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For technical assistance: email expertconsult.help@elsevier.com call 1-800-401-9962 (inside the US) call +1-314-447-8200 (outside the US) Use of the current edition of the electronic version of this book (eBook) is subject to the terms of the nontransferable, limited license granted on expertconsult.inkling.com Access to the eBook is limited to the first individual who redeems the PIN, located on the inside cover of this book, at expertconsult.inkling.com and may not be transferred to another party by resale, lending or other means Better Together Designed as companions to the bestselling Braunwald’s Heart Disease: A Textbook of Cardiovascular Medicine, the Braunwald suite includes titles covering everything from valvular heart disease to lipidology to hypertension, ensuring you’re equipped with all the cardiology resources you need for effective care Visit us.elsevierhealth.com/BraunwaldFamily to shop the entire collection today! The family that keeps families together NEW! NEW! EXPLORE the entire Braunwald family of resources! Heart Failure: A Companion to Braunwald’s Heart Disease, 3rd Edition Mann & Felker 978-1-4557-7237-7 Stay current with recent developments in the field, improved patient management strategies, and new drug therapies and implantable devices that will make a difference in your patients’ lives Diabetes in Cardiovascular Disease: A Companion to Braunwald’s Heart Disease McGuire 978-1-4557-5418-2 This interdisciplinary resource bridges the gap between the cardiology and endocrinology communities of scientists and care providers, and highlights the emerging scientific and clinical topics that are relevant for cardiologists, diabetologists/endocrinologists, and the extended diabetes care team Cardiovascular Intervention: Clinical Lipidology: Bhatt 978-0-323-26219-4 Ballantyne 978-0-323-28786-9 A Companion to Braunwald’s Heart Disease This reference contains focused chapters on how to utilize cutting-edge interventional technologies, with an emphasis on the latest protocols and standards of care Valvular Heart Disease: A Companion to Braunwald’s Heart Disease, 4th Edition Otto & Bonow 978-1-4557-4860-0 Give your patients the most accurate diagnoses, the best possible heart disease treatment options, and the expert care they deserve with this indispensable resource for your everyday practice Vascular Medicine: Hypertension: Creager, Beckman, & Loscalzo 978-1-4377-2930-6 Black & Elliott 978-1-4377-2766-1 A Companion to Braunwald’s Heart Disease, 2nd Edition Make the most of today’s innovative medical therapies, advances in vascular imaging, and new drugs to improve your patients’ cardiovascular health Acute Coronary Syndromes: A Companion to Braunwald’s Heart Disease, 2nd Edition Theroux 978-1-4160-4927-2 Dr Pierre Theroux and his team of expert contributors present advances in diagnostic and imaging techniques, such as biomarkers, nuclear cardiology, echocardiography, and multislice CT; secondary prevention; and new antiplatelet, anti-ischemic, and gene therapies A Companion to Braunwald’s Heart Disease, 2nd Edition This respected cardiology reference covers everything you need to know to effectively manage the chronic problems of your hypertensive patients Preventive Cardiology: A Companion to Braunwald’s Heart Disease Blumenthal, Foody & Wong 978-1-4377-1366-4 Address the prevention and risk stratification of cardiovascular disease so that you can delay the onset of disease and moderate the effects and complications Shop online at us.elsevierhealth.com/BraunwaldFamily A Companion to Braunwald’s Heart Disease, 2nd Edition From basic science to pathogenesis of atherothrombotic disease, this reference offers unparalleled coverage and expert guidance on lipidology in a straightforward, accessible, and user-friendly style Cardiovascular Therapeutics : A Companion to Braunwald’s Heart Disease, 4th Edition Antman 978-1-4557-0101-8 Manage cardiovascular problems more effectively with this comprehensive resource, which addresses pharmacological, interventional, and surgical management approaches for each type of cardiovascular disease Clinical Arrhythmology and Electrophysiology: A Companion to Braunwald’s Heart Disease, 2nd Edition Issa, Miller, & Zipes 978-1-4557-1274-8 With its unique, singular focus on the clinical aspect of cardiac arrhythmias, this title makes it easy to apply today’s most up-to-date guidelines for diagnosis and treatment Mechanical Circulatory Support: A Companion to Braunwald’s Heart Disease Kormos & Miller 978-1-4160-6001-7 Access the clinically relevant information you need to effectively use this therapy to treat and manage end-stage cardiovascular disease BRAUNWALD’S HEART DISEASE REVIEW AND ASSESSMENT This page intentionally left blank BRAUNWALD’S HEART DISEASE REVIEW AND ASSESSMENT 10TH EDITION Leonard S Lilly, MD Professor of Medicine Harvard Medical School Chief, Brigham and Women’s/Faulkner Cardiology Brigham and Women’s Hospital Boston, Massachusetts 1600 John F Kennedy Blvd Ste 1800 Philadelphia, PA 19103-2899 BRAUNWALD’S HEART DISEASE REVIEW AND ASSESSMENT, TENTH EDITION  ISBN: 978-0-323-34134-9 Copyright © 2016 by Elsevier, Inc All rights reserved No part of this publication may be reproduced or transmitted in any form or by any means, electronic or mechanical, including photocopying, recording, or any information storage and retrieval system, without permission in writing from the publisher Details on how to seek permission, and further information about the Publisher’s permissions policies and our arrangements with organizations such as the Copyright Clearance Center and the Copyright Licensing Agency can be found at our website: www.elsevier.com/permissions This book and the individual contributions contained in it are protected under copyright by the Publisher (other than as may be noted herein) Notices Knowledge and best practice in this field are constantly changing As new research and experience broaden our understanding, changes in research methods, professional practices, or medical treatment may become necessary Practitioners and researchers must always rely on their own experience and knowledge in evaluating and using any information, methods, compounds, or experiments described herein In using such information or methods they should be mindful of their own safety and the safety of others, including parties for whom they have a professional responsibility With respect to any drug or pharmaceutical products identified, readers are advised to check the most current information provided (i) on procedures featured or (ii) by the manufacturer of each product to be administered, to verify the recommended dose or formula, the method and duration of administration, and contraindications It is the responsibility of practitioners, relying on their own experience and knowledge of their patients, to make diagnoses, to determine dosages and the best treatment for each individual patient, and to take all appropriate safety precautions To the fullest extent of the law, neither the Publisher nor the authors, contributors, or editors assume any liability for any injury and/or damage to persons or property as a matter of products liability, negligence or otherwise, or from any use or operation of any methods, products, instructions, or ideas contained in the material herein Previous editions copyrighted 2012, 2008, 2006, 2001, 1997, 1992, and 1989 Library of Congress Cataloging-in-Publication Data Braunwald’s heart disease : review and assessment / [edited by] Leonard S Lilly.—Tenth edition    p ; cm   title: Heart disease review and assessment   “Study guide designed to accompany the tenth edition of Braunwald’s heart disease: a textbook of cardiovascular medicine, edited by Dr Douglas Mann, Dr Douglas Zipes, Dr Peter Libby, and Dr Robert Bonow”—Preface   Includes bibliographical references   ISBN 978-0-323-34134-9 (pbk : alk paper)   I.  Lilly, Leonard S., editor.  II.  Braunwald’s heart disease Tenth edition Guide to (work):  III.  Title: Heart disease review and assessment   [DNLM:  1.  Heart Diseases—Examination Questions.  WG 18.2]   RC669.2   616.1′20076—dc23    2015004713 Content Strategist: Dolores Meloni Content Development Specialist: Jennifer Ehlers Publishing Services Manager: Catherine Jackson Senior Project Manager: Rachel E McMullen Design Direction: Xiaopei Chen Printed in the United States of America Last digit is the print number:  9  8  7  6  5  4  3  2  Contributors Marc P Bonaca, MD Cardiovascular Division Brigham and Women’s Hospital Boston, Massachusetts Sections IV and V Fidencio Saldaña, MD Cardiovascular Division Brigham and Women’s Hospital Boston, Massachusetts Section IV Akshay Desai, MD Cardiovascular Division Brigham and Women’s Hospital Boston, Massachusetts Section II Victor Soukoulis, MD, PhD Division of Cardiovascular Medicine University of Virginia Charlottesville, Virginia Section I Neal K Lakdawala, MD Cardiovascular Division Brigham and Women’s Hospital Boston, Massachusetts Section III Garrick Stewart, MD Cardiovascular Division Brigham and Women’s Hospital Boston, Massachusetts Section II Bradley A Maron, MD Cardiovascular Division Brigham and Women’s Hospital; Department of Cardiology Boston VA Healthcare System Boston, Massachusetts Section IV Neil Wimmer, MD Cardiovascular Division Brigham and Women’s Hospital Boston Massachusetts Section III Amy Miller, MD, PhD Cardiovascular Division Brigham and Women’s Hospital Boston, Massachusetts Section I vii This page intentionally left blank 287 BIBLIOGRAPHY ANSWER TO QUESTION 651 C (Braunwald, pp 1905-1906; Fig 87-19) This patient presents with an acute subarachnoid hemorrhage and a markedly abnormal ECG Electrocardiographic abnormalities are present in approximately 70% of patients with subarachnoid hemorrhage and can include ST-segment elevation or depression, deep symmetric T wave inversions as in this patient, and a prolonged QT interval that can lead to torsades de pointes.1 The mechanism of cardiac and electrocardiographic abnormalities in acute brain injury likely relates to autonomic nervous system dysfunction and excessive myocardial catecholamine release.2 In this setting, myocardial damage can occur with release of cardiac biomarkers, without primary acute coronary plaque rupture or thrombus formation The magnitude of peak troponin elevation, but not the degree of electrocardiographic abnormality, is predictive of an adverse cardiac outcome Beta-blockers appear useful in minimizing myocardial damage and controlling arrhythmias in patients with subarachnoid hemorrhage REFERENCES Naidech AM, Kreiter KT, Janjua N, et al: Cardiac troponin elevation, cardiovascular morbidity, and outcome after subarachnoid hemorrhage Circulation 112:2851, 2005 Samuels MA: The brain-heart connection Circulation 116:77, 2007 ANSWER TO QUESTION 652 D (Braunwald, pp 1789-1791) It is generally safe and appropriate to continue most chronically administered cardiac medications up to the day of surgery and to resume them as soon as possible after the operation This is true of beta-blockers in patients with underlying coronary artery disease (or other indications for chronic beta-blocker use) and continuing such therapy perioperatively is a class I American College of Cardiology/American Heart Association guideline recommendation.1 However, there has been controversy about the role of initiating preoperative beta-blocker therapy for the purpose of risk reduction, as summarized in a recent systemic review.2 Conclusions from randomized clinical trials have varied, in part related to methodologic differences in the studies The evidence to date suggests that beta-blockers reduce the perioperative risk of cardiac events (ischemia, atrial fibrillation, need for coronary interventions), but can be associated with bradycardia, hypotension, and stroke, particularly if high doses or longacting preparations are initiated shortly before surgery.3 If initiation of preoperative beta-blocker therapy is planned, it should be started at least 2-7 days before surgery, to assess tolerability and safety, and to allow titration of the dosage if appropriate Thus, current guidelines consider the initiation of a beta-blocker without dose titration immediately before surgery (especially high-dose or long-acting forms) as potentially harmful, and should be avoided (class III indication).1 Although nitrates reduce intraoperative ischemia, cardiac outcomes are not affected Statins have anti-inflammatory and plaque-stabilizing properties, and studies in patients undergoing vascular surgery have demonstrated reduced cardiac event rates in patients on such therapy perioperatively.4 REFERENCES Fleisher LA, Fleischmann KE, Auerbach AD, et al: 2014 ACC/AHA guideline on perioperative cardiovascular evaluation and management of patients undergoing noncardiac surgery: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines Circulation 130:e278, 2014 Wijeysundera DN, Duncan D, Nkonde-Price C, et al: Perioperative beta blockade in noncardiac surgery: a systematic review for the 2014 ACC/AHA guideline on perioperative cardiovascular evaluation and management of patients undergoing noncardiac surgery: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines J Am Coll Cardiol 64:2406, 2014 Devereaux PJ, Yang H, Yusuf S, et al: Effects of extended-release metoprolol succinate in patients undergoing non-cardiac surgery (POISE trial): a randomised controlled trial Lancet 371:1839, 2008 Durazzo AE, Machado FS, Ikeoka DT, et al: Reduction in cardiovascular events after vascular surgery with atorvastatin: a randomized trial J Vasc Surg 39:967, 2004 ANSWER TO QUESTION 653 C (Braunwald, pp 1712-1713) Assessment of the heart’s normal aging process is difficult because of the high prevalence of cardiovascular disease in older individuals Studies in which coronary artery disease and other common cardiovascular conditions have been carefully excluded have revealed several pertinent findings First, there is moderate hypertrophy of left ventricular (LV) myocardial cells, probably in response to increased arterial stiffness and loss of cardiac myocyte number with age Although myocardial cells are unable to proliferate, they can increase in size as an adaptive response Despite alterations in contractile proteins leading to reductions in the velocity of contraction and lengthening of contraction and relaxation times, peak contractile force production is maintained at normal levels, and there appear to be no changes in cardiac output, stroke volume, or ejection fraction at rest with normal aging However, there are changes in beta-adrenoceptor–mediated inotropic and chronotropic cardiovascular responses with aging that result from generalized desensitization Thus, the maximal heart rate during exercise and other cardiovascular responses to exercises are blunted Among the cellular and molecular changes that occur with aging, endothelial production of nitric oxide (NO) decreases, likely reflecting a combination of decreased endothelial cell mass (increased cell senescence and apoptosis) and increased NO utilization because of elevated vascular superoxide anion production in older subjects BIBLIOGRAPHY Lakatta E, Wang M, Najjar S: Arterial aging and subclinical arterial disease are fundamentally intertwined at macroscopic and molecular levels Med Clin North Am 93:583, 2009 O’Rourke M, Hashimoto J: Mechanical factors in arterial aging: a clinical perspective J Am Coll Cardiol 50:1, 2007 Cardiovascular Disease in Special Populations; Cardiovascular Disease and Disorders of Other Organs Canto JG, Rogers WJ, Goldberg RJ, et al: Association of age and sex with myocardial infarction symptom presentation and in-hospital mortality JAMA 307:813, 2012 288 ANSWER TO QUESTION 654 CHAPTERS 76 TO 89 V D (Braunwald, p 1213) Deep sternal wound infection is among the most serious complications of cardiac surgery Approximately 1.4% of patients undergoing median sternotomy experience this adverse outcome Such patients present approximately weeks after surgery with fever, leukocytosis, bacteremia, discharge, and erythema at the wound site Risk factors for the development of mediastinal infection include a prolonged cardiopulmonary bypass time, excessive bleeding necessitating reexploration for hemostatic control, the use of both internal mammary arteries, and older age Atrial fibrillation is also a predictor of mediastinitis in patients undergoing coronary artery bypass grafting.1 Obesity is the most important risk factor for sternal dehiscence, whether or not infection is present The incidence of postoperative deep sternal wound infection appears to be decreasing.2 A significant contribution to this reduction is that the rate among diabetics has fallen from about 3.2% to about 1.0% over