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eart disease affects persons of all ages and ethnicities
and remains the leading cause of death in developed
countries, including the United States. Heart disease
accounts for approximately 30% of deaths worldwide,
including nearly 40% in high-income countries and
approximately 28% in low- and middle-income coun-
tries.
1
Experts predict that heart disease will become
the leading cause of death worldwide by 2020 and
will surpass death rates from infectious diseases as a
result of economic advances, social structures, and
demographics.
1
In an attempt to focus on common health problems
that affect persons of all age groups, the chapter has
been organized into five sections: coronary artery dis-
ease, endocardial and valvular disorders, disorders of
the pericardium, cardiomyopathies, and heart disease in
infants and children.
Coronary Artery Disease
C
oronary artery disease
(CAD) describes heart disease
caused by impaired coronary blood flow. Diseases of
the coronary arteries can cause a spectrum of ischemic
disorders ranging from angina to myocardial infarction
(i.e., heart attack), as well as conduction defects, heart
failure, and sudden cardiac death.
Coronary Circulation
The coronary arteries and coronary veins comprise the
blood vessels of the heart that carry blood to and from
most of the myocardium (Fig. 19-1). The coronary ves-
sels lay across the surface of the heart and are embedded
in adipose tissue just under the epicardium.
There are two main coronary arteries, the left and the
right, which arise from the aortic sinus. The
left main
coronary artery
extends approximately 4 cm and then
divides into the left anterior descending and circumflex
branches.
2,3
The
left anterior descending artery
passes
through the groove between the two ventricles, giving
off diagonal branches, which supply the anterior wall of
the left ventricle, and perforating branches, which sup-
ply the anterior portion of the interventricular septum
H
Disorders of
Cardiac Function
19
C h a p t e r
Coronary Artery Disease
Coronary Circulation
Pathogenesis of Coronary Artery Disease
Plaque Disruption and Thrombus Formation
Acute Coronary Syndrome
Electrocardiographic Changes
Serum Biomarkers
Unstable Angina/Non–ST Elevation
Myocardial Infarction
ST Elevation Myocardial Infarction
Chronic Ischemic Heart Disease
Chronic Stable Angina
Silent Myocardial Ischemia
Variant (Vasospastic) Angina
Diagnosis and Treatment
Endocardial and Valvular Disorders
Disorders of the Endocardium
Infective Endocarditis
Rheumatic Heart Disease
Valvular Heart Disease
Hemodynamic Derangements
Mitral Valve Disorders
Aortic Valve Disorders
Diagnosis and Treatment
Disorders of the Pericardium
Acute Pericarditis
Pericardial Effusion
Cardiac Tamponade
Constrictive Pericarditis
Cardiomyopathies
Primary Cardiomyopathies
Hypertrophic Cardiomyopathy
Arrhythmogenic Right Ventricular Dysplasia
Dilated Cardiomyopathy
Primary Restrictive Cardiomyopathy
Myocarditis
Peripartum Cardiomyopathy
Stress or “Takotsubo” Cardiomyopathy
Secondary Cardiomyopathies
Heart Disease in Infants and Children
Fetal and Perinatal Circulation
Congenital Heart Defects
Shunting
Alterations in Pulmonary Blood Flow
General Manifestations, Diagnosis, and
Treatment
Types of Defects
Kawasaki Disease
Manifestations and Clinical Course
Diagnosis and Treatment
