Porth's Essentials of Pathophysiology, 4e

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 Disorders of Cardiac Function 19 C h a p t e r H

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

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