Cardiology

Goal

Cardiology is the prevention, diagnosis, and management of disorders of the cardiovascular system, including ischemic heart disease, cardiac dysrhythmias, cardiomyopathies, valvular heart disease, pericarditis and myocarditis, endocarditis, congenital heart disease in adults, hypertension, and disorders of the veins, arteries, and pulmonary circulation. Management of risk factors for disease and early diagnosis and intervention for established disease are important elements of cardiology. The general internist should be able to provide primary and secondary preventive care and initially manage the full range of cardiovascular disorders.

Lead Faculty

VA Elective Service: Mark Starling, MD

UMMC Elective Service: Kim Eagle, MD

Coronary Intensive Care: Robert Cody, MD

Objectives

1

0

Patient Care and Medical Knowledge

1

A

Obtain a history and physical examination, and interpret laboratory data to diagnose cardiac disease in a wide variety of patients on other medical or surgical inpatient services.

1

B0

Evaluate and manage a wide range of cardiac disorders, including: ischemic heart disease, hypertensive heart disease, valvular heart disease, adult congenital heart disease, cardiac dysrhythmias, congestive heart failure management, cardiomyopathy assessment, and discuss the implications of systemic disease processes on the heart, endocarditis, the implications of vascular disorders, COPD and chronic renal failure on the heart.

1

B1

Arrhythmias

Describe the pathophysiology of recurrent ventricular and supraventricular arrhythmias.
Develop competence in the use of anti-dysrhythmic drugs to treat acute arrhythmias.

1

B2

Congestive Heart Failure

Describe the pathophysiology of pulmonary edema.
Integrate specific test results into the clinical presentation as developed from a history, physical examination, and laboratory data for patients with acute and chronic ischemic heart disease and congestive heart failure.
Discuss issues regarding the appropriate selection of medical therapy for congestive heart failure.
Clinically manage patients with pulmonary edema and low cardiac output.
Manage patients who have undergone cardiac transplantation or left ventricular assist device implantation.

1

B3

Coronary Artery Disease

Discuss the importance of risk-factor modification in primary and secondary prevention.
Describe the pathology, pathogenesis, and pathophysiology of acute ischemic syndromes, chronic ischemic heart disease, and congestive heart failure.
Discuss issues regarding the appropriate selection of medical therapy for ischemic syndromes.
Discuss the importance of medical therapy, percutaneous revascularization, and surgical therapy for the treatment of ischemic heart disease.

1

B4

Systemic Disease

Discuss the importance of co-morbid disease processes such as hypertension, diabetes, systemic disease, chronic obstructive pulmonary disease, and chronic renal failure on ischemic heart disease and heart failure diagnosis and management.

1

B5

Valvular Disease

Describe the pathophysiology of acute valvular disease, e.g. endocarditis.
Describe the pathophysiology and treatment of acute aortic dissection.
Manage patients with pulmonary hypertension.

1

B6

Describe the natural history of multiple cardiac disease processes and the importance of aging on these disease processes.

1

B6

Describe the pathophysiology and treatment of acute pericardial disease, including: tamponade and constriction.

1

B6

Develop an understanding of heart disease in women.

1

B6

Know the indications for medical and surgical therapy for cardiac complications of endocarditis, pericardial disease, aortic disease, peripheral vascular disease, cardiac trauma, and tumors.

1

C

Appropriately utilize electrocardiograms, echocardiograms, and exercise treadmill tests in planning for diagnostic and therapeutic decisions.

1

D

Describe the indications for electrophysiology, cardiac catheterization, intervention, and cardiac nuclear medicine studies in the evaluation and management of complex patients.

1

D

Develop competence in applying non-invasive pacing techniques.

1

D

Interpret clinical exercise stress tests in patients.

1

D

Interpret electrocardiograms.

1

E

 

3

0

Practice-based Learning and Improvement

3

A

Critically review cardiac clinical trial data in the medical literature.

3

A

Develop skills in presenting clear explanations of the current literature regarding the management of wide range of acute and chronic heart disease issues.

3

A

Utilize the current literature to make appropriate diagnostic and therapeutic plans.