the past decade, possibly related to the introduction of perioperative intravenous insulin About half of deep sternal wound infections are caused by Staphylococcus species, whereas gram-negative organisms account for about 40% Confirmation of a sternal wound infection often requires surgical exploration and removal of material for Gram stain and culture Imaging techniques, including computed tomography or magnetic resonance imaging are helpful Intravenous antibiotics, with possible débridement and irrigation, may be required for prolonged periods Early diagnosis and initiation of treatment enhance the prognosis Mediastinal infections not seem to change patency rates of the bypass grafts themselves pulmonary veno-occlusive disease or impending left ventricular failure When oral calcium channel blockers are used to treat PAH, high doses are required to achieve full clinical benefit (e.g., amlodipine 20 to 30 mg/day, nifedipine 180 to 240 mg/ day, or diltiazem 720 to 960 mg/day) BIBLIOGRAPHY Galiè N, Corris PA, Frost A, et al: Updated treatment algorithm of pulmonary arterial hypertension J Am Coll Cardiol 62:D60, 2013 ANSWER TO QUESTION 656 C (Braunwald, pp 1912-1914, Fig 88-8) ANSWER TO QUESTION 655 Risk factors for contrast-induced acute kidney injury (CIAKI) include chronic renal insufficiency, diabetic nephropathy, intravascular volume depletion, renal artery stenosis, and concurrent use of agents that alter renal hemodynamics (e.g., angiotensin-converting enzyme inhibitors) The smallest possible volume of contrast agent should be used in patients with renal insufficiency, because the risk of nephrotoxicity is related to the amount injected At present, the intervention that has been demonstrated to consistently reduce the incidence of this complication in patients at risk is intravenous normal saline hydration before and after the procedure A randomized trial of IV isotonic sodium bicarbonate in elective coronary procedures showed no difference in post-procedure CI-AKI compared with IV saline, such that either could be used for hydration Several other agents have been evaluated for prevention of CI-AKI, including mannitol, calcium channel antagonists, dopamine, and atrial natriuretic peptide; however, none has been shown to reduce the risk of renal complications.1 It has been hypothesized that lower ionic strength contrast agents should reduce the incidence of contrast nephropathy Although that has not been demonstrated in patients with normal baseline renal function, the risk of contrast-induced nephropathy is reduced in patients with baseline renal insufficiency (with or without diabetes) if nonionic low-osmolar contrast medium is used Several small studies had suggested that oral administration of N-acetylcysteine, an antioxidant, can reduce the risk of CI-AKI; however, a large randomized trial did not confirm this benefit.2 C (Braunwald, p 1689) REFERENCES REFERENCES Elenbaas TW, Soliman Hamad MA, Schönberger JP, et al: Preoperative atrial fibrillation and elevated C-reactive protein levels as predictors of mediastinitis after coronary artery bypass grafting Ann Thorac Surg 89:704, 2010 Matros E, Aranki SF, Bayer LR, et al: Reduction in incidence of deep sternal wound infections: random or real? J Thorac Cardiovasc Surg 139:680, 2010 Cardiac catheterization plays an important role in patients with suspected pulmonary arterial hypertension (PAH), to confirm the diagnosis, establish the severity of disease, and determine prognosis Patients with PAH demonstrate a normal or low pulmonary capillary wedge pressure (PCWP), distinguishing PAH from pulmonary venous hypertension A vasodilator challenge during catheterization allows assessment of pulmonary vasoreactivity and helps to guide therapy Such a challenge can be accomplished with intravenous adenosine, intravenous epoprostenol, or inhaled nitric oxide A favorable acute effect of these vasodilators (i.e., >10 mm Hg decrease in mean PAP and/or >33% decrease in pulmonary vascular resistance) without adverse effects (e.g., a decline in cardiac output or systemic blood pressure, or a rise in PCWP) is predictive of a favorable response to oral calcium channel blockers An increase in PCWP during vasodilator testing would be consistent with James MT, Samuel SM, Manning MA, et al: Contrast-induced acute kidney injury and risk of adverse clinical outcomes after coronary angiography: a systematic review and meta-analysis Circ Cardiovasc Interv 6:37, 2013 ACT Investigators: Acetylcysteine for prevention of renal outcomes in patients undergoing coronary and peripheral vascular angiography: main results from the randomized Acetylcysteine for Contrastinduced nephropathy Trial (ACT) Circulation 124:11, 2011 ANSWER TO QUESTION 657 A (Braunwald, pp 1802-1803; Table 81-4) The major cardiovascular changes that occur in hypothyroidism include a reduction in cardiac contractility, an increase in systemic vascular resistance, and a slowing of the heart rate The decreased cardiac contractility and 289 BIBLIOGRAPHY Klein I: The cardiovascular system in hypothyroidism In Braverman LE, Cooper DS, editors: Werner & Ingbar’s the thyroid: a fundamental and clinical text, ed 10, Philadelphia, 2012, Lippincott, Williams & Wilkins, pp 575 Rodondi N, Bauer DC, Cappola AR: Subclinical thyroid dysfunction, cardiac function, and the risk of heart failure The Cardiovascular Health study J Am Coll Cardiol 52:1152, 2008 ANSWER TO QUESTION 658 C (Braunwald, pp 1282-1287, 1308; see also Answer to Question 67) Marfan syndrome, caused by mutations in the fibrillin gene (FBN1), is associated with significant morbidity and mortality from cardiovascular causes The most life-threatening complication is aortic dissection Patients with Marfan syndrome are predisposed to this complication because of aortic cystic medial degeneration, and such dissections usually commence just above the coronary ostia and may extend into the entire length of the aorta Beta-blockers limit aortic shear stress and are an important component of prevention Prospective studies have confirmed a slowing of aortic dilatation and reduced risk of dissection in patients treated with atenolol or propranolol For hypertensive patients, an angiotensin receptor blocker should also be considered, based on animal studies showing a beneficial effect at slowing progression of aortic enlargement, presumably through effects on TGF-β signaling The dimension of the proximal aorta can be followed serially by transthoracic echocardiography, computed tomography, or magnetic resonance imaging Prophylactic aortic root replacement is recommended in Marfan syndrome patients once the diameter approaches 5 cm to prevent dissection and progressive aortic regurgitation.1 Some groups recommend replacement even earlier, when the diameter is in the 4.5- to 5.0-cm range Aortic dissection is an unfortunate potential complication of pregnancy in Marfan syndrome, occurring most commonly between the third trimester and the first month postpartum The risk of dissection in this setting is related to the size of the aortic root and appears to be low in patients with root diameters of ≤4 cm.2 Progressive valvular impairments are also common in patients with Marfan syndrome The risk of severe aortic regurgitation increases as the diameter of the aortic root enlarges Mitral valve prolapse, associated with elongated and redundant leaflets, is detected in 60% to 80% of patients by echocardiography.3 Progression to severe mitral regurgitation occurs in up to 25% of patients REFERENCES Hiratzka LF, Bakris GL, Beckman JA, et al: 2010 guidelines for the diagnosis and management of patients with thoracic aortic disease: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines, American Association for Thoracic Surgery, American College of Radiology, American Stroke Association, Society of Cardiovascular Anesthesiologists, Society for Cardiovascular Angiography and Interventions, Society of Interventional Radiology, Society of Thoracic Surgeons, and Society for Vascular Medicine Circulation 121:e266, 2010 Goland S, Elkayam U: Cardiovascular problems in pregnant women with Marfan syndrome Circulation 119:619, 2009 Weyman AE, Scherrer-Crosbie M: Marfan syndrome and mitral valve prolapse J Clin Invest 114:1543, 2004 ANSWER TO QUESTION 659 B (Braunwald, p 1824) This patient has heparin-induced thrombocytopenia (HIT), of which there are two forms Type I HIT is the common, milder form that likely results from non–immune-mediated heparin-induced aggregation of platelets Platelet counts usually drop within days of therapy but rarely fall below 100,000/µL, and patients not often develop bleeding complications In the majority of such cases, heparin can be continued and the platelet count will improve Type II HIT, which has developed in the patient presented in this question, is the more dangerous form It produces more severe thrombocytopenia, with levels often 4 METS of activity) without stopping or experiencing anginal symptoms, most surgical procedures will be well tolerated and no additional preoperative cardiac testing is typically necessary Conversely, a patient who develops shortness of breath or chest discomfort with only minor exertion is at high risk for postoperative cardiac events and warrants additional cardiac testing, especially if more than a minor surgical procedure is planned Historically, the cardiac risk of noncardiac surgery in patients with prior myocardial infarction (MI) has related inversely to the length of time that has passed since the acute coronary event Studies from the 1970s concluded that purely elective surgery should be delayed for months after an MI to ensure that cardiovascular risk had returned to baseline In those studies, the risk of reinfarction or death was approximately 30% when patients were operated on within months of an MI, but only 5% when months had elapsed before the operation Later studies, in the era of careful perioperative monitoring, demonstrated much lower cardiac complication rates: about a 6% risk of reinfarction for operations performed within months of an MI and a 2% risk for operations performed within to months These historic risks are less relevant today in the era of early revascularization (mechanical or fibrinolytic) and aggressive postevent pharmacologic therapy for acute coronary syndromes (ACS) Current guidelines suggest that the highest risk of elective surgery for such patients is limited to the first 30 days after an ACS, as disrupted coronary plaque and myocardium heal BIBLIOGRAPHY Fleisher LA, Fleischmann KE, Auerbach AD, et  al: 2014 ACC/AHA guideline on perioperative cardiovascular evaluation and management of patients undergoing noncardiac surgery: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines Circulation 130:e278, 2014 Gupta PK, Gupta H, Sundaram A, et al: Development and validation of a risk calculator for prediction of cardiac risk after surgery Circulation 124:381, 2011 ANSWER TO QUESTION 669 C (Braunwald, pp 1762-1763; see also Answer to Question 636) The presentation of this patient is most consistent with peripartum cardiomyopathy This disorder is a form of dilated cardiomyopathy that manifests in the last trimester of pregnancy or in the early postpartum period.1 The etiology is unknown, and there are no diagnostic tests to confirm the diagnosis Its incidence is higher in women >the age of 30, in twin pregnancies, in multiparous women, and in African Americans The prognosis of this disorder is favorable compared with other forms of dilated cardiomyopathy, with 50% to 60% of patients showing marked improvement or complete recovery within months postpartum The remainder either stabilizes with reduced cardiac function or declines progressively, eventually requiring cardiac transplantation The predictors for a poor outcome include older age, higher parity, severe left ventricular dilatation, and onset of symptoms later after delivery There is a high risk of relapse of peripartum cardiomyopathy in subsequent pregnancies, and that risk appears to be greatest in women who have persistently impaired cardiac function 293 REFERENCE ANSWERS TO QUESTIONS 670 TO 674 670–E, 671–D, 672–B, 673–C, 674–A (Braunwald, pp 1846-1847, 1855, 1856, 1858) The spondyloarthropathies, including ankylosing spondylitis, Reiter syndrome, and psoriatic arthritis, have a predilection for arthritis of the sacroiliac and lumbosacral joints These diseases are associated with the histocompatibility antigen HLA-B27 and occur predominantly in men Ankylosing spondylitis is the most common of these syndromes to involve the heart and classically causes dilatation of the aortic valve ring with fibrous thickening and inflammation.1 The aorta in ankylosing spondylitis is histologically similar to that in syphilitic aortitis, including adventitial scarring, intimal proliferation, and narrowing of the vasa vasorum Aortic regurgitation results from thickening of the valvular cusps and dilatation of the aortic root.2 Conduction system disorders, due to fibrous infiltration in the atrioventricular node and the bundle of His, may be seen in ankylosing spondylitis as well Reiter syndrome is a form of nonpurulent, reactive arthritis that may follow enteric or urogenital infections It is frequently associated with uveitis/conjunctivitis and nongonococcal urethritis The cardiac complications of Reiter syndrome are similar to those of ankylosing spondylitis Cardiac abnormalities in patients with systemic sclerosis/ scleroderma often relate to systemic or pulmonary hypertension, but may also include myocardial fibrosis and contraction band necrosis, causing diastolic and/or systolic ventricular function Symptomatic pericarditis occurs in 7% to 20% of patients Conduction defects and thickening of the mitral and aortic valves may also occur.3 Giant cell arteritis predominantly causes inflammation of the aorta, its major branches, and coronary arteries Weakening of the vessels may lead to dilatation, aneurysm formation, and valvular insufficiency The vascular pathology often reveals granuloma formation Behỗet syndrome is a multisystem disorder highlighted by recurrent oral and genital ulcers and uveitis The ulcers are often painful and necrotic, and eye involvement occasionally progresses to blindness The etiology of the disease is unclear but appears to involve endothelial activation as a mediator of vascular inflammation Venous and arterial thrombosis may occur, as well as aneurysm formation of the large vessels Diffuse aortitis in Behỗet syndrome can lead to aortic root dilatation and valvular insufficiency.4 REFERENCES Bodnar N, Kerekes G, Seres I, et al: Assessment of subclinical vascular disease associated with ankylosing spondylitis J Rheumatol 38:723, 2011 Huffer LL, Furgerson JL: Aortic root dilatation with sinus of Valsalva and coronary artery aneurysms associated with ankylosing spondylitis Tex Heart Inst J 33:70, 2006 Steen V: The heart in systemic sclerosis Curr Rheumatol Rep 6:137, 2004 Tsui KL, Lee KW, Chan WK, et al: Behcet’s aortitis and aortic regurgitation: a report of two cases J Am Soc Echocardiogr 17:83, 2004 ANSWERS TO QUESTIONS 675 TO 678 675–C, 676–B, 677–D, 678–A (Braunwald, pp 688, 692, 961, 1821, 1824) Numerous cardiac medications can cause adverse effects For example, heparin can result in thrombocytopenia by two main mechanisms as described in the Answer to Question 659 A positive direct Coombs test is seen in up to 10% of patients who receive alpha-methyldopa, an antihypertensive that is sometimes used in pregnancy In these patients, IgG antibody is directed against the Rh complex of red cells Hemolysis may be severe but improves within several weeks after cessation of the medication The most common side effects of ticagrelor, a platelet P2Y12 receptor inhibitor, are bleeding, dyspnea (~15% of patients in the PLATO trial1), and ventricular pauses, which are typically asymptomatic Dyspnea, when present, usually occurs soon after initiating therapy and is self-limited The mechanism is unknown Procainamide may cause a syndrome resembling systemic lupus erythematosus (SLE) Symptoms consist of polyarthralgias, pleuritis, and photosensitive rashes Unlike conventional SLE, nephritis and central nervous system complications are very rare Patients with drug-induced lupus are antinuclear antibody (ANA) positive with antibodies to histones but rarely display hypocomplementemia or antibodies to DNA Discontinuation of procainamide typically results in improvement of symptoms within a few days to weeks However, ANA levels may remain elevated for years REFERENCE Storey RF, Becher RC, Harrington RA, et al: Characterization of dyspnoea in PLATO study patients treated with ticagrelor or clopidogrel and its association with clinical outcomes Eur Heart J 32:2945, 2011 ANSWERS TO QUESTIONS 679 TO 683 679–C, 