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To my family, patients, colleagues, and trainees who have taught
me so much over the years
Eyal Herzog
8
Contributors
Eric Adler, MD
Medical Director
Cardiac Transplant
Clinical Professor of Medicine
University of California San Diego
La Jolla, California
Diana Anca, MD
Cardiothoracic Anesthesiologist
Assistant Clinical Professor of Anesthesiology
Icahn School of Medicine at Mount Sinai
Mount Sinai St. Luke’s Hospital
New York, New York
9
Assistant Professor of Medicine
Co-Director Echocardiography Laboratory
Mount Sinai St. Luke’s Hospital
Mount Sinai Heart Institute
Icahn School of Medicine at Mount Sinai
New York, New York
May Bakir, MD
Department of Cardiology
Mount Sinai St. Luke’s Hospital
New York, New York
Gabriela Bambrick-Santoyo, MD
Director of Simulation
Associate Program Director
Internal Medicine Residency Program
Hackensack University Medical Center
Mountainside Hospital
Montclair, New Jersey
10
Chirag Bavishi, MD, MPH
Fellow
Cardiovascular Diseases
Mount Sinai St. Luke’s and Mount Sinai West Hospitals
Icahn School of Medicine at Mount Sinai
New York, New York
Sujata B. Chakravarti, MD
Medical Director
Congenital Cardiovascular Care Unit
Hassenfeld Children’s Hospital at NYU Langone Health
Assistant Professor of Pediatrics
Division of Pediatric Cardiology
New York University School of Medicine
New York, New York
Patricia Chavez, MD
Cardiology Fellow
Mount Sinai St. Luke’s and Mount Sinai West Hospitals
New York, New York
Joanna Chikwe, MD
The Eugene and Carol Chen Chair of Cardiothoracic Surgery
Professor and Chief
Cardiothoracic Surgery
Co-Director of the Heart Institute
Stony Brook University Hospital
Professor
Department of Cardiovascular Surgery
Icahn School of Medicine at Mount Sinai
New York, New York
Ankit Chothani, MD
11
Chief Fellow in Cardiovascular Medicine
Mount Sinai St. Luke’s and Mount Sinai West Hospitals
New York, New York
Randy Cohen, MD
Attending Physician
Crystal Run Healthcare
West Nyack, New York
Ashish Correa, MD
Chief Resident
Internal Medicine
Mount Sinai St. Luke’s and Mount Sinai West Hospitals
Icahn School of Medicine at Mount Sinai
New York, New York
12
Icahn School of Medicine at Mount Sinai
New York, New York
Ernest G. DePuey, MD
Director of Nuclear Medicine
Mount Sinai St. Luke’s and Mount Sinai West Hospitals
Clinical Professor of Radiology
Icahn School of Medicine at Mount Sinai
New York, New York
Matthew Durst, MD
House Staff
Icahn School of Medicine at Mount Sinai
New York, New York
Aeshita Dwivedi, MD
Fellow in Cardiovascular Diseases
The Leon H. Charney Division of Cardiology
New York University Medical School of Medicine
New York, New York
Karim El Hachem, MD
Attending Physician
Assistant Professor of Medicine
Icahn School of Medicine at Mount Sinai
Mount Sinai St. Luke’s and Mount Sinai West Hospitals
New York, New York
Moshe Flugelman, MD
Director
Department of Cardiology
Lady Davis Carmel Medical Center
Faculty of Medicine
Technion – Israel Institute of Technology
Haifa, Israel
Diandra Fortune, BS
Research Assistant
13
Mount Sinai St. Luke’s Hospital
New York, New York
Elissa K. Fory, MD
Attending Neurologist
Mount Sinai St. Luke’s Hospital
Assistant Professor of Neurology
Icahn School of Medicine at Mount Sinai
New York, New York
Rodolfo J. Galindo, MD
Assistant Professor of Medicine
Emory University School of Medicine
Investigator
Center for Diabetes and Metabolism Research
Division of Endocrinology, Diabetes and Lipids
Medical Chair
Hospital Diabetes Taskforce
Emory Healthcare System
Atlanta, Georgia
Carly E. Glick, MD
Gastroenterology Fellow
Mount Sinai Beth Israel, Mount Sinai St. Luke’s, and Mount Sinai West
Hospitals
New York, New York
Gustavo S. Guandalini, MD
Cardiovascular Disease Fellow
The Leon H. Charney Division of Cardiology
New York University School of Medicine
New York, New York
14
Dan G. Halpern, MD
Director
Adult Congenital Heart Disease Program
Assistant Professor of Medicine
The Leon H. Charney Division of Cardiology
New York University School of Medicine