3

E

 

4

0

Interpersonal and Communication Skills

4

A

Communicate with primary care and/or subspecialty physicians on their patient in the inpatient units about the patient’s course, the results of specific tests, the long-term follow-up plans, issues regarding risk-factor modification, and rehabilitation where appropriate.

4

A

Develop an appreciation of the necessary cooperation of the anesthesiologist and the surgeon in developing collective treatment goals for patients.

4

A

Develop an organized approach to the post-discharge treatment and communication regarding patients being seen in consultation.

4

C

Develop a working relationship with colleagues on non-cardiac services.

4

E

 

5

0

Professionalism

5

A

Develop interactive skills and professional attitudes towards surgery patients, their families, and their attending physicians.

5

E

 

6

0

Systems-based Practice

6

D

Develop experience with the triage of patients between the intensive care unit and cardiac telemetry units, as well as other units.

Teaching Methods

Teaching Rounds

Conferences

Evaluation

Learning goals are established with each intern, resident, and fellow by the attending at the beginning of the month. Formative face-to-face feedback to interns, residents, and fellows by attendings occur at mid-month.

Each month, the Cardiology attendings complete written evaluations of interns, residents, and fellows and these learners evaluate the Cardiology attendings. Interns, residents, and fellows evaluate the rotation informally through advisor meetings and contact with CMRs.

Resources

Aaronson KD, Mancini DM. Is percentage of predicted maximal exercise oxygen consumption a better predictor of survival than peak exercise oxygen consumption for patients with severe heart failure? [erratum appears in J Heart Lung Transplant 1996 Jan;15(1 Pt 1):106-7]. Journal of Heart & Lung Transplantation 14(5):981-9, 1995 Sep-Oct.

Aaronson KD, Schwartz JS, Chen TM, Wong KL, Goin JE, Mancini DM. Development and prospective validation of a clinical index to predict survival in ambulatory patients referred for cardiac transplant evaluation. Circulation 95(12):2660-7, 1997 Jun 17.

Acute Infarction Ramipril Efficacy (AIRE) Study Investigators Effect of Ramipril on Mortality and Morbidity of Survivors of Acute Myocardial Infarction with Clinical Evidence of Heart Failure. Lancet 1993; 3423:821-28

Allen J, Helling T, Hartzler G. Operative procedures not involving the heart after percutaneous transluminal coronary angioplasty. Surg Gynecol Obstet 1991; 173:285-28

Ambrosioni E et al: The Effect of the Angiotensin-Converting-Enzyme Inhibitor Zofenopril on Mortality and Morbidity After Anterior Myocardial Infarction. N Engl J Med 1995; 332:80-5

Andrews TC et al: Prevention of supraventricular arrhythmias after coronary bypass surgery, a meta-analysis of randomized control trials. Circulation 1991;84 (suppl lll) lll-235-244

Arnold AER et al: Recombinant Tissue-Type Plasminogen Activator and Immediate Angioplasty in Acute Myocardial Infarction Circulation 1992; 86:111-120

Arous EJ, Baum PL, Cutler BS: The ischemic exercise test in patients with peripheral vascular disease: Implications for management. Arch Surg 1984; 119:780.

Asenbaum S, et al: Post-operative neuropsychiatrische stoungen and durchgangsyndrome. Internist 1992; 33:425-31

Ashton CM, Peterson NJ, Wray NP, et al. The incidence of pre-operative myocardial infarction in men undergoing non-cardiac surgery. Ann Intern Med 1993; 118:504.

Baldwin, JC et al: Task Force 2: Donor Guidelines JACC Vol. 22 July 1993: 15-20

Bashore TM. Bates ER. Kern MJ. Berger PB. Laskey WK. Clark DA. O'Laughlin MP. Cusma JT. Oesterle S. Dehmer GJ. Popma JJ. American College of Cardiology/American Heart Association. American College of Cardiology/Society for Cardiac Angiography and Interventions clinical expert consensus document on cardiac catheterization laboratory standards: summary of a report of the American College of Cardiology Task Force on clinical expert consensus documents. Catheterization & Cardiovascular Interventions. 53(2):281-6, 2001

Bates ER. Ischemic complications after percutaneous transluminal coronary angioplasty. Am J of Med 108(4):309-16, 2000.

