Cardiology Board Review and Self Assessment A Companion

Guide to Hurst's the Heart 1st Edition

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 Questions
Answers

SECTION 6 CIGARETTE SMOKING AND CARDIOVASCULAR DISEASE

CHAPTER 30 Epidemiology of Smoking and Pathophysiology of Cardiovascular Damage

Questions
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CHAPTER 31 Preventing and Mitigating Smoking-Related Heart Disease
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SECTION 7 ATHEROSCLEROSIS AND CORONARY HEART DISEASE

CHAPTER 32 Atherothrombosis: Disease Burden, Activity, and Vulnerability

Questions
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CHAPTER 33 Coronary Thrombosis: Local and Systemic Factors
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CHAPTER 34 Coronary Blood Flow and Myocardial Ischemia
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CHAPTER 35 Nonobstructive Atherosclerotic and Nonatherosclerotic Coronary Heart Disease
Questions
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CHAPTER 36 Definitions of Acute Coronary Syndromes
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CHAPTER 37 Pathology of Myocardial Infarction and Sudden Death
Questions
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CHAPTER 38 Molecular and Cellular Mechanisms of Myocardial Ischemia/Reperfusion Injury
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CHAPTER 39 Evaluation and Management of Non–ST-Segment Elevation Myocardial Infarction
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CHAPTER 40 ST-Segment Elevation Myocardial Infarction
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CHAPTER 41 Antiplatelet and Anticoagulant Therapy in Acute Coronary Syndromes
Questions
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CHAPTER 42 Percutaneous Coronary Interventions in Acute Myocardial Infarction and Acute Coronary Syndromes
Questions
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CHAPTER 43 The Evaluation and Management of Stable Ischemic Heart Disease
Questions
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CHAPTER 44 Coronary Artery Bypass Grafting and Percutaneous Interventions in Stable Ischemic Heart Disease
Questions
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CHAPTER 45 Rehabilitation of the Patient with Coronary Heart Disease
 Questions
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SECTION 8 VALVULAR HEART DISEASE

CHAPTER 46 Acute Rheumatic Fever

Questions
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CHAPTER 47 Aortic Valve Disease
Questions
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CHAPTER 48 Degenerative Mitral Valve Disease
Questions
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CHAPTER 49 Ischemic Mitral Regurgitation
Questions
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CHAPTER 50 Mitral Stenosis
Questions
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CHAPTER 51 Tricuspid and Pulmonary Valve Disease
Questions
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CHAPTER 52 Prosthetic Heart Valves
Questions
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CHAPTER 53 Antithrombotic Therapy for Valvular Heart Disease
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CHAPTER 54 Management of Mixed Valvular Heart Disease
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SECTION 9 CONGENITAL HEART DISEASE

CHAPTER 55 Mendelian Basis of Congenital and Other Cardiovascular Diseases

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CHAPTER 56 Congenital Heart Disease in Adolescents and Adults
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SECTION 10 MYOCARDIAL, PERICARDIAL, AND ENDOCARDIAL DISEASES

CHAPTER 57 Classification of Cardiomyopathies

Questions
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CHAPTER 58 Dilated Cardiomyopathy
Questions
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CHAPTER 59 Hypertrophic Cardiomyopathies
Questions
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CHAPTER 60 Left Ventricular Noncompaction
Questions
 Answers
CHAPTER 61 Restrictive Heart Diseases
Questions
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CHAPTER 62 Arrhythmogenic Cardiomyopathy
Questions
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CHAPTER 63 Myocarditis
Questions
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CHAPTER 64 The Athlete and the Cardiovascular System
Questions
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CHAPTER 65 Cardiovascular Disease in the Elderly: Pathophysiology and Clinical Implications
Questions
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CHAPTER 66 Pericardial Diseases
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CHAPTER 67 Infective Endocarditis
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SECTION 11 HEART FAILURE

CHAPTER 68 Pathophysiology of Heart Failure

Questions
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CHAPTER 69 The Epidemiology of Heart Failure
Questions
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CHAPTER 70 The Diagnosis and Management of Chronic Heart Failure
Questions
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CHAPTER 71 Evaluation and Management of Acute Heart Failure
Questions
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CHAPTER 72 Cardiac Transplantation
Questions
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CHAPTER 73 Mechanically Assisted Circulation
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SECTION 12 CARDIOPULMONARY DISEASE