680–A, 681–B, 682–B, 683–C (Braunwald, pp 1846-1849; see also Answers to Question 632 and Question 633) Takayasu arteritis, also termed pulseless disease, is of unknown etiology and is characterized by marked fibrous and degenerative scarring of the elastic fibers of the vascular media It most commonly involves the aorta and carotid arteries The disease is 10 times more common in women than in men, and in most patients onset occurs during the teen years.1 Patients typically present with malaise, weight loss, night sweats, arthralgias, pleuritic pain, anorexia, and fatigue Regardless of whether a patient goes through this initial phase, after a latent period symptoms and signs referable to the obliterative and inflammatory changes in affected blood vessels begin to appear These include diminished or absent pulses with claudication (upper extremities > lower extremities), hypertension (related to renal artery stenosis or increased vessel rigidity), and aortic root aneurysms with aortic regurgitation Common laboratory abnormalities include elevated sedimentation rate, low-grade leukocytosis, and normocytic anemia Treatment includes glucocorticoid therapy Patients Cardiovascular Disease in Special Populations; Cardiovascular Disease and Disorders of Other Organs Blauwet LA, Cooper LT: Diagnosis and management of peripartum cardiomyopathy Heart 97:1070, 2011 294 with refractory symptoms may respond to the addition of CHAPTERS 76 TO 89 V cyclophosphamide Recent studies have shown beneficial effects of tumor necrosis factor antagonists.2 Giant cell arteritis (GCA; also termed temporal arteritis) is a disease of unknown etiology characterized by granulomatous inflammation of large- to medium-caliber arteries with a special predilection for the vessels of the head and neck.3 It arises primarily in elderly people with a female predominance Clinically, the triad of severe headache, fever, and marked malaise characterizes the illness The headaches are often severe and are typically localized over involved temporal arteries Claudication of the jaw muscles during chewing is present in up to two thirds of patients Involvement of the ophthalmic artery leads to visual symptoms and may result in irreversible blindness The syndrome of polymyalgia rheumatica, consisting of diffuse muscular aching and stiffness, occurs in about 40% of patients with giant cell arteritis In a minority of cases, involvement of the aorta or its major branches may lead to symptoms and signs similar to those of Takayasu arteritis, although renal artery involvement is rare in GCA Patients with giant cell arteritis appear ill and are almost always febrile Affected vessels feel abnormal to palpation and are tender, allowing experienced examiners to make the diagnosis of temporal arteritis at the bedside by identifying an indurated, beaded, tender temporal artery Laboratory tests often reveal a very high sedimentation rate, normochromic, normocytic anemia, and elevated acutephase reactants Biopsy of an involved temporal artery confirms the diagnosis Management of giant cell arteritis includes early intervention with high-dose steroid therapy (60 to 80  mg of prednisone per day) followed by a gradual taper to a maintenance dose, which is typically continued for to years Early administration of steroid therapy is crucial to the prevention of involvement of the ophthalmic arteries and possible blindness REFERENCES Keenan NG, Mason JC, Maceira A, et al: Integrated cardiac and vascular assessment in Takayasu arteritis by cardiovascular magnetic resonance Arthritis Rheum 60:3501, 2009 Mason JC: Takayasu arteritis—advances in diagnosis and management Nat Rev Rheumatol 6:406, 2010 Weyand CM, Goronzy JJ: Medium and large vessel vasculitis N Engl J Med 349:160, 2003 ANSWERS TO QUESTIONS 684 TO 688 684–C, 685–A, 686–B, 687–D, 688–E (Braunwald, pp 1613-1617; Table 69-1) Several chemotherapeutic agents have potential cardiovascular toxicities The anthracyclines (e.g., doxorubicin, daunorubicin, and idarubicin) may cause acute cardiac effects (including atrial and ventricular arrhythmias and pericardial effusion) or more chronic impairment (dilated cardiomyopathy with congestive heart failure) As described in the Answer to Question 544, heart failure due to anthracycline therapy is dose related and develops more frequently when concurrent risk factors are present, including prior heart disease, radiation therapy exposure to the heart, and use of other cardiotoxic chemotherapeutic agents (e.g., trastuzumab, paclitaxel) Patients receiving 5-fluorouracil may experience acute chest pain and myocardial infarction during or immediately after infusion The mechanism of this adverse effect is unknown Cyclophosphamide and ifosfamide are alkylating agents that can cause an acute hemorrhagic myoperi­ carditis Interleukins, which are potent modulators of the immune system, are associated with capillary leak syndrome, hypotension, noncardiogenic pulmonary edema, and nephrotoxicity Sunitinib is a tyrosine kinase inhibitor that targets vascular endothelial cell growth factor receptors and is used to inhibit progression of renal cell carcinoma and gastrointestinal stromal tumors Hypertension is a common side effect, with marked elevation in blood pressure in 8% to 20% of patients BIBLIOGRAPHY Lal H, Kolaja KL, Force T: Cancer genetics and the cardiotoxicity of the therapeutics J Am Coll Cardiol 61:267, 2013 Senkus E, Jassem J: Cardiovascular effects of systemic cancer treatment Cancer Treat Rev 37:300, 2011 ANSWERS TO QUESTIONS 689 TO 693 689–C, 690–D, 691–E, 692–A, 693–B (Braunwald, pp 1795-1804) Endocrine disorders often have cardiovascular manifestations Excess thyroid hormone levels result in tachycardia, palpitations, and hypertension, often with a widened pulse pressure.1 Cardiac examination reveals a hyperdynamic impulse with an accentuated S1 Systolic murmurs are common, and a Means-Lerman scratch, a grating systolic sound at the upper left sternal border, may be auscultated during expiration The cardiovascular manifestations of hypothyroidism include bradycardia, diastolic hypertension with a narrowed pulse pressure, cardiomegaly with a reduced ejection fraction, and pericardial effusion, which only rarely results in tamponade physiology.1 Cushing syndrome is associated with accelerated atherosclerosis, likely related to hypertension and hyperglycemia in this condition Carney complex is a genetic syndrome that includes Cushing syndrome, cardiac myxomas, and pigmented dermal lesions This autosomal dominant syndrome arises most commonly from mutations in the PRKAR1A gene, which encodes a regulatory subunit of protein kinase A.2 Hyperaldosteronism is associated with excess aldosterone production from an adrenal or extra-adrenal source Hypertension, hypokalemia, and metabolic alkalosis are common findings.3 Many of the cardiac findings are nonspecific and are a consequence of the metabolic and electrolyte abnormalities For example, U waves and ventricular arrhythmias result from associated hypokalemia Parathyroid hormone has direct inotropic and chronotropic effects on the heart, likely due to increased myocyte calcium entry.4 Hypercalcemia associated with hyper­ parathyroidism may result in excess calcium deposition in the heart, hypertension, and shortening of the QT interval REFERENCES Klein I, Danzi S: Thyroid disease and the heart Circulation 116:1725, 2007 295 ANSWERS TO QUESTIONS 694 TO 697 694–B, 695–C, 696–D, 697–A (Braunwald, pp 1830-1832) Tissue-type plasminogen activator (tPA), the major physiologic activator of plasminogen, is both synthesized naturally by endothelial cells and produced commercially by recombinant DNA technology for the purpose of therapeutic fibrinolysis The protein is synthesized in a single-chain form, which is subsequently converted to a two-chain form by proteolytic cleavage of a single plasmin-sensitive site Both the single-chain and the two-chain forms have endogenous proteolytic activity The alpha chain of tPA is derived from the amino-terminal portion of single-chain tPA and contains a pair of finger-like structures referred to as “kringle” domains Lysine binding sites located on these domains confer binding specifically for fibrin As a result, tPA is a relatively fibrin-specific activator that converts plasminogen to plasmin two or three times more efficiently in the presence of fibrin The protease domain of tPA contains a proteolytic site responsible for this conversion This portion is homologous with other serine proteases, such as urokinase and trypsin Urokinase is a two-chain serine protease that is synthesized in both renal tubular epithelial cells and endothelial cells While urokinase converts plasminogen to plasmin by hydrolyzing the same bond as that acted on by tPA, the proteolytic activity of urokinase is not enhanced by the presence of fibrin Therefore, urokinase may activate circulating plasminogen as effectively as plasminogen absorbed onto fibrin thrombi Streptokinase is a single polypeptide chain of 414 amino acids that is produced by a strain of hemolytic streptococci Streptokinase does not cause thrombolysis by intrinsic enzymatic activity Instead, it activates the fibrinolytic system by combining with plasminogen to form a plasminogen activator complex that is then capable of converting plasminogen to plasmin Plasmin then degrades fibrin and other procoagulant proteins Many individuals have circulating antibodies to streptokinase as a result of previous streptococcal infections Therefore, a large dose of streptokinase is administered to neutralize these antibodies Antistreptococcal antibodies may remain high up to months after administration Tenecteplase is a genetically engineered mutant form of tPA that displays a prolonged half-life and increased fibrin specificity Unlike tPA, which requires a continuous infusion, tenecteplase is injected as a single intravenous bolus, which facilitates administration ANSWERS TO QUESTIONS 698 TO 702 698–A, 699–B, 700–D, 701–C, 702–A (Braunwald, pp 1822-1826) Unfractionated heparin (UFH) is a naturally occurring compound that acts in vivo by combining with antithrombin (an inhibitor of thrombin and factors X, IX, and XI) The conformational change that occurs in antithrombin allows for an accelerated interaction with the activated clotting factors, limiting thrombin generation and fibrin formation Commercial heparin is extracted from porcine intestinal mucosa and bovine lung and does not inactivate clot-bound thrombin or factor VII Heparin is not absorbed by the gastrointestinal tract and is therefore administered in intravenous or subcutaneous forms The bioavailability of subcutaneous injections of UFH is only 30% The activated partial thromboplastin time (aPTT) test is used to determine the inhibitory effect of UFH For acute thrombosis or embolism, intravenous heparin is administered with a goal aPTT of 1.5 to times the control value Subcutaneous UFH is often used for patients who require a lower level of anticoagulation Heparin therapy’s major complication is bleeding There is up to a 30% incidence of heparin-induced thrombocytopenia that may be associated with thromboembolic events and often resolves with discontinuation of the drug (see Answer to Question 659) In addition, heparin may cause osteoporosis, elevated liver enzymes, increased vascular permeability, alopecia, and hypoaldosteronism (and associated hyperkalemia) Low-molecular-weight heparin (LMWH) also produces an anticoagulant effect by binding to antithrombin However, in distinction to UFH, LMWH preferentially inhibits factor Xa more than thrombin LMWH formulations bind less with platelet factor 4, plasma proteins, and endothelial cells, and therefore have >90% bioavailability when administered by subcutaneous injection Other advantages of LMWH include a prolonged half-life and predictable anticoagulant responses (Table 5-6) Patients receiving LMWH not require serial laboratory monitoring to monitor the anticoagulant effect, except those with renal failure, extreme obesity, or pregnancy Heparin-induced thrombocytopenia can occur with LMWH but is less common than with UFH BIBLIOGRAPHY Garcia DA, Baglin TP, Weitz JL, et al: Parenteral anticoagulants: Antithrombotic Therapy and Prevention of Thrombosis, ed 9: American College of Chest Physicians Evidence-based Clinical Practie Guidelines Chest 141:e24S, 2012 TABLE 5-6  Advantages of Low-Molecular-Weight Heparin and Fondaparinux over Heparin ADVANTAGE CONSEQUENCE Better bioavailability and longer half-life after subcutaneous injection Can be given subcutaneously once or twice daily for both prophylaxis and treatment Dose-independent clearance Simplified dosing Predictable anticoagulant response Monitoring of coagulation is unnecessary in most patients BIBLIOGRAPHY Lower risk for HIT Longstaff C, William S, Thelwell C: Fibrin binding and the regulation of plasminogen activators during thrombolytic therapy Cardiovasc Hematol Agents Med Chem 6:212, 2008 Safer than heparin for short- or long-term administration Lower risk for osteoporosis Safer than heparin for long-term administration Cardiovascular Disease in Special Populations; Cardiovascular Disease and Disorders of Other Organs Vezzosi D, Vignaux O, Dupin N, et al: Carney complex: clinical and genetic 2010 update Ann Endocrinol 6:486, 2010 Stowasser M: Primary aldosteronism in 2011: towards a better understanding of causation and consequences Nat Rev Endocrinol 8:70, 2011 Andersson P, Rydberg E, Willenheimer R: Primary hyperparathyroidism and heart disease: a review Eur Heart J 25:1776, 2004 296 ANSWERS TO QUESTIONS 703 TO 706 CHAPTERS 76 TO 89 V 703–D, 704–B, 705–A, 706–C (Braunwald, pp 1844-1845, 1846-1847, 1853, 1854, 1856, 1858-1859; see also Answers to Questions 670 to 674) Rheumatologic disorders often involve the cardiovascular system and can result in pericardial, myocardial, valvular, or arterial abnormalities Aortic involvement is estimated to occur in 15% of patients with giant cell arteritis Inflammation often involves the proximal aorta and aortic valve cusps, resulting in dilatation of the vessel and aortic regurgitation.1 Other rheumatologic diseases that prominently involve the aorta include ankylosing spondylitis and psoriatic arthritis Valvular abnormalities are found by transesophageal echocardiography in 50% of patients with systemic lupus erythematosus.2 The most common involvement, termed Libman-Sacks endocarditis, represents noninfectious valve thickening, usually on the atrial side of the mitral valve and the arterial side of the aortic valve Over time, fibrosis may result in valvular insufficiency Much less commonly, the vegetations may occlude the valve orifice, causing stenosis Clinical manifestations of Libman-Sacks lesions, such as infective endocarditis or peripheral embolism, are rare.2 Although pulmonary hypertension can develop in many rheumatologic disorders, it is a particularly prominent feature of scleroderma and is one of the leading causes of morbidity and mortality in that condition.3 Behỗet disease typically results in inflammation of the thoracic aorta and branch vessels, leading to stenoses and aneurysmal dilatation of the subclavian and carotid arteries.4 Thoracic and abdominal aortic aneurysms may also result REFERENCES Weyand CM, Goronzy JJ: Medium and large vessel vasculitis N Engl J Med 349:160, 2003 Perez-Villa F, Font J, Azqueta M, et al: Severe valvular regurgitation and antiphospholipid antibodies in systemic lupus erythematosus: a prospective, long-term follow-up study Arthritis Rheum 53:460, 2005 McMahan ZH, Hummers LK: Systemic sclerosis—challenges for clinical practice Nat Rev Rheumatol 9:90, 2013 Ambrose NL, Haskard DO: Differential diagnosis and management of Behỗet syndrome Nat Rev Rheumatol 9:79, 2013 This page intentionally left blank This page intentionally left blank This page intentionally left blank This page intentionally left blank Smarter search Faster answers Smarter, Faster Search for Better Patient Care Unlike a conventional search engine, ClinicalKey is specifically designed to serve doctors by providing 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Visit ClinicalKey.com for more information and subscription options ... clinically relevant information you need to effectively use this therapy to treat and manage end-stage cardiovascular disease BRAUNWALD’S HEART DISEASE REVIEW AND ASSESSMENT This page intentionally... nuclear scintigraphy or echocardiography? A A 53-year-old woman with hypertension and left ventricular hypertrophy by echocardiography who has developed exertional chest pressure B A 74-year-old man... cm   title: Heart disease review and assessment   “Study guide designed to accompany the tenth edition of Braunwald’s heart disease: a textbook of cardiovascular medicine, edited by Dr Douglas