Bender JS, Smith-Meek MA, Jones CE. Routine pulmonary artery catheterization does not reduce morbidity and mortality of elective vascular surgery: results of a prospective randomized trial. Ann Surg 1997; 226:229-36; discussion 236-7.

Bittner, V et al. Prediction of Mortality and Morbidity with a 6-Minute Walk Test in Patients with Left Ventricular Dysfunction. JAMA 1993;270:1702-1707

Boersma E, Poldermans D, Box JJ et al. Predictors of cardiac events after major vascular surgery: role of clinical characteristics, dobutamine, echocardiography, and beta-blocker therapy. JAMA 2001;285:1865-73.

Boucher CA, Brewster DC, Darling RC et al: Determination of cardiac risk by dipyridamole-thallium imaging before peripheral vascular surgery. N Engl J Med 1985; 312:389.

Braitman LE. Confidence Intervals Assess Both Clinical Significance and Statistical Significance Annals of Internal Medicine 1991; 114:515-517

Breslow MJ, Jordan DA, Christopherson R, et al. Epidural morphine decreases postoperative hypertension by attenuating sympathetic nervous system hyperactivity. JAMA 1989; 261:3577.

Brown MM et al: Control of post-operative bleeding in the cardiac surgery patient. J Cardiovaasc Nurs 1993; 7:59-70

Brussel BL et al: Venous coronary artery bypass surgery, a 15 year follow-study. Circulation 1993; 88(part 2):87-92

Captopril Multicenter Research Group. A Placebo-Controlled Trial of Captopril in Refractory Chronic Congestive Heart Failure. J Am Coll Cardiol Vol 2 No 4 October 1993:775-63

The Cardiac Arrhythmia Suppression Trial Investigators Special Report Preliminary Report: Effect of Encainide and Flecainide on Morality in a Randomized Trial of Arrhythmia Suppression After Myocardial Infarction. N Engl J Med 1989;321:406-12

Cardiovascular Clinics, 1986, vol. 16, #3: Advances in Critical Care Cardiology. Ed. CE Rackley

Cardiovascular Clinics, 1991, vol. 21 #2: Care of the patient with previous coronary bypass surgery. Ed. DD Waters & MG Bourassa

Cardiovascular Clinics, 1992, vol. 22, #2: Geriatric Cardiology, Ed. DT Lwenthal

Carliner NH, Fisher ML, Plotnick GD, et al. Routine preoperative exercise testing in patients undergoing major non-cardiac surgery. Am J Cardiol 1985; 56:51.

Cigarroa CG, et al: Dobutamine stress echocardiography identifies hibernating myocardium and predicts recovery of left ventricular function after coronary revascularization. Circulation 1993; 88:430-436

Clark RE, Cardiopulmonary bypass and thyroid hormone metabolism. Ann Thorac Surg 1993; 56:S45-42

Cody RJ. Kubo SH. Pickworth KK. Diuretic treatment for the sodium retention of congestive heart failure. Arch Intern Med 154(17):1905-14, 1994 Sep 12.

Cohn, JN et al Effect of Vasodilator Therapy on Mortality in Chronic Congestive Heart Failure. N Engl J Med 1986; 314:1547-52

Coley CM, Fields TS, Abraham SA, et al. Usefulness of dipyridamole-thallium scanning for preoperative evaluation of cardiac risk for non-vascular surgery. Am J Cardiol 1992; 69:1280.

CONSENSUS Trial Study Group Effects of Enalapril in Mortality in Severe Congestive Heart Failure. N Engl J Med 1987; 316:1429-35

Coriat P, Daloz M, Bousseau D, etal. Prevention of intraoperative myocardial ischemia during noncardiac surgery with intravenous nitroglycerin. Anesthesiology 1984; 61:193-6.