CHAPTER 74 Pulmonary Hypertension

Questions
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CHAPTER 75 Pulmonary Embolism
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CHAPTER 76 Cor Pulmonale: The Heart in Parenchymal Lung Disease
Questions
 Answers
CHAPTER 77 Sleep-Disordered Breathing and Cardiac Disease
Questions
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SECTION 13 RHYTHM AND CONDUCTION DISORDERS

CHAPTER 78 Electrophysiologic Anatomy

Questions
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CHAPTER 79 Mechanisms of Cardiac Arrhythmias and Conduction Disturbances
Questions
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CHAPTER 80 Genetics of Channelopathies and Clinical Implications
Questions
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CHAPTER 81 Approach to the Patient with Cardiac Arrhythmias
Questions
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CHAPTER 82 Invasive Diagnostic Electrophysiology
Questions
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CHAPTER 83 Atrial Fibrillation, Atrial Flutter, and Atrial Tachycardia
Questions
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CHAPTER 84 Supraventricular Tachycardia: Atrial Tachycardia, Atrioventricular Nodal Reentry, and Wolff–Parkinson–White
Syndrome
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CHAPTER 85 Ventricular Arrhythmias
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CHAPTER 86 Bradyarrhythmias
Questions
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CHAPTER 87 Antiarrhythmic Drugs
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CHAPTER 88 Catheter-Ablative Techniques
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CHAPTER 89 Pacemakers and Defibrillators
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CHAPTER 90 Diagnosis and Management of Syncope
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CHAPTER 91 Sudden Cardiac Death
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CHAPTER 92 Cardiopulmonary and Cardiocerebral Resuscitation
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 SECTION 14 DISEASES OF THE GREAT VESSELS AND PERIPHERAL VESSELS

CHAPTER 93 Diseases of the Aorta

Questions
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CHAPTER 94 Cerebrovascular Disease and Neurologic Manifestations of Heart Disease
Questions
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CHAPTER 95 Carotid Artery Stenting
Questions
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CHAPTER 96 Diagnosis and Management of Diseases of the Peripheral Arteries
Questions
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CHAPTER 97 Diagnosis and Management of Diseases of the Peripheral Venous System
Questions
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SECTION 15 MISCELLANEOUS CONDITIONS AND CARDIOVASCULAR DISEASE

CHAPTER 98 Perioperative Evaluation for Noncardiac Surgery

Questions
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CHAPTER 99 Anesthesia and the Patient with Cardiovascular Disease
Questions
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CHAPTER 100 Rheumatologic Diseases and the Cardiovascular System
Questions
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CHAPTER 101 The Diagnosis and Management of Cardiovascular Disease in Patients with Cancer
Questions
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CHAPTER 102 HIV/AIDS and the Cardiovascular System
Questions
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CHAPTER 103 Heart Disease in Pregnancy
Questions
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CHAPTER 104 Traumatic Heart Disease
Questions
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CHAPTER 105 The Kidney in Heart Disease
Questions
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CHAPTER 106 Exercise in Health and Cardiovascular Disease
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SECTION 16 POPULATIONS AND SOCIAL DETERMINANTS OF CARDIOVASCULAR DISEASE

CHAPTER 107 Social Determinants of Cardiovascular Disease

Questions
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CHAPTER 108 Women and Ischemic Heart Disease: An Evolving Saga
 Questions
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CHAPTER 109 Race, Ethnicity, and Cardiovascular Disease
Questions
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CHAPTER 110 Environment and Heart Disease
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CHAPTER 111 Behavioral Cardiology: Epidemiology, Pathophysiology, and Clinical Management
Questions
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CHAPTER 112 Economics and Cost-Effectiveness in Cardiology
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Index
CONTRIBUTORS
MARIA L. ALCARAZ, BA
Clinical Research Assistant
Division of Clinical Epidemiology
Department of Medicine
Jewish General Hospital
McGill University
Montreal, Quebec, Canada

EMMANUEL E. EGOM, MD, MSc, PHD

Clinician-Lead for Heart Health Clinic and Hearts in Motion Program
Department of Medicine
St Martha’s Regional Hospital
Antigonish, Nova Scotia, Canada

INNA ERMEICHOUK, MSc

Clinical Research Assistant
Division of Clinical Epidemiology
Department of Medicine
Jewish General Hospital
McGill University
Montreal, Quebec, Canada

CAROLINE FRANCK, MSc

Clinical Research Assistant
Division of Clinical Epidemiology
Department of Medicine
Jewish General Hospital/McGill University
Montreal, Quebec, Canada