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  • Front cover

  • Inside front cover

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  • Braunwald's Heart Disease Review and Assessment

  • Copyright page

  • Contributors

  • Preface

  • Table of Contents

  • I (Chapters 1 to 20)

    • 1 Fundamentals of Cardiovascular Disease; Genetics and Personalized Medicine; Evaluation of the Patient

      • Directions:

      • Question 1

      • Question 2

      • Question 3

      • Question 4

      • Question 5

      • Question 6

      • Question 7

      • Question 8

      • Question 9

      • Question 10

      • Question 11

      • Question 12

      • Question 13

      • Question 14

      • Question 15

      • Question 16

      • Question 17

      • Question 18

      • Question 19

      • Question 20

      • Question 21

      • Question 22

      • Question 23

      • Question 24

      • Question 25

      • Question 26

      • Question 27

      • Question 28

      • Question 29

      • Question 30

      • Question 31

      • Question 32

      • Question 33

      • Question 34

      • Question 35

      • Question 36

      • Question 37

      • Question 38

      • Question 39

      • Question 40

      • Question 41

      • Question 42

      • Question 43

      • Question 44

      • Question 45

      • Question 46

      • Question 47

      • Question 48

      • Question 49

      • Question 50

      • Question 51

      • Question 52

      • Question 53

      • Question 54

      • Question 55

      • Question 56

      • Question 57

      • Question 58

      • Question 59

      • Question 60

      • Question 61

      • Question 62

      • Question 63

      • Question 64

      • Question 65

      • Question 66

      • Question 67

      • Question 68

      • Question 69

      • Question 70

      • Question 71

      • Question 72

      • Question 73

      • Question 74

      • Question 75

      • Question 76

      • Question 77

      • Question 78

      • Question 79

      • Question 80

      • Question 81

      • Question 82

      • Question 83

      • Question 84

      • Question 85

      • Question 86

      • Question 87

      • Question 88

      • Question 89

      • Question 90

      • Question 91

      • Question 92

      • Question 93

      • Question 94

      • Question 95

        • Directions:

      • Questions 96 to 100

      • Questions 101 to 104

      • Questions 105 to 109

      • Questions 110 to 113

      • Questions 114 to 117

      • Questions 118 to 121

      • Questions 122 to 125

      • Questions 126 to 129

      • Questions 130 to 133

      • Echocardiograms

        • Directions:

      • Electrocardiograms

        • Directions:

    • Fundamentals of Cardiovascular Disease; Genetics and Personalized Medicine; Evaluation of the Patient

      • Answer to Question 1

        • D (Braunwald, pp. 156, 161, 162)

        • Bibliography

      • Answer to Question 2

        • C (Braunwald, pp. 103-104; Figure 11-8)

      • Answer to Question 3

        • D (Braunwald, p. 35; Table 13-10)

      • Answer to Question 4

        • C (Braunwald, pp. 104-106; Tables 11-5 and 11-8)

      • Answer to Question 5

        • E (Braunwald, pp. 100-101)

        • Bibliography

      • Answer to Question 6

        • C (Braunwald, pp. 1640-1645; Figures 71-8 and 71-9)

        • References

      • Answer to Question 7

        • D (Braunwald, pp. 100, 104-105)

      • Answer to Question 8

        • B (Braunwald, pp. 118, 141-142, 149; Tables 12-1 and 12-9)

        • Bibliography

      • Answer to Question 9

        • C (Braunwald, pp. 76-77, 82; Tables 9-1 to 9-3)

        • References

      • Answer to Question 10

        • D (Braunwald, p. 156; Table 13-1)

        • References

      • Answer to Question 11

        • B (Braunwald, pp. 271-272, 279-280, 301; Figure 16-12)

        • Bibliography

      • Answer to Question 12

        • B (Braunwald, p. 103)

      • Answer to Question 13

        • D (Braunwald, pp. 162-163, 164, 165)

        • Bibliography

      • Answer to Question 14

        • C (Braunwald, pp. 165-166, 170; Tables 13-11, 13G-1, and 16G-1)

        • Bibliography

      • Answer to Question 15

        • D (Braunwald, pp. 366-367, 385, 1912-1914; Table 19-5)

        • Bibliography

      • Answer to Question 16

        • D (Braunwald, p. 118; Figures 12-38 and 12-40)

      • Answer to Question 17

        • C (Braunwald, pp. 183, 204-205)

        • Bibliography

      • Answer to Question 18

        • C (Braunwald, pp. 110-111, 204-205; Figures 11-9 and 14-31)

        • Bibliography

      • Answer to Question 19

        • D (Braunwald, pp. 146-148)

        • Reference

      • Answer to Question 20

        • E (Braunwald, pp. 165-166, 170; Table 13G-1; see also Answer to Question 14)

        • Bibliography

      • Answer to Question 21

        • C (Braunwald, pp. 135-136; Figure 12-28)

      • Answer to Question 22

        • C (Braunwald, pp. 104, 106; Table 11-5; Figure 11-10)

      • Answer to Question 23

        • D (Braunwald, pp. 98-99; Figures 11-2, 11-3)

      • Answer to Question 24

        • D (Braunwald, pp. 377-379; Figures 19-11 and 19-12)

      • Answer to Question 25

        • C (Braunwald, p. 192; Figures 14-17 and 14-18)

        • References

      • Answer to Question 26

        • D (Braunwald, pp. 184, 216-216, 1473; Figures 14-38, 14-39, 63-21)

      • Answer to Question 27

        • B (Braunwald, pp. 98, 183, 196, 233; Figure 14-76; Tables 14-8 and 14G-1)

        • Bibliography

      • Answer to Question 28

        • C (Braunwald, pp. 155-156, 160-161; Table 13-9)

        • Bibliography

      • Answer to Question 29

        • D (Braunwald, pp. 104-105, 1453, 1461-1462, 1473, 1484-1485, 1495; Table 11-6)

      • Answer to Question 30

        • C (Braunwald, p. 372, 1288-1302)

        • Bibliography

      • Answer to Question 31

        • D (Braunwald, pp. 162-164; Figure 13-3)

      • Answer to Question 32

        • C (Braunwald, pp. 121, 122-123, 129-130, 143; Table 12-5)

      • Answer to Question 33

        • D (Braunwald, pp. 155-156, 157-159, 162)

        • Bibliography

      • Answer to Question 34

        • D (Braunwald, pp. 95-96, 110-112, 1399, 1407-1409, 1411)

      • Answer to Question 35

        • B (Braunwald, pp. 136-143; Figure 12-35)

        • References

      • Answer to Question 36

        • C (Braunwald, pp. 272-274, 279, 282-283, 295-296, 305)

        • Bibliography

      • Answer to Question 37

        • C (Braunwald, pp. 163, 164; Table 13-24; see also Answer to Question 31)

      • Answer to Question 38

        • E (Braunwald, pp. 345-348)

        • Bibliography

      • Answer to Question 39

        • A (Braunwald, pp. 274-275, 276-279, 280, 298, 301; Figure 16-31)

        • Bibliography

      • Answer to Question 40

        • A (Braunwald, pp. 330-331)

        • Bibliography

      • Answer to Question 41

        • E (Braunwald, pp. 381-382)

      • Answer to Question 42

        • B (Braunwald, pp. 207-208, 1578-1582; Figure 14-33)

      • Answer to Question 43

        • C (Braunwald, pp. 226-228, 330-331, 1640-1642; Figures 71-8 and 71-9)

      • Answer to Question 44

        • E (Braunwald, pp. 280-283, 298, 299-300, 306-307, 310; Figure 16-12)

        • References

      • Answer to Question 45

        • B (Braunwald, pp. 324-326)

        • Bibliography

      • Answer to Question 46

        • B (Braunwald, pp. 217-219, 379, 1453; Figures 14-48, 14-49, and 19-13)

        • Bibliography

      • Answer to Question 47

        • C (Braunwald, pp. 381-382)

        • Bibliography

      • Answer to Question 48

        • C (Braunwald, pp. 161-165)

      • Answer to Question 49

        • C (Braunwald, pp. 104, 106; Table 11-6)

      • Answer to Question 50

        • B (Braunwald, pp. 95-96, 1057-1059; Table 50-1)

      • Answer to Question 51

        • E (Braunwald, pp. 160-162, 276-279)