Cox JL: A perspective of post-operative atrial fibrillation in cardiac operations. Ann Thorac Surg 1993; 56:S86-91

Creswell LL, et al: Hazards of post-operative atrial arrhythmias. Ann Thorac Surg 1993; 56:439-49

Cutler BS, Wheeler HB, Paraskos JA, et al. Applicability and interpretation of electrocardiographic stress testing in patients with peripheral vascular disease. Am J Surg 1981; 41:501.

Davila-Roman VG, Waggoner AD, Sicard GA, et al. Dobutamine stress echocardiography predicts surgical outcome in patients with an aortic aneurysm and peripheral vascular disease. J Am Coll Cardiol 1993; 21:957.

Detsky AS, Abrams HB, Forbath N, et al. Cardiac assessment for patients undergoing non-cardiac surgery: A multifactorial clinical risk index. Arch Inter Med 1986; 146:2131.

Dodds TM, Stone JG, Coromilas J, Weinberger M, Levy DG. Prophylactic nitroglycerin infusion during noncardiac surgery does not reduce perioperative ischemia. Anesth Analg 1993; 76:705-13.

Don, Burl R., M.D. et al. Pseudohy Perkalemia Caused by Fist Clenching During Phlebotomy. N Engl J Med 1991;325:1468-75

Dyke DB, Pagani FD, Aaronson KD. Circulatory assist devices-2000: an update. Congestive Heart Failure. 2000;6:259-271.

Eagle KA, Brundage BH, Chaitman BR, Ewy GA, Fleisher LA, Hertzer NR, et al. ACC/AHA Task Force Report Guidelines for Perioperative cardiovascular evaluation for non-cardiac surgery. Circulation 1996; 93 (in press).

Eagle KA, Coley CM, Newell JB, et al. Combining clinical and thallium data optimizes preoperative assessment of cardiac risk before major vascular surgery. Ann Inter Med 1989; 110:589.

Eagle KA, Rihal CS, Mickel MC, Holmes DR, Foster ED, Gersh BJ. Cardiac risk of noncardiac surgery: influence of coronary disease and type of surgery in 3368 operations. CASS Investigators and University of

Eagle KA, Singer DE, Brewster DC, et al. Dipyridamole-thallium scanning in patients undergoing vascular surgery. JAMA 1987; 257:2185.

Ellis JE, Drijvers G, Pedlow S, et al. Premedication with oral and transdermal clonidine provides safe and efficacious postoperative sympatholysis. Anesth Analg 1994; 79:1133-40.

Elmore J, Hallett J, Gibbons R, et al. Myocardial revascularization before abdominal aortic aneurysmorrhaphy: Effect of coronary angioplasty. Mayo Clin Proc 1993; 68:637-641.

Farnett et al: The J-curve phenomenon and the treatment of hypertension. Is there a point beyond which pressure reduction is dangerous? JAMA 1991; 265:489-495

Feldman, Arthur M., et al: Effects of Vesnarinone on Morbidity in Patients with Heart Failure N Engl J Med 1993; 329:149-55

Fleisher LA, Eagle K. Lowering cardiac risk in noncardiac surgery. N Engl J Med 2001;345:1677-1682.

Fleisher LA, Eagle KA, Shaffer T, Anderson GF. Perioperative- and long-term mortality rates after major vascular surgery: the relationship to preoperative testing in the medicare population. Anesth Analg 1999; 89:849-55.

Frankel, E.N. Inhibition of Oxidation of Human Low-Density Lipoprotein by Phenolic Substance in Red Wine. Lancet 1993;341:454-57

Friedman M, et al: Parameters of pulmonary injury after total or partial cardiopulmonary bypass. Circulation 1994; 90(Part 2):ll 262-268

Gerson MC, Hurst JM, Hetzberg VS, et al. Cardiac prognosis in non-cardiac geriatric surgery. Ann Intern Med 1985; 103:832.