New York, New York
Yaron Hellman, MD
Cardiology Department
Rambam Health Care Campus
Haifa, Israel
Eyal Herzog, MD
Director
Cardiac Care Unit
Director
Echocardiography Laboratories
Mount Sinai St. Luke’s Hospital
Associate Professor of Medicine
Icahn School of Medicine at Mount Sinai
New York, New York
Lee Herzog
Icahn School of Medicine at Mount Sinai
New York, New York
Andrew Higgins, MD
Fellow in Cardiovascular Disease
Cleveland Clinic Lerner College of Medicine
Case Western Reserve University
15
Cleveland Clinic
Cleveland, Ohio
Chetan Huded, MD
Fellow in Cardiovascular Disease
Cleveland Clinic Lerner College of Medicine
Case Western Reserve University
Cleveland Clinic
Cleveland, Ohio
Ronen Jaffe, MD
Director of Interventional Cardiology
Carmel Medical Center
Assistant Professor of Medicine
Rappaport School of Medicine
Technion – Israel Institute of Technology
Haifa, Israel
Karen Kan, MD
Fellow
Cardiovascular Disease
NYU Langone Medical Center
New York, New York
Samir Kapadia, MD
Professor of Medicine
Section Head
Interventional Cardiology
Director
Cardiac Catheterization Laboratory
Cleveland Clinic
Cleveland, Ohio
16
Basheer Karkabi, MD
Senior Cardiologist
Cardiology Division
Lady Davis Carmel Hospital
Haifa, Israel
Bette Kim, MD
Director
Cardiomyopathy Program
Director
Mount Sinai West Echocardiography Laboratory
Assistant Professor of Clinical Medicine
Mount Sinai West Hospital
Icahn School of Medicine at Mount Sinai
New York, New York
Donald P. Kotler, MD
Chief
Division of Gastroenterology
Jacobi Medical Center
Bronx, New York
Ismini Kourouni, MD
Senior Fellow
Pulmonary and Critical Care Medicine
Mount Sinai St. Luke’s and Mount Sinai West Hospitals
Icahn School of Medicine at Mount Sinai
New York, New York
Itzhak Kronzon, MD
Professor in Cardiology
17
Hofstra University School of Medicine
Lenox Hill Hospital—Northwell Health
Department of Cardiology
New York, New York
Nina Kukar, MD
Director
Women’s Heart NY
Director
Cardiac MRI Mount Sinai West and Mount Sinai St. Luke’s Hospitals
Assistant Professor of Medicine
Icahn School of Medicine at Mount Sinai
New York, New York
Gina LaRocca, MD
Associate Director
Adult Congenital Heart Disease
Assistant Professor of Medicine in Cardiology
Icahn School of Medicine at Mount Sinai
New York, New York
Shawn Lee, MD
Medical Resident
Mount Sinai St. Luke’s Hospital
New York, New York
18
Long Island University
LIU Pharmacy
Brooklyn, New York
Adjunct Assistant Professor
University of Connecticut School of Pharmacy
Storrs, Connecticut
Pavan K. Mankal, MD
Division of Gastroenterology
Department of Medicine
Mount Sinai St. Luke’s and Mount Sinai West Hospitals
New York, New York
19
Davendra Mehta, MD
Director
Cardiac Electrophysiology Cardiology
Mount Sinai St. Luke’s Hospital
New York, New York
Ira Meisels, MD
Chief
Division of Nephrology
Mount Sinai St. Luke’s and Mount Sinai West Hospitals
Associate Professor of Medicine
Icahn School of Medicine at Mount Sinai
New York, New York
Arie Militianu, MD
Director
Arrhythmia Service
Lady Davis Carmel Medical Center
Technion – Israel Institute of Technology
Haifa, Israel
Ahmadreza Moradi, MD
Internal Medicine Resident
Mount Sinai St. Luke’s and Mount Sinai West Hospitals
Icahn School of Medicine at Mount Sinai
New York, New York
20
Noah Moss, MD
Medical Director of Mechanical Circulatory Support
Mount Sinai Hospital
Assistant Professor of Medicine
Icahn School of Medicine at Mount Sinai
New York, New York
Mary O’Sullivan, MD
Director of Margarita Camche Smoking Cessation Clinic
Mount Sinai St. Luke’s Hospital
Associate Professor of Medicine
Icahn School of Medicine at Mount Sinai
New York, New York
Yuvrajsinh J. Parmar, MD
Fellow
Department of Cardiology
Hofstra University School of Medicine
Lenox Hill Hospital – Northwell Health
New York, New York
Vishal P. Patel, DO
21
Attending Physician
Naples Community Hospital
Naples, Florida
Sean P. Pinney, MD
Director
Heart Failure and Transplantation
Mount Sinai Health System
Professor of Medicine
Icahn School of Medicine at Mount Sinai
New York, New York
Hooman Poor, MD