SARAH B. WINDLE, MPH

Clinical Research Associate
Division of Clinical Epidemiology
Department of Medicine
Jewish General Hospital
McGill University
Montreal, Quebec, Canada
PREFACE
Cardiology Board Review and Self-Assessment is an all-inclusive study guide written to complement the 14th Edition of Hurst’s
The Heart. Edited by Drs. Valentin Fuster, Robert A. Harrington, Jagat Narula, and Zubin J. Eapen, the 14th Edition of Hurst’s
The Heart is an exhaustive and thorough state-of-the-art review of the entire field of cardiovascular medicine.
Cardiology Board Review contains over 1100 questions and answers presented in a multiple-choice format. Each of the 112
chapters of Hurst’s The Heart is represented in Cardiology Board Review with 10 multiple-choice questions. Detailed answers
are provided for each question including not only an explanation of why the correct answer is correct but also why incorrect
answers are incorrect. Questions and answers correspond to appropriate sections of Hurst’s The Heart and include tables,
figures, and references. The more than 1100 questions presented in Cardiology Board Review span the depth and breadth of the
fascinating field of cardiovascular medicine.
Cardiology Board Review is designed to be a study guide for individuals preparing to take the Subspecialty Examination in
Cardiovascular Disease given by the American Board of Internal Medicine. Thus, Cardiology Board Review will be of particular
interest to cardiology fellows preparing to take the board examination for the first time and for practicing cardiologists preparing
to take the board examination as part of their recertification process. Cardiology Board Review will also be of interest to medical
students, residents, fellows, practicing physicians, and other health care professionals who wish to advance their knowledge of
cardiovascular medicine.
The current generation of health care professionals increasingly obtains their knowledge from nontraditional formats. To that
end, Cardiology Board Review and Self-Assessment is available in multiple electronic formats in addition to the traditional print
format. The book will be available in print, e-book, and online on McGraw-Hill Education’s cardiology web site at
www.AccessCardiology.com.
It has been my distinct pleasure to work with four coauthors while preparing Cardiology Board Review: Drs. Jonathan
Afilalo, Jacqueline E. Joza, Ravi Karra, and Patrick R. Lawler. Each of us contributed original questions and answers
corresponding to our particular areas of expertise. We would like to thank the members of the editorial and production
departments at McGraw-Hill Education with whom we worked, including Karen Edmonson, Robert Pancotti, and Shivani
Salhotra. We would also like to acknowledge the contributions and assistance of a number of other individuals, including Maria
L. Alcaraz, Emmanuel E. Egom, Inna Ermeichouk, Caroline Franck, and Sarah B. Windle. Finally, on behalf of myself and my
coauthors, we would like to express thanks to our families and colleagues for their encouragement and forbearance during the
many months it took to prepare this study guide.
Taking care of patients with cardiovascular disease is an honor and a privilege. Many of these patients have life-threatening
conditions that require advanced knowledge and highly technical skills. It is our responsibility, as health care professionals, to
ensure that our knowledge and skills match the needs of our patients. It is our hope that you will find Cardiology Board Review
and Self-Assessment to be an essential and valuable tool in your study of the ever expanding and always fascinating field of
cardiovascular medicine.
Mark J. Eisenberg, MD, MPH
CREDITS FOR FIGURES AND TABLES
The following figures and tables have been used with permission from this McGraw-Hill Education publication:

Fuster V, Harrington RA, Narula J, Eapen ZJ, eds. Hurst’s The Heart. 14th ed. New York: McGraw-Hill Education; 2017:

Chapter 9: Figure 9-1.

Chapter 11: Figures 11-1, 11-2, and 11-3.Chapter 14: Figures 14-1, 14-2, 14-3, and 14-4.
Chapter 15: Figures 15-1, 15-2, 15-3, 15-4, 15-5, 15-6, 15-7, and 15-8.
Chapter 16: Figures 16-1, 16-2, 16-3, 16-4, and 16-5.
Chapter 17: Figures 17-1, 17-2, 17-3, 17-4, and 17-5.
Chapter 18: Figures 18-1 and 18-2.
Chapter 19: Figures 19-1, 19-2, 19-3, and 19-4.
Chapter 20: Figure 20-1.
Chapter 33: Figure 33-1.
Chapter 34: Figure 34-2.
Chapter 39: Figure 39-1 and Tables 39-1 and 39-2.
Chapter 40: Table 40-1.
Chapter 45: Table 45-1.
Chapter 55: Figure 55-2.
Chapter 59: Figure 59-1.
Chapter 61: Figure 61-1.
Chapter 63: Figure 63-1.
Chapter 66: Tables 66-1 and 66-2.
Chapter 72: Figure 72-1.
Chapter 74: Figure 74-1.
Chapter 76: Tables 76-1 and 76-2.
Chapter 78: Figure 78-1.
Chapter 80: Figure 80-1.
Chapter 82: Figure 82-1.
Chapter 86: Figure 86-1.
Chapter 89: Figure 89-1.
Chapter 94: Table 94-1.
Chapter 111: Figure 111-1.