Gibson, Robert S., M.D., et al: Diltiazem and Reinfarction in Patients with Non-Q-Wave Myocardial Infarction N Engl J Med 1986; 315:423-9

GISSI-2: A Factorial Randomized Trial of Alteplase Versus Steptokinas and Heparin Versus No Heparin Among 12 490 Patient with Acute Myocardial Infarction Lancet 1990; 336:65-71

GISSI-3 Effects of Lisinopril and Transdermal Glyceryl Trinitrate Singly and Together on 6-Week Mortality and Ventricular Function After Myocardial Infarction. Lancet 1994;343:1115-22

Godet G, Coriat P, Baron JF, et al. Prevention of intra-operative myocardial ischemia during non-cardiac surgery with intravenous diltiazem: A randomized trial versus placebo. Anesthesiology 1987; 66:241.

Goldman L, Caldera DL, Nussbaum SR, et al. Multifactorial index of cardiac risk in non-cardiac surgical problems. N Engl J Med 1977; 297:845.

Gottlieb A, Banoub M, Sprung J, Levy PJ, Beven M, Mascha EJ. Perioperative cardiovascular morbidity in patients with coronary artery disease undergoing vascular surgery after percutaneous transluminal coronary angioplasty. J Cardiothorac Vasc Anesth 1998; 12:501-6.

Grines, Cindy L., M.D., et al: A Comparison of Immediate Angioplasty with THOMBOLYTIC Therapy For Acute Myocardial Infarction N Engl J Med 1993; 328:673-9

GUSTO Investigators: The Effects of Tissue Plasminogen Activator, Streptokinase, or Both On Coronary Artery Patency, Ventricular Function, and Survival After Acute Myocardial Infarction N Engl J Med 1993; 329:1615-22

Hassan SA, Hlatky MA, Boothroyd D, Mark DB, Brooks MM, Eagle KA. Outcomes of non-cardiac surgery after coronary artery bypass surgery or coronary angioplasty in the Bypass Angioplasty Revascularization Investigation (BARI). Am J Med 2001;110:260-6

Hertzer NR, Even EG, Young JR, et al. Coronary artery disease in peripheral vascular patients: A classification of 1,000 coronary angiograms and results of surgical management. Ann Surg 1984; 199:223.

Hsia, Judith, M.D., et al: A Comparison Between Heparin and Low-Dose Aspirin as Adjunctive Therapy with Tissue Plasminogen Activator for Acute Myocardial Infarction Lancet 1990; 336:1433-7

Huber KC, Evans MA, Bresnaham JF, et al. Outcome of non-cardiac operations in patients with severe coronary artery disease successfully treated perioperatively with coronary angioplasty. Mayo Clinic Proc 1992; 67:15.

Hunnunghake, Donald B., M.D. et al. The Efficancy of Intensive Dietary Therapy Alone or Combined with Lovastatin in Outpatients with Hypercholesterolemia. N Engl J Med 1993;328:1213-9

Isaacson IJ, Lowdon JD, Berry AJ, et al. The value of pulmonary artery and central venous monitoring in patients undergoing abdominal aortic reconstructive surgery: a comparative study of two selected, randomized groups. J Vasc Surg 1990; 12:754-6

Jones M, et al: Antibiotic prophylaxis in surgery. NZ Med J 1993; 106:229-31

Kaluza GL, Lee JR, Raizner ME, Raizner AE. Catastrophic outcomes of noncardiac surgery soon after coronary stenting. J Am Coll Cardiol 2000; 35:1288-94.

Kannel, William B., M.D., et al: Incidence and Prognosis of Unrecognized Myocardial Infarction N Engl J Med 1984; 311:1144-7

Kazmers A, Cerqueira MD, Zierler E. The role of perioperative radionuclide left ventricular ejection fraction for risk assessment in carotid surgery. Arch Surg 1988; 123:416.

Ko W, et al: Survival analysis of octogenarian patients with coronary artery disease managed by elective coronary artery bypass surgery vs. conventional medical treatment. Circulation 1992; 86(Suppl ll): 191-197

Koelling TM, Cody RJ. Approach to the patient with hypotension and shock. In: Kelley’s Textbook of Internal Medicine. 3rd Edition Humes HD (ed). Lippincott Williams and Wilkins, Philadelphia. pp415-427, 2000

Kudenchuk, Peter J,. M.D. et al. Day-to-day Reproducibility of Antiarrhythmic Drug Trials Using Programmed Extrastimulus Techniques for Ventricular Tachyarrhythmias Associated with Coronary Arter Disease. Am J. Cardiol 1990;66:725-730

Lahey SJ, et al: Preoperative risk-factors that predict hospital length in coronary artery bypass grafting patients >60 years old. Circulation 1992; 86(Suppl ll): 181-185

Langan EM, Youkely JR, Franklin DP, et al. Dobutamine stress echocardiography for cardiac risk assessment before aortic surgery. J Vasc Surg 1993; 18:905.

