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1

Association, American Heart, ed. The AHA clinical cardiac consult. 3rd ed. Wolters Kluwer Health/Lippincott Williams & Wilkins, 2011.

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E, Willner Allen, ed. Cerebral damage before and after cardiac surgery. Kluwer Academic Publishers, 1993.

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Shaibani, Aziz. Dyspnea. Oxford University Press, 2015. http://dx.doi.org/10.1093/med/9780199898152.003.0009.

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The most common causes of dyspnea are not neuromuscular but rather are cardiac and pulmonary. However, dyspnea is an important and serious manifestation of many neuromuscular disorders, and it may compound an underlying pulmonary or cardiac problem. The diaphragm is a skeletal muscle under the control ofperipheral nerves(phrenic nerves) and may be targeted by inflammatory neuropathies such as Guillain-Barrésyndrome(GBS), chronic inflammatory demyelinating polyneuropathy(CIDP), and brachial plexitis, myopathies such as acid maltase deficiency and muscular dystrophies, and neuromuscular disorder
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Hagendorff, Andreas, Elie Chammas, and Mohammed Rafique Essop. Diseases with a main influence on heart valves. Oxford University Press, 2016. http://dx.doi.org/10.1093/med/9780198726012.003.0058.

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The high spatial and temporal resolution, widespread availability, and non-invasive nature of echocardiography make it the imaging modality of choice for assessment of cardiac valvular disease. Echocardiography allows not only detailed evaluation of valve morphology, but also makes possible assessment of the haemodynamic consequences and impact on left and right ventricular size and function. Based on this data, a more informed decision may be made on the nature and timing of surgical or percutaneous intervention. A wide variety of diseases may afflict the cardiac valves. In some such as rheum
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Hagendorff, Andreas, and Laura Ernande. Diseases with a main influence on pericardium. Oxford University Press, 2016. http://dx.doi.org/10.1093/med/9780198726012.003.0059.

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The high spatial and temporal resolution, widespread availability, and non-invasive nature of echocardiography make it the imaging modality of choice for assessment of cardiac valvular disease. Echocardiography allows not only detailed evaluation of valve morphology, but also makes possible assessment of the haemodynamic consequences and impact on left and right ventricular size and function. Based on this data, a more informed decision may be made on the nature and timing of surgical or percutaneous intervention. A wide variety of diseases may afflict the cardiac valves. In some such as rheum
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Shaibani, Aziz. Dyspnea. Oxford University Press, 2018. http://dx.doi.org/10.1093/med/9780190661304.003.0009.

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The most common causes of dyspnea are not neuromuscular, but rather cardiac and pulmonary. However, dyspnea is an important and serious manifestation of many neuromuscular disorders, and it may compound an underlying pulmonary or cardiac problem. The diaphragm is a skeletal muscle under the control of a peripheral nerve and may be targeted by inflammatory neuropathies such as Guillain-Barré syndrome (GBS), chronic inflammatory demyelinating polyneuropathy (CIDP), and brachial plexitis or myopathies such as acid maltase deficiency, muscular dystrophy (MD), and neuromuscular disorders such as my
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Andrade, Maria João, Jadranka Separovic Hanzevacki, and Ricardo Ronderos. Cardiac tumours. Oxford University Press, 2016. http://dx.doi.org/10.1093/med/9780198726012.003.0052.

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Transthoracic and transoesophageal echocardiography represent the first-line diagnostic tools for imaging space-occupying lesions of the heart. Cardiac masses can be classified as tumours, thrombi, vegetations, iatrogenic material, or normal variants. Occasionally, extracardiac masses may compress the heart and create a mass effect. Cardiac masses may be suspected from the clinical presentation. This is the case in patients with an embolic event presumed to be of cardiac origin or in patients with infective endocarditis. Otherwise, a cardiac mass can be identified during the routine investigat
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Galderisi, Maurizio, Juan Carlos Plana, Thor Edvardsen, Vitantonio Di Bello, and Patrizio Lancellotti. Cardiac oncology. Oxford University Press, 2016. http://dx.doi.org/10.1093/med/9780198726012.003.0064.

