Title Page, Copyright

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pp. i-iv

Contents

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pp. v-viii

Contributors

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pp. ix-xvi

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The Concept of Iatrogenicity

John B. Kostis and Ihor B. Gussak

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pp. 1-2

In a narrow sense, iatrogenicity is harm caused by a physician’s diagnosis and treatment, although it does not imply an improper act by the physician. Merriam-Webster Medical Dictionary defines iatrogenesis, the word from which iatrogenicity is derived, as “inadvertent and preventable induction of disease or complications by the medical...

Part I: Medical Harm

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1. Iatrogenicity: Definition, History, and Modern Context

Maria L. Gussak, Ihor B. Gussak, and John B. Kostis

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pp. 5-15

This book requires a caveat, one that all of its authors kept in mind while writing: the discussion of iatrogenicity is not motivated by emotional appeals, although we recognize with deep sadness that countless patients, family, friends, and medical personnel have been touched by iatrogenic complications or medical harm. This book is...

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2. Epidemiology and Public Health Aspects and Implications of Iatrogenicity: Regulatory, Legal and Ethical Dimensions

Miriam A. Gonzalez-Siegel and Stephen K. Jones

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pp. 16-21

The process by which a condition or behavior is defined as a medical problem requiring a medical solution is known as medicalization. For medicalization to occur, one or more organized social groups must have both a vested interest in the condition and sufficient power to convince others to accept the newly proposed need for a...

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3. Risk Management: The Medical Center Administration Perspective

Stephen K. Jones and Miriam A. Gonzalez-Siegel

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pp. 22-27

Risk management is the business of reducing the likelihood of errors through a process of identification, assessment, and prioritization of risks, followed by coordinated and economical application of resources to minimize, monitor, and control the probability and/or impact of unfortunate events or to maximize the realization of...

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4. Iatrogenicity from the Patient’s Perspective

Jeanne M. Dobrzynski

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pp. 28-33

Physicians have an ethical duty to their patients, who trust them and rely on them for their well-being. Prior experiences related to adverse outcomes color the physician-patient interaction. Patient characteristics such as age, gender, education, use of the Internet, and frailty are key factors influencing the occurrence and perception of...

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5. A Naturopathic Perspective on Iatrogenesis

Christie Fleetwood

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pp. 34-44

Iatrogenic disease literally means “illness caused by medical exam or treatment” (1). In the United States, iatrogenicity is the third leading cause of death, with preventable harm killing between 210,000 and 440,000 patients each year (2). Some estimates are as high as 700,000 (3,4). This means that harm—up to and including death—has...

Part II: Iatrogenicity of Cardiovascular Drugs and Cardiovascular Toxicity of Noncardiac Drugs

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6. Clinical Manifestations of Acute and Chronic Drug-Induced Iatrogenic Cardiovascular Diseases and Syndromes

Ihor B. Gussak, Gan-Xin Yan, Arshad Jahangir, Georg Gussak, and John B. Kostis

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pp. 47-61

Medicine is a part of life, and iatrogenicity is a part of medicine. Iatrogenicity in cardiovascular (CV) medicine, a part of general (medical) iatrogenicity, is well known among clinicians, drug developers, regulators, and patients, and caretakers long ago realized that even intended effects of drugs were not always or entirely beneficial...

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7. Drug-Induced Cardiac Arrhythmias and Sudden Cardiac Death

Aalap Narichania, Yasuhiro Yokoyama, and Win K. Shen

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pp. 62-76

This case typifies the presentation and management of torsade de pointes (TdP). How does the clinician approach this case? What is the underlying mechanism? Why was this patient at risk and what amplified her risk? Could TdP have been predicted? What other arrhythmias may be the result of drugs? What does the future...

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8. Chemotherapy-Induced Cardiomyopathy

Edo Y. Birati and Mariell Jessup

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pp. 77-87

Cancer remains one of the leading causes of morbidity and mortality worldwide. According to the World Health Organization, there were 14 million new diagnoses of cancer in 2012, and the incidence of new cancer cases is expected to increase by 70% over the next two decades (1). The most common sites of cancer in men are...

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9. Iatrogenicity of Blood Pressure Measurement in the Diagnosis of Hypertension

Thomas D. Giles, Gary E. Sander, and Camilo Fernandez

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pp. 88-100

The man who coined the term “blood pressure” almost 300 years ago was an English scientist, the Reverend Stephen Hales (1, 2). Hales first measured blood pressure (BP) in a series of famous experiments during the first quarter of the eighteenth century. He assessed arterial BP directly and invasively, first in dogs in 1708 and later in...