Leslie J, et al: Treatment of post-operative hypertension after coronary artery bypass surgery. Circulation 1994; 90(Part ll): 256-261

Lette J, Waters D, Bernier H, et al. Perioperative and long-term cardiac risk assessment: predictive value of 23 clinical descriptors, 7 multivariate scoring systems, and quantitative dipyridamole imaging in 360 patients. Ann Surg 1992; 216:192.

L’Italien GJ, Cambria RP, Cutler BS, et al. Comparative early and late cardiac mortality among patients requiring different vascular procedures. J Vasc Surgery 1995; 21:935.

Lowenstein E.: Implications of triodothyronine administration before cardiac and non-cardiac operations. Ann Thorac Surg 1993; 56:S43-47.

Maggioni AP et al: The Risk of Stroke in Patients with Acute Myocardial Infarction After Thrombolytic and Antithrombolytic Treatment N Engl J Med 1992; 327:1-6

Mancini D. Katz S. Donchez L. Aaronson K. Coupling of hemodynamic measurements with oxygen consumption during exercise does not improve risk stratification in patients with heart failure. Circulation 94(10):2492-6, 1996 Nov 15.

Mandak JS. Aaronson KD. Mancini DM. Serial assessment of exercise capacity after heart transplantation. Journal of Heart & Lung Transplantation 14(3):468-78, 1995 May-Jun.

Mangano DT. Perioperative cardiac morbidity. Anesthesiology 1990; 72:153.

Mangano DT, Goldman L. Preoperative evaluation of patients with known or suspected coronary disease. N Engl J Med 1995;333:1750-6.

Mangano DT, Layug EL, Wallace A, Tateo I. Effect of atenolol on mortality and cardiovascular morbidity after noncardiac surgery. Multicenter Study of Perioperative Ischemia Research Group. N Engl J Med 1996; 335:1713-20.

Moscucci M. O'Connor GT. Ellis SG. Malenka DJ. Sievers J. Bates ER. Muller DW. Werns SW. Rogers EK. Karavite D. Eagle KA. Validation of risk adjustment models for in-hospital percutaneous transluminal coronary angioplasty mortality on an independent data set. J Am Coll Cardiol 34(3):692-7, 1999

Mudge, Gilbert H, M.D., et al: Task Force 3: Recipient Guidelines/Prioritization JACC Vol 22 July 1993:21-31

Nicklas, JM et al: Randomized, Double-blind, Placebo-Controlled Trial of Tissue Plasminogen Activator in

Nicklas, JM et al. Prospective, Double Blind, Placebo-Controlled Trial of Low-Dose Amiodarone in Patients with Severe Heart Failure Asymptomatic Frequent Ventricular Ectopy. Am Heart J 1991;122:1016

Oliver MF, Goldman L, Julian DG, Holme I. Effect of mivazerol on perioperative cardiac complications during non- cardiac surgery in patients with coronary heart disease: the European Mivazerol Trial (EMIT). Anesthesiology 1999; 91:951-61.

Packer, M et al. Effect of Oral Milrinone on Mortality in Severe Chronic Heart Failure. N Engl J Med 1991;325:1468-75

Packer, M et al. Withdrawal of Digoxin from Patients with Chronic Heart Failure Treated with Angiotension –Converting-Enzyme Inhibitors. N Engl J Med 1993;329:1-7

Packer M. Coats AJ. Fowler MB. Katus HA. Krum H. Mohacsi P. Rouleau JL. Tendera M. Castaigne A. Roecker EB. SchultzMK. DeMets DL. Carvedilol Prospective Randomized Cumulative Survival Study Group. Effect of carvedilol on survival in severe chronic heart failure. N Engl J Med 344(22):1651-8, 2001 May 31.