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Cancer therapeutics may induce cardiac damage in the left and the right ventricle. Radiotherapy most frequently induces valvular damage, carotid stenosis, and coronary artery disease. Pericardial disease may be due to both chemo- and radiotherapy. The manifestations of both chemo- and radiotherapy can develop acutely but also become overt years after their performance, in particular after radiotherapy. The main cardiac damage of cancer therapeutics-related cardiac dysfunction (CTRCD) corresponds to the reduction of left ventricular (LV) systolic function. The Expert Consensus document from ASE
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Mebazaa, Alexandre, and Mervyn Singer. Pathophysiology and causes of cardiac failure. Oxford University Press, 2016. http://dx.doi.org/10.1093/med/9780199600830.003.0151.

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Organ congestion upstream of the dysfunctional left and/or right ventricle, with preserved stroke volume, is the most frequkeywordent feature of myocardial failure.Clinical manifestations do not necessarily correlate with the degree of left ventricular systolic dysfunction (i.e. left ventricular ejection fraction).Systolic and/or diastolic dysfunction may be present, with systolic dysfunction usually predominating.Pulmonary oedema is related to left ventricular diastolic dysfunction. Compensatory mechanisms (within the heart and/or periphery) may prove paradoxically disadvantageous on ventricu
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Arntz, Hans-Richard. Sudden cardiac death: epidemiology and prevention. Oxford University Press, 2015. http://dx.doi.org/10.1093/med/9780199687039.003.0005.

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Even if sudden cardiac death is considered to be the most frequent cause of death in adults in industrialized countries, its incidence varies widely, depending on the definition and the source and quality of underlying data. It is estimated that about 70-80% of cases are due to coronary heart disease. The remaining 20% are attributable to a wide variety of inborn, genetically determined or acquired diseases, including a small group with hitherto undefined background. Prevention primarily encompasses the treatment of cardiovascular risk factors to avoid manifestations of coronary heart disease.
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Benyounes, Nadia, Mauro Pepi, Roberta Esposito, Carmen Ginghina, and Ariel Cohen. Cardiac masses and potential sources of emboli. Oxford University Press, 2016. http://dx.doi.org/10.1093/med/9780198726012.003.0051.

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Cardiac masses are abnormal structures within or immediately adjacent to the heart. They have to be distinguished from variants of normal cardiac structures, postoperative changes, and ultrasound artefacts. These abnormal masses may be localized in the left or right heart cavities, with different clinical manifestations according to their localization. Among the abnormal cardiac masses (thrombus, vegetations, tumours), tumours are not discussed in this chapter. Echocardiography is the main but not the only imaging technique for the evaluation of cardiac masses, and is largely available. Hence,
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Klarich, Kyle W. The Heart and Systemic Disease, Pregnancy and Heart Disease, and Miscellaneous Cardiac Disorders. Oxford University Press, 2012. http://dx.doi.org/10.1093/med/9780199755691.003.0047.

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Many systemic diseases may have manifestations in the heart. This section describes those that are most likely to be included on the examination: hyperthyroidism, hypothyroidism, diabetes mellitus, amyloidosis, hemochromatosis, carcinoid disease, systemic lupus erythematosus, hypereosinophilic syndrome, scleroderma, and rheumatoid arthritis, among others, are included. Sections on pericardial disease, tumors of the heart, and valve diseases are covered. Physiologic changes of the heart in pregnancy and their effect on existing heart disease are also reviewed.
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Shah, Aali. Hypomagnesemia/Hypermagnesemia. Edited by Matthew D. McEvoy and Cory M. Furse. Oxford University Press, 2017. http://dx.doi.org/10.1093/med/9780190226459.003.0039.

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Hypomagnesemia is a relatively common electrolyte abnormality that may produce little to no significant clinical manifestations in patients. Commonly used medications such as proton-pump inhibitors and antidepressants can cause magnesium deficiency. The primary cardiac effect of hypomagnesemia is a prolongation of the Q-T interval. It is exposure to other drugs in the perioperative period and physiologic changes caused by anesthesia and surgery that can further alter cardiac electrophysiology and lead to serious ventricular dysrhythmias. Hypermagnesemia is generally iatrogenic from excessive i
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Thorne, Sara, and Sarah Bowater. Cyanosis. Oxford University Press, 2017. http://dx.doi.org/10.1093/med/9780198759959.003.0007.