Data from Fuster V, Alexander RW, O’Rourke RA, et al. Hurst’s The Heart. 11th ed. New York: McGraw-Hill; 2004:

Chapter 5: Figure 5-1.

SECTION 1

Cardiovascular Disease: Past, Present, and Future

CHAPTER 1
A History of the Cardiac Diseases, and the Development of
Cardiovascular Medicine as a Specialty
Mark J. Eisenberg

QUESTIONS

DIRECTIONS: Choose the one best response to each question.

1-1. All of the following were experimental questions asked by William Harvey except:
A. What is the relationship of the motion of the auricle to the ventricle?
B. Do the arteries distend because of the propulsive force of the heart?
C. What purpose is served by the orientation of the cardiac and venous valves?
D. How much blood is present, and how long does its passage take?
E. All were questions asked by William Harvey

1-2. What were the primary component(s) of the clinical examination until the 17th century?
A. Palpating the pulse
B. Palpating the pulse and inspecting the urine
C. Palpating the pulse and percussion
D. Palpating the pulse and auscultation
E. Palpating the pulse, percussion, and auscultation

1-3. Which physician received the Nobel Prize for his work in electrophysiology?
A. Albert von Kölliker
B. Heinrich Müller
C. Augustus Waller
D. Willem Einthoven
E. Thomas Lewis

1-4. Who performed the first cardiac catheterization in a human?

A. Werner Forssmann
B. Claude Bernard
C. Dickinson Richards
D. Etienne Jules Marey
E. André Cournand

1-5. From which Latin word is the term angina appropriated?

A. Pain
B. Stress
C. Strangulation
D. Anxiety
E. Discomfort

1-6. Before the defibrillator and coronary care units, the in-hospital mortality associated with acute myocardial infarction was
approximately:
A. 10%
B. 15%
C. 20%
 D. 30%
E. 40%

1-7. Who first described audible heart murmurs?

A. James Hope
B. John Mayow
C. William Cowper
D. René Laennec
E. Raymond Vieussens

1-8. Which procedure pioneered by Helen Taussig and Alfred Blalock was a pivotal breakthrough in thinking about congenital
heart abnormalities?
A. Balloon atrial septostomy
B. Subclavian-pulmonary artery shunt
C. Closure of atrial septal defect
D. Closure of ventricular septal defect
E. Stenting of patent ductus arteriosus

1-9. Who invented the first device for measuring blood pressure?
A. Etienne Jules Marey
B. Jean Poiseuille
C. Scipione Riva-Rocci
D. Karl von Vierordt
E. Carl Ludwig

1-10. Which of the following statements about hypertension is false?

A. In 1913, Janeway showed that patients, once diagnosed with hypertensive heart disease and symptoms, lived an average
of 4 to 5 years
B. Until the latter half of the 20th century, the asymptomatic state of most patients with hypertension and a prevalent view
that lowering the blood pressure would be deleterious to the kidney and brain lulled most physicians into accepting the
condition as being normally associated with aging
C. Effective oral treatment was available before President Franklin Roosevelt’s death in 1945 from severe hypertension
D. In the 1970s, reports from the Framingham Heart Study showed hypertension to be a major contributing cause to stroke,
heart attack, and heart and kidney failure
E. Richard Bright’s 1836 discovery of the relationship of cardiac hypertrophy and dropsy to shrunken kidneys introduced the
kidneys as a cause of heart failure long before hypertension was known