      • Answer to Question 52

        • B (Braunwald, pp. 182-183, 217-220)

        • Bibliography

      • Answer to Question 53

        • B (Braunwald, pp. 97, 1397, 1399, 1414, 1461, 1528)

      • Answer to Question 54

        • D (Braunwald, pp. 769, 1431-1432; Figure 14-100)

        • Bibliography

      • Answer to Question 55

        • B (Braunwald, pp. 235-236, 1526-1527, 1531; Tables 64-5 and 64G-3)

        • Bibliography

      • Answer to Question 56

        • D (Braunwald, pp. 98-99, 100-101, 1579; Figures 11-2 and 11-5)

        • Bibliography

      • Answer to Question 57

        • C (Braunwald, pp. 366, 368-371, 385)

        • Reference

      • Answer to Question 58

        • A (Braunwald, pp. 155-156, 159-160, 171, 481)

        • Bibliography

      • Answer to Question 59

        • D (Braunwald, pp. 323-334, 1552, 1559)

        • Bibliography

      • Answer to Question 60

        • D (Braunwald, p. 35, 165-166)

      • Answer to Question 61

        • D (Braunwald, pp. 192-193, 207-208, 1574-1579)

        • Bibliography

      • Answer to Question 62

        • D (Braunwald, pp. 367-368; Figure 19-10; Table 19-4)

      • Answer to Question 63

        • E (Braunwald, pp. 102-106, 1579; Table 11-6)

      • Answer to Question 64

        • D (Braunwald, pp. 146, 1580; Figure 12-46)

      • Answer to Question 65

        • D (Braunwald, p. 104; Table 11-5; Figure 11-8)

      • Answer to Question 66

        • C (Braunwald, pp. 399-404, 408-412)

        • Bibliography

      • Answer to Question 67

        • E (Braunwald, p. 97; Table 57-2)

        • Bibliography

      • Answer to Question 68

        • A (Braunwald, pp. 214-216, 219-220, 1462-1463)

        • Bibliography

      • Answer to Question 69

        • C (Braunwald, pp. 290-292)

        • Bibliography

      • Answer to Question 70

        • B (Braunwald, pp. 102-105, 110)

        • Bibliography

      • Answer to Question 71

        • C (Braunwald, pp. 146, 697-698, 702-703, 756, 786, 788, 791, 797e.1)

      • Answer to Question 72

        • D (Braunwald, pp. 272-274, 284-286, 292-295, 301, 306-309)

        • References

      • Answer to Question 73

        • B (Braunwald, pp. 104-106, 111, 1452-1453, 1579; Figure 11-5)

      • Answer to Question 74

        • C (Braunwald, pp. 803-804)

        • References

      • Answer to Question 75

        • D (Braunwald, pp. 276-280, 288; see also Answer to Question 51)

        • Reference

      • Answer to Question 76

        • A (Braunwald, pp. 100-101; Figure 11-6)

      • Answer to Question 77

        • A (Braunwald, pp. 164, 169-170)

        • Bibliography

      • Answer to Question 78

        • D (Braunwald, pp. 103, 1495; Figures 11-7, 11-8, and 63-40; Table 11-6)

      • Answer to Question 79

        • D (Braunwald, pp. 129, 144, 1687; Table 12-45; Figure 12-20)

      • Answer to Question 80

        • C (Braunwald, pp. 184, 331, 381-382; see also Answer to Question #41)

      • Answer to Question 81

        • D (Braunwald, p. 129; Figure 12-19; Table 12-9)

      • Answer to Question 82

        • D (Braunwald, pp. 98-99, 207, 1578, 1585-1587; Figure 11-5)

      • Answer to Question 83

        • D (Braunwald, pp. 114-119)

      • Answer to Question 84

        • C (Braunwald, pp. 380-381)

      • Answer to Question 85

        • C (Braunwald, pp. 288-292; see also Answer to Question 69)

      • Answer to Question 86

        • B (Braunwald, p. 97, 1570)

        • Bibliography

      • Answer to Question 87

        • D (Braunwald, pp. 102-106, 1495; Figures 11-7 and 63-40; Table 11-6)

      • Answer to Question 88

        • E (Braunwald, pp. 115-147; Figure 12-40; see also Answer to Question 19)

      • Answer to Question 89

        • D (Braunwald, pp. 143-144; Table 12-10)

      • Answer to Question 90

        • B (Braunwald, pp. 160-164; Table 13G-2)

        • Bibliography

      • Answer to Question 91

        • A (Braunwald, pp. 181-184, 212-216, 1473-1474, 1485-1486)

      • Answer to Question 92

        • E (Braunwald, p. 47)

        • Bibliography

      • Answer to Question 93

        • B (Braunwald, pp. 831, 1574-1582)

        • Bibliography

      • Answer to Question 94

        • C (Braunwald, pp. 833, 1557-1560)

        • Bibliography

      • Answer to Question 95

        • C (Braunwald, pp. 739, 1526-1527, 1543-1544)

        • Bibliography

      • Answers to Questions 96 to 100

        • 96–A, 97–D, 98–B, 99–C, 100–D (Braunwald, pp. 96, 861-865; Table 40-4)

        • Bibliography

      • Answers to Questions 101 to 104

        • 101–B, 102–A, 103–D, 104–C (Braunwald, pp. 102-106, 112, 127-129, 130, 144, 145, 146-148; 1579-1580)

      • Answers to Questions 105 to 109

        • 105–A, 106–C, 107–B, 108–E, 109–D (Braunwald, pp. 396, 408-412)

      • Answers to Questions 110 to 113

        • 110–D, 111–B, 112–C, 113–A (Braunwald, pp. 208, 238, 327, 330, 333-334, 1557-1560, 1865; Figure 14-25)

        • References

      • Answers to Questions 114 to 117

        • 114–D, 115–A, 116–B, 117–C (Braunwald, pp. 193-195; Figures 14-17 and 14-18)

        • Bibliography

      • Answers to Questions 118 to 121

        • 118–A, 119–C, 120–D, 121–B (Braunwald, pp. 266-269, 1400, 1407-1409, 1463, 1474, 1642-1645; Figure 15-3)

      • Answers to Questions 122 to 125

        • 122–C, 123–A, 124–B, 125–D (Braunwald, pp. 121, 663, 753-756; Figure 37-4)

      • Answers to Questions 126 to 129

        • 126–B, 127–C, 128–A, 129–F (Braunwald, pp. 35, 165-166, 174-176, 276; Table 13-10; Figure 16-9)

        • Bibliography

      • Answers to Questions 130 to 133

        • 130–D, 131–A, 132–C, 133–B (Braunwald, pp. 133-135, 146-147, 1638-1639, 1687)

      • Answers to Questions 134 to 142

        • (Braunwald, Chapter 14)

      • Answers to Questions 143 to 167

  • II (Chapters 21 to 40)

    • 2 Heart Failure; Arrhythmias, Sudden Death, and Syncope

      • Directions:

      • Question 168

      • Question 169

      • Question 170

      • Question 171

      • Question 172

      • Question 173

      • Question 174

      • Question 175

      • Question 176

      • Question 177

      • Question 178

      • Question 179

      • Question 180

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      • Question 246

      • Question 247

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      • Question 249

      • Question 250

      • Question 251

      • Question 252

      • Question 253

      • Questions 254 to 257

      • Questions 258 to 261

      • Questions 262 to 265

      • Questions 266 to 269

      • Questions 270 to 273

      • Questions 274 to 277

      • Questions 278 to 282

      • Questions 283 to 286

      • Questions 287 to 290

      • Questions 291 to 294

    • Heart Failure; Arrhythmias, Sudden Death, and Syncope

      • Answer to Question 168

        • E (Braunwald, pp. 458, 478, 491; Figure 22-7, A)

        • References

      • Answer to Question 169

        • D (Braunwald, pp. 520-523; Figure 25-10; Table 25-7)

        • References

      • Answer to Question 170

        • E (Braunwald, pp. 491, 536, 547; Figure 24-5; Table 25-6)

        • References

      • Answer to Question 171

        • C (Braunwald, pp. 488, 495, 526; Figures 24-4, 25-5)

        • References

      • Answer to Question 172

        • B (Braunwald, pp. 527-532, 534)

        • References

      • Answer to Question 173

        • C (Braunwald, pp. 582-588)

        • References

      • Answer to Question 174

        • C (Braunwald, p. 476)

        • Bibliography

      • Answer to Question 175

        • E (Braunwald, p. 477)

        • References

      • Answer to Question 176

        • B (Braunwald, pp. 432-433, 443; Figures 21-5, 21-14)

        • Bibliography

      • Answer to Question 177

        • B (Braunwald, pp. 585-586; Table 28-3)

        • References

      • Answer to Question 178

        • E (Braunwald, pp. 447-448, 450, 481)

        • Reference

      • Answer to Question 179

        • A (Braunwald, p. 462; Figure 22-8)

      • Answer to Question 180

        • A (Braunwald, pp. 551-552)

        • References

      • Answer to Question 181

        • C (Braunwald, pp. 547-551)

        • References

      • Answer to Question 182

        • C (Braunwald, p. 494)

        • Bibliography

      • Answer to Question 183

        • D (Braunwald, pp. 475-476; Table 23-4)

      • Answer to Question 184

        • E (Braunwald, pp. 569-570; Figure 27-11)

        • References

      • Answer to Question 185

        • E (Braunwald, pp. 1598, 1600)

        • References

      • Answer to Question 186

        • D (Braunwald, pp. 592-594, 595-596)

        • References

      • Answer to Question 187

        • D (Braunwald, pp. 446-447; Figure 21-17)

      • Answer to Question 188

        • A (Braunwald, pp. 475-476; Table 23-3; see also Answer to Question 183)

      • Answer to Question 189

        • B (Braunwald, pp. 575-577, 581; Figures 28-3, 28-5)

        • References

      • Answer to Question 190

        • E (Braunwald, p. 534)

        • Bibliography

      • Answer to Question 191

        • C (Braunwald, p. 1118)

        • References

      • Answer to Question 192

        • C (Braunwald, pp. 595-596)

        • References

      • Answer to Question 193

        • D (Braunwald, p. 488; see also Answer to Question 171)

        • References

      • Answer to Question 194

        • D (Braunwald, pp. 547-551)

        • References

      • Answer to Question 195

        • C (Braunwald, pp. 486-487; Figure 24-2)

        • References

      • Answer to Question 196

        • B (Braunwald, pp. 475-476, 537)

        • References

      • Answer to Question 197

        • A (Braunwald, p. 367)

      • Answer to Question 198

        • B (Braunwald, p. 584)

        • Bibliography

      • Answer to Question 199

        • D (Braunwald, pp. 490, 493, 502, 503)

        • References

      • Answer to Question 200

        • C (Braunwald, pp. 454-457, 465; Figure 22-1)

        • References

      • Answer to Question 201

        • D (Braunwald, pp. 585-588)

        • References

      • Answer to Question 202

        • D (Braunwald, p. 595)

        • References

      • Answer to Question 203

        • A (Braunwald, pp. 527-530, 534, 535)

        • References

      • Answer to Question 204

        • B (Braunwald, p. 1603)

        • Bibliography

      • Answer to Question 205

        • C (Braunwald, pp. 760-761, 771-772)

      • Answer to Question 206

        • D (Braunwald, pp. 625, 781)

        • References

      • Answer to Question 207

        • E (Braunwald, pp. 551-552; see also Answer to Question 180)

        • References

      • Answer to Question 208

        • A (Braunwald, pp. 792-796)

      • Answer to Question 209

        • D (Braunwald, pp. 666-668)

        • Bibliography

      • Answer to Question 210

        • D (Braunwald, pp. 861-864)

        • Bibliography

      • Answer to Question 211

        • D (Braunwald, pp. 723-724, 727)

        • Bibliography

      • Answer to Question 212

        • D (Braunwald, p. 728; Figure 36-10)

      • Answer to Question 213

        • D (Braunwald, p. 801)

        • References

      • Answer to Question 214

        • D (Braunwald, pp. 690-692)

      • Answer to Question 215

        • B (Braunwald, pp. 670-674)

        • Bibliography

      • Answer to Question 216

        • B (Braunwald, p. 702; Table 35-4)

      • Answer to Question 217

        • B (Braunwald, pp. 808-810)

        • Bibliography

      • Answer to Question 218

        • D (Braunwald, pp. 802-805; Figure 38-6)

        • References

      • Answer to Question 219

        • D (Braunwald, pp. 801, 806)

        • References

      • Answer to Question 220

        • B (Braunwald, pp. 629-630, 639-641; Figure 33-16)

      • Answer to Question 221

        • E (Braunwald, pp. 698; Table 35-4)

        • Bibliography

      • Answer to Question 222

        • C (Braunwald, pp. 757-761, 773-774; Figures 37-8, 37-15)

      • Answer to Question 223

        • C (Braunwald, p. 781; Figure 37-30)

        • References

      • Answer to Question 224

        • E (Braunwald, pp. 697-700; Tables 35-1, 35-4)

      • Answer to Question 225

        • C (Braunwald, pp. 639-640; Figure 33-10)

      • Answer to Question 226

        • D (Braunwald, pp. 793-795; Figures 37-46, 37-47)

        • Bibliography

      • Answer to Question 227

        • D (Braunwald, pp. 774-777; Figure 37-28; Table 37-7)

      • Answer to Question 228

        • A (Braunwald, pp. 703-706; Table 35-4)

      • Answer to Question 229

        • C (Braunwald, pp. 782-784; Figure 37-33)