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This chapter explores cyanosis in ACHD, including examples of cyanotic congenital defects, non-cardiac manifestations of cyanosis, and management of common emergencies in cyanotic heart disease. It also presents a checklist for inpatients with cyanotic heart disease.
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Thorne, Sara, and Paul Clift, eds. The Eisenmenger syndrome. Oxford University Press, 2011. http://dx.doi.org/10.1093/med/9780199228188.003.0016.

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Introduction 114Natural history 114Complications and extra-cardiac manifestations 114Physical signs 114Investigations 116Management 116Large communication between the systemic and pulmonary circulations at atrial, ventricular, or arterial level: → high pulmonary blood flow (L-to-R shunt);→ development of high pulmonary vascular resistance;...
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Thorne, Sara, and Paul Clift, eds. Cyanosis. Oxford University Press, 2011. http://dx.doi.org/10.1093/med/9780199228188.003.0006.

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Introduction 58Non-cardiac manifestations of cyanosis 60Checklist for inpatients and emergencies with cyanotic heart disease 62Cyanosis is only present where there is a R-to-L shunt. The shunt may be anywhere e.g. intracardiac, between great vessels, intrapulmonary. Cyanosis is usually clinically detectable at SaO...
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17

Chang, Yonmee, and Andrew J. Matisoff. Williams-Beuren Syndrome. Edited by Kirk Lalwani, Ira Todd Cohen, Ellen Y. Choi, and Vidya T. Raman. Oxford University Press, 2018. http://dx.doi.org/10.1093/med/9780190685157.003.0011.

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Williams-Beuren syndrome, also known as Williams syndrome (WS) is a genetic disorder involving the elastin gene on chromosome 7q11.23. Elastin is important for elasticity of vascular walls, and its deficiency can lead to widespread arteriopathy, most notably supravalvar aortic stenosis of the ascending aorta and coronary artery stenosis. Because of these cardiac defects, patients with WS are at high risk for cardiac arrest under anesthesia with a documented incidence around 5%. Appropriate perioperative management of all anesthetics includes a multidisciplinary approach to risk stratification,
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Miller, Aaron E., and Teresa M. DeAngelis. Dermatomyositis. Oxford University Press, 2013. http://dx.doi.org/10.1093/med/9780199732920.003.0020.

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Dermatomyositis (DM) is not purely a disorder of muscle and skin, but may affect multiple organs with cardiac, pulmonary, and gastrointestinal features. In this chapter, we review the clinical manifestations of DM as well as its occurrence as a paraneoplastic phenonomenon. In addition, we discuss the diagnostic modalities and outline therapeutic recommendations.
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Andrade, M. J. Tumours and masses. Oxford University Press, 2011. http://dx.doi.org/10.1093/med/9780199599639.003.0022.

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Transthoracic and transoesophageal echocardiography is the first-line diagnostic tool for imaging space-occupying lesions of the heart. Cardiac masses can be classified as tumours, thrombi, vegetations, iatrogenic material, or normal variants. Occasionally, extracardiac masses may compress the heart and create a mass effect. Cardiac masses may be suspected from the clinical presentation. This is the case in patients with an embolic event presumed of cardiac origin or in patients with infective endocarditis. Otherwise, a cardiac mass can be identified during the routine investigation of common,
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20

Nixon, J. V. (Ian), Gerard P. Aurigemma, Ann F. Bolger, Bernard R. Chaitman, and Joseph S. Alpert. The The AHA 5-Minute Clinical Cardiac Consult (The 5-Minute Consult Series). 2nd ed. Lippincott Williams & Wilkins, 2006.

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Khanna, Ashish K., and Piyush Mathur. Bariatric Surgery and Acute Cardiovascular Complications in the ICU. Edited by Tomasz Rogula, Philip Schauer, and Tammy Fouse. Oxford University Press, 2018. http://dx.doi.org/10.1093/med/9780190608347.003.0019.

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The increased numbers of bariatric surgical procedures worldwide have translated into a higher number of postoperative intensive care unit (ICU) admissions. The pathophysiologic perturbations in obesity mean that a large fraction of bariatric surgical patients have both diagnosed and undiagnosed underlying coronary artery disease, hypertension, cardiac rhythm disturbances, and baseline cardiac dysfunction. Manifestations of cardiac complications in this patient population are usually extremely subtle, both intraoperatively under anesthesia and in the ICU during the immediate postoperative peri
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22

Schmidt, Jens. Extramuscular complications occurring in myositis. Edited by Hector Chinoy and Robert Cooper. Oxford University Press, 2018. http://dx.doi.org/10.1093/med/9780198754121.003.0004.