Packer M. Bristow MR. Cohn JN. Colucci WS. Fowler MB. Gilbert EM. Shusterman NH. The effect of carvedilol on morbidity and mortality in patients with chronic heart failure. U.S. Carvedilol Heart Failure Study Group. N Engl J Med 334(21):1349-55, 1996 May 23.

Palda VA, Detsky AS. Perioperative assessment and management of risk from coronary artery disease. Ann Intern Med 1997; 127:313-28.

Pasternack PF, Grossi EA, Baumann FG, et al. Beta blockade to decrease silent myocardial ischemia during peripheral vascular surgery. Am J Surg 1989; 158:113.

Paul SD, Eagle KA. A stepwise strategy for coronary risk assessment for non-cardiac surgery. Med Clinics N America 1995; 75:1241-1262.

Pfeffer, Marc A. et al Effect of Captopril on Mortality and Morbidity in Patients with Left Ventricular Dysfunction After Myocardial Infarction. N Engl J Med 1992; 327; 669-77

Pitt B, Poole-Wilson PA, Segal R, Martinez FA, Dickstein K, Camm AJ, Konstam MA, Riegger G, Klinger GH, Neaton J, Sharma D, Thiyagarajan B. Effect of losartan compared with captopril on mortality in patients with symptomatic heart failure: randomised trial--the Losartan Heart Failure Survival Study ELITE II. Lancet 355(9215):1582-7, 2000 May 6.

Pitt B, Zannad F, Remme WJ, Cody R, Castaigne A, Perez A, Palensky J, Wittes J. The effect of spironolactone on morbidity and mortality in patients with severe heart failure. Randomized Aldactone Evaluation Study Investigators. N Engl J Med 341(10):709-17, 1999 Sep 2.

Poldermans D, Fioretti PM, Forster T, et al. Dobutamine stress echocardiography for assessment of perioperative cardiac risk in patients undergoing major vascular surgery. Circulation 1993; 87:1506.

Poldermans D, Boersma E, Bax JJ, et al. The effect of bisoprolol on perioperative mortality and myocardial infarction in high-risk patients undergoing vascular surgery. Dutch Echocardiographic Cardiac Risk Evaluation Applying Stress Echocardiography Study Group. N Engl J Med 1999; 341:1789-94.

Posner KL, Van Norman GA, Chan V. Adverse cardiac outcomes after noncardiac surgery in patients with prior percutaneous transluminal coronary angioplasty. Anesth Analg 1999; 89:553-60.

Michigan Heart Care Program. Coronary Artery Surgery Study. Circulation 1997; 96:1882-7.

Pronovost PJ, Jenckes MW, Dorman T, et al. Organizational characteristics of intensive care units related to outcomes of abdominal aortic surgery. JAMA 1999; 281:1310-7.

Raby KE, Bary J, Creager MA, et al. Detection and significance of intra-operative and postoperative myocardial ischemia in peripheral vascular surgery. JAMA 1992; 268:222.

Renlund DG. Cardiac Transplantation. Chapter 101, Comprehensive Cardiovascular Medicine – Eric J Topol. Pages 2701-2723.

Reul GJ, Cooley DA, Duncan JM, et al. The effect of coronary bypass on the outcome of peripheral vascular operations in 1093 patients. J Vasc Surg 1986; 3:788.

Shabetai, R et al. The Hemodynamics of Cardiac Tamponade and Constructive Paricarditis. Am J of Cardiol 1970;26:480-9

Sherman CT et al: Coronary Angioscopy in Patients with Unstable Angina Pectoris N Eng J Med 1986; 315:913-9

SOLVD Investigator Effect of Enalapril on Survival in Patients with Reduced Left Ventricular Ejection Fractions and Congestive Heart Failure. N Engl J Med 1991;325:292-302

SOLVD Investigators Effect of Enalapril in Mortality and the Development of Heart Failure in Asymptomatic Patients with Reduced Left Ventricular Ejection Fractions. N Engl J Med 1992; 327:685-91