        • References

      • Answer to Question 230

        • C (Braunwald, pp. 773-776)

      • Answer to Question 231

        • C (Braunwald, p. 659)

      • Answer to Question 232

        • E (Braunwald, pp. 743-745; Tables 36G-1, 36G-2, 36G-3, 36G-4)

        • Bibliography

      • Answer to Question 233

        • B (Braunwald, pp. 647-651)

      • Answer to Question 234

        • D (Braunwald, p. 733; Table 36-4)

      • Answer to Question 235

        • D (Braunwald, pp. 790-792; Figures 37-41, 37-42)

        • Bibliography

      • Answer to Question 236

        • C (Braunwald, p. 781; Figure 37-30; Table 37-9)

        • References

      • Answer to Question 237

        • D (Braunwald, pp. 798-803; Figure 38-6; see also Answer to Question 218)

        • Bibliography

      • Answer to Question 238

        • B (Braunwald, pp. 699-700)

        • References

      • Answer to Question 239

        • B (Braunwald, pp. 763-770; Figures 37-14, 37-18)

      • Answer to Question 240

        • B (Braunwald, p. 784)

        • Bibliography

      • Answer to Question 241

        • D (Braunwald, pp. 822-829; Figure 39-5)

      • Answer to Question 242

        • D (Braunwald, pp. 702-703; 755-756)

      • Answer to Question 243

        • B (Braunwald, pp. 823, 825, 828-829, 849; Figure 39-8)

        • Bibliography

      • Answer to Question 244

        • D (Braunwald, pp. 670-673; Figures 34-8, 34-9)

        • Reference

      • Answer to Question 245

        • B (Braunwald, pp. 745-747; Table 36G-11; see also Answer to Question 207)

        • Bibliography

      • Answer to Question 246

        • C (Braunwald, pp. 727-731; Table 36-1; see also Answer to Question 211)

        • Bibliography

      • Answer to Question 247

        • D (Braunwald, pp. 733-734; Table 36-4)

      • Answer to Question 248

        • A (Braunwald, pp. 733-739)

      • Answer to Question 249

        • B (Braunwald, pp. 762-767; Table 37-4; Figures 37-14, 37-15)

        • Bibliography

      • Answer to Question 250

        • C (Braunwald, pp. 547-551; Table 26G-1)

        • References

      • Answer to Question 251

        • D (Braunwald, pp. 762-767)

        • Bibliography

      • Answer to Question 252

        • C (Braunwald, p. 700; Table 35-4)

      • Answer to Question 253

        • C (Braunwald, pp. 800-801)

        • Bibliography

      • Answers to Questions 254 to 257

        • 254–A, 255–D, 256–B, 257–C (Braunwald, pp.781-784; Table 37-10; see also Answers to Questions 206, 229, and 240)

        • Bibliography

      • Answers to Questions 258 to 261

        • 258–D, 259–B, 260–A, 261–C (Braunwald, pp. 685-701; Tables 35-1 and 35-5)

      • Answers to Questions 262 to 265

        • 262–B, 263–C, 264–C, 265–A (Braunwald, p. 807)

        • Bibliography

      • Answers to Questions 266 to 269

        • 266–C, 267–D, 268–A, 269–E (Braunwald, pp. 520-527; Figure 25-10; Table 25-7)

      • Answers to Questions 270 to 273

        • 270–D, 271–B, 272–C, 273–E (Braunwald, pp. 692-694; Table 45-2)

        • Bibliography

      • Answers to Questions 274 to 277

        • 274–D, 275–C, 276–A, 277–B (Braunwald, pp. 1557-1560, 1566-1568, 1598, 1600; Figures 65-4, 65-6)

        • Bibliography

      • Answers to Questions 278 to 282

        • 278–C, 279–B, 280–A, 281–D, 282–E (Braunwald, pp. 683-684; Tables 40-2 and 40-6)

        • Bibliography

      • Answers to Questions 283 to 286

        • 283–C, 284–E, 285–A, 286–B (Braunwald, pp. 475-476)

        • Bibliography

      • Answers to Questions 287 to 290

        • 287–A, 288–C, 289–B, 290–D (Braunwald, pp. 530-532)

      • Answers to Questions 291 to 294

        • 291–A, 292–C, 293–B, 294–B (Braunwald, pp. 463-464, 469; Figure 22-8)

  • III (Chapters 41 to 61)

    • 3 Preventive Cardiology; Atherosclerotic Cardiovascular Disease

      • Directions:

      • Question 295

      • Question 296

      • Question 297

      • Question 298

      • Question 299

      • Question 300

      • Question 301

      • Question 302

      • Question 303

      • Question 304

      • Question 305

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      • Question 311

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      • Question 330

      • Question 331

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      • Question 333

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      • Question 341

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      • Question 343

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      • Question 359

      • Question 360

      • Question 361

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      • Question 369

      • Question 370

      • Question 371

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      • Question 375

      • Question 376

      • Question 377

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      • Question 380

      • Question 381

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      • Question 383

      • Question 384

      • Question 385

      • Question 386

      • Question 387

      • Question 388

      • Question 389

      • Question 390

      • Question 391

      • Question 392

        • Directions:

      • Questions 393 to 396

      • Questions 397 to 400

      • Questions 401 to 405

      • Questions 406 to 409

      • Questions 410 to 414

      • Questions 415 to 419

      • Questions 420 to 423

      • Questions 424 to 427

      • Questions 428 to 431

      • Questions 432 to 435

    • Preventive Cardiology; Atherosclerotic Cardiovascular Disease

      • Answer to Question 295

        • D (Braunwald, pp. 993-995)

        • References

      • Answer to Question 296

        • C (Braunwald, pp. 953-956)

        • References

      • Answer to Question 297

        • C (Braunwald, pp. 947-948)

        • References

      • Answer to Question 298

        • B (Braunwald, pp. 946, 948)

        • References

      • Answer to Question 299

        • B (Braunwald, p. 945)

        • References

      • Answer to Question 300

        • B (Braunwald, p. 969)

        • Bibliography

      • Answer to Question 301

        • E (Braunwald, pp. 950, 1805)

        • Bibliography

      • Answer to Question 302

        • C (Braunwald, pp. 959, 961)

        • Reference

      • Answer to Question 303

        • B (Braunwald, p. 960)

        • References

      • Answer to Question 304

        • D (Braunwald, p. 993)

        • Bibliography

      • Answer to Question 305

        • D (Braunwald, pp. 991-992)

        • References

      • Answer to Question 306

        • B (Braunwald, pp. 987-988)

        • References

      • Answer to Question 307

        • C (Braunwald, p. 997)

        • References

      • Answer to Question 308

        • D (Braunwald, pp. 982, 989; Table 45-2)

        • References

      • Answer to Question 309

        • E (Braunwald, pp. 991-996)

        • References

      • Answer to Question 310

        • B (Braunwald, p. 989)

        • Bibliography

      • Answer to Question 311

        • B (Braunwald, pp. 996-997)

        • References

      • Answer to Question 312

        • C (Braunwald pp. 1155, 1163-1166, 1179; Fig. 53-7)

        • References

      • Answer to Question 313

        • C (Braunwald, pp. 1336-1342)

        • References

      • Answer to Question 314

        • D (Braunwald, p. 1630)

        • Reference

      • Answer to Question 315

        • D (Braunwald, pp. 893-894)

        • Reference

      • Answer to Question 316

        • D (Braunwald, pp. 1016-1017)

        • Reference

      • Answer to Question 317

        • E (Braunwald, p. 911)

        • References

      • Answer to Question 318

        • D (Braunwald, p. 902)

        • References

      • Answer to Question 319

        • D (Braunwald, p. 1025)

        • References

      • Answer to Question 320

        • C (Braunwald, pp. 1010, 1023)

        • References

      • Answer to Question 321

        • C (Braunwald, pp. 1098-1099, 1113, 1115-1119)

        • References

      • Answer to Question 322

        • A (Braunwald, pp. 988-989; Table 45-4)

        • Bibliography

      • Answer to Question 323

        • B (Braunwald, p. 989)

        • References

      • Answer to Question 324

        • D (Braunwald, p. 1258; Table 55-2; see also Answer to Question 388)

        • Bibliography

      • Answer to Question 325

        • D (Braunwald, pp. 1329-1330; Figs. 58-18 and 58-19)

        • References

      • Answer to Question 326

        • B (Braunwald, pp. 981-985; Figs. 45-3 and 45-4; Tables 45-1 and 45-2)

      • Answer to Question 327

        • A (Braunwald, pp. 906-908)

        • References

      • Answer to Question 328

        • D (Braunwald, pp. 947-948, 1326)

        • Bibliography

      • Answer to Question 329

        • E (Braunwald, p. 967; Table 44-9)

        • References

      • Answer to Question 330

        • A (Braunwald, pp. 1084-1085, 1089-1090)

      • Answer to Question 331

        • D (Braunwald, pp. 1100-1108; Figs. 52-11 and 52-12)

        • References

      • Answer to Question 332

        • E (Braunwald, p. 1078)

        • References

      • Answer to Question 333

        • A (Braunwald, p. 1128; Table 52-11)

        • References

      • Answer to Question 334

        • B (Braunwald, pp. 1124-1127; Fig. 52-27)

        • References

      • Answer to Question 335

        • C (Braunwald, pp. 1129-1130)

        • Bibliography

      • Answer to Question 336

        • B (Braunwald, p. 1136)

        • References

      • Answer to Question 337

        • E (Braunwald, pp. 1133-1134; Table 52-13)

        • Bibliography

      • Answer to Question 338

        • C (Braunwald, pp. 1101-1106)

        • References

      • Answer to Question 339

        • C (Braunwald, pp. 1070-1072)

        • References

      • Answer to Question 340

        • D (Braunwald, pp. 1106-1108)

        • Bibliography

      • Answer to Question 341

        • B (Braunwald, pp. 1128, 1136-1137; Fig. 52-28)

        • Reference

      • Answer to Question 342

        • D (Braunwald, p. 1135)

        • References

      • Answer to Question 343

        • A (Braunwald, p. 1132)

        • Bibliography

      • Answer to Question 344

        • E (Braunwald, pp. 1158-1159; Table 53-2)

        • References

      • Answer to Question 345

        • B (Braunwald, pp. 1106, 1246; see also Answer to Question 331)

        • References

      • Answer to Question 346

        • D (Braunwald, pp. 1213-1214)

        • References

      • Answer to Question 347

        • A (Braunwald, pp. 1049-1052; Figs. 49-26 and 49-27; Table 49-2)

        • References

      • Answer to Question 348

        • D (Braunwald, pp. 1162-1168; Fig. 53-9; Table 53-3)

        • References

      • Answer to Question 349

        • D (Braunwald, p. 1045)

        • References

      • Answer to Question 350

        • D (Braunwald, pp. 1209-1212; Figs. 54-11 and 54-12)

        • References

      • Answer to Question 351

        • D (Braunwald, p. 1280)

        • References

      • Answer to Question 352

        • C (Braunwald, pp. 1279, 1296-1300; Figs. 57-10 and 57-17; Table 57-7)

        • References

      • Answer to Question 353

        • D (Braunwald, pp. 1203-1204; Fig. 54-10)

        • References

      • Answer to Question 354

        • C (Braunwald, pp. 1279, 1280; Fig. 57-1)

        • Reference

      • Answer to Question 355

        • D (Braunwald, pp. 1166-1167)

        • References

      • Answer to Question 356

        • D (Braunwald, pp. 1172-1173; Fig. 53-15)

        • References

      • Answer to Question 357

        • C (Braunwald, pp. 1329-1330; Figs. 58-18 and 58-19; see also Answer to Question 325)

        • Bibliography

      • Answer to Question 358

        • D (Braunwald, pp. 1030-1032; Fig. 49-7)

        • Bibliography

      • Answer to Question 359

        • A (Braunwald, p. 1303; Fig. 57-25)

        • Bibliography

      • Answer to Question 360

        • B (Braunwald, p. 1167)

        • Reference

      • Answer to Question 361

        • D (Braunwald, pp. 1155-1161; Fig. 53-7)

        • References

      • Answer to Question 362

        • C (Braunwald, p. 1313; Fig. 58-1; Table 58-1)

        • References

      • Answer to Question 363

        • C (Braunwald, pp. 1290-1292)

        • Bibliography

      • Answer to Question 364

        • A (Braunwald, pp. 1314-1318)

        • Bibliography

      • Answer to Question 365

        • C (Braunwald, pp. 1255-1256)

        • References

      • Answer to Question 366

        • D (Braunwald, p. 1202; Fig. 54-2; Table 54-9)

        • Bibliography

      • Answer to Question 367

        • A (Braunwald, pp. 1166-1167; Fig. 53-3)

        • References

      • Answer to Question 368

        • B (Braunwald, pp. 1360-1361; Fig. 60-23; Table 60-3)

        • References

      • Answer to Question 369

        • D (Braunwald, pp. 1222-1223)

        • References

      • Answer to Question 370

        • E (Braunwald, pp. 1281-1282; Fig. 57-2; Table 57-1)

        • References

      • Answer to Question 371

        • B (Braunwald, pp. 1323-1325; Figs. 58-12, 58-13, and 58-14)

        • References

      • Answer to Question 372

        • C (Braunwald, p. 1296; see also Answer to Question 352)

        • Bibliography

      • Answer to Question 373

        • E (Braunwald, pp. 1365, 1367-1368; Fig. 61-1)

        • References

      • Answer to Question 374

        • C (Braunwald, pp. 1033-1034; Fig. 49-6)

