension and elevated pulmonary vascular resistance in the absence of other disease of the lungs or heart. Pathologically, it is characterized by diffuse narrowing of the pulmonary…

Introduction
Pericardial effusion can develop during any of the processes discussed in the preceding paragraphs. The speed of accumulation determines the physiologic importance of the effusion. Because the pericardium stretches, large effusions (>…

The pericardium consists of two layers: the inner visceral layer, which is attached to the epicardium, and an outer parietal layer. The pericardium stabilizes the heart in anatomic position and reduces contact between the heart…

Acute Myocarditis

A. Case Management, Diet, and Exercise Training
Thirty to 50 percent of congestive heart failure patients who are hospitalized will be readmitted within 3-6 months. Strategies to prevent clinical deterioration,…

A. Symptoms
The symptoms of cardiac failure have been discussed in part in earlier sections. The most common complaint is shortness of breath, chiefly exertional dyspnea at first and then progressing…

The treatment of chronic heart failure is discussed here. Acute heart failure and pulmonary edema are discussed in the next section.

A. Correction of Reversible Causes
The major reversible causes…

Introduction
Acute coronary syndromes comprise the spectrum of unstable cardiac ischemia from unstable angina to acute myocardial infarction. Rather than the traditional nomenclature of unstable angina, non-Q wave and Q wave myocardial…