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Extra-muscular complications affecting patients suffering from the idiopathic inflammatory myopathies (IIM) are common, and appear in recognizable patterns affecting the skin, lungs, joints, oesophagus or heart, although these complications rarely all occur simultaneously. During the initial presentation of symptoms, involvement of organs other than muscle can aid the confirmation of the correct IIM subtype. Extra-muscular manifestations can be severe and life-threatening, e.g. with respiratory or cardiac involvement. Escalations of immunosuppression and other treatment modalities will likely
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Denton, Christopher P., and Pia Moinzadeh. Systemic sclerosis. Oxford University Press, 2013. http://dx.doi.org/10.1093/med/9780199642489.003.0121.

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The term 'scleroderma' describes a group of conditions in which the development of thickened, fibrotic skin is a cardinal feature. This includes localized forms of scleroderma (e.g. morphoea) and also systemic forms of the disease that are more correctly termed systemic sclerosis. Systemic sclerosis (SSc) is a multiorgan, autoimmune disease that has a high clinical burden and mortality, due to affecting the skin as well as internal organs. As with other related diseases there is a female predominance and marked clinical diversity. The pathogenesis of SSc is not fully elucidated; it includes en
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24

Karon, Barry L., and Naveen L. Pereira. Heart Failure and Cardiomyopathies. Oxford University Press, 2012. http://dx.doi.org/10.1093/med/9780199755691.003.0046.

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Heart failure is a clinical syndrome characterized by the inability of the heart to maintain adequate cardiac output to meet the metabolic demands of the body while still maintaining normal or near-normal ventricular filling pressures. Heart failure may be present at rest, but often it is present only during exertion as a result of the dynamic nature of cardiac demands. For correct treatment of heart failure, the mechanism, underlying cause, and any reversible precipitating factors must be identified. Typical manifestations of heart failure are dyspnea and fatigue that limit activity tolerance
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Keogh, Karina A. Vasculitis in the critically ill. Oxford University Press, 2016. http://dx.doi.org/10.1093/med/9780199600830.003.0277.

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The vasculitic syndromes are a heterogeneous group of rare disorders characterized by degrees of inflammation and necrosis of blood vessels with a wide variety of clinical manifestations. Intensive care treatment is most commonly required for vasculitis involving small blood vessels, including capillaries. Involvement of these vessels in the lung causes alveolar haemorrhage, which may lead to respiratory failure. In the kidneys it may cause glomerulonephritis leading to renal failure. Severe cardiac, neurological, and gastrointestinal manifestions can also be seen. Non-vasculitic manifestation
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Patterson, Marc C. Congenital Disorders of Glycosylation. Oxford University Press, 2017. http://dx.doi.org/10.1093/med/9780199937837.003.0066.

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Congenital disorders of glycosylation (CDG) comprise a family of multisystem diseases in which N- and O-linked glycosylation and glypiation of a variety of proteins and lipids is deficient. The hypoglycosylation of multiple glycoconjugates impairs normal development of the brain (and other organs), and is associated with both episodic and chronic organ dysfunction. Developmental disorders; seizures; strokelike episodes (and stroke); hearing and visual loss; peripheral neuropathy; coagulopathy; and immune, liver, endocrine, cardiac, and cutaneous manifestations may occur in varying combinations
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Khamashta, Munther A., Graham R. V. Hughes, and Guillermo Ruiz-Irastorza. Anti-phospholipid antibody syndrome. Oxford University Press, 2013. http://dx.doi.org/10.1093/med/9780199642489.003.0120.

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The anti-phospholipid syndrome (APS) described almost 30 years ago, is now recognized as a major cause of deep vein thrombosis, stroke, and heart attacks in young people (<45 years of age). It is also the commonest treatable cause of recurrent miscarriages and a major cause of late fetal death. Other clinical manifestations are cardiac valvular disease, livedo reticularis, renal thrombotic microangiopathy, thrombocytopenia, haemolytic anaemia, epilepsy, and cognitive impairment. The presence of anti-phospholipid antibodies (aPL) has been closely related to the development of thrombosis and
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Khamashta, Munther A., Graham R. V. Hughes, and Guillermo Ruiz-Irastorza. Anti-phospholipid antibody syndrome. Oxford University Press, 2015. http://dx.doi.org/10.1093/med/9780199642489.003.0120_update_001.