      • Answer to Question 375

        • C (Braunwald, pp. 1038-1054; Figs. 49-26, 49-27, and 49-28; Table 49-2)

        • References

      • Answer to Question 376

        • C (Braunwald, p. 1160; Fig. 53-6)

      • Answer to Question 377

        • B (Braunwald, pp. 1218-1221; Figs. 54-18 and 54-19)

        • References

      • Answer to Question 378

        • C (Braunwald, p. 1171)

        • References

      • Answer to Question 379

        • B (Braunwald, pp. 1162-1165; Fig. 53-3)

        • References

      • Answer to Question 380

        • B (Braunwald, pp. 1117-1118; Figs. 52-21 and 52-22; see also Answer to Question 321)

        • References

      • Answer to Question 381

        • C (Braunwald, p. 1325; Fig. 58-16)

        • Reference

      • Answer to Question 382

        • D (Braunwald, pp. 971-973; Fig. 44-9)

        • Bibliography

      • Answer to Question 383

        • A (Braunwald, pp. 1282-1284; Table 57-2)

        • References

      • Answer to Question 384

        • B (Braunwald, pp. 1123-1124; Figs. 52-24, 52-25, and 52-26)

        • References

      • Answer to Question 385

        • D (Braunwald, p. 1124; Fig. 52-27; see also Answer to Question 334)

        • Bibliography

      • Answer to Question 386

        • B (Braunwald, pp. 1316-1317; Fig. 58-4)

        • Bibliography

      • Answer to Question 387

        • B (Braunwald, pp. 1251, 1252-1253)

        • Reference

      • Answer to Question 388

        • C (Braunwald, pp. 1253-1254; see also Answer to Question 324)

        • References

      • Answer to Question 389

        • A (Braunwald, pp. 917, 919)

        • Bibliography

      • Answer to Question 390

        • B (Braunwald, p. 1029; Fig. 49-2)

        • Bibliography

      • Answer to Question 391

        • D (Braunwald, p. 1260)

        • Bibliography

      • Answer to Question 392

        • C (Braunwald, p. 1165; Fig. 53-3; Table 53-3)

        • References

      • Answers to Questions 393 to 396

        • 393–B, 394–C, 395–A, 396–D (Braunwald, pp. 876-879)

        • Bibliography

      • Answers to Questions 397 to 400

        • 397–B, 398–A, 399–D, 400–C (Braunwald, pp. 1196-1198; Table 54-4)

        • Reference

      • Answers to Questions 401 to 405

        • 401–A, 402–B, 403–B, 404–C, 405–B (Braunwald, pp. 1127-1128; Fig. 52-28)

        • Bibliography

      • Answers to Questions 406 to 409

        • 406–C, 407–E, 408–D, 409–C (Braunwald, pp. 1167-1168)

        • Bibliography

      • Answers to Questions 410 to 414

        • 410–B, 411–C, 412–D, 413–C, 414–A (Braunwald, pp. 876-879; see also Answer to Questions 393-396)

        • References

      • Answers to Questions 415 to 419

        • 415–B, 416–D, 417–D, 418–A, 419–A (Braunwald, p. 1103; Table 52-5)

        • Bibliography

      • Answers to Questions 420 to 423

        • 420–C, 421–C, 422–B, 423–A (Braunwald, pp. 1128-1130)

        • Bibliography

      • Answers to Questions 424 to 427

        • 424–C, 425–C, 426–A, 427–C (Braunwald, pp. 993-995; Fig. 45-6)

        • References

      • Answers to Questions 428 to 431

        • 428–D, 429–D, 430–B, 431–C (Braunwald, p. 992; Table 45-5)

        • Reference

      • Answers to Questions 432 to 435

        • 432–A, 433–A, 434–C, 435–B (Braunwald, pp. 988, 989-990; Table 45-4)

  • IV (Chapters 62 to 75)

    • 4 Diseases of the Heart, Pericardium, and Pulmonary Vascular Bed

      • Directions

      • Question 436

      • Question 437

      • Question 438

      • Question 439

      • Question 440

      • Question 441

      • Question 442

      • Question 443

      • Question 444

      • Question 445

      • Question 446

      • Question 447

      • Question 448

      • Question 449

      • Question 450

      • Question 451

      • Question 452

      • Question 453

      • Question 454

      • Question 455

      • Question 456

      • Question 457

      • Question 458

      • Question 459

      • Question 460

      • Question 461

      • Question 462

      • Question 463

      • Question 464

      • Question 465

      • Question 466

      • Question 467

      • Question 468

      • Question 469

      • Question 470

      • Question 471

      • Question 472

      • Question 473

      • Question 474

      • Question 475

      • Question 476

      • Question 477

      • Question 478

      • Question 479

      • Question 480

      • Question 481

      • Question 482

      • Question 483

      • Question 484

      • Question 485

      • Question 486

      • Question 487

      • Question 488

      • Question 489

      • Question 490

      • Question 491

      • Question 492

      • Question 493

      • Question 494

      • Question 495

      • Question 496

      • Question 497

      • Question 498

      • Question 499

      • Question 500

      • Question 501

      • Question 502

      • Question 503

      • Question 504

      • Question 505

      • Question 506

      • Question 507

      • Question 508

      • Question 509

      • Question 510

      • Question 511

      • Question 512

      • Question 513

      • Question 514

      • Question 515

      • Question 516

      • Question 517

      • Question 518

      • Question 519

      • Question 520

      • Question 521

      • Question 522

      • Question 523

      • Question 524

      • Question 525

      • Question 526

      • Question 527

      • Question 528

      • Question 529

      • Question 530

      • Question 531

      • Question 532

      • Question 533

      • Question 534

      • Question 535

      • Question 536

      • Question 537

      • Question 538

      • Question 539

      • Question 540

      • Question 541

      • Question 542

      • Question 543

      • Question 544

      • Question 545

      • Question 546

      • Question 547

      • Question 548

      • Question 549

        • Directions

      • Questions 550 to 553

      • Questions 554 to 558

      • Questions 559 to 562

      • Questions 563 to 566

      • Questions 567 to 571

      • Questions 572 to 575

      • Questions 576 to 580

      • Questions 581 to 585

      • Questions 586 to 589

      • Questions 590 to 593

      • Questions 594 to 597

      • Questions 598 to 601

      • Questions 602 to 606

      • Questions 607 to 611

      • Questions 612 to 615

      • Questions 616 to 619

      • Questions 620 to 624

      • Questions 625 to 629

    • Diseases of the Heart, Pericardium, and Pulmonary Vascular Bed

      • Answer to Question 436

        • D (Braunwald, p. 1562; Fig. 65-7)

        • Bibliography

      • Answer to Question 437

        • C (Braunwald, pp. 1637-1640)

        • References

      • Answer to Question 438

        • A (Braunwald, pp. 1432-1434)

        • References

      • Answer to Question 439

        • C (Braunwald, pp. 1446-1458)

        • References

      • Answer to Question 440

        • B (Braunwald, pp. 1606-1607)

        • References

      • Answer to Question 441

        • D (Braunwald, pp. 1407-1412)

        • Bibliography

      • Answer to Question 442

        • B (Braunwald, p. 1400)

        • Bibliography

      • Answer to Question 443

        • D (Braunwald, pp. 1412-1413)

        • Bibliography

      • Answer to Question 444

        • A (Braunwald, pp. 1407-1412)

        • References

      • Answer to Question 445

        • E (Braunwald, pp. 1865-1866)

        • Bibliography

      • Answer to Question 446

        • B (Braunwald, pp. 1524-1542; Table 64-4)

        • Reference

      • Answer to Question 447

        • C (Braunwald, pp. 1272-1274, 1455)

        • References

      • Answer to Question 448

        • E (Braunwald, pp. 1865-1866, 1870-1871)

        • Bibliography

      • Answer to Question 449

        • D (Braunwald, p. 1570 )

        • Reference

      • Answer to Question 450

        • C (Braunwald, pp. 1640-1646)

        • Bibliography

      • Answer to Question 451

        • B (Braunwald, pp. 1499-1501, 1570-1571)

        • Bibliography

      • Answer to Question 452

        • B (Braunwald, pp. 1524-1542)

        • Bibliography

      • Answer to Question 453

        • C (Braunwald, p. 1397)

        • Bibliography

      • Answer to Question 454

        • C (Braunwald, p. 1630)

        • Bibliography

      • Answer to Question 455

        • B (Braunwald, pp. 1407-1412; see also Answer to Question 444)

        • Bibliography

      • Answer to Question 456

        • E (Braunwald, p. 1575; Fig. 66-2)

        • Bibliography

      • Answer to Question 457

        • C (Braunwald, pp. 1492-1493)

        • Reference

      • Answer to Question 458

        • B (Braunwald, pp. 1471-1472, 1648; Figs. 63-25 and 71-12)

      • Answer to Question 459

        • B (Braunwald, pp. 1637-1640)

        • Bibliography

      • Answer to Question 460

        • E (Braunwald, p. 1653)

        • Bibliography

      • Answer to Question 461

        • D (Braunwald, pp. 1578-1580)

        • Bibliography

      • Answer to Question 462

        • D (Braunwald, p. 1441)

        • Bibliography

      • Answer to Question 463

        • D (Braunwald, pp. 1391-1393)

        • Bibliography

      • Answer to Question 464

        • D (Braunwald, pp. 1526-1527, 1548; Table 64G-1)

        • Bibliography

      • Answer to Question 465

        • A (Braunwald, p. 1689; Table 74-3)

        • Bibliography

      • Answer to Question 466

        • C (Braunwald, p. 1508)

        • Reference

      • Answer to Question 467

        • C (Braunwald, pp. 1472-1473)

        • Bibliography

      • Answer to Question 468

        • C (Braunwald, pp. 1461-1462)

      • Answer to Question 469

        • A (Braunwald, p. 1651)

        • Biblography

      • Answer to Question 470

        • A (Braunwald, pp. 1582-1583)

        • Bibliography

      • Answer to Question 471

        • C (Braunwald, pp. 1449-1450)

      • Answer to Question 472

        • C (Braunwald, pp. 1524-1543)

        • Bibliography

      • Answer to Question 473

        • E (Braunwald, p. 1652)

        • Bibliography

      • Answer to Question 474

        • A (Braunwald, pp. 1570-1571; see also Answer to Question 451)

        • Reference

      • Answer to Question 475

        • C (Braunwald, pp. 1419-1420)

        • Bibliography

      • Answer to Question 476

        • B (Braunwald, pp. 1660-1661)

        • Bibliography

      • Answer to Question 477

        • D (Braunwald, pp. 1566-1568)

        • Bibliography

      • Answer to Question 478

        • C (Braunwald, pp. 1412-1413)

        • References

      • Answer to Question 479

        • C (Braunwald, p. 1570)

        • Bibliography

      • Answer to Question 480

        • A (Braunwald, pp. 1581-1582)

        • Bibliography

      • Answer to Question 481

        • C (Braunwald, p. 1415)

        • Bibliography

      • Answer to Question 482

        • D (Braunwald, p. 1526)

        • Bibliography

      • Answer to Question 483

        • E (Braunwald, p. 1570)

        • Bibliography

      • Answer to Question 484

        • E (Braunwald, p. 1418)

        • Bibliography

      • Answer to Question 485

        • B (Braunwald, p. 1668)

        • Bibliography

      • Answer to Question 486

        • C (Braunwald, p. 1707)

        • Bibliography

      • Answer to Question 487

        • D (Braunwald, pp. 1528-1529)

        • Bibliography

      • Answer to Question 488

        • C (Braunwald, p. 1551; Table 65-2)

        • Bibliography

      • Answer to Question 489

        • C (Braunwald, p. 1581)

        • Bibliography

      • Answer to Question 490

        • D (Braunwald, p. 1689)

        • Bibliography

      • Answer to Question 491

        • C (Braunwald, p. 1563)

        • Bibliography

      • Answer to Question 492

        • E (Braunwald, pp. 1495-1497)

        • Bibliography

      • Answer to Question 493

        • C (Braunwald, p. 1407)

        • Bibliography

      • Answer to Question 494

        • A (Braunwald, p. 1463)

        • Bibliography

      • Answer to Question 495

        • B (Braunwald, p. 1473; Table 63-7)

        • Bibliography

      • Answer to Question 496

        • D (Braunwald, pp. 1640, 1652; see also Answer to Question 473)

        • Bibliography

      • Answer to Question 497

        • A (Braunwald, p. 1411)

        • Bibliography

      • Answer to Question 498

        • D (Braunwald, pp. 1487-1489)

        • Bibliography

      • Answer to Question 499

        • E (pp. 1486-1488)

        • References

      • Answer to Question 500

        • B (Braunwald, p. 1415; see also answer to Question 481)

        • References

      • Answer to Question 501

        • A (Braunwald, p. 1669)

        • References

      • Answer to Question 502

        • A (Braunwald, p. 1648)

        • Bibliography

      • Answer to Question 503

        • A (Braunwald, p. 1865)

        • Bibliography

      • Answer to Question 504

        • A (Braunwald, pp. 1646, 1650)

        • Bibliography

      • Answer to Question 505

        • B (Braunwald, p. 1539)

        • References

      • Answer to Question 506

        • C (Braunwald, p. 1684)

        • Bibliography

      • Answer to Question 507

        • D (Braunwald, p. 1446)

        • Bibliography

      • Answer to Question 508

        • D (Braunwald, p. 1563)

        • Bibliography

      • Answer to Question 509

        • Answer: B (Braunwald, p. 1693)