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10. Antihypertensive Drug–Induced Iatrogenic Cardiovascular Syndromes

Rigas G. Kalaitzidis and George L. Bakris

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pp. 101-115

Public health policy supports best practice and appropriate use of prescription drugs. Emphasis should be placed on prevention of physician-associated iatrogenic errors during professional training by teaming physicians with pharmacists who will help recognize prescription errors and help with drug interactions. Health care is not as safe...

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11. Iatrogenicity of Cardiovascular Drugs Associated With Cardiac and Noncardiac Toxicities: Antihypertensive Agents and Biologics

Evelyn R. Hermes-DeSantis and Joseph A. Barone

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pp. 116-142

Of the top 20 individual medications by prescription volume in 2014, eight (40%) were cardiovascular agents (1). These agents are ubiquitous in the care of patients. All medications have the potential to cause iatrogenic effects, and clinicians need to be vigilant in determining their presence. The recent Systolic Blood Pressure Intervention...

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12. Iatrogenic Aspects of Hypertension in Pregnancy: Focus on Preeclampsia

Costas Thomopoulos and Thomas Makris

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pp. 143-155

Hypertensive disorders in pregnancy (HDP), especially preeclampsia, are closely associated with increased maternal and perinatal morbidity and mortality (1). However, the lack of consensus on the classification and diagnostic criteria for HDP has contributed to controversial clinical attitudes toward management of the disease...

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13. Women and Iatrogenic Cardiovascular Disease: Menopausal Estrogen as the Prime Suspect

Gloria Bachmann, Nancy Phillips, and Margaret Rees

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pp. 156-162

The association of a pharmacologic substance with a negative aftereffect does not always show direct cause and effect. In many instances, several health modifiers are involved; these include heredity, lifestyle, age of use, pregnancy status, and social, cultural, and financial factors. As well, there is often a time lag between linking the...

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14. Iatrogenic Aspects of Lipid-Lowering, Antiplatelet, and Anticoagulant Agents

Konstantinos Tsioufis, Dimitris Konstantinidis, Nikolaos Vogiatzakis, Kyriakos Dimitriadis, and Dimitris Tousoulis

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pp. 163-174

Statins (hydroxyl-methyl- glutaryl- coenzyme A reductase [HMG-CoA] inhibitors), discovered in the late 1970s, are one of the most prescribed classes of medication worldwide (1–5). The landmark Scandinavian Simvastatin Survival Study in the 1990s first established the long-term survival benefits of statins; since then, statins...

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15. Iatrogenic Effects of Urologic Drugs on the Cardiovascular System

Konstantinos Stavropoulos, Chrysoula Boutari, Konstantinos Imprialos, Vasilios Papademetriou, and Michael Doumas

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pp. 175-187

Pharmacological agents for the management of urological disorders may exert cardiovascular effects. Medications for the treatment of overactive bladder syndrome, benign prostatic hyperplasia (BPH), hypogonadism, and erectile dysfunction may have hemodynamic effects via actions on the myocardium and peripheral vasculature. In particular...

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16. Iatrogenicity and Antianginal Drugs

Abel E. Moreyra and William J. Kostis

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pp. 188-193

A common manifestation of ischemic heart disease, angina is described by patients as pressure, tightness, burning, or pain usually affecting a diffuse part of the retrosternal area and often radiating to the inner aspect of the left arm or to the jaw. The discomfort of angina is referred to the dermatomes innervated by afferent nerves that enter...

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17. Antidiabetic Drugs and Cardiovascular Risk: Where Do We Stand?

Rajesh Kumar

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pp. 194-204

Type 2 diabetes (T2D) is a major global health problem, imposing a huge economic burden on society. It is a progressive chronic condition associated with insulin resistance or the inability to produce enough insulin because of impaired beta cell function. T2D patients have a very high prevalence and incidence of coronary heart disease (1). A...

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18. Cardiovascular Iatrogenicity in Older Adults

Ariba Khan, Fatima Ali, Vibha Iyengar, Yuya Hagiwara, VJ Periyakoil, Neela Patel, and Michael Malone

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pp. 205-218

An iatrogenic adverse event is defined as any unintended injury or complication that results from medical management rather than the underlying disease process and results in prolonged hospitalization or disability at discharge (1,2). Older patients are more likely to experience iatrogenic complications than younger patients (45%...

Part III: Iatrogenicity of Diagnostic and Therapeutic, Invasive and Noninvasive Cardiovascular Interventions, Devices, and Surgeries

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19. Iatrogenic Aspects of Noninvasive and Invasive Diagnostic Methods in Interventional Cardiology

Christina Dösch, Dirk Loßnitzer, and Theano Papavassiliu

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pp. 221-232

In healthy individuals, physical exercise can increase myocardial blood flow two-to threefold via an endothelium-dependent flow-mediated process (1). This mechanism allows to meet increased oxygen demand during exercise. In patients with significant coronary artery stenosis, myocardial blood flow decreases during exercise (2)...