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The anti-phospholipid syndrome (APS) described almost 30 years ago, is now recognized as a major cause of deep vein thrombosis, stroke, and heart attacks in young people (<45 years of age). It is also the commonest treatable cause of recurrent miscarriages and a major cause of late fetal death. Other clinical manifestations are cardiac valvular disease, livedo reticularis, renal thrombotic microangiopathy, thrombocytopenia, haemolytic anaemia, epilepsy, and cognitive impairment. The presence of anti-phospholipid antibodies (aPL) has been closely related to the development of thrombosis and
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Siebert, Stefan, Sengupta Raj, and Alexander Tsoukas. Complications of axial spondyloarthritis. Oxford University Press, 2016. http://dx.doi.org/10.1093/med/9780198755296.003.0009.

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In addition to the well-recognized extra-articular manifestations (EAMs) of ankylosing spondylitis (AS), this condition can also be associated with a number of clinically important complications. While EAMs are considered part of the spondyloarthritis (SpA), the complications are generally a consequence of having the disease. Patients with AS are at increased risk of osteoporosis and spinal fractures. The latter may occur after seemingly minor trauma and may lead to significant neurological compromise. Other potential neurological complications include atlantoaxial subluxation and compressive
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Manlapaz, Mariel, and Perin Kothari. Neuromuscular Disorders and Anesthesia. Edited by David E. Traul and Irene P. Osborn. Oxford University Press, 2018. http://dx.doi.org/10.1093/med/9780190850036.003.0029.

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The various neuromuscular diseases present with different airway, cardiovascular, pulmonary, and anesthetic considerations. It is useful to categorize these different diseases into nerve, neuromuscular junction, and primary muscle diseases. Understanding their pathophysiology is paramount in choosing the right anesthetic drugs (for example, depolarizing versus nondepolarizing and regional versus general anesthesia). Knowing their manifestations such as autonomic dysfunction, skeletal/cardiac/smooth/bulbar muscle involvement, or tendency for tonic contraction, allows for expectant perioperative
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Miller, Aaron E., and Teresa M. DeAngelis. Sjögren’s Syndrome. Oxford University Press, 2013. http://dx.doi.org/10.1093/med/9780199732920.003.0014.

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Primary Sjögren’s syndrome involves the cardinal siccal syndrome of xerostomia and xeroophthalmia. Neurological manifestations generally affect the peripheral nervous system in the form of neuropathy but can also target the central nervous system and overlap with demyelinating diseases such as multiple sclerosis and neuromyelitis optica. In this chapter, we review the systemic and neurologic features of Sjögren’s syndrome, and how to approach a patient with neurological symptoms secondary to Sjögren’s syndrome.
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Mannucci, Pier Mannuccio. Bleeding and haemostasis disorders. Oxford University Press, 2015. http://dx.doi.org/10.1093/med/9780199687039.003.0070.

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The main cause of haemostasis defects and related bleeding complications in patients with acute coronary syndromes admitted to the intensive cardiac care unit is the use of multiple antithrombotic drugs, alone or concomitantly with invasive procedures such as percutaneous coronary intervention with stent deployment and coronary artery bypass surgery. These drugs, that act upon several components of haemostasis (platelet function, coagulation, fibrinolysis), are associated with bleeding complications, particularly in elderly patients (more so in women than in men), those who are underweight, an
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Mannucci, Pier Mannuccio. Bleeding and haemostasis disorders. Oxford University Press, 2016. http://dx.doi.org/10.1093/med/9780199687039.003.0070_update_001.

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The main cause of haemostasis defects and related bleeding complications in patients with acute coronary syndromes admitted to the intensive cardiac care unit is the use of multiple antithrombotic drugs, alone or concomitantly with invasive procedures such as percutaneous coronary intervention with stent deployment and coronary artery bypass surgery. These drugs, that act upon several components of haemostasis (platelet function, coagulation, fibrinolysis), are associated with bleeding complications, particularly in elderly patients (more so in women than in men), those who are underweight, an
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Mannucci, Pier Mannuccio. Bleeding and haemostasis disorders. Oxford University Press, 2017. http://dx.doi.org/10.1093/med/9780199687039.003.0070_update_002.

