Selected disorders of the cardiovascular system

Abstract

The prevalence of peripheral artery disease (PAD) increases with age from <5 % before age 60 to over 20 % after age 74 with over 80 % of PAD patients identified as current or former smokers (Hirsch et al., Circulation 113:e463-654, 2006). The primary importance in diagnosing PAD lies in its role in identifying patients at risk for CAD morbidity and mortality. Acute pericarditis is relatively common and accounts for 5 % of emergency room admissions for chest pain (Imazio, Curr Opin Cardiol 27(3):308-317, 2012). Initial management focuses on treating the underlying cause, if possible. Otherwise, most idiopathic or viral pericarditis resolves spontaneously or with simple, first-line treatment such as nonsteroidal anti-inflammatory drugs and colchicine (Little and Freeman, Circulation 113(12):1622-1632, 2006). Infectious endocarditis (IE) is an infection of the endocardial surface mainly due to bacteria but rarely may be caused by fungi and protozoa (Baddour et al., Circulation 111(23):e394-434, 2005). Untreated bacterial endocarditis (BE) is almost uniformly fatal; therefore, if BE is suspected, aggressive evaluation and treatment, to include early surgery in some cases, is essential (Murdoch et al., Arch Intern Med 169(5):463-473, 2009; Nishimura et al., J Am Coll Cardiol 63:e57-185, 2014). Primary cardiomyopathies are subdivided into three categories: genetic, mixed, and acquired (Maron et al., Circulation 113(14):1807-1816, 2006). Hypertrophic cardiomyopathy and myocarditis are addressed in detail with brief discussions of other cardiomyopathies to include arrhythmogenic right ventricular, dilated, primary restrictive nonhypertrophied, stress, peripartum, and tachycardia-induced (Wexler et al., Am Fam Physician 79(9):778-784, 2009; Gersh et al., Circulation 124:2761-2796, 2011; Basso et al., Lancet 373(9671):1289-1300, 2009; Sisakian, World J Cardiol 6(6):478-494, 2014; Felker et al., N Engl J Med 342(15):1077-1084, 2000; Canter and Simpson, Circulation 129(1):115-128, 2014; Cooper, N Engl J Med 360(15):1526-1538, 2009; Caforio et al., Eur Heart J 34(33):2636-2648. 2648a-2648d, 2013; Yancy et al., Circulation 128:e240-327, 2013). Pulmonary hypertension (PH) is a complex disease with multiple etiologies. Regardless of the underlying cause, it is defined by a mean pulmonary artery pressure >25 mmHg at rest measured by right heart catheterization (RHC) (Hoeper et al., J Am Coll Cardiol 62(25):D42-50, 2013). Treatment of PH focuses on management of the underlying disease process (Mandel and Poch, Ann Intern Med 158(9):ITC5-1-16, 2013).