        • Bibliography

      • Answer to Question 510

        • D (Braunwald, p. 1654)

        • References

      • Answer to Question 511

        • E (Braunwald, p. 1638; Fig. 71-2)

        • Bibliography

      • Answer to Question 512

        • B (Braunwald, p. 1454)

        • Bibliography

      • Answer to Question 513

        • B (Braunwald, Fig. 74-5)

        • Bibliography

      • Answer to Question 514

        • C (Braunwald, p. 1658; Table 72-1)

        • Bibliography

      • Answer to Question 515

        • C (Braunwald, p. 1414)

        • Reference

      • Answer to Question 516

        • B (Braunwald, p. 1557)

        • Bibliography

      • Answer to Question 517

        • C (Braunwald, p. 1563)

        • Reference

      • Answer to Question 518

        • E (Braunwald, p. 1525)

        • References

      • Answer to Question 519

        • B (Braunwald, p. 1431)

        • Bibliography

      • Answer to Question 520

        • C (Braunwald, p. 1571)

        • References

      • Answer to Question 521

        • B (Braunwald, p. 1688)

        • Bibliography

      • Answer to Question 522

        • C (Braunwald, p. 1469)

      • Answer to Question 523

        • E (Braunwald, p. 1475)

        • Bibliography

      • Answer to Question 524

        • D (Braunwald, pp. 1651-1652; Table 71-1)

        • Bibliography

      • Answer to Question 525

        • D (Braunwald, p. 1593)

        • Bibliography

      • Answer to Question 526

        • C (Braunwald, p. 1409)

        • Bibliography

      • Answer to Question 527

        • D (Braunwald, pp. 1474-1477; see also Answer to Question 522)

        • Bibliography

      • Answer to Question 528

        • A (Braunwald, p. 1414)

        • Bibliography

      • Answer to Question 529

        • A (Braunwald, pp. 1574-1581)

        • Bibliography

      • Answer to Question 530

        • D (Braunwald, pp. 1458-1465)

        • Bibliography

      • Answer to Question 531

        • A (Braunwald, pp.1415-1418)

        • Bibliography

      • Answer to Question 532

        • B (Braunwald, pp. 1696-1698)

        • References

      • Answer to Question 533

        • B (Braunwald, pp. 1432-1435)

        • References

      • Answer to Question 534

        • B (Braunwald, pp. 1865-1866)

        • Bibliography

      • Answer to Question 535

        • D (Braunwald, pp. 1669-1672; Fig. 73-11)

        • References

      • Answer to Question 536

        • D (Braunwald, pp. 1863-1973; see also Answer to Question 503)

        • References

      • Answer to Question 537

        • C (Braunwald, pp. 1640-1644)

        • References

      • Answer to Question 538

        • D (Braunwald, pp. 1646, 1647, 1648)

        • Bibliography

      • Answer to Question 539

        • D (Braunwald, pp. 1446-1458; see also Answer to Question 507)

        • References

      • Answer to Question 540

        • C (Braunwald, pp. 1458-1468)

        • References

      • Answer to Question 541

        • D (Braunwald, pp. 1624-1628)

        • References

      • Answer to Question 542

        • A (Braunwald, pp. 1399, 1432)

        • Reference

      • Answer to Question 543

        • B (Braunwald, pp. 1890-1893)

        • References

      • Answer to Question 544

        • C (Braunwald, pp. 1613-1615)

        • References

      • Answer to Question 545

        • C (Braunwald, p. 1620)

        • References

      • Answer to Question 546

        • B (Braunwald, pp. 1399, 1411)

        • Bibliography

      • Answer to Question 547

        • E (Braunwald, pp. 1620-1621)

        • References

      • Answer to Question 548

        • D (Braunwald, pp. 1551-1556)

        • Bibliography

      • Answer to Question 549

        • C (Braunwald, pp. 1646-1649; Figs. 71-10 and 71-12)

        • Bibliography

      • Answers to Questions 550 to 553

        • 550–B, 551–A, 552–C, 553–D (Braunwald, p. 1528)

        • Bibliogrpahy

      • Answers to Questions 554 to 558

        • 554–C, 555–B, 556–E, 557–A, 558–B (Braunwald, pp. 1559, 1566, 1589, 1593)

      • Answers to Questions 559 to 562

        • 559–D, 560–C, 561–C, 562–B (Braunwald, pp. 1504-1506)

        • Bibliography

      • Answers to Questions 563 to 566

        • 563–C, 564–A, 565–A, 566–B (Braunwald, pp. 1649-1650)

        • References

      • Answers to Questions 567 to 571

        • 567–A, 568–C, 569–C, 570–D, 571–B (Braunwald, pp. 1865-1869)

        • References

      • Answers to Questions 572 to 575

        • 572–C, 573–B, 574–D, 575–A (Braunwald, pp. 1822-1823, 1825)

        • References

      • Answers to Questions 576 to 580

        • 576–C, 577–A, 578–D, 579–A, 580–B (Braunwald, pp. 1563-1566, 1570)

        • References

      • Answers to Questions 581 to 585

        • 581–A, 582–B, 583–B, 584–A, 585–B (Braunwald, pp. 1497-1499, 1502)

        • Bibliography

      • Answers to Questions 586 to 589

        • 586–C, 587–D, 588–B, 589–B (Braunwald, pp. 1690-1692)

        • References

      • Answers to Questions 590 to 593

        • 590–C, 591–B, 592–A, 593–B (Braunwald, pp. 1649-1650; Table 71-6; see also Answers to Questions 563 to 566)

        • Bibliography

      • Answers to Questions 594 to 597

        • 594–D, 595–B, 596–C, 597–A (Braunwald, p. 1452)

        • Bibliography

      • Answers to Questions 598 to 601

        • 598–A, 599–B, 600–C, 601–A (Braunwald, p. 1548)

        • References

      • Answers to Questions 602 to 606

        • 602–B, 603–B, 604–C, 605–A, 606–D (Braunwald, pp. 1410-1411, 1424-1425)

        • Bibliography

      • Answers to Questions 607 to 611

        • 607–D, 608–C, 609–C, 610–A, 611–B (Braunwald, pp. 1392, 1399, 1439)

        • References

      • Answers to Questions 612 to 615

        • 612–C, 613–A, 614–B, 615–D (Braunwald, pp. 1528, 1564, 1568, 1853)

        • References

      • Answers to Questions 616 to 619

        • 616–A, 617–B, 618–B, 619–C (Braunwald, p. 1399; see also Answers to Questions 607 to 611)

      • Answers to Questions 620 to 624

        • 620–C, 621–A, 622–B, 623–A, 624–A (Braunwald, pp. 1415-1418)

        • References

      • Answers to Questions 625 to 629

        • 625–A, 626–A, 627–B, 628–B, 629–D (Braunwald, pp. 1613-1615, 1620-1621)

        • References

  • V (Chapters 76 to 89)

    • 5 Cardiovascular Disease in Special Populations; Cardiovascular Disease and Disorders of Other Organs

      • Directions:

      • Question 630

      • Question 631

      • Question 632

      • Question 633

      • Question 634

      • Question 635

      • Question 636

      • Question 637

      • Question 638

      • Question 639

      • Question 640

      • Question 641

      • Question 642

      • Question 643

      • Question 644

      • Question 645

      • Question 646

      • Question 647

      • Question 648

      • Question 649

      • Question 650

      • Question 651

      • Question 652

      • Question 653

      • Question 654

      • Question 655

      • Question 656

      • Question 657

      • Question 658

      • Question 659

      • Question 660

      • Question 661

      • Question 662

      • Question 663

      • Question 664

      • Question 665

      • Question 666

      • Question 667

      • Question 668

      • Question 669

        • Directions

      • Questions 670 to 674

      • Questions 675 to 678

      • Questions 679 to 683

      • Questions 684 to 688

      • Questions 689 to 693

      • Questions 694 to 697

      • Questions 698 to 702

      • Questions 703 to 706

    • Cardiovascular Disease in Special Populations; Cardiovascular Disease and Disorders of Other Organs

      • Answer to Question 630

        • C (Braunwald, pp. 1582-1583, 1771-1772, 1774-1775)

        • Bibliography

      • Answer to Question 631

        • D (Braunwald, pp. 1909, 1918)

        • Bibliography

      • Answer to Question 632

        • C (Braunwald, pp. 1846-1850)

        • BIBLIOGRAPHY

      • Answer to Question 633

        • D (Braunwald, pp. 1846-1847)

        • References

      • Answer to Question 634

        • D (Braunwald, pp. 1763-1764)

        • Bibliography

      • Answer to Question 635

        • B (Braunwald, pp. 1744, 1747, 1752-1753)

        • References

      • Answer to Question 636

        • B (Braunwald, pp. 1762-1763)

        • References

      • Answer to Question 637

        • C (Braunwald, pp. 1214-1215, 1785-1787)

        • References

      • Answer to Question 638

        • E (Braunwald, pp. 1213-1214)

        • Bibliography

      • Answer to Question 639

        • A (Braunwald, pp. 1774-1775; see also Answer to Question 630)

        • Bibliography

      • Answer to Question 640

        • D (Braunwald, p. 1747)

        • References

      • Answer to Question 641

        • B (Braunwald, pp. 803-804, 1829-1830; Table 82-10; see also Answer to Question 74)

        • Bibliography

      • Answer to Question 642

        • D (Braunwald, pp. 1747, 1752-1753)

        • Bibliography

      • Answer to Question 643

        • D (Braunwald, pp. 1214-1215)

        • References

      • Answer to Question 644

        • B (Braunwald, p. 1763)

        • Reference

      • Answer to Question 645

        • C (Braunwald, p. 1787)

        • References

      • Answer to Question 646

        • C (Braunwald, pp. 1726-1727)

        • Bibliography

      • Answer to Question 647

        • A (Braunwald, p. 1779)

        • Bibliography

      • Answer to Question 648

        • B (Braunwald, pp. 1718-1720)

        • Bibliography

      • Answer to Question 649

        • E (Braunwald, pp. 1755-1756)

      • Answer to Question 650

        • E (Braunwald, pp. 1747-1750; see also Answer to Question 640)

        • Bibliography

      • Answer to Question 651

        • C (Braunwald, pp. 1905-1906; Fig. 87-19)

        • References

      • Answer to Question 652

        • D (Braunwald, pp. 1789-1791)

        • References

      • Answer to Question 653

        • C (Braunwald, pp. 1712-1713)

        • Bibliography

      • Answer to Question 654

        • D (Braunwald, p. 1213)

        • References

      • Answer to Question 655

        • C (Braunwald, p. 1689)

        • Bibliography

      • Answer to Question 656

        • C (Braunwald, pp. 1912-1914, Fig. 88-8)

        • References

      • Answer to Question 657

        • A (Braunwald, pp. 1802-1803; Table 81-4)

        • Bibliography

      • Answer to Question 658

        • C (Braunwald, pp. 1282-1287, 1308; see also Answer to Question 67)

        • References

      • Answer to Question 659

        • B (Braunwald, p. 1824)

        • References

      • Answer to Question 660

        • D (Braunwald, pp. 803-804, 1829-1830)

        • Bibliography

      • Answer to Question 661

        • C (Braunwald, pp. 1871-1872)

        • Bibliography

      • Answer to Question 662

        • A (Braunwald, pp. 1836-1838)

        • Bibliography

      • Answer to Question 663

        • D (Braunwald, pp. 1844, 1856, 1857; Table 84-1)

        • Bibliography

      • Answer to Question 664

        • C (Braunwald, pp. 1829-1830)

        • Bibliography

      • Answer to Question 665

        • B (Braunwald, pp. 1804-1805)

        • Bibliography

      • Answer to Question 666

        • D (Braunwald, pp. 1703-1704; see also Answer to Question 486)

        • References

      • Answer to Question 667

        • A (Braunwald, p. 1675)

        • Bibliography

      • Answer to Question 668

        • B (Braunwald, pp. 1779-1782)

        • Bibliography

      • Answer to Question 669

        • C (Braunwald, pp. 1762-1763; see also Answer to Question 636)

        • Reference

      • Answers to Questions 670 to 674

        • 670–E, 671–D, 672–B, 673–C, 674–A (Braunwald, pp. 1846-1847, 1855, 1856, 1858)

        • References

      • Answers to Questions 675 to 678

        • 675–C, 676–B, 677–D, 678–A (Braunwald, pp. 688, 692, 961, 1821, 1824)

        • Reference

      • Answers to Questions 679 to 683

        • 679–C, 680–A, 681–B, 682–B, 683–C (Braunwald, pp. 1846-1849; see also Answers to Question 632 and Question 633)

        • References

      • Answers to Questions 684 to 688

        • 684–C, 685–A, 686–B, 687–D, 688–E (Braunwald, pp. 1613-1617; Table 69-1)

        • Bibliography

      • Answers to Questions 689 to 693

        • 689–C, 690–D, 691–E, 692–A, 693–B (Braunwald, pp. 1795-1804)

        • References

      • Answers to Questions 694 to 697

        • 694–B, 695–C, 696–D, 697–A (Braunwald, pp. 1830-1832)

        • Bibliography

      • Answers to Questions 698 to 702

        • 698–A, 699–B, 700–D, 701–C, 702–A (Braunwald, pp. 1822-1826)

        • Bibliography

      • Answers to Questions 703 to 706

        • 703–D, 704–B, 705–A, 706–C (Braunwald, pp. 1844-1845, 1846-1847, 1853, 1854, 1856, 1858-1859; see also Answers to Questions 670 to 674)

        • References

  • Inside back cover

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