ANSWERS

1-1. The answer is E. (Hurst’s the Heart, 14th Edition, Chap. 1) Starting in 1603, Harvey dissected the anatomy and observed
the motion of the cardiac chambers and the flow of blood in more than 80 species of animals. His experimental questions
“to seek unbiased truth” can be summarized in the following questions: What is the relationship of the motion of the
auricle to the ventricle? Which is the systolic and which is the diastolic motion of the heart? Do the arteries distend
because of the propulsive force of the heart? What purpose is served by the orientation of the cardiac and venous valves?
How does blood travel from the right ventricle to the left side of the heart? Which direction does the blood flow in the
veins and the arteries? How much blood is present, and how long does its passage take? After many experiments and
without knowledge of the capillary circulation of the lungs, which was not known until 1661, Harvey stated, “It must of
necessity be concluded that the blood is driven into a round by a circular motion and that it moves perpetually; and hence
does arise the action or function of the heart, which by pulsation it performs.” This was published in 1628 as Exercitatio
Anatomica de Motu Cordis et Sanguinis in Animalibus.1 This revolutionary concept eventually became accepted in
Harvey’s lifetime and remains the foundation of our understanding of the purpose of the heart.

1-2. The answer is B. (Hurst’s the Heart, 14th Edition, Chap. 1) Until the 17th century, the clinical examination consisted of
palpating the pulse and inspecting the urine to reveal disease and predict prognosis. Percussion was first suggested in
1761 by Leopold Auenbrugger, a Viennese physician, who published a book proposing “percussion of the human thorax,
whereby, according to the character of the particular sounds thence elicited, an opinion is formed of the internal state of
that cavity.”2 It was reintroduced by Jean-Nicolas Corvisart in early 19th-century France and became an essential addition
to the chest examination until it was mostly supplanted by the chest x-ray. While auscultation of the chest was first
practiced by Hippocrates (460-370 BC), who applied his ear directly to the chest, it was not until the mid-19th century that
the stethoscope (first invented by René Laennec in Paris in 1816) moved auscultation to the forefront of the clinical
 examination.3,4

1-3. The answer is D. (Hurst’s the Heart, 14th Edition, Chap. 1) In 1856, von Kölliker and Müller demonstrated that the heart
also produced electricity. Augustus Waller, with a capillary electrometer device (1887), detected cardiac electricity from
the limbs, a crude recording that he called an “electrogram.” Willem Einthoven, a physiologist in Utrecht, devised a more
sensitive string galvanometer (1902), for which he received the Nobel Prize, and the modern electrocardiogram was born.
Initially weighing 600 lb and requiring five people to operate, the three-lead electrocardiograph would eventually become
portable, 12 leads, routine, and capable of providing both static and continuous recordings of cardiac rhythm.5 With the
electrocardiogram, the activation and sequence of stimulation of the human heart could now be measured, and the
anatomic basis for the conduction system confirmed. Thomas Lewis in London was the first to realize its great potential,
beginning in 1909, and his books on disorders of the heartbeat became essential for aspiring electrocardiographers.2,6

1-4. The answer is A. (Hurst’s the Heart, 14th Edition, Chap. 1) Claude Bernard in 1844 was the first to insert a catheter into
the hearts of animals to measure temperature and pressure.2 In the early 1860s, Auguste Chauveau, a veterinary
physiologist, and Etienne Jules Marey, inventor of the sphygmograph, collaborated to develop a system of devices called
sounds, forerunners of the modern cardiac catheter, which they used to catheterize the right heart and left ventricle of the
horse.7 Cardiac catheterization in humans was thought an inconceivable risk until Werner Forssmann, a 29-year-old
surgical resident in Germany, performed a self-catheterization in 1929.8,9 Interested in discovering a method of injecting
adrenaline to treat cardiac arrest, Forssmann passed a ureteral catheter into his antecubital vein and confirmed its right
atrial position using x-ray. The next year he tried to image his heart using an iodide injection. However, he was
reprimanded by superiors and did not experiment further. Catheterization began in earnest in the early 1940s in New York
and London. André Cournand and Dickinson Richards at Bellevue, interested in respiratory physiology, developed and
demonstrated the safety of complete right heart catheterization, for which they shared the Nobel Prize with Forssmann in
1956.7,10

1-5. The answer is C. (Hurst’s the Heart, 14th Edition, Chap. 1) On July 21, 1768, William Heberden presented “Some
Account of a Disorder of the Breast” to the Royal College of Physicians, London: “But there is a disorder of the breast
marked with strong and peculiar symptoms, considerable for the kind of danger belonging to it, and not extremely rare.
The seat of it, and sense of strangling and anxiety with which it is attended, may make it not improperly be called angina
pectoris.”2,11 Heberden appropriated the term angina from the Latin word for strangling. His classic account marks the
beginning of our appreciation of coronary artery disease and myocardial ischemia. Edward Jenner and Caleb Parry were
the first to suspect a coronary etiology, which Parry published in 1799. Allan Burns, in Scotland, likened the pain of
angina pectoris to the discomfort brought about by walking with a tight ligature placed on a limb (1809), a prescient
concept that remains relevant today.