Steering Committee of The Physicians’ Health Study Research Group Special Report Preliminary Report: Finding from the Aspirin Component of the Ongoing Physician’s Health Study. N Engl J 1988;318:262-64

Steinback G et al. A Comparison of Electrophysiologically Guided Antiarrhythmic Drug Therapy with ¢ eta-Blocker Therapy in Patients with Symptomatic, Sustained Ventricular Tachyarrhymias. N Eng J Med 1992;327:987-92

Steingart, RM et al. Sex Difference in Management of Coronary Artery Disease. N Engl J Med 1991;325:226-30

Stevenson LW et al. Afterload Reduction with Vasociators and Diuretics Decreases Mitral Regurgitation During Upright Exercise in Advanced Heart Failure. J Am Coll Cardiol 1990;15:174-80

Stevenson LW et al. The Limited Reliability of Physical Signs for Estimating Hemodynamics in Chronic Heart Failure. JAMA 1989;261:884-888

Stone JG, Foex P, Sear JW, et al. Myocardial ischemia in untreated hypertensive patients: Effect of a single small oral dose of beta-adrenergic blocking agent. Anesthesiology 1988; 68:495.

Stuhmeier KD, Mainzer B, Cierpka J, Sandmann W, Tarnow J. Small, oral dose of clonidine reduces the incidence of intraoperative myocardial ischemia in patients having vascular surgery. Anesthesiology 1996; 85:706-12.

Swedberg, Karl, M.D. et al Effects of the Early Administration of Enalapril on Mortality in Patients with Acute Myocardial Infarction. N Engl J Med 1992; 327:678-84

Taylor, GJ et al. Importance of Prolonged Compression During Cardiopulmonary Resuscitation in Man. N Engl J. Med 296;26:1515-17

TIMI Study Group. Comparison of Invasive and Conservative Strategies After Treatment with Intravenous Tissue Plasinogen Activator in Acute Myocardial Infarction N Engl J Med 1989; 320:618-27

Valentine RJ, Duke ML, Inman MH, et al. Effectiveness of pulmonary artery catheters in aortic surgery: a randomized trial. J Vasc Surg 1998; 27:203-11; discussion 211-2.

Waagstein, F et al: Beneficial Effects of Metoprolol in Idiopathic Dialated Cardiomyopathy Lancet 1993; 342:1441-46

Wallace A, Layug B, Tateo I, et al. Prophylactic atenolol reduces postoperative myocardial ischemia. McSPI Research Group. Anesthesiology 1998; 88:7-17.

Wilcox, RG et al: Trial of early Nifedipline in Acute Myocardial Infarction: The Trnt Study Br Med J 1986; 293:203-8

Williams, DO. et al. The Effect of Intraaortic Balloon Counterpulsation on Regional Myocardial Blood Flow and Oxygen Consumption in the Presence of Coronary Artery Stenosis in Patients with Unstable Angina. Circulation 1982;66, No 3

Woods, KL et al: Intravenous Magnesium Sulphate in Suspected Acute Myocardial Infarction: Results of the Second Leicester Intravenous Magnesium Intervention Trial (LIMIT-2) Lancet 1992; 339:1553-58

Yusuf, S et al: Effect of Enalapril on Myocardial Infarction and Unstable Angina in Patients with Low Ejection Fractions. Lancet 1992; 340:1173-78

Schedule

 

Monday

Tuesday

Wednesday

Thursday

Friday

AM

7:00 Work Rounds

8:00 Morning Report

9:00 Work Rounds

7:00 Work Rounds

8:00 Morning Report

9:00 Work Rounds

7:00 Work Rounds

8:00 Morning Report

9:00 Work Rounds

7:00 Work Rounds

8:00 Morning Report

9:00 Work Rounds

7:00 Work Rounds

8:00 Morning Report

9:00 Work Rounds

PM

12:00 Noon Conference

2:00 Teaching Rounds

12:30 Intern Report

2:00 Teaching Rounds

12:00 Noon Conference

2:00 Teaching Rounds

12:00 Noon Conference

2:00 Teaching Rounds

12:00 Grand Rounds

2:00 Teaching Rounds