Assistant Professor of Medicine
Director of Pulmonary Vascular Disease
Mount Sinai–National Jewish Health Respiratory Institute
Associate Program Director
Fellowship Training Program
Division of Pulmonary, Critical Care and Sleep Medicine
Zena and Michael A. Wiener Cardiovascular Institute
Icahn School of Medicine at Mount Sinai
New York, New York
Jonathan Price, MD
Department of Surgery
Mount Sinai St. Luke’s Hospital
New York, New York
Olga Reynbakh, MD
Medical Resident
Mount Sinai St. Luke’s Hospital
New York, New York
22
Richard Ro, MD
Clinical Cardiologist
Division of Cardiovascular Diseases
Assistant Professor of Medicine
Columbia University Medical Center
Mount Sinai Medical Center
Miami, Florida
Alan Rozanski, MD
Director
Cardiovascular Fellowship Training Program
Director
Nuclear Cardiology and Cardiac Stress Testing
Professor of Medicine
Icahn School of Medicine at Mount Sinai
New York, New York
23
Muhamed Saric, MD, PhD
Associate Professor
Director
Noninvasive Cardiology
The Leon H. Charney Division of Cardiology
New York University
New York, New York
Jorge E. Schliamser, MD
Director
Cardiac Electrophysiology Laboratory
Department of Cardiovascular Medicine
Lady Davis Carmel Medical Center
Haifa, Israel
Allison Selby, DO
Cardiology Fellow
Mount Sinai St. Luke’s and Mount Sinai West Hospitals
New York, New York
Arpit Shah, MD
24
Interventional Cardiology Fellow
Mount Sinai St. Luke’s Hospital
New York, New York
Avinoam Shiran, MD
Director
Echocardiography
Lady Davis Carmel Medical Center
Clinical Associate Professor
The Ruth and Bruce Rappaport Faculty of Medicine
Technion – Israel Institute of Technology
Haifa, Israel
Nektarios Souvaliotis, MD
Clinical Cardiac Electrophysiology Fellow
Mount Sinai St. Luke’s Hospital
New York, New York
Karan Sud, MD
Resident Physician
Department of Internal Medicine
Icahn School of Medicine at Mount Sinai
Mount Sinai St. Luke’s and Mount Sinai West Hospitals
New York, New York
25
Icahn School of Medicine at Mount Sinai
New York, New York
Henry Tannous, MD
Associate Professor of Cardiovascular Surgery
Icahn School of Medicine at Mount Sinai
Associate Professor of Cardiothoracic Surgery
Stony Brook University Medical Center
New York, New York
Seth Uretsky, MD
Medical Director
Cardiovascular Imaging
Atlantic Health System
Associate Professor of Medicine
Sidney Kimmel Medical College
Thomas Jefferson University
Morristown, New Jersey
Alan F. Vainrib, MD
Clinical Instructor
The Leon H. Charney Division of Cardiology
New York University
New York, New York
26
†
Deceased. His untimely passing at the end of 2016 has left a void in our hearts
and minds.
27
Preface
Heart disease is the leading cause of death in the world. Advances in the
treatment of heart disease are considered among the greatest achievements
of modern medicine. Physicians, nurses, and all health care providers who
care for patients with heart disease consider the cardiac care unit (CCU)
the most exciting place in the hospital.
The CCU Book is essentially two books combined into one. Most
chapters have two sections: the first is for physicians and other health care
providers, and the second is for patients and their families.
The first section of each chapter is aimed toward physicians (interns,
residents, fellows, and attendings), medical students, nurses, physician
assistants, and other health care providers who rotate or practice in the
CCU. It is organized such that readers will not need to consult any
textbooks regarding the topics discussed and will be able to understand the
simplified pathophysiology and management of the disease. This includes
diagnostic modalities, initial critical care management in the CCU, follow-
up care in a step-down unit, and plans for discharge. Algorithms and
pathways for management are provided for easy implementation in any
health care system.
The second part of each chapter covers the same topics previously
discussed but is directed toward the patients and their families. The
language and the medical terminology are simpler and geared toward the
general public.