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20. Iatrogenicity Associated With Interventional Treatment Modalities in Cardiology

Naga Venkata Pothineni, Aatish Garg, Hakan Paydak, and Jawahar L. Mehta

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pp. 233-242

The word iatrogenic, derived from the Greek iatros, meaning physician or healer, is defined as “induced inadvertently by a physician or surgeon or by medical treatment or diagnostic procedures.” The practice of modern cardiology has evolved into a procedure-laden field with increasing indications for catheter-based interventions...

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21. Iatrogenicity of Diagnostic and Therapeutic, Invasive and Noninvasive Cardiovascular Interventions, Devices, and Surgeries

Michael Behnes, Tobias Becher, Stefan Baumann, Uzair Ansari, and Ibrahim Akin

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pp. 243-254

Structural heart disease (SHD) has been described this way: “. . . it seems that the term refers to non-coronary heart disease for which some therapy, surgical or percutaneous, exists (1).” This vague definition reveals the difficulty in clarifying a heterogeneous group of diseases in terms of pathophysiological background, diagnostic...

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22. Iatrogenic Aspects of Cardiac Electrophysiology

Boris Rudic, Erol Tülümen, Volker Liebe, and Martin Borggrefe

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pp. 255-270

During the past several decades, electrophysiological (EP) studies have become well-established interventions not only for diagnostic and prognostic purposes but also as an effective therapeutic option for patients with arrhythmias. Like other invasive procedures, EP studies can have various complications. As EP procedures are performed...

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23. Iatrogenic Aspects in Cardiac Device Therapy

Susanne Röger and Jürgen Kuschyk

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pp. 271-286

The approach to cardiac pacemaker implantation has evolved over the past half century. The early trend from the epicardial approach to the simpler transvenous cutdown led to the percutaneous technique developed by Littleford and Spector (1). Conventional pacing systems consist of a pacemaker containing electronics and battery...

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24. Cardiovascular Iatrogenicity of Respiratory Therapeutic Modalities

Michael S. Nolledo, Pauline O. Lerma, and Teodoro V. Santiago

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pp. 287-306

The heart and lungs are both driven by pressure, share space in the thorax and are anatomically contiguous. It should not be surprising that therapeutic modalities that target the chest and lungs by alterations in pressure, surgery or radiation may affect the heart in a negative manner, inducing iatrogenic complications. Furthermore, certain...

Part IV: Iatrogenic Aspects of Sport Cardiology and Lifestyle Modifications

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25. Trained Athletes

Gino Seravalle, Guido Grassi, and Giuseppe Mancia

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pp. 309-317

Regular physical exercise is a therapeutic lifestyle intervention for achieving optimal cardiovascular (CV) and overall health, as several international guidelines have emphasized (1–4). Physical activity triggers beneficial physiological effects on the entire body (5) and can be a valuable tool for preventing and treating chronic diseases...

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26. Sports Cardiology

Giovanni Campanile

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pp. 318-326

SCD is the leading medical cause of death in athletes. The precise incidence is unknown and annual rates vary widely, from 1 per 917,000 participants to 1 per 3,000 participants, but the range is more likely to be between 1 per 40,000 to 1 per 80,000. African American athletes and basketball players appear to be at higher risk...

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27. Dangers of Lifestyle Modification Advice

Giovanni Campanile

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pp. 327-334

Lifestyle medicine is a new discipline practiced by a wide variety of health care professionals in an effort to improve the deleterious effects of chronic disease. Averting problems by counseling patients on the modifiable risk factors accounting for the five leading causes of death—heart disease, cancer...

Part V. Iatrogenicity of Dietary Supplements, Herbal Products, and Other Nontraditional Therapies in Cardiovascular Medicine

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28. Safety of Dietary and Herbal Supplements: Side Effects and Contraindications

Sulaiman Sultan, Ahad Jahangir, Ihor B. Gussak, A. Jamil Tajik, and Arshad Jahangir

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pp. 337-369

Vitamins, minerals, and herbs are commonly consumed as dietary supplements or medicinal compounds to maintain wellness and to prevent or treat diseases. Vitamins are organic compounds that the body cannot synthesize in sufficient quantities and therefore must be obtained through diet, to act as cofactors in facilitating chemical reactions...

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29. Interactions Between Supplements and Medications

Sulaiman Sultan, Ahad Jahangir, Ihor B. Gussak, John B. Kostis, A. Jamil Tajik, and Arshad Jahangir

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pp. 370-414

Dietary and herbal supplements are commonly used by patients who are also taking prescription and over-the counter medicines, and thus the likelihood of significant interactions between biologically active constituents in supplements and medications is quite high (1–4). Although biological interactions between drugs are well documented, the...

Index

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pp. 415-432