1-6. The answer is D. (Hurst’s the Heart, 14th Edition, Chap. 1) Before the defibrillator and coronary care units, the in-
hospital mortality associated with acute myocardial infarction was approximately 30%. With the development of the
defibrillator by William Kouwenhoven, Claude Beck and Paul Zoll were able to prove that rescue of cardiac arrest victims
was possible. Beck’s concept that “the heart is too good to die” instilled optimism into the care of coronary patients and
aggressiveness into their providers. Myocardial infarction was no longer a disease to be watched but rather one that might
benefit from aggressive therapeutic interventions. Zoll reported closed chest defibrillation in 1956 and cardioversion of
ventricular tachycardia in 1960. The monitoring of patients in close proximity to skilled nursing personnel who could
perform cardiopulmonary resuscitation was a logical next step suggested by Desmond Julian in 1961.

1-7. The answer is D. (Hurst’s the Heart, 14th Edition, Chap. 1) Valvular pathology was described in the 17th and 18th
centuries; however, Laennec was the first to describe audible heart murmurs, calling them “blowing, sawing, filing, and
rasping.”3 Originally, he attributed the noises to actual valvular disease, but he later decided that they were caused by
spasm or contraction of a cardiac chamber. James Hope in England was the first to classify valvular murmurs in A
Treatise on the Diseases of the Heart and Great Vessels (1832).12 He interpreted physical findings in early physiologic
terms and provided detailed pathologic correlations.13 Constriction of the mitral valve was recorded by John Mayow
(1668) and Raymond Vieussens (1715); the latter also recognized that this condition could cause pulmonary congestion.14
The presystolic murmur of mitral stenosis was described by Bertin (1824), timed as both early diastolic and presystolic by
Williams (1835), and placed on firmer grounds by Fauvel (1843) and Gairdner (1861). Aortic stenosis was first described
pathologically by Rivière (1663), and Laennec pointed out that the aortic valve was subject to ossification (1819).15
Corvisart showed an astute grasp of the natural history of aortic stenosis (1809). Early descriptions of aortic regurgitation
were by William Cowper (1706) and Raymond Vieussens (1715),16 whereas Giovanni Morgagni recognized the
hemodynamic consequences of aortic regurgitation (1761). In 1832, Corrigan provided his classic description of the
arterial pulse and murmur of aortic regurgitation. Flint added that the presystolic murmur was sometimes heard with
severe aortic regurgitation (1862).4

1-8. The answer is B. (Hurst’s the Heart, 14th Edition, Chap. 1) The pivotal breakthrough in thinking about congenital
abnormalities came from Helen Taussig and Alfred Blalock at Johns Hopkins Hospital with their “blue baby operation.”
Taussig had observed that patients with cyanotic heart disease worsened when their ductus arteriosus closed. She
suggested creating an artificial ductus to improve oxygenation.17 Blalock, assisted by Vivian Thomas, successfully
created a shunt from the subclavian to the pulmonary artery in November 1944. This innovative operation, in which a blue
 baby was dramatically changed to a pink one—the Blalock-Taussig shunt—was highly publicized, and other operations
soon followed. These include closure of atrial septal defects (1950s), closure of ventricular septal defects (1954), and
tetralogy of Fallot repair (1954). In 1966, Rashkind introduced the balloon septostomy, a novel catheter therapeutic
technique that bought time for severely cyanotic infants with transposition of the great arteries.7 In the 1980s, catheters
were adapted to dilate stenotic aortic and pulmonic valves as well as aortic coarctation. Today, transcatheter closure of
patent ductus arteriosus (1971), atrial septal defects (1976), and ventricular septal defects (1987) has become routine.
Indomethacin therapy to enable closure of a patent ductus in the premature infant (1976) and prostaglandin infusion to
maintain ductal patency (1981) profoundly changed the medical management of fragile newborns. Stents now help keep
the ductus open as well as alleviate right ventricular obstruction in tetralogy of Fallot.