It is my hope that this book will serve as a teaching tool to save the
28
lives of patients with heart disease in the CCU.
Eyal Herzog
29
Another random document with
no related content on Scribd:
the 26th April, at noon, accompanied by his aide-de-camp,
Captain del Pilar, and Mr. Leyba, his private secretary. …
{594}
"I have the honor to report that I sent you on the 27th
instant, and confirmed in my dispatch Number 211 of that date,
a telegram which deciphered read as follows. … 'General
Aguinaldo gone my instance Hongkong arrange with Dewey
co-operation insurgents Manila.
PRATT.'
{595}
The truth was that Cervera was then just entering the
Caribbean Sea, considerably to the south of Sampson's search.
He touched at the French island of Martinique, and at the
Dutch island of Curaçoa, and then slipped across to Santiago
de Cuba, where he was to be overtaken by his fate. In the long
hill-sheltered bay, with a narrow entrance, which forms this
excellent Cuban harbor, the Spanish fleet was so hidden that
nearly a fortnight passed before its whereabouts could be
fully ascertained. It was not until May 20 that a blockade of
Santiago was established by a flying squadron of the American
fleet, under Commodore Schley, with certainty that the
squadron of Cervera was harbored there. On the 1st of June,
Admiral Sampson arrived on the scene, with a stronger naval
force, and took command. To attempt to force the narrow
entrance of the harbor, strongly fortified and thickly mined
as it was, and attack the Spanish fleet in the bay, was not
deemed practicable. The course resolved upon was to hold the
enemy fast in the shelter he had sought, until Santiago could
be taken, by a land attack. In pursuance of this plan, an
exploit of splendid daring was performed, in the early morning
of June 3, by a young officer, Lieutenant Richmond Pearson
Hobson, with a crew of seven volunteers, who placed and sank a
huge coaling ship, the "Merrimac," in the channel that leads
into Santiago Bay. The following is Admiral Sampson's report
of the undertaking and its achievement:
"The firing had ceased. It was evident the enemy had not seen
us in the general mass of moving objects; but soon the tide
began to drift these away, and we were being left alone with
the catamaran. The men were directed to cling close in, bodies
below and only heads out, close under the edges, and were
directed not to speak above a whisper, for the destroyer was
near at hand, and boats were passing near. We mustered; all
were present, and direction was given to remain as we were
till further orders, for I was sure that in due time after
daylight a responsible officer would come out to reconnoiter.
It was evident that we could not swim against the tide to
reach the entrance. Moreover, the shores were lined with
troops, and the small boats were looking for victims that
might escape from the vessel. The only chance lay in remaining
undiscovered until the coming of the reconnoitering boat, to
which, perhaps, we might surrender without being fired on. …
The air was chilly and the water positively cold. In less than
five minutes our teeth were chattering; so loud, indeed, did
they chatter that it seemed the destroyer or the boats would
hear. … We remained there probably an hour."
{597}
{598}
While Admiral Dewey was holding Manila Bay, before the taking
of the city, there were many rumors and exciting stories
afloat, of offensive behavior towards the American fleet by
commanders of German war ships that were sent to the scene. As
far as possible, the facts were officially suppressed, in
order to avoid a quarrel between the two countries, and no
authoritative account of what occurred can be found. But some
incidents obtained publicity which are probably true in the
main. The first unpleasant happening appears to have been the
arrival in Manila Bay of a German naval vessel, which steamed
in with entire disregard of the blockading fleet, as though
the port was its own. Thereupon Admiral Dewey sent a forcible
reminder to the captain that he was intruding upon a blockade,
by firing a shot across his bow, and ordering him to heave to.
The German captain, in a rage, is said to have called on the
commanding officer of a British squadron that was in the Bay,
for advice as to what he should do, and was told that he owed
the American Admiral an apology for his violation of naval
etiquette, well settled for such circumstances as those
existing in Manila Bay. According to the story, the British
commander, Captain Sir Edward Chichester, himself on the best
of terms with Admiral Dewey, visited the latter, on behalf of
the German officer, and made the matter smooth.
{599}
But, either through indiscretion of his own, or because he had
instructions to interfere as much as possible with the
proceedings of the Americans, the German commander continued
to pursue an offensive course. According to report, be went so
far as to stop a movement which Aguinaldo (then a recognized
ally of the United States) was making, to take possession of a
certain island, and to capture some Spaniards who were on it.
This provoked Admiral Dewey to a demonstration against him so
threatening that he drew back in haste, and the island was
occupied.
4. On transportation.