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The main cause of haemostasis defects and related bleeding complications in patients with acute coronary syndromes admitted to the intensive cardiac care unit is the use of multiple antithrombotic drugs, alone or concomitantly with invasive procedures such as percutaneous coronary intervention with stent deployment and coronary artery bypass surgery. These drugs, that act upon several components of haemostasis (platelet function, coagulation, fibrinolysis), are associated with bleeding complications, particularly in elderly patients (more so in women than in men), those who are underweight, an
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van der Burg, Jorien M. M., N. Ahmad Aziz, and Maria Björkqvist. Peripheral Pathology. Oxford University Press, 2014. http://dx.doi.org/10.1093/med/9780199929146.003.0014.

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Clinicians and researchers have previously focused on the neurologic and psychiatric aspects of Huntington’s disease (HD). However, it is becoming evident that many neurodegenerative disorders are also complicated by pathology in tissues outside the brain. Although many clinical features of HD can be ascribed to neuronal loss and dysfunction, there is accumulating evidence indicating a role for the pathology of non-neuronal tissues in the disease process. Mutant huntingtin is expressed throughout the body and may induce pathology in parallel in both the brain and other organs. Insights into pe
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36

Rhodes, Ben, and Caroline Gordon. Clinical features of systemic lupus erythematosus. Oxford University Press, 2016. http://dx.doi.org/10.1093/med/9780198739180.003.0004.

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Systemic lupus erythematosus is characterized by diverse clinical features that reflect underlying multisystem inflammation. This chapter discusses the range of these clinical presentations, including common problems such as arthritis, serositis, and cutaneous lupus, along with rarer manifestations such as neuropsychiatric lupus, and gastrointestinal and cardiac disease. It highlights both the diagnostic features that are an essential part of disease classification, and also less specific, but common, clinical features such as fatigue. Recognized organ-specific classification systems for lupus
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Johnson, Nicholas J., and Judd E. Hollander. Management of cocaine poisoning. Oxford University Press, 2016. http://dx.doi.org/10.1093/med/9780199600830.003.0324.

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Cocaine is powerful central nervous system (CNS) stimulant derived from the coca plant. It affects the body via a number of mechanisms including blockade of fast sodium channels, increased catecholamine release, inhibition of catecholamine reuptake, and increased concentration of excitatory amino acid concentrations in the CNS. It is rapidly absorbed via the aerodigestive, respiratory, gastrointestinal, and genitourinary mucosa, and also may be injected. When injected intravenously or inhaled, cocaine is rapidly distributed throughout the body and CNS, with peak effects in 3–5 minutes. With na
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38

Goldsmith, David J. Cardiovascular disease and chronic kidney disease. Edited by David J. Goldsmith. Oxford University Press, 2015. http://dx.doi.org/10.1093/med/9780199592548.003.0098.

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Even after as full a statistical adjustment as can be made for traditional cardiovascular risk factors has been undertaken, impaired kidney function and raised concentrations of albumin in urine each increase the risk of cardiovascular disease (CVD) by two- to fourfold, the degree increasing with severity. If the patient is also suffering from diabetes (as either the cause of CKD or a complication of it), the risks of CVD increase two- to fourfold again. CKD patients should, therefore, be acknowledged as having perhaps the highest cardiovascular risk of any patient cohort. CVD is underdiagnose
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Luxon, Linda. Vertigo and imbalance. Oxford University Press, 2011. http://dx.doi.org/10.1093/med/9780198569381.003.0325.

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The mechanism for maintaining balance in man is complex. Vision, proprioception, and vestibular inputs are integrated in the central nervous system, and modulated by activity from the cerebellum, the extrapyramidal system, the reticular formation, and the cortex. This integrated, modulated information provides one mechanism for control of oculomotor activity, controls posture, gait, and motor skills and allows perception of the head and body in space. Recent evidence also supports an effect upon autonomic function, cognition, and emotion. The complexity of the system is such that pathology in
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