1-9. The answer is B. (Hurst’s the Heart, 14th Edition, Chap. 1) Stephen Hales, an English country parson, reported in his
Statical Essays (1733) that the arterial blood pressure of the cannulated artery of a recumbent horse rose more than eight
feet above the heart—the first true measurement of arterial pressure and the beginning of sphygmometry.2,18,19 His
pioneering efforts stood alone until 1828 when Jean Poiseuille introduced a mercury manometer device to measure blood
pressure.20,21 Over the next 60 years, various sphygmomanometric methods were developed—notably by Ludwig (1847),
Vierordt (1855), and Marey (1863)—to refine the measurement of the arterial pressure. An inflatable arm cuff coupled to
the sphygmograph, a device small enough to allow measurement outside the laboratory, was invented by Riva-Rocci
(1896), who also noted the “white-coat effect” on blood pressure.22 Nicolai Korotkoff, a Russian military surgeon, first
auscultated brachial arterial sounds (1905), a discovery that marked the advent of modern blood pressure recording. This
auscultatory approach eventually ensured its widespread use by the 1920s. In 1939, blood pressure recordings were
standardized by committees of the American Heart Association (AHA) and the Cardiac Society of Great Britain and
Ireland.

1-10. The answer is C. (Hurst’s the Heart, 14th Edition, Chap. 1) President Franklin Roosevelt’s death in 1945 from severe
hypertension and stroke called international attention to the consequences of hypertension and its inadequate treatment—
he had been managed with diet, digitalis, and phenobarbital. Effective oral treatment became possible in 1949, first with
reserpine and then with hydrochlorothiazide.23 Lumbar sympathectomy and adrenalectomy (1925), the last resort, was
abandoned. Subsequently, β-adrenergic blockers, calcium channel blockers, ACE inhibitors, angiotensin receptor blocking
agents, and direct renin inhibitors have brought antihypertensive relief to many. Severe salt restriction, as practiced earlier
with the Kempner rice diet, has taken a lesser role, whereas the Dietary Approaches to Stop Hypertension (DASH) diet,
exercise, and alcohol restriction are encouraged. Since 1973, recommendations published by the Joint National Committee
(JNC) on Detection, Evaluation, and Treatment of High Blood Pressure have been very helpful.

References
1. Harvey W. Anatomical Studies on the Motion of the Heart and Blood. Leake CD, trans. Springfield, IL: Charles C Thomas;
1970.
2. Acierno LJ. The History of Cardiology. London, UK: Parthenon; 1994.
3. Duffin JM. The cardiology of RTH Laënnec. Med Hist. 1989;33:42-71.
4. Hanna IR, Silverman ME. A history of cardiac auscultation and some of its contributors. Am J Cardiol. 2002;90:259-267.
5. Burch GE, DePasquale NP. A History of Electrocardiography. Chicago, IL: Year Book; 1964.
6. Fleming P. A Short History of Cardiology. Amsterdam, Netherlands: Rodopi; 1997.
7. Bing RJ. Cardiology: The Evolution of the Science and the Art. Basel, Switzerland: Harwood; 1992.
8. Forssmann-Falck R. Werner Forssmann: a pioneer of cardiology. Am J Cardiol. 1997;79: 651-660.
9. Mueller RL, Sanborn TA. The history of interventional cardiology: cardiac catheterization, angioplasty, and related
interventions. Am Heart J. 1995;129:146-172.
10. Fishman AP, Dickinson WR. Circulation of the Blood: Men and Ideas. Bethesda, MD: American Physiological Society;
1982.
11. Leibowitz JO. The History of Coronary Heart Disease. Berkeley, CA: University of California Press; 1970.
12. Flaxman N. The hope of cardiology: James Hope (1801–1841). Bull Hist Med. 1938;6:1-21.
13. Vander Veer JB. Mitral insufficiency: historical and clinical aspects. Am J Cardiol. 1958;2:5-10.
14. Rolleston H. The history of mitral stenosis. Br Heart J. 1941;3:1-12.
15. Vaslef SN, Roberts WC. Early descriptions of aortic valve stenosis. Am Heart J. 1993;125:1465-1474.
16. Vaslef SN, Roberts WC. Early descriptions of aortic regurgitation. Am Heart J. 1993;125:1475-1483.
17. Engle MA. Growth and development of state of the art care for people with congenital heart disease. J Am Coll Cardiol.
1989;13:1453-1457.
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